Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · May 2012
ReviewInvasive and noninvasive ventilation in the emergency department.
This article reviews invasive and noninvasive ventilation for emergency physicians. It presents an overview of respiratory physiology principles that will help emergency physicians adapt their ventilation strategies to any clinical situation. ⋯ This review highlights a variety of ventilation strategies to be used for patients with normal lung mechanics and gas exchange, acute hypoxemic respiratory failure, decreased lung compliance, airflow obstruction, and weakness or restriction of the chest wall. This article will help clinicians prevent, recognize, and treat complications of mechanical ventilation.
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Emergency department presentations of pleural-based diseases are common, with severity ranging from mild to life threatening. The acute assessment, diagnosis, and treatment of pleural disease are critical as urgent invasive maneuvers such as thoracocentesis and thoracostomy may be indicated. The emergency physician must have a systematic approach to these conditions that allows for rapid recognition, diagnosis, and definitive management. This article focuses on nontraumatic pleural disease, including diagnostic and treatment considerations of pleural effusion, empyema, primary spontaneous pneumothorax, secondary spontaneous pneumothorax, pediatric pneumothorax, spontaneous hemothorax, and spontaneous tension pneumothorax.
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Emerg. Med. Clin. North Am. · May 2012
ReviewAcute aortic dissection in the emergency department: diagnostic challenges and evidence-based management.
Acute aortic dissection in the emergency department (ED) remains one of the riskiest clinical and medicolegal challenges facing ED physicians. The variability in clinical presentations and mimics, the unreliability of clinical assessments and initial screening tools, and the need for advanced imaging all present obstacles in making an accurate and timely diagnosis for this entity. This article reviews available information and evidence regarding pathophysiology, risk factors, clinical variations in presentation, the usefulness of different diagnostic testing modalities, and management options in the ED when considering this diagnosis. Key recommendations from recent guidelines are reviewed in the context of ED practice.
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Pulmonary embolism (PE) remains one of the most challenging medical diseases in the emergency department. PE is a potentially life threatening diagnosis that is seen in patients with chest pain and/or dyspnea but can span the clinical spectrum of medical presentations. ⋯ This article offers a review of PE in the emergency department. It emphasizes the appropriate determination of pretest probability, the approach to diagnosis and management, and special considerations related to pregnancy and radiation exposure.
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Emerg. Med. Clin. North Am. · May 2012
Evaluation and management of seasonal influenza in the emergency department.
Seasonal influenza causes significant morbidity and mortality, primarily due to increased complication rates among the elderly population and patients with chronic diseases. Timely diagnosis of influenza and early recognition of an influenza outbreak or epidemic are key components in preventing influenza-related complications, hospitalizations, and deaths. Emergency departments are the most frequent points of entry for most influenza cases and are well positioned to identify and manage influenza community outbreaks and epidemics. Emergency departments need specific infection control measures to curb the spread of influenza in the Emergency Department and hospital during the influenza season.