Emergency medicine clinics of North America
-
Patients with cardiac rhythm disturbances may present in a variety of conditions. Patients may be unstable, requiring immediate interventions, or stable, allowing for a more deliberate approach. ⋯ This article discusses the differential diagnosis and treatment of adult patients presenting with primary bradyarrhythmias and tachyarrhythmias, with the exception of atrial fibrillation and atrial flutter, covered elsewhere in this issue. A concise approach to diagnosis and determination of appropriate therapy is presented.
-
Aortic emergencies present a diagnostic and treatment challenge for emergency physicians. Both acute aortic dissection and abdominal aortic aneurysms can be difficult to recognize, and a missed or delayed diagnosis may be fatal. A high clinical suspicion and rapid patient evaluation are important. Although many patients ultimately require surgical intervention, early and aggressive attention to hemodynamic stability by the emergency physician can provide a window to definitive treatment.
-
Atrial fibrillation (AF) results from the chaotic depolarization of atrial tissue and is the most common dysrhythmia diagnosed in United States (US) emergency departments. AF affects greater than 1% of the general population, with a peak prevalence of 10% in those greater than 80 years of age. ⋯ AF has significant health effects, and places a considerable economic burden on the health care system. This article discusses recommendations that are derived from a combination of existing guidelines, additional evidence, and consensus.
-
Postdischarge mortality and morbidity from acute heart failure syndrome (AHFS) are high, affecting nearly half of all discharged patients within 90 days. Emergency department therapy remains largely empiric, with minimal evidence to support definitive recommendations to guide therapy. However, lessons learned from recent registries and trials suggest an approach to initial management based on clinical profiles, as defined by high, normal, or low blood pressure. Clinicians are provided with a practical and consensus-driven approach to everyday AHFS management.
-
Emerg. Med. Clin. North Am. · Nov 2011
ReviewDiagnosis and management of valvular heart disease in emergency medicine.
A popular saying holds that if one can hear a heart murmur in the middle of a loud and busy emergency department, then by definition the murmur is significant. Whether or not this is actually true, it does capture the frustration emergency physicians feel when trying to diagnose or manage valvular pathologic conditions with familiar yet limited tools. This article focuses on the valve-related issues the emergency physician will face, from the trauma patient with a mechanical valve who may need his or her anticoagulation reversed to the febrile patient with a new murmur.