Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Aug 2010
ReviewThe emergency department approach to syncope: evidence-based guidelines and prediction rules.
Syncope is a sudden, transient loss of consciousness associated with inability to maintain postural tone followed by spontaneous recovery and return to baseline neurologic status. Global cerebral hypoperfusion is the final pathway common to all presentations of syncope, but this symptom presentation has a broad differential diagnosis. It is important to identify patients whose syncope is a symptom of a potentially life-threatening condition. This article reviews the current status of syncope from the emergency department perspective, focusing on the current evidence behind the various clinical decision rules derived during the past decade.
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In 2001 and then again in 2006, the Centers for Disease Control and Prevention (CDC) published guidelines recommending universal HIV screening in acute care settings, including emergency departments (EDs). The value of early identification and treatment of HIV-infected patients is clear, but the most effective method for accomplishing this has yet to be determined. ⋯ The goal of this article is to encourage thought regarding previous experiences with HIV screening and future ideas for improving efforts to this end. By examining the variety of HIV testing kits available, the debate regarding targeted testing versus screening, the consent and patient education requirements, and the staffing models used to implement HIV testing in the ED, this review aims to provide emergency physicians and administrators with options that can be tailored based on the resources available in their specific venue.
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Emerg. Med. Clin. North Am. · May 2010
Acute HIV infection: diagnosis and management in the emergency department.
Acute human immunodeficiency virus (HIV) infection, also known as primary HIV infection, is the initial phase of infection, spanning from inoculation to the establishment of CD4 count and viral load set points. This phase is marked by dynamic changes in viral replication and host immune responses and contains 2 important clinical events: acute retroviral syndrome and seroconversion. Acute HIV infection is challenging to diagnose, but with recent improvements in diagnostic testing and a heightened awareness of acute HIV, the emergency physician is well positioned to make this diagnosis and initiate important interventions for the individual patient and public health.
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Respiratory complaints are a common reason for patients with HIV infection to present to an emergency department (ED). "HIV and shortness of breath" is one of the most frequent chief complaints on ED triage sheets, and the differential diagnosis is broad. Pulmonary etiologies include infectious and noninfectious causes that are related and unrelated to underlying HIV infection and range from the minor to the life threatening. This article focuses on respiratory emergencies among HIV-infected patients and discusses their typical presentation and diagnostic evaluation as well as therapeutic interventions that should be initiated in an ED.
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Emerg. Med. Clin. North Am. · May 2010
Diarrhea in patients infected with HIV presenting to the emergency department.
Diarrhea is an exceedingly common complaint in patients with human immunodeficiency virus (HIV) infection, and the severity of symptoms ranges from mild, self-limiting diarrhea to debilitating disease that can result in malnutrition, volume loss, and shock. Up to 40% of patients with HIV infection report at least 1 episode of diarrhea in a given month, and approximately 1 quarter of patients experience chronic diarrhea at some point. The prevalence of diarrhea increases with decreasing CD4 counts. The clinical features, diagnosis, and management of diarrhea in patients with HIV are reviewed.