Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Feb 2010
ReviewEarly identification of shock in critically ill patients.
Emergency providers must be experts in the resuscitation and stabilization of critically ill patients, and the rapid recognition of shock is crucial to allow aggressive targeted intervention and reduce morbidity and mortality. This article reviews the physiologic definition of shock, the importance of early intervention, and the clinical and diagnostic signs that emergency department providers can use to identify patients in shock.
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There are few conditions in emergency medicine as potentially challenging and high-risk as the difficult or failed airway. The emergency physician must be able to anticipate the difficult or failed airway, recognize associated physiologic deficits, and plan accordingly. ⋯ There are a myriad of airway devices new to emergency medicine, which can increase the chance of successful airway management and rescue. Understanding why the airway is potentially difficult and assessing whether oxygenation can be maintained can guide the clinician's strategy and technique for successful management of the high-risk airway.
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Emerg. Med. Clin. North Am. · Feb 2010
The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll.
The RUSH exam (Rapid Ultrasound in SHock examination), presented in this article, represents a comprehensive algorithm for the integration of bedside ultrasound into the care of the patient in shock. By focusing on a stepwise evaluation of the shock patient defined here as "Pump, Tank, and Pipes," clinicians will gain crucial anatomic and physiologic data to better care for these patients.
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Fever is defined as a rectal temperature greater than 38.0 degrees C (>100.4 degrees F). A recently documented fever at home should be considered the same as a fever in the ED and should be managed similarly. All febrile infants younger than 28 days should receive a "full sepsis workup" and be admitted for parenteral antibiotic therapy. ⋯ MRSA infections are now common and should be considered in all patients with pyoderma, severe pneumonia, and catheter-related sepsis. HSV infection of the CNS should be considered whenever a patient has altered mental status and CSF findings are not diagnostic of bacterial meningitis. Fever rarely represents life-threatening pathology; however, a handful of less common serious causes of pediatric fever exist with the potential for morbidity and mortality.
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Risk stratification and management of the patient with low-risk chest pain continues to be challenging despite the considerable effort of numerous investigators. Evidence exists that a specific subset of young patients can be defined as low risk in whom further testing may not be necessary. ⋯ The initial history, electrocardiogram (ECG), and biomarkers are important, but serial ECGs and biomarkers improve sensitivity in detecting ACS. Unless chest pain is clearly explained, objective testing, such as exercise treadmill testing, nuclear scintigraphy, stress echocardiography, or coronary computed tomography angiogram, should be considered before, or soon after, discharge.