Emergency medicine clinics of North America
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Care for patients who have time-sensitive disease processes in the emergency department and critical care settings is optimized with rapid diagnosis and intervention. Recent advances in medical imaging have increased portability, decreased image acquisition time, improved data resolution, and increased use of noninvasive studies. This article discusses the use of portable imaging techniques such as bedside ultrasound and radiography as well as CT and CT angiography in the diagnosis and care of critically ill patients.
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Emerg. Med. Clin. North Am. · Aug 2008
ReviewSevere sepsis and septic shock: improving outcomes in the emergency department.
With an increasing incidence of sepsis, increasing use of the emergency department by populations at risk, and an increase in time spent in the emergency department awaiting hospital admission, emergency medicine practitioners are offered a valuable opportunity to make a significant difference in the fight against sepsis. By administering appropriate antibiotics in a timely fashion, removing possible sources of infection, practicing early goal-directed hemodynamic optimization, using lung-protective ventilation strategies, and judiciously using corticosteroids and intensive insulin therapy, the goal of reducing mortality from sepsis can be achieved.
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Emerg. Med. Clin. North Am. · Aug 2008
ReviewNoninvasive positive pressure ventilation in the emergency department.
Noninvasive positive pressure ventilation (NPPV) is becoming more commonplace, both in the ICU and also in the Emergency Department. This article addresses the rationale and mechanism of action for NPPV. ⋯ NPPV should be considered for most patients who have respiratory distress who are being considered for intubation. After NPPV is initiated, very close monitoring and follow-up must be employed to identify those patients who are at risk for treatment failure.
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Emerg. Med. Clin. North Am. · Aug 2008
ReviewThe use of vasopressors and inotropes in the emergency medical treatment of shock.
Shock is a final common pathway associated with regularly encountered emergencies including myocardial infarction, microbial sepsis, pulmonary embolism, significant trauma, and anaphylaxis. Shock results in impaired tissue perfusion, cellular hypoxia, and metabolic derangements that cause cellular injury. ⋯ It is important that emergency physicians, familiar with the broad differential diagnosis of shock, be prepared to rapidly recognize, resuscitate, and target appropriate therapies aimed at correcting the underlying process. This article focuses on the basic pathophysiology of shock states and reviews the rationale regarding vasoactive drug therapy for cardiovascular support of shock within an emergency environment.
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Emergency physicians are trained to separate "sick" from "not sick" patients during their training. Nevertheless, every emergency physician will face situations in which early intervention is critical to their patient's outcome. Infectious diseases are responsible for many of these potentially poor outcomes. This article discusses early identification and treatment for several rapidly fatal infections, including two newly identified travel-related illnesses.