Emergency medicine clinics of North America
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Bedside sonography has become an important tool in the emergency physician's diagnostic armamentarium. Sonography is useful in the evaluation of a number of conditions, including cholecystitis, abdominal aortic aneurysm, and ectopic pregnancy. ⋯ Echocardiography also has a role in differentiating patients with cardiac activity from those in ventricular standstill and in estimating central venous pressure. This article reviews these and other clinical applications and the physics of ultrasound, techniques for sonographic evaluation, and the practical aspects of emergency department use, such as strategic placement of the equipment for quick activation and storage of collected data.
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Chest pain is among the most frequently evaluated presenting complaints in the emergency department (ED). Diagnostic etiologies range from benign to life-threatening. Failure to diagnose the life-threatening chest emergencies-specifically acute coronary syndrome, aortic dissection, and pulmonary embolism-can lead to catastrophic medical and legal outcomes for the patient and physician respectively. This article focuses on clinical and risk management strategies to minimize misdiagnosis and produce favorable medical and medicolegal outcomes.
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The clinical spectrum of hyperthyroidism varies from asymptomatic,subclinical hyperthyroidism to the life-threatening "thyroid storm". Hyperthyroidism is a common form of thyroid disease that mimics many of the common complaints in the emergency department. The diagnosis of hyperthyroidism is often challenging due to the multitude of physical and even psychiatric complaints. Recognition and treatment by emergency physicians of severe hyperthyroidism is critical and can be life saving.
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Emerg. Med. Clin. North Am. · Aug 2005
Review Case ReportsRecognition and management of adrenal emergencies.
Although clinical conditions associated with dysfunction of the ad-renal gland are often subtle, even insidious, in their presentation,and diagnosis and treatment usually are confined to outpatient clinics and offices, there are several situations that warrant the attention of emergency physicians. Recognition of the spectrum of presentations of pheochromocytoma, adrenal insufficiency, and pituitary apoplexy, and the sequelae of corticosteroid therapy and withdrawal, are critically important areas to emergency medicine. Prompt diagnosis with appropriate treatment and referral will reduce morbidity and mortality in many patients each year. A related topic pertinent to emergency physicians is the management of incidental adrenal masses that are discovered on abdominal radio-logic imaging.
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Hyperosmolar hyperglycemic state (HHS) is the most serious acute complication of type 2 diabetes mellitus. Emergency department management focuses on prompt diagnosis and restoration of hemodynamic stability with appropriate fluid therapy while maintaining electrolyte homeostasis. Identification of any precipitating illness is essential. The emergence of HHS as a critical presentation of type 2 diabetes mellitus in adolescents is highlighted.