Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Nov 2003
ReviewAbdominal surgical emergencies in infants and young children.
Surgical emergencies can be missed easily in children, who are not always able to volunteer relevant information. Awareness of the entities discussed in this review might help the EP uncover subtle clues to early diagnoses that might not be initially apparent. Ill-appearing children who have abdominal pain and vomiting should be considered to have ischemic or necrotic bowel until proven otherwise. ⋯ Rectal bleeding with unstable vital signs can result from an upper GI bleed (eg, peptic ulcer disease). Painless rectal bleeding can result from a Meckel's diverticulum, polyps, arteriovenous malformation, or a tumor. Examination of the genitalia is imperative, especially in boys, to exclude the possibility of an incarcerated hernia or testicular torsion.
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Emerg. Med. Clin. North Am. · Nov 2003
ReviewSurgical management and strategies in the treatment of hypothermia and cold injury.
Increased participation in outdoor activities and the epidemic of homelessness have caused the incidence of cold injuries in the civilian population to rise dramatically over the last 20 years. Knowledge of the treatment is crucial for emergency physicians in rural and urban areas. Recent developments have significantly advanced the understanding of the pathophysiology of hypothermic and frostbite injuries. Together with improved rewarming techniques and use of radiological assessment of tissue viability, future advancements should allow for a more aggressive and active approach to the management of these injuries.
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Prompt recognition of actual or impending aortic emergencies is essential to the effective practice of emergency medicine. Understanding the pathophysiologic principles and awareness of the potential subtleties in the clinical presentations of aortic dissection, aneurysm, and occlusive disease are prerequisites to this task. ⋯ Awareness of the potential complications of these conditions and the necessary interventional and resuscitative measures that might be called for in the appropriate clinical setting are likewise essential requirements for the EP. Appropriate surgical consultation and mobilization of operative resources form the backbone of appropriate management in the patient who has an aortic emergency.
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Emerg. Med. Clin. North Am. · Aug 2003
ReviewComplications of second and third trimester pregnancies.
The second and third trimester of pregnancy is a period of extensive physical growth and maturation of the fetus. Unfortunately, it is also a period that is marked by complications that can be life threatening for both the mother and fetus. The top three complications that affect pregnancy are hemorrhage, infection, and the hypertensive diseases of pregnancy. This article focuses on preterm labor, premature rupture of membranes, chorioamnionitis, bleeding in later pregnancy, and the hypertensive diseases of pregnancy.
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The first and foremost diagnosis to exclude in the pregnant patient presenting with vaginal bleeding is ectopic pregnancy. Once ectopic pregnancy is ruled out, miscarriage should be considered as a clinical spectrum. ⋯ Treatment with anti-D immune globulin is warranted for all Rh-negative patients. Urgent obstetric consultation is necessary for most miscarriage presentations.