Emergency medicine clinics of North America
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Diseases of the foreskin, penis, and urethra are uncommon conditions that constitute a small percentage of emergency department visits. However, it is important that the emergency physician recognize and treat these conditions and understand which conditions require urologic consultation. Rapid and proper treatment in the emergency department can alleviate patient discomfort, increase patient satisfaction, and prevent future morbidity.
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The emergency physician can expect to commonly evaluate patients with hematuria, and the differential diagnosis will include both benign and life-threatening causes. This differential is divided into the following categories: glomerular or nonglomerular, coagulopathy-related, traumatic, and factitious causes. Nonglomerular causes account for the majority of hematuria evaluated in the ED, with infection and stones being the most prevalent diagnoses. ⋯ Painless atraumatic gross hematuria in the elderly is caused by a malignancy until proven otherwise. A focused history, physical exam, and appropriate diagnostic testing in the ED usually yields a diagnosis. If the patient is discharged home, proper follow-up with the primary care physician, urologist, or nephrologist is indicated, depending upon the diagnosis.
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Emerg. Med. Clin. North Am. · May 2001
ReviewSerum markers in the emergency department diagnosis of acute myocardial infarction.
No currently used cardiac-specific serum marker meets all the criteria for an "ideal" marker of AMI. No test is both highly sensitive and highly specific for acute infarction within 6 hours following the onset of chest pain, the timeframe of interest to most emergency physicians in making diagnostic and therapeutic decisions. Patients presenting to the ED with chest pain or other symptoms suggestive of acute cardiac ischemia therefore cannot make a diagnosis of AMI excluded on the basis of a single cardiac marker value obtained within a few hours after symptom onset. ⋯ Although it is recognized that normal values obtained within 6 hours of symptom onset do not exclude an acute coronary syndrome, patients at low clinical risk and having normal cardiac marker tests could be provisionally admitted to low-acuity hospital settings or ED observation. After 6 to 8 hours of symptom duration has elapsed, the cardiac-specific markers are highly effective in diagnosing AMI, and such values obtained can be used more appropriately to make final disposition decisions. At no time should results of serum marker tests outweigh ECG findings or clinical assessment of the patient's risk and stability.
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Emerg. Med. Clin. North Am. · May 2001
ReviewPitfalls in the emergency department diagnosis of acute myocardial infarction.
The accurate assessment and triage of patients with potential ACS is a complex decision-making process based on information that is not entirely reliable. The knowledgeable EP recognizes that assessment of patients with chest pain requires an understanding of the various clinical presentations of ACS and high-risk patient types, as well as careful use of the available modalities to diagnose these syndromes efficiently while incurring minimal risk to the patients safety. The busy EP is faced with sick patients with chest pain daily, so that it behoove anyone in emergency medicine to familiarize themselves with these diagnostic pitfalls.
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Emerg. Med. Clin. North Am. · May 2001
ReviewElectrocardiographic diagnosis of acute myocardial infarction.
The widely recognized benefits of early diagnosis and treatment of acute myocardial infarction (AMI) have only emphasized the importance of emergency physician (EP) competence in electrocardiographic interpretation. As such, the EP must be an expert in the interpretation of the electrocardiogram (ECG) in the emergency department chest pain center patient. The ECG is a powerful clinical tool used in the evaluation of patients, assisting in making the diagnosis of AMI and other syndromes, selecting appropriate therapies (including thrombolysis and primary angioplasty), securing the location of an adequate inpatient disposition, and predicting the risk of cardiovascular complications and death. This article will discuss the appropriate uses of the ECG in the patient with possible or confirmed AMI and review the typical electrocardiographic findings of AMI, diagnostically confounding patterns, mimickers of infarction, and new techniques.