Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Aug 1997
Review Case ReportsApproach to generalized weakness and peripheral neuromuscular disease.
A large number of intellectually engaging and potentially serious neuromuscular diseases have been presented. The emergency medicine physician must be able to recognize those entities that have the potential to clinically deterioration. The evaluation of weakness requires a comprehensive, broad-based differential that is driven by the history and physical. ⋯ Thus, this disease is the opposite of the cholinergic syndrome seen with organophosphate insecticide poisonings except that cognitive functioning is not impaired in botulism. Case 6. This is a celebrated case that took a great deal of sleuthing
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An approach to the initial evaluation, resuscitation, and treatment of the patient with severe traumatic brain injury is presented in terms of the underlying physiology and literature support. The primary importance of rapid and complete systemic resuscitation in terms of the "ABCs" is stressed, with the goal of optimizing cerebral perfusion and preventing secondary insults to the injured brain. The integration of brain-specific treatments and diagnostic maneuvers into resuscitation protocols is discussed, including the role of mannitol and hyperventilation as well as the prioritization of CT imaging of the brain.
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Emerg. Med. Clin. North Am. · Aug 1997
Review Case ReportsCarotid and vertebral artery dissections.
Dissections of the carotid and vertebral arteries are a common cause of stroke in young adults. The diagnosis may be missed because the typical signs and symptoms are often delayed in onset, or easily confused with other more commonly encountered entities. Dissections of the carotid and vertebral arteries may occur spontaneously or may accompany mild to severe trauma. They present with a variety of findings including headache, neck and face pain, Horner's syndrome, or stroke.
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This article provides brief updates, pearls, and pitfalls on aspects of emergency practice that are dealt with routinely, including the application of diagnostic testing in the emergency department, ruling out subarachnoid hemorrhage, and the use of tympanic temperatures. Physician-patient and physician-physician communication skills are addressed. Finally, medicolegal and administrative topics, such as EMTALA, writing admitting orders, treating minors in the emergency department, and blood product therapy in Jehovah's Witnesses are also discussed.
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Emergency cardiac problems are a frequent and significant occurrence in the daily life of the emergency physician. The first part of this article discusses some of the pearls and pitfalls of caring for the cardiac patient ranging from treating wide-complex tachycardia and troubleshooting pacemaker malfunction to diagnosing acute myocardial infarction in the setting of bundle branch blocks. The second part of this article updates the reader on several of the newer technologies and treatments, such as transesophageal echocardiography and intravenous amiodarone, now in use in the emergency department setting.