Emergency medicine clinics of North America
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Wide complex tachycardias (WCT) are frequently encountered in the emergency department. Causes of WCT vary from benign (eg, supraventricular with rate-related aberrancy) to life threatening (eg, atrial fibrillation with WPW, or ventricular tachycardia). ⋯ Treatment of WCT depends on patient stability, regularity of the rhythm, and QRS morphology. When in doubt, monomorphic WCT should be presumed to be ventricular tachycardia and treated as such.
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High-sensitivity cardiac troponin (hs-cTn) assays are highly specific to cardiac tissue and can detect small amounts of myocardial injury rapidly. Hs-cTn assays are the recommended cardiac biomarkers in the major US and European guidelines. ⋯ This can have significant downstream impacts on the percentage of patients discharged from the emergency department (ED), ED lengths of stay, cardiac testing, and hospitalizations. There are many proposed diagnostic protocols and experts recommend institutions implement a single validated protocol.
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One of the most common complaints encountered in the emergency department is chest pain. In many evaluations, the leading diagnostic consideration is an acute coronary syndrome (ACS). ⋯ Failure to diagnose and manage ACS properly is a frequent cause of medico-legal litigation. In this article, we review the initial identification and critical management steps in patients presenting to the emergency department with ACS.
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As the US populations ages, emergency medicine providers will require increased understanding of and expertise in the care of older adults presenting to the emergency department. No more is this evident than within the domain of cardiovascular emergency care. Cardiovascular emergencies and complications related to an aging cardiovascular system are some of the most common reasons this patient populations presents for emergency evaluation. This article provides guidance on the nuances of evaluation and treatment associated with these diseases in the older adult population.