Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Nov 2018
ReviewEmergency Department Approach to the Patient with Suspected Central Nervous System Infection.
Central nervous system (CNS) infections require early recognition and aggressive management to improve patient survival and prevent long-term neurologic sequelae. Although early detection and treatment are important in many infectious syndromes, CNS infections pose unique diagnostic and therapeutic challenges. The nonspecific signs and symptoms at presentation, lack of characteristic infectious changes in laboratory and imaging diagnostics, and closed anatomic and immunologically sequestered space each present challenges to the emergency physician. This article proposes an approach to the clinical evaluation of patients with suspected CNS infection and highlights methods of diagnosis, treatment, and complications associated with CNS infections.
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Emergency providers are likely to encounter sickle cell disease-related emergencies. The pathophysiology of emergent complaints are usually related to either an acute anemia or a vasoocclusive crisis. ⋯ Vasoocclusive crises must be appropriately treated with aggressive pain management, gentle hydration, and other appropriate adjuncts. Early recognition and treatment are key in providing excellent emergency care to those with sickle cell disease.
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Emerg. Med. Clin. North Am. · Aug 2018
ReviewRapid Fire: Infectious Disease Emergencies in Patients with Cancer.
Patients with cancer can be immunocompromised because of their underlying malignancy as well as the medical therapies with which they are treated. Infections frequently present atypically and can be challenging to diagnose. The spectrum of infectious diseases encountered in patients receiving chemotherapy, hematopoietic stem cell transplant, and immunotherapy is broad depending on the depth of immunosuppression. Early recognition of infectious processes followed by appropriate diagnostic testing, imaging, and empiric antibiotic therapy in the emergency department are critical to providing optimal care and improving survival in this complex patient population.
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Hypercalcemia is commonly encountered in the clinical setting and requires identification by the clinician to avoid disastrous patient outcomes. The 2 most common causes are malignancy and hyperparathyroidism. The underlying cause for hypercalcemia may be readily known at presentation or may require further investigation. ⋯ In the emergency setting, intravenous hydration with isotonic fluids is the treatment mainstay. Other commonly used medications to further decrease calcium include bisphosphates, calcitonin, steroids, and (rarely) furosemide. In life-threatening circumstances, dialysis can be implemented.