Cardiology clinics
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Approximately 330,000 ST-elevation myocardial infarctions (STEMI) occur yearly in the United States. Emergent reperfusion is the cornerstone of STEMI therapy and the key to restoration of coronary blood flow in an infarct-related vessel. ⋯ Timely reperfusion is highly dependent on a well-structured care system designed to meet the needs of each individual community. This article reviews the data behind different reperfusion strategies and introduces successful systems-of-care models.
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Acute coronary syndromes result in a significant burden of morbidity and mortality in the United States. This spectrum of acute coronary thrombosis (including unstable angina, non-ST-segment elevation myocardial infarction, and ST-elevation myocardial infarction) has been well studied in large clinical trials. This review details the initial management of patients presenting with possible acute coronary syndromes in the context of care from the emergency department to the cardiac care unit. The importance of a rapid and focused evaluation, risk stratification, and appropriate therapies are discussed.
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Blunt chest trauma represents a spectrum of injuries to the heart and aorta that vary markedly in character and severity. The setting, signs, and symptoms of chest trauma are often nonspecific, which represents a challenge to emergency providers. Individuals with suspected blunt chest trauma who have only mild or no symptoms, a normal electrocardiogram (ECG), and are hemodynamically stable typically have a benign course and rarely require further diagnostic testing or long periods of close observation. Individuals with pain, ECG abnormalities, or hemodynamic instability may require rapid evaluation of the heart by echocardiography and the great vessels by advanced imaging.
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Care of the patient with return of spontaneous circulation following sudden cardiac death is complex and challenging. A systematic and comprehensive approach can increase the chances of meaningful recovery of the postarrest patient. This article focuses on a systematic approach to the postarrest patient, which includes optimizing oxygenation and ventilation, maintaining adequate perfusion pressure, monitoring oxygen delivery, initiating and maintaining therapeutic hypothermia, and identifying patients appropriate for emergent cardiac catheterization. Using this approach, providers treating the postarrest patient can maximize the chance that a patient walks out of the hospital neurologically intact.