Rev Cardiovasc Med
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Acute chest discomfort and dyspnea are 2 of the most common nontraumatic symptoms that prompt emergency department evaluations in the United States. The overlap between these presenting symptoms is considerable. In addition, each symptom calls for a broad differential diagnosis that requires rapid refinement according to details in the history, physical examination, blood biomarkers, and radiographic evaluation. This article highlights the epidemiology and the evidence supporting critical decision making, which makes judicious use of the clinical laboratory and diagnostic radiology in the evaluation of the acutely ill patient with chest discomfort and dyspnea.
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Approximately 6 million patients are evaluated annually in US emergency departments for acute chest pain. The delineation of the presence or absence of acute coronary syndromes in these patients must be accurate and efficient in order to prevent missed diagnoses. Coronary computed tomography angiography has great promise as a tool to expedite the triage of patients with acute chest pain to early discharge or further inpatient diagnosis and treatment.
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Cardiocerebral resuscitation is a new approach to patients with primary cardiac arrest that has been shown to dramatically increase survival. The term cardiocerebral is used to stress that the issue is immediate and effective support of the central circulation. Cardiocerebral resuscitation consists of continuous chest compressions--without mouth-to-mouth ventilations--administered by bystanders, and a new algorithm for emergency medical services that consists of sets of 200 chest compressions before and immediately after electrocardiographic analysis and, if indicated, a single shock. ⋯ Early establishment of intravenous or intraosseous access for epinephrine is emphasized. Postresuscitation care for comatose patients includes early coronary intervention and 24 hours of mild hypothermia. Studies show marked improvement in prehospital cardiac arrest patients with return of spontaneous circulation who subsequently received specialized postresuscitation care.