Drug treatment of hypertensive urgencies and emergencies

Although systemic hypertension is a common clinical condition, hypertensive emergencies are distinctly unusual in clinical practice. There are some situations, however, that qualify as hypertensive emergencies or urgencies. It is important, therefore, to diagnose these conditions because immediate treatment of severe hypertension is indicated. The diagnosis of hypertensive emergencies depends on the consideration of the clinical manifestations as well as the absolute level of blood pressure. Depending on the target organ that is affected, manifestations of hypertensive emergencies can be quite profound, yet variable. Thus, the physician has to make an accurate clinical diagnosis properly to render appropriate therapy. Fortunately, effective drug therapy is available to decrease blood pressure quickly in hypertensive emergencies. Physicians should be familiar with the pharmacologic and clinical actions of drugs that are used in the treatment of hypertensive emergencies. With proper clinical diagnosis, hypertensive emergencies can be treated successfully and the complications can be prevented with timely intervention. This review discusses the treatment of hypertensive emergencies in general and the therapeutic role of fenoldopam in particular.     

Laparoscopy in gynecologic emergencies

Laparoscopy is ideal for the diagnosis of acute pelvic pain and the treatment of gynecologic emergencies. It is as safe and effective as laparotomy for the treatment of ectopic pregnancy, ovarian cysts, dermoid cysts, and adnexal torsion. Treatment with laparoscopy results in shorter hospital stay and faster recovery. Future fertility is not compromised and in some cases may be improved with laparoscopic treatment. There are also studies suggesting that laparoscopy can be used safely for the diagnosis and treatment of gynecologic emergencies in the first and second trimester of pregnancy.     

血管外科急症诊治中值得关注的几个问题

血管外科急症往往病情变化较快，严重时威胁病人的生命，及时诊断和正确治疗是抢救病人和提高医疗质量的必备条件。在诊治过程中，一方面要优化救治流程，包括做好院前救治、预检分诊、绿色通道和多学科协作等环节；另一方面提高医护人员对各种血管外科急症的诊断和救治能力是保障病人安全的重要基石。应通过救治体系的优化和医护人员能力的加强来提高急症病人的救治成功率。     

血管外科急症诊治中值得关注的几个问题

血管外科急症往往病情变化较快，严重时威胁病人的生命，及时诊断和正确治疗是抢救病人和提高医疗质量的必备条件。在诊治过程中，一方面要优化救治流程，包括做好院前救治、预检分诊、绿色通道和多学科协作等环节；另一方面提高医护人员对各种血管外科急症的诊断和救治能力是保障病人安全的重要基石。应通过救治体系的优化和医护人员能力的加强来提高急症病人的救治成功率。     

急性肠系膜缺血性疾病诊治现代策略

急性肠系膜缺血性疾病是血管外科的急症之一,也是外科最为凶险的急腹症之一。其原因来源于肠系膜动脉或静脉发生阻塞,导致血液供应或回流突然中断,肠管出现营养不良与障碍,最终发生肠管功能丧失、坏死。该病起病隐匿、进展快、危害大、后果严重。CT血管成像（CTA）是当前被推荐的首选诊断方法。早期诊断、复苏、抗凝、恢复肠系膜的血液供应、切除无生机的肠管、维持水盐电解质平衡以及静脉高营养是成功诊治该病的重要支柱。     

Spontaneous rupture of the urinary bladder

Two cases of spontaneous bladder rupture are presented. The aetiology, clinical picture and treatment are described. The mortality rate is high in this condition, and clinicians should be aware of the diagnosis in differentiation of abdominal emergencies with urinary symptoms.     

Popliteal arterial aneurysm

Popliteal arterial aneurysms are rare in young individuals. A case without a penetrating trauma presenting in a young woman is described. Complications may lead to vascular emergencies. Early diagnosis and surgical treatment is important.     

Emergency treatment of movement disorders

Opinion statement Movement disorder emergencies occur in both hypokinetic and hyperkinetic patients. Prompt recognition of these emergencies is crucial, and diagnosis is based on history and phenomenology. Supportive and temporizing measures must be implemented immediately before disease-specific therapy is begun. For neuroleptic malignant syndrome and related conditions, we recommend a three-tier approach depending on severity, starting with benzodiazepines, dopamine agonists or levodopa, and dantrolene or electroconvulsive therapy. Methylprednisolone pulse therapy also is beneficial for neuroleptic malignant syndrome due to abrupt medication withdrawal in patients with Parkinson’s disease. In treatment of other acute antidopaminergic-induced emergencies, anticholinergics usually suffice. To manage airway obstruction related to movement disorders, we rely on laryngoscopic evaluation to determine whether noninvasive or invasive interventions are needed. Hyperkinetic emergencies are treated individually based on the type of abnormal movements. If an antidopaminergic is needed, we prefer a dopamine depletor to a dopamine receptor blocker because of the risk of tardive syndromes with the latter. When focal hyperkinetic movements dominate the picture, botulinum toxin injection is a useful adjunct to medications.     

急性肠系膜缺血性疾病诊治现代策略

急性肠系膜缺血性疾病是血管外科的急症之一,也是外科最为凶险的急腹症之一。其原因来源于肠系膜动脉或静脉发生阻塞,导致血液供应或回流突然中断,肠管出现营养不良与障碍,最终发生肠管功能丧失、坏死。该病起病隐匿、进展快、危害大、后果严重。CT血管成像（CTA）是当前被推荐的首选诊断方法。早期诊断、复苏、抗凝、恢复肠系膜的血液供应、切除无生机的肠管、维持水盐电解质平衡以及静脉高营养是成功诊治该病的重要支柱。     

Laparoscopic treatment of a strangulated obturator hernia

Summary The authors report a case of strangulated obturator hernia, presenting a non-specific clinical picture, where the diagnosis and treatment were made by laparoscopy. This mini-invasive approach, in a predominantly female population where precise preoperative diagnosis is rare, allowed both rapid diagnosis and repair of the hernia. Apart from emergencies, laparoscopy also appears to be the intra- or preperitoneal approach of choice in the treatment of obturator hernias.     

Non-gynecological abdominal emergencies during pregnancy

Although the incidence of non-gynecological abdominal emergencies during pregnancy is low, surgeons may be confronted with this problem. Maternal and fetal prognosis is conditioned by the severity of the lesion and the delay in diagnosis and not the associated pregnancy. Gestation modifies the clinical picture and biological signs, particularly during the last two trimesters, making diagnosis even more difficult. The most frequently encountered lesions are abdominal contusions and appendicitis, of lesser frequency being occlusions, digestive hemorrhage, biliopancreatic disorders and acute inflammatory colon disease. An exceptional finding is a spontaneous rupture of liver. These various clinical pictures and their surgical treatment are reviewed as a function of documented data and personal experiences, and principles of obstetrical therapy defined. Pregnancy should not modify the surgeon's attitude to non-gynecological abdominal emergencies, the prognosis being related to the rapidity with which he acts.     

Emergencies in delayed diaphragmatic herniation due to blunt trauma

A transthoracic approach was used in the treatment of 2 patients with emergencies due to traumatic diaphragmatic hernia. Relevant symptoms began respectively 3 months and 8 months after closed injury. Strangulation and necrosis of abdominal organs herniated into the chest are associated with a high mortality. Awareness and early diagnosis will reduce mortality.     

Klinikaufnahme vital bedrohter Kinder

Emergencies during childhood are so rare and differ so immensely from emergencies during adulthood that physicians and nurses not actively involved in pediatrics are seldom skilled in routine care of these patients. Considerable difficulties are encountered in assessing the severity of the disease and differential diagnosis of the clinical picture. Nevertheless, it should be possible in every hospital to stabilize vital parameters in children of all ages to ensure safe transfer to the nearest pediatric clinic. Since most pediatric emergencies involve respiratory function, securing patent airways should have first priority. Prerequisites of personnel, site, and materials for managing pediatric emergencies and specific procedures for the majority of emergencies are presented.     

Responses to simulated anaesthetic emergencies by anaesthetists with different durations of clinical experience

We have compared the responses of four groups of anaesthetists, with different durations of clinical experience, to nine different simulated emergencies. Five anaesthetists in each group completed each of the nine simulated emergencies. Anaesthetists with less than 1 yr experience performed less well than the three other groups of anaesthetists (chi-square, P < 0.02). However, all groups made serious errors in both diagnosis and treatment, and accepted treatment guidelines were not followed. We have shown that a simple, inexpensive simulator can be used to evaluate the performance of anaesthetists of different durations of clinical experience.      

Peritonitis: laparoscopic approach

Background  

Laparoscopy has became as the preferred surgical approach to a number of different diseases because it allows a correct diagnosis and treatment at the same time. In abdominal emergencies, both components of treatment – exploration to identify the causative pathology and performance of an appropriate operation – can often be accomplished via laparoscopy. There is still a debate of peritonitis as a contraindication to this kind of approach. Aim of the present work is to illustrate retrospectively the results of a case-control experience of laparoscopic vs. open surgery for abdominal peritonitis emergencies carried out at our institution.     

Laparoscopic diagnosis and treatment in gynecologic emergencies.

OBJECTIVE: To present an analysis of our experience with 22 consecutive cases of acute abdominal gynecologic emergencies managed with a laparoscopic approach. METHODS: From March 1997 to October 1998, 22 patients with a diagnosis of acute abdominal gynecologic emergencies underwent laparoscopic intervention. A transvaginal ultrasound was performed on all patients preoperatively to supplement the diagnostic workup. Surgical time, complications, and length of hospital stay were evaluated, and the laparoscopic diagnosis was compared with the preoperative diagnosis. RESULTS: The laparoscopic diagnosis was different from the preoperative diagnosis in 31.8% of patients. Of the 22 patients, laparoscopic therapeutic procedures were performed in 18 (81.8%), all satisfactorily, and with no need for conversion to open surgery. No morbidity or mortality occurred. CONCLUSION: Laparoscopy is a safe and effective method for diagnosing and treating gynecologic emergencies.     

Duodenal ulceration presenting in childhood longterm follow-up

Forty-one children diagnosed as suffering from duodenal ulceration by endoscopy and barium studies have been reviewed 5 to 15 years (mean 8.6 years) later. Mean age at diagnosis was 8.6 years. All were managed medically as children. Fifty-one percent are now asymptomatic, off all treatment; the rest have chronic symptoms typical of duodenal ulcer. Six patients (15%) required surgery, four as emergencies for complications and two for failure of medical management.     

Spinal emergencies

True spinal emergencies are rare and represent a potential loss of function if not treated properly. This review describes the most frequently encountered spinal emergencies. Early diagnosis is the key to preventing significant morbidity in the form of permanent disability. The recognition of red flags, followed by a thorough neurologic exam and appropriate imaging, should prompt a thorough examination with a heightened sense of urgency regarding the workup for serious forms of pathology. Spinal emergencies threaten loss of function if not treated properly. Providers must be aware of the presenting symptoms and be able to accurately interpret imaging results in order to promptly diagnose and treat these conditions.     

Emergency vascular surgical care in populations with unique physiologic characteristics: Pediatric,pregnant, and frail populations

Vascular surgical emergencies are common in vascular surgical care and require complex decision making and multidisciplinary care. They are especially challenging when they occur in patients with unique physiological characteristics, such as pediatric, pregnant, and frail patients. Among the pediatric and pregnant population, vascular emergencies are rare. This rarity challenges accurate and timely diagnosis of the vascular emergency. This landscape review summarizes these three unique populations' epidemiology and emergency vascular considerations. Understanding the epidemiology is the foundation for accurate diagnosis and subsequent management. Considering each population's unique characteristics is crucial to the emergent vascular surgical interventions decision making. Collaborative and multidisciplinary care is vital in gaining expertise in managing these special populations and achieving optimal patient outcomes.     

Adult Surgical Emergencies in a Developing Country: The Experience of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria

The goal of this study was to examine the adult surgical emergencies seen at the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, with a view to proffering preventive solutions where appropriate and improving outcome. From the register of patients seen at the Casualty department and from the operations register in the main operation room of NAUTH, names and hospital numbers of adult patients treated as emergencies over a 5-year period, from 7 September 1998 to 6 September 2003, were obtained. The hospital folders were then retrieved from the Records Department. From each folder, the following details about each patient were extracted: age, sex, diagnosis at presentation, causative factors, treatment given, and outcome. A total of 902 adult patients were treated during the period. The commonest emergency operation was appendectomy for acute appendicitis in 139 patients (97 women and 42 men), followed closely by road traffic accidents (RTAs) involving 137 patients (103 men and 34 women). Gunshot injuries, which resulted mainly from armed robbery attacks, accounted for 127 cases. More men (113) sustained gunshot injuries than women (14). Of the 92 cases of acute intestinal obstruction seen, 62 occurred in women and 30 in men. Some 126 men presented with acute urinary retention, and two others presented with priapism. Governments at various levels should provide modern diagnostic tools for the accurate preoperative diagnosis of surgical emergencies in hospitals. Governments should also inculcate strict discipline into drivers using the highways, particularly in relation to abuse of alcohol and drugs. Good roads and adequate security should be provided for the people. The need for Pre-Hospital Care for the efficient evacuation of accident victims is emphasized. These measures will help to improve the management and outcome of surgical emergencies, and decrease the number of surgical emergencies resulting from RTAs and gunshot wounds.