Emergency department management of mammalian bites

Mammalian bites have reached epidemic proportions with more than one half million people being bitten by an animal or another person. Although the bite wound may initially appear to be innocuous, it may lead to severe complication that can be prevented by a timely and comprehensive treatment program that is outlined in this report. Our approach to these challenging injuries includes a complete evaluation of the injury, planned surgical intervention, antimicrobial therapy, immunoprophylaxis, and appropriate postoperative care.     

Emergency department management of life-threatening arrhythmias

Emergency treatment of life-threatening arrhythmias is related to appreciation of their hemodynamic consequences. In all case, attention should be paid to treating the patient and not merely the electrical rhythm. Emergency cardioversion or defibrillation should be performed in tachyarrhythmias with associated significant end-organ hypoperfusion. Early drug therapy, stabilization, and referral for definitive therapy may be appropriate when tachyarrhythmias do not produce significant hemodynamic consequences. Asymptomatic bradycardia should not be treated emergently but referred for definitive care in those circumstances in which it is necessary. Bradycardia associated with end-organ hypoperfusion should be treated with trials of atropine, or isoproterenol, or emergency pacemaker insertion, and the stabilized patient referred to the cardiac procedure laboratory or cardiac care unit as appropriate. This same approach to bradyarrhythmias applies regardless of the anatomic and electrophysiologic etiology of the decreased heart rate. Attention to these few management principles clearly stresses the primary importance of the hemodynamic effects of any arrhythmia other than the arrhythmia itself.     

Emergency department management of maxillofacial trauma

This paper highlights critical aspects of examination, diagnosis and early management of the maxillofacial trauma patient.     

“一站式”杂交手术方法治疗胸主动脉瘤及夹层动脉瘤的介入护理

目的探讨“一站式”杂交手术治疗胸主动脉瘤及夹层动脉瘤的术中护理配合的经验及管理。方法对10例胸主动脉瘤和夹层动脉瘤患者,在导管室行杂交手术,术中护士与医生的默契配合,严密生命体征监护,充分的各种抢救药品、器械的准备,保证手术顺利进行,防止各种并发症的发生。结果通过介入护理,患者均成功顺利完成杂交手术,术中无并发症发生。结论严格的护理管理,介入专科护士技能的培训,对杂交手术治疗胸主动脉瘤和夹层动脉瘤患者护理是安全有效的,术中介入护士与医生的默契、熟练配合,严密的生命体征监护对保证手术成功有重要作用。     

Emergency department evaluation and management of peripartum cardiomyopathy

Peripartum cardiomyopathy (PPCM) affects 1000-1300 women in the United States each year. We present three cases of PPCM seen in our Emergency Department (ED) that cover the entire spectrum of disease from mild heart failure to sudden cardiac death. Without previous heart disease, these women develop cardiomyopathy with impairment of left ventricular function in the last month of pregnancy, or during the first 5 months postpartum. The etiology of PPCM is not clear, although various mechanisms have been proposed, including infection, autoimmune response, prolonged tocolysis during labor, and maladaptive responses to the hemodynamic changes of pregnancy. The initial presentation of these patients is frequently to the ED. The differential diagnosis and key characteristics of PPCM are discussed. ED management should focus on three elements: reduction in pre-load, reduction in afterload, and increase in inotropy. Key differences between the antepartum and postpartum states are highlighted.     

Myocarditis: emergency department recognition and management

Myocarditis is an acute inflammatory syndrome involving the heart and related structures. In many instances, the presentation is obvious, and appropriate treatment and disposition follow accordingly. In other situations, patients present with viral illness of the respiratory or gastrointestinal tracts (or both) or nonspecific symptoms such as fatigue and weakness,leading the clinician astray. Management is largely supportive, including aggressive cardiorespiratory support.     

胸主动脉夹层动脉瘤腔内转流术的术后监护

总结7例胸主动脉夹层动脉瘤腔内转流术术后的监护.介绍了术后监护患者生命体征和凝血功能的重点和难点.指出由于患者术前多伴有心血管疾病,加上术中放置的人造血管移植物可导致血流动力学变化和免疫应激反应,术后加强监护是提高手术成功率、保障患者安全的重要措施.     

Emergency department management of pulmonary embolism.

There are several points that bear repetition. First, consider the diagnosis of PE in all patients presenting with chest pain, dyspnea, syncope, oxygen desaturation, or unexplained hypotension. Evaluate these patients in a rational manner. At any individual hospital, develop algorithms with consultants so that when one is faced with a patient with a PE, the flow of both diagnostics and therapeutics flows smoothly and rapidly. Consider the concept of risk stratification, and remember that not all patients with PE are created equal. In particular, be on the same page with all consultants regarding the use of right heart echocardiography, both for its potential diagnostic capabilities and for its ability to identify patients who could be at greater risk for bad outcomes.     

Emergency department management of penetrating eye injuries

Penetrating injuries are rare but important for the patient both visually and socioeconomically. This guide intends to provide a structure for emergency department personnel to enable targeted history taking, effective examination, appropriate investigation and timely referral for those presenting with penetrating eye trauma.     

Emergency department management of selected orthopedic injuries

Rather than providing an encyclopedic review of extremity injuries, this article reviews selected serious injuries of the extremities that can be missed in the emergency department, either because they are relatively uncommon or because they are subtle in their clinical and radiographic presentation. They include injuries to the scapula, the shoulder, the forearm, the femur and hip, the knee, the tibia (which is the most common long bone fracture), and the ankle and foot. Their various causes include sports injuries, falls, and motor vehicle accidents. Several of these injuries can result in emergent complications or have time-dependent outcomes. Consequently, these injuries often must be managed by emergency physicians before specialist expertise becomes available.     

Emergency department management of the salicylate-poisoned patient

Salicylate toxicity continues to be encountered commonly in emergency medicine. This article portrays the signs and symptoms of salicylate toxicity, reviews the erratic absorption and elimination kinetics, describes the devastating physiologic effects of overdose, and illustrates the potentially subtle manifestations of chronic aspirin toxicity.     

Emergency department management of the acute headache

Headache is a common complaint of patients seeking care at an emergency department (ED). A survey of more than 16,755 walk-in patients at an ED showed that 323 (1.9%) had a chief complaint of migraine (1). Almost one sixth of these patients had used the ED more than once. In fact, migraineurs used the ED and other health care providers 2 to 5 times more than nonmigraineurs (2). Fortunately, headaches associated with significant morbidity and mortality occur infrequently (3). The ED physician must be able to address the patient's need for pain management and establish the correct diagnosis for the headache while also ruling out any possibility of organic disease or life-threatening illness. Potential problems include ensuring appropriate follow-up and avoidance of narcotic habituation.     

Emergency department management of the acute headache

Headache is a common complaint of patients seeking care at an emergency department (ED). A survey of more than 16,755 walk-in patients at an ED showed that 323 (1.9%) had a chief complaint of migraine (1). Almost one sixth of these patients had used the ED more than once. In fact, migraineurs used the ED and other health care providers 2 to 5 times more than nonmigraineurs (2). Fortunately, headaches associated with significant morbidity and mortality occur infrequently (3). The ED physician must be able to address the patient's need for pain management and establish the correct diagnosis for the headache while also ruling out any possibility of organic disease or life-threatening illness. Potential problems include ensuring appropriate follow-up and avoidance of narcotic habituation.     

Emergency department management of sexually transmitted infections

Patients seeking treatment for sexually transmitted infections (STIs) account for a large number of emergency department (ED) visits per year. Despite the large volume of patients, STIs are often missed or treated inappropriately. Due to the high prevalence and incidence of STIs in the United States, it is important that emergency practitioners recognize symptoms consistent with STIs, and treat presumptively. This practice leads to overtreatment of STIs; however, when weighed against the public health risk and complications of untreated disease, empiric treatment is recommended. This article provides an overview of STIs encountered in the ED and recommendations for their treatment.     

Emergency department management of puncture wounds and needlestick exposure

Puncture wounds are common and challenging problems facing the physician. In general, puncture wounds can be classified into two distinct types. In one type, a child usually sustains a puncture wound of the foot. The other type of puncture wounds occur among hospital employees. These seemingly innocuous injuries may have serious sequelae that can be averted by prompt appropriate care of the wound. The fundamental trends of treatment of puncture wounds include cleansing the wound, débridement of any necrotic or devitalized tissue, and appropriate immunoprophylaxis.