Abstract:
:A better understanding of coronary syndromes allow physicians to appreciate UAP and AMI as part of a continuum of ACI. ACI is a life-threatening condition whose identification can have major economic and therapeutic importance as far as threatening dysrhythmias and preventing or limiting myocardial infarction size. The identification of ACI continues to challenge the skill of even experienced clinicians, yet physicians continue (appropriately) to admit the overwhelming majority of patients with ACI; in the process, they admit many patients without acute ischemia [2], overestimating the likelihood of ischemia in low-risk patients because of magnified concern for this diagnosis for prognostic and therapeutic reasons. Studies of admitting practices from a decade ago have yielded useful clinical information but have shown that neither clinical symptoms nor the ECG could reliably distinguish most patients with ACI from those with other conditions. Most studies have evaluated the accuracy of various technologies for diagnosing ACI, yet only a few have evaluated the clinical impact of routine use. The prehospital 12-lead ECG has moderate sensitivity and specificity for the diagnosis of ACI. It has demonstrated a reduction of the mean time to thrombolysis by 33 minutes and short-term overall mortality in randomized trials. In the general ED setting, only the ACI-TIPI has demonstrated, in a large-scale multicenter clinical trial, a reduction in unnecessary hospitalizations without decreasing the rate of appropriate admission for patients with ACI. The Goldman chest pain protocol has good sensitivity for AMI but was not shown to result in any differences in hospitalization rate, length of stay, or estimated costs in the single clinical impact study performed. The protocol's applicability to patients with UAP has not been evaluated. Single measurement of biomarkers at presentation to the ED has poor sensitivity for AMI, although most biomarkers have high specificity. Serial measurements can greatly increase the sensitivity for AMI while maintaining their excellent specificity. Biomarkers cannot identify most patients with UAP. Finally, diagnostic technologies to evaluate ACI in selected populations, such as echocardiography, sestamibi perfusion imaging, and stress ECG, may have very good to excellent sensitivity; however, they have not been sufficiently studied.
journal_name
Emerg Med Clin North Amjournal_title
Emergency medicine clinics of North Americaauthors
Pope JH,Selker HPdoi
10.1016/s0733-8627(02)00079-2subject
Has Abstractpub_date
2003-02-01 00:00:00pages
27-59issue
1eissn
0733-8627issn
1558-0539pii
S0733-8627(02)00079-2journal_volume
21pub_type
杂志文章,评审abstract::Bleeding in late-term pregnancy can present as an innocuous start to parturition or a catastrophic maternal-fetal hemorrhage masked by the physiologic adaptations of pregnancy. The emergency management of late-term bleeding can be challenging, especially when providing stabilizing care in a limited-resource environmen...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.emc.2019.01.006
更新日期:2019-05-01 00:00:00
abstract::Determining the appropriate immunizations for international travelers is a complex, multifaceted process. This article proposes a stepwise and systematic approach to the immunization needs of the traveler-patient. Vaccines for routine health maintenance as well as special issues of the elderly, pregnant, immunocomprom...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0733-8627(05)70285-6
更新日期:1997-02-01 00:00:00
abstract::Urinary retention is a common problem encountered in the emergency department. Acute urinary retention (AUR) presents as a sudden inability to voluntarily void, and is typically associated with lower abdominal pain. Its etiology can be varied and multifactorial. Treatment of AUR aims to relieve the obstruction and mit...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.emc.2019.07.005
更新日期:2019-11-01 00:00:00
abstract::Orthopedic injuries in children are unique when compared to those of adults because of the physiologic differences, especially the growth plates, stronger periosteum, and dynamic state of growth. The approach to the orthopedically injured child requires a gentle yet thorough focus with consideration of the growth plat...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.emc.2014.12.012
更新日期:2015-05-01 00:00:00
abstract::As the geriatric population increases in the United States, there is an increase in number of visits to emergency departments for end-of-life and palliative care. This provides the emergency physician with a unique opportunity to alleviate and prevent further suffering in this vulnerable population. Competency in comm...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.emc.2016.04.013
更新日期:2016-08-01 00:00:00
abstract::The treatment of acute ischemic stroke is one of the most rapidly evolving areas in medicine. Like all ischemic vascular emergencies, the priority is reperfusion before irreversible infarction. The central nervous system is sensitive to brief periods of hypoperfusion, making stroke a golden hour diagnosis. Although th...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.emc.2020.09.014
更新日期:2021-02-01 00:00:00
abstract::Elderly trauma patients present unique challenges and face more significant obstacles to recovery than younger patients. Despite overall higher mortality, longer length of stay, increased resource use, and higher rates of discharge to rehabilitation, most elderly trauma patients return to independent or preinjury func...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.emc.2007.06.005
更新日期:2007-08-01 00:00:00
abstract::The transition of biphasic waveforms from ICDs to external defibrillators constitutes a significant technological advances for transthoracic defibrillation. Impedance compensation has enabled the delivery of defibrillating current adapted to each patient and each shock in the same patient. Optimally designed biphasic ...
journal_title:Emergency medicine clinics of North America
pub_type: 历史文章,杂志文章,评审
doi:10.1016/s0733-8627(02)00028-7
更新日期:2002-11-01 00:00:00
abstract::The recognition of hypothyroidism may not always be easy in the emergency department setting. Laboratory evaluations of thyroid function are not usually performed on a 24-hour basis, and therefore the emergency physician, although suspecting the presence of hypothyroidism, may be unable to confirm the diagnosis while ...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1989-11-01 00:00:00
abstract::Most dog and cat bite injuries are minor wounds that require only local wound care as well a patient evaluation for tetanus and rabies postexposure immunoprophylaxis. For larger wounds, primary or delayed primary closure can be performed safely where indicated. When antimicrobial agents are necessary, inexpensive peni...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1992-11-01 00:00:00
abstract::The threat of a BT event has catalyzed serious reflection on the troublesome issues that come with event management and triage. Such reflection has had the effect of multiplying the efforts to find solutions to what could become a catastrophic public health disaster. Management options are becoming more robust, as are...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0733-8627(01)00008-6
更新日期:2002-05-01 00:00:00
abstract::The diagnosis of acute scrotal pain can be difficult. The most common causes include torsion of a testicular appendage, epididymitis, and testicular torsion, which account for 85% to 90% of all cases. These entities may be clinically indistinguishable because characteristic symptoms and signs for each overlap, whereas...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0733-8627(05)70033-x
更新日期:1998-11-01 00:00:00
abstract::Stroke is rare in children but leads to significant morbidity and mortality. Emergency department physicians are likely to be the first to evaluate children suffering strokes and it is, therefore, important for them to recognize common presenting features and risk factors for pediatric stroke. This review describes th...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.emc.2012.05.005
更新日期:2012-08-01 00:00:00
abstract::Few presentations to the emergency department are as critical or dramatic as the patient in shock. Cardiovascular disasters that commonly present with shock include massive pulmonary embolism, cardiac tamponade, aortic dissection and aneurysm, and cardiogenic shock associated with acute myocardial infarction. Because ...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1995-11-01 00:00:00
abstract::Prompt recognition of actual or impending aortic emergencies is essential to the effective practice of emergency medicine. Understanding the pathophysiologic principles and awareness of the potential subtleties in the clinical presentations of aortic dissection, aneurysm, and occlusive disease are prerequisites to thi...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0733-8627(03)00063-4
更新日期:2003-11-01 00:00:00
abstract::The management of the patient presenting to the Emergency Department with nephrolithiasis or renal colic should include evaluation of the patient for concurrent diseases, risk factors for stone formation, and possible etiologies for stones. Suspicion of ureterolithiasis is based on a cogent history and physical examin...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1988-08-01 00:00:00
abstract::The general concepts of defibrillation are reviewed. Research continues in the area of implanted defibrillators, new circuiting, and more effective current transfer. ...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1983-12-01 00:00:00
abstract::Acute urinary retention is a common emergency genitourinary symptom. The etiology of acute retention includes obstructive, neurogenic, pharmacologic, and psychogenic causes. The emergency management of acute urinary retention is bladder decompression, which is usually accomplished with a Foley catheter. ...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1988-08-01 00:00:00
abstract::This article reviews current issues regarding the Focused Assessment with Sonography for Trauma (FAST) examination. Technical performance issues, decision-making and practice algorithms, fluid volume and scoring systems, proficiency and training, and the role of the FAST in pediatric trauma are covered. This article e...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.emc.2004.04.007
更新日期:2004-08-01 00:00:00
abstract::Pneumonia is a common disease seen in Emergency Department patients and is caused by a wide range of pathogens. The clinical and laboratory data that help to provide a specific etiologic diagnosis of the pneumonia are reviewed. In addition, current recommendations for the treatment and hospitalization of patients with...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1989-05-01 00:00:00
abstract::Patients presenting to the emergency department with certain traumatic conditions can be managed in observation units. The evidence base supporting the use of observation units to manage injured patients is smaller than the evidence base supporting the management of medical conditions in observation units. The conditi...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.emc.2017.03.010
更新日期:2017-08-01 00:00:00
abstract::Although there are complications associated with cardioversion, they are relatively infrequent and usually of small magnitude compared with the primary disease. Cardioversion is an invaluable part of the emergency physician's armamentarium. ...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章
doi:
更新日期:1983-12-01 00:00:00
abstract::Helium-oxygen ("heliox") mixtures have been used for decades in the treatment of various respiratory problems ranging from acute upper airway obstructions to lower airway derangements, such as asthma and exacerbations of chronic bronchitis. This review presents a brief history of helium and helium-oxygen mixtures and ...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.emc.2008.07.007
更新日期:2008-11-01 00:00:00
abstract::This article is designed to review proper procedure by an emergency or primary care physician when evaluating a patient with decreased hearing. It will cover the anatomy and physiology of hearing, as well as the evaluation and initial management of conductive and sensorineural hearing loss. ...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:
更新日期:1987-05-01 00:00:00
abstract::The aging population of the United States creates pharmaceutical challenges for the practicing emergency physician. Polypharmacy, drug-drug and drug-disease interactions, and other pharmaceutical complications from the pathophysiologic changes associated with aging need to be recognized in order to optimize outcomes i...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.emc.2016.04.003
更新日期:2016-08-01 00:00:00
abstract::Tumor lysis syndrome is most often seen after the treatment of blood and solid malignancies. The resultant hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia can lead to life threatening complications. Expeditious evaluation and therapy are paramount in preventing the most serious sequelae of acute renal...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章
doi:10.1016/j.emc.2009.04.010
更新日期:2009-08-01 00:00:00
abstract::Respiratory failure is a frequent disease process encountered in the emergency department. There is significant need for improvement in the care of patients on mechanical ventilation. If not contraindicated, lung-protective ventilation strategies should be used. It is important to consider pathophysiology (shunting, d...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.emc.2014.07.012
更新日期:2014-11-01 00:00:00
abstract::Pediatric patients often present to the emergency department with orthopedic pathology that can challenge the emergency department physician. This article focuses on key diagnoses that are frequently mismanaged. These diagnoses require specific knowledge to execute appropriate treatment. Pediatric fractures, compartme...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.emc.2009.09.008
更新日期:2010-02-01 00:00:00
abstract::UTIs are common, potentially severe infections that the emergency physician must manage efficiently and effectively. In most cases, this entity is well recognized, and the clinician will be confident of the correct course. However, in certain populations, complications are common, and the best therapy has yet to be pr...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/s0733-8627(05)70208-x
更新日期:2001-08-01 00:00:00
abstract::Pediatric mechanical ventilation is first initiated by emergency physicians when performing active airway management in a critically ill or injured child. When initiating and adjusting mechanical ventilation, the child has unique anatomy and physiology to consider. The EP is the first to respond to ventilator alarm tr...
journal_title:Emergency medicine clinics of North America
pub_type: 杂志文章,评审
doi:10.1016/j.emc.2017.12.008
更新日期:2018-05-01 00:00:00