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 waveforms have been shown clinically to have greater efficacy in the termination of VF when compared with monophasic waveforms, and because peak current delivery is less, these waveforms are likely to be less injurious to myocardial function. Advances in the understanding of the mechanisms of fibrillation and defibrillation have identified the electrophysiologic events that initiate and sustain VF and the effects of defibrillation shocks on those events. Definition of the role of VEP and postshock excitation has clarified the mechanisms by which shocks can either fail or succeed. The ability of the second phase of optimal biphasic waveform shocks to exploit recruited sodium channels in negatively polarized areas and thus induce rapid propagation of postshock excitation assures uniform depolarization and prevention of re-entry. This appears to be the major mechanism of greater efficacy of biphasic waveforms. It seems certain that continuing investigation of virtual electrodes will enhance our understanding of defibrillation and optimal waveforms. At the same time, much more needs to be known regarding translation of these experimental observations to mechanisms of defibrillation in human hearts with long-standing underlying structural heart disease, which often arises of multiple factors. This represents a major challenge in defibrillation research.
journal_name
Emerg Med Clin North Amjournal_title
Emergency medicine clinics of North Americaauthors
White RDdoi
10.1016/s0733-8627(02)00028-7subject
Has Abstractpub_date
2002-11-01 00:00:00pages
785-807issue
4eissn
0733-8627issn
1558-0539pii
S0733-8627(02)00028-7journal_volume
20pub_type
历史文章,杂志文章,评审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 widely recognized benefits of early diagnosis and treatment of acute myocardial infarction (AMI) have only emphasized the importance of emergency physician (EP) competence in electrocardiographic interpretation. As such, the EP must be an expert in the interpretation of the electrocardiogram (ECG) in the emergency...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：10.1016/s0733-8627(05)70185-1
更新日期：2001-05-01 00:00:00
abstract：:Although the clinical manifestations of an abnormal serum sodium concentration are uncommon, imbalances in sodium and water occur frequently. The major indications for the determination of the serum sodium are those situations in which the signs and symptoms of hyponatremia or hypernatremia are likely. In other situat...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：
更新日期：1986-02-01 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：:Pediatric medical complaints and differential diagnoses often vary from adults, requiring a specialized knowledge base and behavioral skill set. This article addresses a variety of congenital and acquired pediatric genitourinary disorders. Genitourinary emergencies include paraphismosis, priapism, serious infection, s...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：10.1016/j.emc.2011.04.003
更新日期：2011-08-01 00:00:00
abstract：:Avoiding legal pitfalls of orthopedic injuries in the emergency department (ED) requires an understanding of certain high-risk injuries, their presentation, evaluation, and disposition. Various pitfalls pertaining to both upper and lower extremity injuries are discussed in detail, with recommendations regarding the hi...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：10.1016/j.emc.2010.06.002
更新日期：2010-11-01 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：:Pediatric asthma is a disease that is managed across outpatient physicians, hospitalists, critical care physicians, and emergency department (ED) physicians. Scoring systems may facilitate a rapid assessment of the child with asthma in the ED. Short-acting beta agonists are still the mainstay of therapy for acute exac...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：10.1016/j.emc.2013.05.001
更新日期：2013-08-01 00:00:00
abstract：:Sepsis is recognized by the presence of physiologic and laboratory changes that reflect the inflammatory response to infection on cellular and systemic levels. Comorbid conditions, such as cirrhosis, end-stage renal disease, and obesity, alter patients' susceptibility to infection and their response to it once present...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：10.1016/j.emc.2016.08.006
更新日期：2017-02-01 00:00:00
abstract：:This article focuses on the use of hyperbaric oxygen therapy (HBOt) in the treatment of open fractures and crush injuries. Based on the clinical evidence and cost analysis, medical institutions that treat open fracture and crush injuries are justified in incorporating HBOt as a standard of care. Both Medicare and Unde...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：10.1016/j.emc.2007.01.008
更新日期：2007-02-01 00:00:00
abstract：:Central nervous system (CNS) infections require early recognition and aggressive management to improve patient survival and prevent long-term neurologic sequelae. Although early detection and treatment are important in many infectious syndromes, CNS infections pose unique diagnostic and therapeutic challenges. The non...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：10.1016/j.emc.2018.06.004
更新日期：2018-11-01 00:00:00
abstract：:Defibrillation has emerged as the single most effective intervention for resuscitation of patients from cardiac arrest. This article reviews the electrophysiologic basis of defibrillation, and ways to increase the effectiveness of counter-shocks, particularly for refractory ventricular fibrillation. Automatic implanta...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：
更新日期：1988-05-01 00:00:00
abstract：:Acid-base disorders should be considered a process with the goal being to treat the patient and the underlying condition, not the numbers. A good understanding of the normal acid-base regulation in the body, as well as the most common derangements can prepare the emergency physician for this very common disorder that ...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：10.1016/j.emc.2014.01.002
更新日期：2014-05-01 00:00:00
abstract：:International EM development requires a comprehensive assessment of the current system and careful planning to ensure that the most important needs are addressed. Modeling a country's EM system after an existing foreign system underestimates the complex needs for instituting appropriate system interventions. Planning ...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：10.1016/j.emc.2004.09.005
更新日期：2005-02-01 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 iron poisoning continues to be one of the most common and deadly poisonings seen by emergency physicians. There are many potential pitfalls in the assessment, diagnosis, and treatment of iron-poisoned patients. This article reviews the pathophysiology of acute iron poisoning and describes a comprehensive managem...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：
更新日期：1994-05-01 00:00:00
abstract：:Stroke should not solely be considered a disease of the elderly, and racial disparities are most evident among young adults. Acute stroke can present at any age and it is important to be familiar with the evaluation and treatment of stroke to provide timely care. The National Institute of Health Stroke Scale helps phy...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：10.1016/j.emc.2012.05.004
更新日期：2012-08-01 00:00:00
abstract：:Ultrasound has rapidly become an essential tool in the emergency department, specifically in procedural guidance. Its use has been demonstrated to improve the success rate of procedures, while decreasing complications. In this article, we explore some of these specific procedures involving needle guidance and structur...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章
doi：10.1016/j.emc.2012.09.008
更新日期：2013-02-01 00:00:00
abstract：:Despite the improvement of medical treatment for acute coronary syndromes throughout the 20th century, the authors believe that many cases of life-threatening coronary events could be avoided through early detection of CAD and the use of preventive strategies. Establishing chest pain units that are linked to the ED is...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：10.1016/s0733-8627(05)70195-4
更新日期：2001-05-01 00:00:00
abstract：:Resuscitation goals for the patient with sepsis and septic shock are to return the patient to a physiologic state that promotes adequate end-organ perfusion along with matching metabolic supply and demand. Ideal resuscitation end points should assess the adequacy of tissue oxygen delivery and oxygen consumption, and b...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：10.1016/j.emc.2016.09.001
更新日期：2017-02-01 00:00:00
abstract：:The pathophysiology of esophageal and gastric disorders is complicated and broad and includes iatrogenic, structural, inflammatory, neuromuscular, neoplastic, and infectious causes. Symptoms can be nonspecific and are often initially attributed to cardiac or respiratory causes. These disorders have both acute and chro...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：10.1016/j.emc.2011.01.007
更新日期：2011-05-01 00:00:00
abstract：:A rapid controlled induction of anesthesia is useful to facilitate emergency intubation and to reduce the complications of intubation in pediatric patients. A protocol for rapid sequence intubation and suggestions for optimizing airway management in the Emergency Department are described. The use of end tidal carbon d...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：
更新日期：1991-08-01 00:00:00
abstract：:Cardiogenic pulmonary edema (CPE) is a life-threatening condition that is frequently encountered in standard emergency medicine practice. Traditionally, diagnosis was based on physical assessment and chest radiography and treatment focused on the use of morphine sulfate and diuretics. Numerous advances in diagnosis an...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：10.1016/j.emc.2005.07.005
更新日期：2005-11-01 00:00:00
abstract：:The spectrum of acute coronary syndromes (ACS) includes several clinical complexes that frequently cause critical instability in affected patients. This article focuses on several critical care aspects of these unstable ACS patients. The management of cardiogenic shock can be particularly challenging because the mecha...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：10.1016/j.emc.2008.04.002
更新日期：2008-08-01 00:00:00
abstract：:The scope of gynecologic infections presenting to the emergency department is quite diverse. This article presents an update on the current literature for vaginitis, cervicitis, pelvic inflammatory disease, tubo-ovarian abscesses, the Fitz-Hugh-Curtis syndrome, herpes, and syphilis. Inadequate identification or treatm...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：10.1016/s0733-8627(03)00039-7
更新日期：2003-08-01 00:00:00
abstract：:Nonenhanced CT scan remains the most valuable and available neuroimaging study available in the ED. Nonenhanced CT scans are excellent for identifying acute hemorrhage, mass lesions, hydrocephalus, and cerebral edema. It is of limited value in identifying old blood, small abscesses and tumors, arteriovenous malformati...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：10.1016/s0733-8627(05)70315-1
更新日期：1997-08-01 00:00:00
abstract：:Cardiac arrhythmias may result from poisoning by a variety of agents. Although some cardiac disturbances are of limited concern, others occur because of the specific cardiac properties of the ingested drugs, and require specific antidotes. Clinicians must understand the resultant pathophysiology so that therapy is app...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：10.1016/s0733-8627(05)70009-2
更新日期：1998-05-01 00:00:00
abstract：:Toxidromes aid emergency care providers in the context of the patient presenting with suspected poisoning, unexplained altered mental status, unknown hazardous materials or chemical weapons exposure, or the unknown overdose. The ability to capture an adequate chemical exposure history and to recognize toxidromes may r...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：10.1016/j.emc.2014.09.004
更新日期：2015-02-01 00:00:00
abstract：:Adolescents are the victims, perpetrators, and witnesses of violent acts in the home, at school, and on the streets. Adolescent violence describes a dynamic, destructive, and repercussive process. This article discusses the unique aspects of adolescent violence and the involvement undertaken by the emergency departmen...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：10.1016/s0733-8627(05)70084-5
更新日期：1999-08-01 00:00:00
abstract：:Results of prospective studies have shown that physicians' estimate of clinical likelihoods of PE have predictive value. The ability of clinicians to assess the factors that determine the probability of disease based on clinical manifestations such as history and signs and symptoms at presentation, and to make bedside...
journal_title：Emergency medicine clinics of North America
pub_type： 杂志文章,评审
doi：10.1016/s0733-8627(05)70227-3
更新日期：2001-11-01 00:00:00
