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These next two issues of Emergency Medicine Reports will cover many of the complications and problems that may cause the pregnant woman to come see you. Part I will focus on miscarriage, ectopic pregnancy, gestational trophoblastic disease, and venous thromboembolic states. Part II will discuss hypertensive disorders, amniotic fluid embolism, and late pregnancy bleeding.
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Prompt, accurate assessment of the severity of injury and early initiation
of appropriate critical care — including adequate oxygenation,
ventilation and correction of hypotension — is of crucial importance
in preventing deaths in children with severe trauma. This article reviews
the critical aspects of airway assessment and management in the pediatric
trauma patient.
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Most cases of thrombocytopenia seen in the emergency department (ED) are expected. Patients are known to have hematological disease or are receiving chemotherapy. At times, however, the ED physician is confronted with an unexpected laboratory finding in an assymptomatic patient, or with a patient who is bleeding. The challenge, as usual, is to determine the need for acute treatment and the appropriate disposition.
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How many of your patients have a CT scan during their ED evaluation? Many hospitals report rates of 20% or more. A significant number of these scans are of the abdomen and pelvis. It is important for the emergency physician to have the knowledge to view and interpret these images.
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Prompt, accurate assessment of the severity of injury and early initiation of appropriate critical care — including adequate oxygenation, ventilation and correction of hypotension — is of crucial importance in preventing deaths in children with severe trauma. This article reviews the critical aspects of airway assessment and management in the pediatric trauma patient.
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The first part of this series discussed abdominal pain in pediatric patients. This second and final part will cover abdominal pain in elderly, immunocompromised, and pregnant patients. Those 65 years of age and older constitute the fastest-growing segment of the population, and currently comprise about 12% of the U.S. population. This means that abdominal pain in the elderly will be a commonplace occurrence in EDs.
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In part II of this two-part series, the Antibiotic Therapy in Bacterial Sinusitis (ATBS) Clinical Consensus Panel outlines risk-directed strategies for management of patients with acute bacterial rhinosinusitis. Outlining specific symptomatic, historical, and host criteria that prompt empiric antibiotic therapy, and a sequencing strategy for antimicrobial drug selection, this review provides practical, evidence-based strategies for patient management.
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Drug-seeking behaviors are commonplace in emergency departments. Many physicians have faced patients with multiple alleged allergies to narcotics who are asking for a medication that the physician never would have initially thought of prescribing, whose medications were stolen, and who become angry, threatening, and agitated upon refusal to refill the stolen prescription. This article defines various terms used in the drug-seeking literature, provides an overview of drug-seeking behaviors, and proposes some techniques to manage these patients both at the individual and at the institutional levels.
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Hypertensive disorders of pregnancy range from chronic pre-existing disease to life-threatening conditions such as HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) and eclampsia. They often represent a continuum from bad to worse. The emergency department physician is likely to evaluate a pregnant patient for many conditions unrelated to the pregnancy itself, and knowledge of abnormalities that warrant further assessment and follow-up is essential.
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