Acute Coronary Syndromes
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Side Effects of Opioids
More than 40% of ED visits are related to pain.1 The Joint Commission has made the assessment and treatment of pain in the ED one of its standards.2 The use of opioid medications has been increasing in both adults and children.3-5 In 2009 there were more than 200 million prescriptions for opioid medications, with enough medication dispensed to supply every adult in the United States with the equivalent of 5 mg of hydrocodone every four hours for one month.
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The Photosensitive Patient
A 65-year-old female presents to the emergency department with a chief complaint of a severe rash. The rash has been present for two weeks on her arms, neck, and scalp. It began while she was sitting on her porch one afternoon. She denies any associated fevers, chills, headache, or muscle ache. She denies any exposure to pets, new soaps, detergents, or lotions, and she denies recent travel.
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Pediatric Myocarditis
Myocarditis can at times be asymptomatic and has a varied presentation; consequentially, it often goes undiagnosed and its true incidence is unknown -
Emergency Ultrasound Part I: Pelvic Ultrasound and the First Trimester Patient
In this article and the succeeding two parts in this series, three distinctive applications of ultrasound in the ED will be discussed. The ability to perform a proficient and diagnostically effective ultrasound examination requires a judicious understanding of the underlying principles. -
ECG Review: Chest Pain and Lots of P Waves
The 12-lead ECG shown in the figure was obtained from a 55-year-old woman with new-onset chest pain. Many more P waves than QRS complexes are seen on the tracing. How would you interpret this ECG? -
Syncope Should Not Be Taken Lightly
The authors of this study in the New England Journal of Medicine evaluated participants enrolled in the Framingham Heart Study between 1971 and 1998 who reported syncopal events. -
Fibrinolysis in Acute MI and Hospital Revascularization Capability
In this retrospective study of the GUSTO-1 database, investigators compared clinical outcomes of more than 25,000 patients with acute myocardial infarction who were treated with fibrinolytic therapy in U.S. hospitals with and without coronary revascularization capability for percutaneous transluminal coronary angioplasty and coronary artery bypass grafting. -
Special Feature: Metabolic Alkalosis
A systematic approach with an understanding of the pathophysiology can help the clinician correctly diagnose and treat metabolic alkalosis, a condition that carries a high morbidity and mortality rate. -
Oral Vitamin K Lowers INR Faster than Subcutaneous Vitamin K
Crowther and associates tested the hypothesis that oral vitamin K would reduce high international normalized ratio values faster than subcutaneous vitamin K. -
Hyperbaric Oxygen for Carbon Monoxide Poisoning
The value of hyperbaric oxygen therapy for the treatment of CO-poisoned patients, and its ability to prevent long-term cognitive sequelae, has been debated for years among toxicology and hyperbaric experts. This study from the University of Utah addressed this difficult issue.