Part I of this series focused on hypertensive syndromes and clinical evaluation. This second and final part will cover antihypertensive medications and management of hypertension in specific disease processes.
An emergency physician often is the first and only health care provider that families interact with after a loved ones death. Yet emergency physicians often are uncomfortable and undertrained in delivering bad news. This is especially true when the death involves a child. Counseling families after a death needs to be performed properly and systematically to help manage the grief response of survivors. The emergency physician also must be well versed in the after care that is associated with a death in the emergency department, such as organ donation. This issue of Emergency Medicine Specialty Reports offers the means to provide an effective and compassionate death notification in a variety of circumstances.
This issue of Emergency Medicine Reports reviews urgent and emergent hypertension syndromes encountered in the ED and approaches to patient assessment and pharmacologic management. Part I will cover the clinical evaluation of hypertensive patients and hypertension syndromes. Part II will discuss antihypertensive medications and the management of hypertension in specific disease processes.
In its earlier years, the Emergency Medical Treatment and Active Labor Act (EMTALA) was defined by court decisions that often were inconsistent with real clinical practice. Although there still are uncertainties with the application of EMTALA to specific clinical scenarios, refinements to the statute have clarified some of its ambiguities. The author discusses some of the recent refinements to EMTALA that help to clarify the statutes meaning to hospitals and the practice of emergency medicine.
This review will provide a guide to ventilator management to aid the ED physician. Pulmonary physiology and adverse effects of artificial ventilation on the pulmonary system will be discussed. Assist control ventilation is the most common mode of ventilation and should be used initially for patients in the ED. Pitfalls of therapy and troubleshooting the ventilator will be reviewed, recognizing that the respiratory therapist is a valuable reference and capable of handling the majority of mechanical ventilation issues. Finally, difficult cases will arise requiring early consultation with a critical care specialist to provide optimal ventilation while avoiding complications.
