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Optimizing outcomes in patients with acute coronary syndrome requires matching patients with strategies that will produce the best results in specific clinical subgroups. Identifying those patients with ST elevation myocardial infarction (STEMI) who represent ideal candidates for fibrinolysis, and who are likely to have outcomes that are at least as favorable as they would have with percutaneous interventions, has become an area of intense focus among cardiologists and emergency physicians. Significant improvements in patient outcomes will be made when patients are managed according to their institutional capabilities, with the understanding that prompt thrombolysis in the setting of STEMI is fundamental to optimal patient care. This article, the second in a two-part series, provides a practical, evidence-based approach to comprehensive management of this patient population.
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In this second part of our two-part series, the SCMARTI (Selection of Cephalosporins, Macrolides, and AFQs for Respiratory Tract Infections) Consensus Panel presents recommendations for antimicrobial therapy in acute bacterial exacerbations of chronic bronchitis, along with a comprehensive treatment table to guide therapy in the emergency department and outpatient setting.
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Part I of this two-part series on respiratory diseases covered two viral infections, severe acute respiratory syndrome and influenza. Part II focuses on a bacterial infection, community-acquired pneumonia.
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Emergency Medicine Reports received a 2004 First Place award in the Best Single-Topic Newsletter category from the Newsletter and Electronic Publishers Foundation for the two-part article on immigrant medicine published Feb. 10 and Feb. 24, 2003. The authors of the winning article are Mary Meyer, MD, Danica Barron, MD, and Carter Clements, MD. The article was edited by Gideon Bosker, MD, and Shelly Morrow Mark.
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Since acute pain management is protean in nature, the focus of this report consciously will be to avoid such topics as procedural sedation, alternative nonpharmacologic adjuncts, medication pharmacokinetics, sickle cell pain crisis management, cancer pain management, and physician liability in withholding analgesic treatment.
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For the emergency physician, sexual assault represents the most common presenting complaint associated with the potential for an unintended pregnancy. Annually, approximately 40,000 people in the United States visit EDs after sexual assault. Pregnancy is estimated to occur in approximately 5% of sexual assaults. Thus, pregnancy prevention is an important part of the care for these patients. For the emergency physician, EC represents the most viable treatment option. However, while highly effective when used properly, it is associated with a number of issues that make it much less commonly used.
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The outcome of a medical malpractice case often depends on an experts opinion and how well that expert conveys that opinion to a jury. Despite the important role that experts play within the medical malpractice system, until recently, there has been little oversight of expert witness actions. With the increasing number of professional and legal actions against expert witnesses, it appears that the same experts hired to review the actions of their peers are starting to be scrutinized themselves. This months issue of the ED Legal Letter will address some of these issues that relate to the role of the expert witness.
