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This article focuses on specific populations presenting with abdominal pain to the ED and their specific or unique diagnoses. The pediatric, elderly, pregnant, and immunocompromised patients are special populations that pose a particular challenge to clinicians. These high-risk groups often present atypically, and serious conditions can be missed or misdiagnosed. This article discusses unusual diagnoses that often present with abdominal pain as one of the main symptoms.
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Although headache is a common symptom in children and adolescents, only a very small percentage of patients present to the emergency department for evaluation of this complaint. The majority of these headaches are benign and are either primary, such as migraine or tension-type headaches, or secondary to a viral etiology. Parents and children themselves are most concerned about the possibility of a brain tumor, whereas ED physicians are also on the alert for carbon monoxide toxicity, subarachnoid hemorrhage, meningitis, and increased intracranial pressure. The authors review the causes, diagnostic testing, and treatment of the common headache, as well as some unusual causes of non-traumatic headache.
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This second and final part of a series covers the topics of differential diagnosis that must be considered when a patient presents with symptoms consistent with PE, treatment, and considerations for prevention of this disease state.
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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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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.
