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Emergency medicine physicians routinely deal with cardiac emergencies in adult patients but rarely encounter infants with critical cardiac conditions. While the infant's cardiac physiology can be very different from an adult's, the general principles of preload, afterload, contractility, and vascular resistance are the same.
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What do parents do when their child is out of control? Often, they all end up in the ED. The child is sullen and defiant, occasionally agitated. The parents are frustrated and often at the end of their rope. So, as the emergency physician on duty, how do you evaluate this situation?
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The National Institutes of Health (NIH) in 2007 estimated that 17.6 million (1 in 12) adults in the United States abuse or are dependent on alcohol. Alcohol withdrawal syndrome (AWS) is a potentially life-threatening condition that can develop as a result of sudden reduction or discontinuation of alcohol use.
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The drowned patient represents a unique and difficult challenge. A wide range of physiologic insults may occur, making each management decision critical. This review describes the epidemiology, pathophysiology, critical actions, and prognostic factors the emergency physician must know to provide the best care for the drowned patient.
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I remember when the Goldman myocardial infarction (MI) algorithm came out, quickly followed by a seven-button hand-held "calculator." It promised to reduce all decision-making regarding ED chest pain patients to seven yes or no questions. But when you looked into the mathematics, if you answered no or negative to all of the questions, it indicated a 4% chance of acute cardiac ischemia. So, what would you do with this information? Could you tell the patient that there was only a 4% chance of a heart attack, so it was OK to go home?
