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Although cervical spine injuries are uncommon in children, a missed or
delayed diagnosis may have devastating consequences for the patient. A
thorough understanding of normal pediatric anatomy, injury patterns,
and children who are at increased risk for injury is critical for the
physician caring for the acutely injured child.
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The diagnosis and management of patients with manifestations of drug-induced cardiotoxicity is challenging for even the most experienced emergency physician. The following report reviews the pathophysiology and clinical manifestations of cardiotoxins to provide the front-line practitioners with evidence-based protocols for managing patients with life-threatening toxicity.
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Child abuse can be difficult to recognize, especially in the often chaotic environment of the emergency department. As the leaders of the community and medical safety net that is the ED, emergency physicians play a unique role in detecting, treating, and preventing child abuse. This issue of Emergency Medicine Specialty Reports provides an update on the patterns, diagnosis, and treatment of physical child abuse injuries.
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Whether a bite or sting results in an anaphylactic reaction, impressive
local effects, or a life-threatening systemic reaction, the emergency
physician must be able to institute appropriate and effective
treatment. Emergency physicians also must be able to recognize clinical
envenomation patterns, since some critically ill patients may not be
able to convey the details of the attack. Since all areas of the
country are represented in the envenomation statistics, all emergency
physicians should be familiar with identification and stabilization of
envenomated patients and know what resources are available locally for
further management of these often complicated patients.
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The recognition of non-accidental injury is critical for a pediatric
trauma patient. In the year 2000, almost 3 million reports of child
abuse were made to social service agencies. Forty-four percent of the
fatalities were children younger than 1 year of age. Not only are these
statistics alarming, but they point out the need for emergency
department and trauma physicians and nurses to recognize non-accidental
injury and aggressively protect the children who seek our medical
expertise and protection.
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The final version of the recently proposed changes to the Emergency Medical Treatment and Labor Act (EMTALA) takes effect on Nov. 10. To provide you with critical information on the updated regulations from the Centers for Medicare and Medicaid Services, Thomson American Health Consultants offers "New EMTALA Regulations: Are They Too Good to be True?" an audio conference on Tuesday, Oct. 21, from 2:30-3:30 p.m., EST.
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In practice, the ability of medical staff to detect delirium may not always be straightforward. In a typical busy emergency department, constraints on time can impair the collection of salient historical points and observation of the more subtle clinical signs. Therefore, delirium often is missed, overlooked as senescence, or incorrectly diagnosed as a psychiatric disorder or dementia.
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Part I of this two-part series covered gastrointestinal causes of chest pain and aortic dissection. This second and final part of the series will focus on pulmonary, psychiatric, and musculoskeletal causes of chest pain.
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You have just taken sign-out when a nurse comes up to you and says that there is a 64-year-old man in the critical bay who took an overdose of his medications. The patient has a history of hypertension, atrial fibrillation, and depression. The patient is lethargic but arousable, and reports he took about 40 tablets of immediate-release metoprolol three hours ago in an attempt to "end it all." The nurses are starting IV lines, checking vitals, and putting the patient on the monitor. You wonder, "Is it too late for gastric decontamination? If he is symptomatic, which therapy will I try first, and what are my options?"
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This issue is the second in a two-part series covering vaginal bleeding in pregnancy. Part I discussed spontaneous abortion and ectopic pregnancy. Part II will discuss other causes of vaginal bleeding that typically present later in pregnancy.
