Emergency Medicine Clinics of North America RSS feed: Current Issue. Emergency Medicine Clinics of North America updates you on the latest trends in patient management; keeps you up to date on the newest advances; and provides a sound basis for choosing treatment options. Each issue focuses on a single topic in emergency medicine and is presented under the direction of an experienced guest editor. In addition, you can earn valuable CME credits - up to 60 per year - with your subscription. http://www.emed.theclinics.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Emergency Medicine Clinics of North America0733-8627302May 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.emed.theclinics.com/article/PIIS0733862712000089/abstract?rss=yesContributors10.1016/S0733-8627(12)00008-9Emergency Medicine Clinics of North America 30, 2 (2012)2012-05-01Emergency Medicine Clinics of North America2012-05-01302S0733-8627(11)X0006-8iiivhttp://www.emed.theclinics.com/article/PIIS0733862712000090/abstract?rss=yesContents10.1016/S0733-8627(12)00009-0Emergency Medicine Clinics of North America 30, 2 (2012)2012-05-01Emergency Medicine Clinics of North America2012-05-01302S0733-8627(11)X0006-8viixhttp://www.emed.theclinics.com/article/PIIS0733862712000107/abstract?rss=yesForthcoming Issues10.1016/S0733-8627(12)00010-7Emergency Medicine Clinics of North America 30, 2 (2012)2012-05-01Emergency Medicine Clinics of North America2012-05-01302S0733-8627(11)X0006-8xixihttp://www.emed.theclinics.com/article/PIIS0733862712000119/abstract?rss=yesCME Accreditation Page and Author Disclosure10.1016/S0733-8627(12)00011-9Emergency Medicine Clinics of North America 30, 2 (2012)2012-05-01Emergency Medicine Clinics of North America2012-05-01302S0733-8627(11)X0006-8xiixiihttp://www.emed.theclinics.com/article/PIIS073386271200003X/abstract?rss=yes“The unofficial mantra of the specialty of emergency medicine is ‘A-B-C: airway, breath sounds, circulation.”’ This mnemonic emphasizes the well-accepted priority in the approach to managing unstable patients. The Emergency Medicine Clinics series has addressed airway as well as circulation issues considerably in recent months and years. This should serve as no surprise to anyone who keeps up with the emergency medicine literature … airway and cardiovascular issues always attract great notoriety and excitement. The “B” in our traditional mantra, however, often tends to be neglected or relegated to being of secondary importance. Yet nothing could be further from the truth. The “B” represents the lungs, which form the vital link between the celebrated airway and cardiovascular system. Poor lung function compromises every other vital organ in the body by depriving them of the body's primary nutrient, oxygen. Poor lung function also allows the rapid buildup of the body's most dangerous poison, carbon dioxide, which can impair virtually every vital organ and metabolic process. It should be clear to everyone that the “B,” though less eminent than “A” and “C,” certainly deserves its rightful place within our specialty's mantra.ForewordAmal Mattu10.1016/j.emc.2012.01.002Emergency Medicine Clinics of North America 30, 2 (2012)2012-02-13Emergency Medicine Clinics of North America2012-02-13302S0733-8627(11)X0006-8xiiixivhttp://www.emed.theclinics.com/article/PIIS0733862712000028/abstract?rss=yesAirway, Breathing Circulation … Airway, Breathing Circulation …. This mantra has been ingrained into every medical student, resident, and attending staff as THE priority in assessing medical and trauma patients presenting to the emergency department. As such, any condition, be it infectious, traumatic, or vascular, which compromises the thoracic cavity can result in profound and deleterious effects on a patient’s airway, respiratory, and cardiovascular status, and, by extension, his/her morbidity and mortality.PrefaceJoel P. Turner10.1016/j.emc.2012.01.001Emergency Medicine Clinics of North America 30, 2 (2012)2012-02-03Emergency Medicine Clinics of North America2012-02-03302S0733-8627(11)X0006-8xvxvihttp://www.emed.theclinics.com/article/PIIS0733862711001131/abstract?rss=yesAsthma is a chronic inflammatory airway disease that is commonly seen in the emergency department (ED). This article provides an evidence-based review of diagnosis and management of asthma. Early recognition of asthma exacerbations and initiation of treatment are essential. Treatment is dictated by the severity of the exacerbation. Treatment involves bronchodilators and corticosteroids. Other treatment modalities including magnesium, heliox, and noninvasive ventilator support are discussed. Safe disposition from the ED can be considered after stabilization of the exacerbation, response to treatment and attaining peak flow measures.Asthma Diagnosis and ManagementAriana Murata, Patrick M. Ling10.1016/j.emc.2011.10.004Emergency Medicine Clinics of North America 30, 2 (2012)2011-12-12Emergency Medicine Clinics of North America2011-12-12302S0733-8627(11)X0006-8203222http://www.emed.theclinics.com/article/PIIS0733862711001143/abstract?rss=yesChronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality worldwide. Acute exacerbations of COPD (AECOPDs) are a common presentation to emergency departments and are an important cause of respiratory failure. This article discusses the disease process and diagnosis of COPD and AECOPD. A further in-depth discussion is undertaken of evidence-based treatments, palliation, and disposition of patients who present to emergency departments with AECOPD.Acute Exacerbations of Chronic Obstructive Pulmonary Disease in the Emergency DepartmentCory A. Brulotte, Eddy S. Lang10.1016/j.emc.2011.10.005Emergency Medicine Clinics of North America 30, 2 (2012)2012-05-01Emergency Medicine Clinics of North America2012-05-01302S0733-8627(11)X0006-8223247http://www.emed.theclinics.com/article/PIIS0733862711001374/abstract?rss=yesIn those patients who are hospitalized with pneumonia, mortality is 15%. Close to 90% of deaths attributed to pneumonia are in patients older than 65 years. This article provides the emergency physician with an understanding of how to make the diagnosis, initiate early and appropriate antibiotic therapy, risk stratify patients with respect to the severity of illness, and recognize indications for admission. The discussion is balanced with an emphasis on cost-effective management, an understanding of the changing spectrum of pathogenesis, and a cognizance toward variable and less common presentations.Pneumonia in Adults: the Practical Emergency Department PerspectiveKaren G.H. Woolfrey10.1016/j.emc.2011.12.002Emergency Medicine Clinics of North America 30, 2 (2012)2012-02-24Emergency Medicine Clinics of North America2012-02-24302S0733-8627(11)X0006-8249270http://www.emed.theclinics.com/article/PIIS0733862711001209/abstract?rss=yesSeasonal influenza causes significant morbidity and mortality, primarily due to increased complication rates among the elderly population and patients with chronic diseases. Timely diagnosis of influenza and early recognition of an influenza outbreak or epidemic are key components in preventing influenza-related complications, hospitalizations, and deaths. Emergency departments are the most frequent points of entry for most influenza cases and are well positioned to identify and manage influenza community outbreaks and epidemics. Emergency departments need specific infection control measures to curb the spread of influenza in the Emergency Department and hospital during the influenza season.Evaluation and Management of Seasonal Influenza in the Emergency DepartmentMarc Afilalo, Errol Stern, Matthew Oughton10.1016/j.emc.2011.10.011Emergency Medicine Clinics of North America 30, 2 (2012)2012-05-01Emergency Medicine Clinics of North America2012-05-01302S0733-8627(11)X0006-8271305http://www.emed.theclinics.com/article/PIIS0733862711001362/abstract?rss=yesAcute aortic dissection in the emergency department (ED) remains one of the riskiest clinical and medicolegal challenges facing ED physicians. The variability in clinical presentations and mimics, the unreliability of clinical assessments and initial screening tools, and the need for advanced imaging all present obstacles in making an accurate and timely diagnosis for this entity. This article reviews available information and evidence regarding pathophysiology, risk factors, clinical variations in presentation, the usefulness of different diagnostic testing modalities, and management options in the ED when considering this diagnosis. Key recommendations from recent guidelines are reviewed in the context of ED practice.Acute Aortic Dissection in the Emergency Department: Diagnostic Challenges and Evidence-Based ManagementSuneel Upadhye, Karen Schiff10.1016/j.emc.2011.12.001Emergency Medicine Clinics of North America 30, 2 (2012)2012-05-01Emergency Medicine Clinics of North America2012-05-01302S0733-8627(11)X0006-8307327http://www.emed.theclinics.com/article/PIIS0733862711001398/abstract?rss=yesPulmonary embolism (PE) remains one of the most challenging medical diseases in the emergency department. PE is a potentially life threatening diagnosis that is seen in patients with chest pain and/or dyspnea but can span the clinical spectrum of medical presentations. In addition, it does not have any particular clinical feature, laboratory test, or diagnostic modality that can independently and confidently exclude its possibility. This article offers a review of PE in the emergency department. It emphasizes the appropriate determination of pretest probability, the approach to diagnosis and management, and special considerations related to pregnancy and radiation exposure.Pulmonary EmbolismDavid W. Ouellette, Catherine Patocka10.1016/j.emc.2011.12.004Emergency Medicine Clinics of North America 30, 2 (2012)2012-05-01Emergency Medicine Clinics of North America2012-05-01302S0733-8627(11)X0006-8329375http://www.emed.theclinics.com/article/PIIS0733862711001192/abstract?rss=yesSevere chest trauma, blunt or penetrating, is responsible for up to 25% of traumatic deaths in North America. Respiratory compromise is the most frequent dramatic presentation in blunt trauma, while injuries to the heart and great vessels pose the greatest risk of immediate death following penetrating trauma. More than 80% of patients will be managed with interventions that can be performed in the emergency department. This article reviews the presentation, diagnosis, and management of the most important thoracic injuries. A structured approach to the acutely unstable patient is proposed to guide resuscitation decisions.Initial Management and Resuscitation of Severe Chest TraumaBruno Bernardin, Jean-Marc Troquet10.1016/j.emc.2011.10.010Emergency Medicine Clinics of North America 30, 2 (2012)2012-01-03Emergency Medicine Clinics of North America2012-01-03302S0733-8627(11)X0006-8377400http://www.emed.theclinics.com/article/PIIS0733862711001404/abstract?rss=yesPatients requiring airway management in the emergency department present an enormous challenge. It requires not only a firm concept of techniques for securing the airway but also of dealing with the potential difficult airway (DA) in which establishing a definite airway is not possible with techniques routinely used. This article highlights the importance of recognition and management of the DA in emergent situations. Both awake and nonawake intubation are discussed, and indications and guidelines are given for the use of nonsurgical and surgical airway interventions.Emergency Airway Management: the Difficult AirwayJoe Nemeth, Nisreen Maghraby, Sara Kazim10.1016/j.emc.2011.12.005Emergency Medicine Clinics of North America 30, 2 (2012)2012-05-01Emergency Medicine Clinics of North America2012-05-01302S0733-8627(11)X0006-8401420http://www.emed.theclinics.com/article/PIIS0733862711001179/abstract?rss=yesThis article reviews invasive and noninvasive ventilation for emergency physicians. It presents an overview of respiratory physiology principles that will help emergency physicians adapt their ventilation strategies to any clinical situation. The basic modes of ventilation are summarized. The advantages and limitations of certain novel modes of ventilation are presented. This review highlights a variety of ventilation strategies to be used for patients with normal lung mechanics and gas exchange, acute hypoxemic respiratory failure, decreased lung compliance, airflow obstruction, and weakness or restriction of the chest wall. This article will help clinicians prevent, recognize, and treat complications of mechanical ventilation.Invasive and Noninvasive Ventilation in the Emergency DepartmentPatrick M. Archambault, Maude St-Onge10.1016/j.emc.2011.10.008Emergency Medicine Clinics of North America 30, 2 (2012)2012-05-01Emergency Medicine Clinics of North America2012-05-01302S0733-8627(11)X0006-8421449http://www.emed.theclinics.com/article/PIIS0733862711001386/abstract?rss=yesDyspnea and hypotension often present a diagnostic challenge to the emergency physician. With limitations on traditional methods of evaluating these patients, lung ultrasound has become an essential assessment tool. With the sensitivity of lung ultrasound approaching that of CT scan for many indications, it is quickly becoming a fundamental technique in assessing patients with thoracic emergencies. This article reviews the principles of thoracic ultrasound; describes the important evidence-based sonographic features found in pneumothorax, pleural effusion, pneumonia, and pulmonary edema; and provides a framework of how to use thoracic ultrasound to aid in assessing a patient with severe dyspnea.Thoracic UltrasoundJoel P. Turner, Jerrald Dankoff10.1016/j.emc.2011.12.003Emergency Medicine Clinics of North America 30, 2 (2012)2012-05-01Emergency Medicine Clinics of North America2012-05-01302S0733-8627(11)X0006-8451473http://www.emed.theclinics.com/article/PIIS0733862711001210/abstract?rss=yesEmergency department presentations of pleural-based diseases are common, with severity ranging from mild to life threatening. The acute assessment, diagnosis, and treatment of pleural disease are critical as urgent invasive maneuvers such as thoracocentesis and thoracostomy may be indicated. The emergency physician must have a systematic approach to these conditions that allows for rapid recognition, diagnosis, and definitive management. This article focuses on nontraumatic pleural disease, including diagnostic and treatment considerations of pleural effusion, empyema, primary spontaneous pneumothorax, secondary spontaneous pneumothorax, pediatric pneumothorax, spontaneous hemothorax, and spontaneous tension pneumothorax.Pleural Disease in the Emergency DepartmentErin Weldon, Jen Williams10.1016/j.emc.2011.10.012Emergency Medicine Clinics of North America 30, 2 (2012)2011-12-02Emergency Medicine Clinics of North America2011-12-02302S0733-8627(11)X0006-8475499http://www.emed.theclinics.com/article/PIIS0733862711001155/abstract?rss=yesPhysiologic sequelae from increasing ambient pressure in underwater activities, decreasing ambient pressure while at altitude, or the consequences of drowning present a unique set of challenges to emergency physicians. In addition, several environmental toxins cause significant respiratory morbidity, whether they be pulmonary irritants, simple asphyxiants, or systemic toxins. It is important for emergency physicians to understand the pathophysiology of these illnesses as well as to apply this knowledge to the clinical arena either in the prehospital setting or in the emergency department. Current treatment paradigms and controversies within these regimens are discussed.Diagnosis and Management of Environmental Thoracic EmergenciesPaul D. Tourigny, Chris Hall10.1016/j.emc.2011.10.006Emergency Medicine Clinics of North America 30, 2 (2012)2011-12-08Emergency Medicine Clinics of North America2011-12-08302S0733-8627(11)X0006-8501528http://www.emed.theclinics.com/article/PIIS0733862711001180/abstract?rss=yesPediatric respiratory illnesses are a huge burden to emergency departments worldwide. This article reviews the latest evidence in the epidemiology, assessment, management, and disposition of children presenting to the emergency department with asthma, croup, bronchiolitis, and pneumonia.Common Pediatric Respiratory EmergenciesJoseph Choi, Gary L. Lee10.1016/j.emc.2011.10.009Emergency Medicine Clinics of North America 30, 2 (2012)2011-12-19Emergency Medicine Clinics of North America2011-12-19302S0733-8627(11)X0006-8529563http://www.emed.theclinics.com/article/PIIS0733862711001167/abstract?rss=yesWith the increasing prevalence of human immunodeficiency virus/AIDS patients and patients receiving chemotherapy for various malignancies, the numbers of immunosuppressed patients who present to the emergency department is on the increase. Thoracic-related emergencies in these vulnerable patients are serious and challenging to diagnose for the emergency physician, due mainly to atypical presentations, atypical pathogens, and to the often tenuous state of health of the patient. This article addresses a variety of cardiovascular, pulmonary, and esophageal emergencies that are seen specifically in immunocompromised patients presenting to the emergency department. Epidemiology, clinical presentation, investigations, prognosis, management, and evidence-based recommendations are discussed.Thoracic Emergencies in Immunocompromised PatientsSaleh Fares, Furqan B. Irfan10.1016/j.emc.2011.10.007Emergency Medicine Clinics of North America 30, 2 (2012)2012-05-01Emergency Medicine Clinics of North America2012-05-01302S0733-8627(11)X0006-8565589http://www.emed.theclinics.com/article/PIIS0733862712000120/abstract?rss=yesIndex10.1016/S0733-8627(12)00012-0Emergency Medicine Clinics of North America 30, 2 (2012)2012-05-01Emergency Medicine Clinics of North America2012-05-01302S0733-8627(11)X0006-8591599