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E/M Medical Decision Making

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8881. Screening and Diagnostic Tests (Follow-up)

for employment. for: Medscape. Jon Mark Hirshon, MD, MPH, PhD Professor, Department of Emergency Medicine, University of Maryland School of Medicine Jon Mark Hirshon, MD, MPH, PhD is a member of the following medical societies: , , , , Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Pfizer. Chief Editor Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System Robert E O'Connor, MD, MPH (...) with their criterion standard is a decrease in accuracy. How to account for this trade-off between diagnostic accuracy and patient acceptability is the subject of this article. Patient Diagnostic and Screening Decisions In order for patients to make informed decisions regarding diagnostic and screening options when there is more than one option, when no option has a clear advantage, and when the risk-benefit profile may be valued differently, decision aids such as pamphlets, videos, or Web-based tools may be used

2014 eMedicine Emergency Medicine

8882. Sinusitis (Follow-up)

of Forensic Examiners, American College of Physicians, and American Medical Association Disclosure: Nothing to disclose. Thomas E Herchline, MD Professor of Medicine, Wright State University Boonshoft School of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio Thomas E Herchline, MD is a member of the following medical societies: , , and Disclosure: Nothing to disclose. Erhun Serbetci, MD Director, Department of Otolaryngology, Section of Nose and Sinus Surgery, Associate (...) D, Bhattacharyya N, Cheung D, Eisenberg S, Ganiats TG, et al. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg . 2007 Sep. 137(3 Suppl):S1-31. . [Guideline] Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg . 2015 Apr. 152 (2 Suppl):S1-S39. . Hansen JG, Schmidt H, Rosborg J, Lund E. Predicting acute maxillary sinusitis in a general practice population

2014 eMedicine Emergency Medicine

8883. Yellow Fever (Overview)

: , , , , , and Disclosure: Nothing to disclose. Aleksandr Gleyzer, MD, FAAEM Assistant Professor, Department of Emergency Medicine, State University of New York Downstate Medical Center; Attending Physician, Department of Emergency Medicine, Kings County Medical Center and Brooklyn Veterans Affairs Medical Center Aleksandr Gleyzer, MD, FAAEM is a member of the following medical societies: and Disclosure: Nothing to disclose. Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School (...) of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio Thomas E Herchline, MD is a member of the following medical societies: , , and Disclosure: Nothing to disclose. Emily Nichols, MD Clinical Assistant Instructor, State University of New York Downstate Medical Center, Kings County Hospital Center Emily Nichols, MD is a member of the following medical societies: , , , and Disclosure: Nothing to disclose. Mark L Plaster, MD, JD Executive Editor, Emergency Physicians Monthly Mark

2014 eMedicine Emergency Medicine

8884. Abdominal Pain in Elderly Persons (Treatment)

of an elderly patient with abdominal pain should be the exception rather than the rule. Previous References Esses D, Birnbaum A, Bijur P, et al. Ability of CT to alter decision making in elderly patients with acute abdominal pain. Am J Emerg Med . 2004 Jul. 22(4):270-2. . Hustey FM, Meldon SW, Banet GA, et al. The use of abdominal computed tomography in older ED patients with acute abdominal pain. Am J Emerg Med . 2005 May. 23(3):259-65. . Lewis LM, Banet GA, Blanda M, et al. Etiology and clinical course (...) Center at El Paso; Medical Director, Department of Emergency Medicine, Thomason Hospital E David Bryan, MD is a member of the following medical societies: , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Chief Editor Barry E Brenner, MD, PhD, FACEP Professor

2014 eMedicine Emergency Medicine

8885. Acute Coronary Syndrome (Treatment)

with suspected acute coronary syndrome. Am J Emerg Med . 2010 Feb. 28(2):170-6. . Katritsis DG, Siontis GC, Kastrati A, van't Hof AW, Neumann FJ, Siontis KC, et al. Optimal timing of coronary angiography and potential intervention in non-ST-elevation acute coronary syndromes. Eur Heart J . 2011 Jan. 32(1):32-40. . Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G, et al. The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making (...) delay and its impact on time to treatment in ST-elevation myocardial infarction. Am J Emerg Med . 2011 May. 29(4):396-400. . Wood S. STEMI in Women: Same Plaques, Same Stent Outcomes: OCTAVIA. Medscape Medical News. Available at . Accessed: May 27, 2014. Than M, Cullen L, Reid CM, Lim SH, Aldous S, Ardagh MW, et al. A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): a prospective observational validation study. Lancet . 2011 Mar 26. 377(9771

2014 eMedicine Emergency Medicine

8886. Urinary Tract Infection, Female (Overview)

, Winthrop-University Hospital Burke A Cunha, MD is a member of the following medical societies: , , Disclosure: Nothing to disclose. Jeffrey M Tessier, MD Assistant Professor, Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University School of Medicine Jeffrey M Tessier, MD is a member of the following medical societies: Disclosure: Nothing to disclose. Chief Editor Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart (...) : , , , , and Disclosure: Sepracor None None Allison M Loynd, DO Resident Physician, Department of Emergency Medicine, Wayne State University School of Medicine, Detroit Receiving Hospital Allison M Loynd, DO is a member of the following medical societies: , , and Disclosure: Nothing to disclose. Mark Jeffrey Noble, MD Consulting Staff, Urologic Institute, Cleveland Clinic Foundation Mark Jeffrey Noble, MD is a member of the following medical societies: , , , , , Society of University Urologists, and Disclosure

2014 eMedicine Emergency Medicine

8887. Central Vertigo (Treatment)

Disclosure: Received salary from Medscape for employment. for: Medscape. J Stephen Huff, MD, FACEP Professor of Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia School of Medicine J Stephen Huff, MD, FACEP is a member of the following medical societies: , , Disclosure: Nothing to disclose. Chief Editor Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Sanz Laniado Medical (...) Center, Netanya, Israel Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: , , , , , , , , , Disclosure: Nothing to disclose. Additional Contributors Francis Counselman, MD, FACEP Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School Francis Counselman, MD, FACEP is a member of the following medical societies: , , , , Disclosure: Nothing to disclose. What would you like to print? What would you like to print? Sections Central Vertigo Find Us

2014 eMedicine Emergency Medicine

8888. Body Fluid Exposures (Treatment)

and follow-up is done in an expeditious manner without any hitches. Still, one of the greatest difficulties remains in "making the call" as to whether an exposure warrants prophylaxis. While leaving the decision up to the patient will result in a higher than necessary rate of medication dispensing, until methods of HIV detection and management can provide greater and more timely reassurance, this will likely remain the course most practitioners will take. Pregnancy should not preclude the use of optimal (...) of the following medical societies: , , , , , South Carolina College of Emergency Physicians, Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Employed contractor - Chief Editor for Medscape. Acknowledgements Samuel M Keim, MD Associate Professor, Department of Emergency Medicine, University of Arizona College of Medicine Samuel M Keim, MD is a member of the following medical societies: , , , , and Disclosure: Nothing to disclose. Darrell G Looney, MD, FAAEM

2014 eMedicine Emergency Medicine

8889. Decompression Sickness (Treatment)

, and the uncontrolled environment make it less than ideal and increase the risks of drowning. [ ] However, in remote areas without reasonable-distance hyperbaric oxygen (HBO) chamber support, this may be the only option. Studies exist of indigenous native fishermen divers. In Thailand, home to the diving Urak Lawoi fishermen, 72.1% exceed the no-decompression limits, yet medical treatment and HBO facilities are distant (10 h and 16 h, respectively). In this population, one third reported having experienced (...) with 100% oxygen and rehydration. Type II DCS with disabling signs would make IWR too risky. [ ] A consensus statement from Divers Alert Network (DAN) and the Undersea and Hyperbaric Medical Society (UHMS) addresses the concept of IWR. They recognize that many diving activities occur in remote areas that lack the resources for an HBO therapy and are distant from appropriate facilities. In the case of significant or progressive symptoms, IWR may be a reasonable emergent alternative to avoid delays

2014 eMedicine Emergency Medicine

8890. Coping With the Death of a Child in the ED (Treatment)

provided to survivors. [ , , , ] After a young patient is pronounced dead in the emergency department (ED), surviving family members are in crisis. [ ] Survivors can benefit from the engagement of the emergency physician who treated the family member. In addition to making medical decisions during resuscitation, the role of the emergency physician is seen as one of assisting in alleviation of suffering. A patient's death in the ED, especially the death of a child, is often unexpected. The nature of ED (...) Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center; Chairman, Pediatric Institutional Review Board, Mercy St Vincent Medical Center, Toledo, Ohio Wayne Wolfram, MD, MPH is a member of the following medical societies: , , Disclosure: Nothing to disclose. Coauthor(s) Jane E Bradlaw, DO Attending Emergency Medicine Physician, Emergency Department, Porter Memorial Hospital Jane E Bradlaw, DO is a member of the following medical societies: Disclosure: Nothing to disclose. Specialty

2014 eMedicine Emergency Medicine

8891. Constipation (Treatment)

, Baylor College of Medicine BS Anand, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Acknowledgements BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine BS Anand, MD is a member of the following medical societies: , , , and Disclosure: Nothing to disclose. Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine (...) , University Hospitals, Case Medical Center Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: , , , , , , , , , , and Disclosure: Nothing to disclose. William K Chiang, MD Associate Professor, Department of Emergency Medicine, New York University School of Medicine; Chief of Service, Department of Emergency Medicine, Bellevue Hospital Center William K Chiang, MD is a member of the following medical societies: , , and Disclosure: Nothing to disclose. Ronnie Fass, MD, FACP, FACG

2014 eMedicine Emergency Medicine

8892. Compartment Syndrome, Extremity (Treatment)

of Emergency Medicine, New York University School of Medicine; Chief of Service, Department of Emergency Medicine, Bellevue Hospital Center William K Chiang, MD is a member of the following medical societies: , , and Disclosure: Nothing to disclose. Patrick M Foye, MD Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine (...) and Dentistry of New Jersey, New Jersey Medical School Patrick M Foye, MD is a member of the following medical societies: , , , and Disclosure: Nothing to disclose. Stuart B Goodman, MD, PhD, FRCS(C), FACS, FBSE Robert L and Mary Ellenburg Professor of Surgery, Professor, Department of Orthopedic Surgery, Fellowship Director, Orthopedic Adult Reconstruction, Affiliated Faculty, Department of Bioengineering, Affiliated Faculty, Stanford Center on Longevity, Stanford University School of Medicine, Stanford

2014 eMedicine Emergency Medicine

8893. Coccidioidomycosis (Treatment)

, and what agent should be used. [ , ] However, the Infectious Diseases Society of America has published . [ ] Three questions should be asked before a case of coccidioidomycosis is treated. Is intervention necessary? If antifungal therapy would be beneficial, which agents are appropriate? Is a surgical procedure necessary for debridement and reconstruction of destructive lesions? In the decision-making process, significant weight is given to the severity of infection, risk factors for dissemination (eg (...) peripartum Elevated CF IgG titers and higher-risk ethnicity (eg, Filipino, black, Hispanic) may sway the decision to treat patients. Typical antifungal therapy of acute primary pulmonary coccidioidomycosis in these high-risk groups consists mainly of oral azoles at the recommended adult doses (see Medication). During pregnancy, amphotericin B is the treatment of choice because the azoles may be teratogenic. No consensus has been reached on the duration of therapy, but 6 months of treatment is most common

2014 eMedicine Emergency Medicine

8894. Deep Venous Thrombosis and Thrombophlebitis (Treatment)

decision-making, because recanalization may be achieved faster than before and with a decreased dose of lytic; therefore, the bleeding risk may be decreased. Inpatient Versus Outpatient Treatment Acute DVT may be treated in an outpatient setting with LMWH. Patients with low-risk PE may be safely discharged early from hospital or receive only outpatient treatment with LMWH, followed by vitamin K antagonists, although nonvitamin K-dependent oral anticoagulants may be as effective but safer than the LMWH (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTkxMTMwMy10cmVhdG1lbnQ= processing > Deep Venous Thrombosis (DVT) Treatment & Management Updated: Jul 05, 2017 Author: Kaushal (Kevin) Patel, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP Share Email Print Feedback Close Sections Sections Deep Venous Thrombosis (DVT) Treatment Approach Considerations The primary objectives for the treatment of deep venous thrombosis (DVT) are to prevent pulmonary embolism (PE), reduce morbidity, and prevent or minimize the risk of developing the postthrombotic syndrome (PTS

2014 eMedicine Emergency Medicine

8895. Congestive Heart Failure and Pulmonary Edema (Treatment)

=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTYzMDYyLXRyZWF0bWVudA== processing > Heart Failure Treatment & Management Updated: May 07, 2018 Author: Ioana Dumitru, MD; Chief Editor: Gyanendra K Sharma, MD, FACC, FASE Share Email Print Feedback Close Sections Sections Heart Failure Treatment Approach Considerations Medical care for heart failure includes a number of nonpharmacologic, pharmacologic, and invasive strategies to limit and reverse its manifestations. [ , , ] ​ Depending on the severity of the illness, nonpharmacologic therapies include dietary (...) restoration. [ , , , , ] has been the criterion standard for therapy when progressive end-stage heart failure occurs despite maximal medical therapy, when the prognosis is poor, and when there is no viable therapeutic alternative. [ , , ] However, mechanical circulatory devices such as ventricular assist devices (VADs) and total artificial hearts (TAHs) can bridge the patient to transplantation; in addition, VADs are increasingly being used as permanent therapy. [ ] Comorbidities to consider Coronary

2014 eMedicine Emergency Medicine

8896. Review of Cardiac Tests (Overview)

environment, emergency healthcare providers are ordering these tests and using the results for clinical decision making. The image below depicts , a preinfarction stage of CAD that often progresses to a devastating anterior wall MI. Classic Wellens syndrome T-wave changes. This ECG represents a patient after becoming pain free secondary to medications. Notice the deep T waves in V3-V5 and slight biphasic T wave in V6 in this chest pain free ECG. The patient had negative cardiac enzyme levels and later had (...) of interest, a post-test probability is calculated which can guide decision making. In day-to-day practice, this is performed more qualitatively than quantitatively. In addition, this process is reflected in diagnostic protocols for chest pain. Previous Next: Exercise Tolerance Test Test physiology and technique Physical exercise places stress on the cardiopulmonary system. The physiologic response to exercise is an increase in heart rate and blood pressure (BP). This results in increased myocardial

2014 eMedicine Emergency Medicine

8897. Rapid Sequence Induction (Overview)

of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose. Luis M Lovato, MD Associate Clinical Professor, University of California, Los Angeles, David Geffen School of Medicine; Director of Critical Care, Department of Emergency Medicine, Olive View-UCLA Medical Center Luis M Lovato, MD is a member of the following medical societies: , , Disclosure: Nothing to disclose. Chief Editor Guy W Soo Hoo, MD, MPH Clinical Professor of Medicine, University of California, Los Angeles (...) patient of French Society of Anaesthesia and Intensive Care Medicine (SFAR) and French-speaking Intensive Care Society (SRLF) : In collaboration with the pediatric Association of French-speaking Anaesthetists and Intensivists (ADARPEF), French-speaking Group of Intensive Care and Paediatric emergencies (GFRUP) and Intensive Care physiotherapy society (SKR). Ann Intensive Care . 2019 Jan 22. 9 (1):13. . Amour J, Le Manach YL, Borel M, Lenfant F, Nicolas-Robin A, Carillion A, et al. Comparison of single

2014 eMedicine Emergency Medicine

8898. Pregnancy, Preeclampsia (Overview)

, 2018 Author: Kee-Hak Lim, MD; Chief Editor: Ronald M Ramus, MD Share Email Print Feedback Close Sections Sections Preeclampsia Overview Practice Essentials Preeclampsia is a disorder of widespread vascular endothelial malfunction and vasospasm that occurs after 20 weeks' gestation and can present as late as 4-6 weeks post partum. It is clinically defined by hypertension and proteinuria, with or without pathologic edema. Definitions Preeclampsia is defined as the presence of (1) a systolic blood (...) including (nonreassuring nonstress test, biophysical profile score, and/or persistent absent or reversed diastolic flow on umbilical artery Doppler velocimetry) Ruptured membranes Uncontrollable BP (unresponsive to medical therapy) Oligohydramnios, with amniotic fluid index (AFI) of less than 5 cm Severe intrauterine growth restriction in which the estimated fetal weight is less than 5% Oliguria (< 500 mL/24 hr) Serum creatinine level of at least 1.5 mg/dL Pulmonary edema Shortness of breath or chest

2014 eMedicine Emergency Medicine

8899. Pulmonary Embolism (Overview)

warfarin or low molecular weight heparin upon discharge from the hospital, they must be advised regarding potential interactions between these agents and other medications. For patient education resources, see the patient education articles and . Previous References Amesquita M, Cocchi MN, Donnino MW. Pulmonary Embolism Presenting as Flank Pain: A Case Series. J Emerg Med . 2009 Mar 26. . Carrascosa MF, Batán AM, Novo MF. Delirium and pulmonary embolism in the elderly. Mayo Clin Proc . 2009. 84(1):91-2 (...) vein thrombosis?. J R Soc Med . 1989 Apr. 82(4):203-5. . . Kotsakis A, Cook D, Griffith L, Anton N, Massicotte P, MacFarland K, et al. Clinically important venous thromboembolism in pediatric critical care: a Canadian survey. J Crit Care . 2005 Dec. 20(4):373-80. . Van Ommen CH, Peters M. Acute pulmonary embolism in childhood. Thromb Res . 2006. 118(1):13-25. . Kabrhel C, Varraso R, Goldhaber SZ, Rimm E, Camargo CA Jr. Physical inactivity and idiopathic pulmonary embolism in women: prospective

2014 eMedicine Emergency Medicine

8900. Pregnancy, Ectopic (Overview)

of pregnancies of unknown location. Hum Reprod . 2007 Jun. 22(6):1744-50. . [Guideline] Practice Committee of American Society for Reproductive Medicine. Medical treatment of ectopic pregnancy. Fertil Steril . 2008 Nov. 90(5 Suppl):S206-12. . Ustunyurt E, Duran M, Coskun E, Ustunyurt OB, Simsek H. Role of initial and day 4 human chorionic gonadotropin levels in predicting the outcome of single-dose methotrexate treatment in women with tubal ectopic pregnancy. Arch Gynecol Obstet . 2013 Nov. 288(5):1149-52 (...) level of care. When an ectopic pregnancy is identified, medical or surgical treatment is provided as indicated. Those with ectopic pregnancy who require admission or surgery should be admitted to an obstetrics/gynecology service. Pharmacologic treatment The current standard medical treatment of unruptured ectopic pregnancy consists of the administration of (MTX). [ , , ] This decision to initiate MTX therapy should be made in conjunction with, if not by, the consulting obstetrician/gynecologist

2014 eMedicine Emergency Medicine

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