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E/M Medical Decision Making

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8921. Abdominal Pain in Elderly Persons (Overview)

abdominal pain score were 18% compared to rates of 21% for decreasing pain score 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

8922. Ventricular Tachycardia (Follow-up)

electrophysiology is a subspecialty devoted to the diagnosis and management of cardiac arrhythmias. In rare cases, a patient with a stable, recurrent episode of VT that is controlled in the emergency department can be discharged rather than admitted, provided that appropriate follow-up care is available. However, this decision must be made in consultation with a cardiologist. Previous Next: Long-Term Monitoring Outpatient medication choices for patients with ventricular tachycardia (VT) depend on the degree (...) al. Reversal of cardiomyopathy in patients with repetitive monomorphic ventricular ectopy originating from the right ventricular outflow tract. Circulation . 2005 Aug 23. 112 (8):1092-7. . Yokokawa M, Kim HM, Good E, et al. Relation of symptoms and symptom duration to premature ventricular complex-induced cardiomyopathy. Heart Rhythm . 2012 Jan. 9 (1):92-5. . Tsatsopoulou AA, Protonotarios NI, McKenna WJ. Arrhythmogenic right ventricular dysplasia, a cell adhesion cardiomyopathy: insights

2014 eMedicine Emergency Medicine

8923. Trauma, Upper Genitourinary (Follow-up)

Association for the Surgery of Trauma Renal Injury grading system. J Trauma . 2011 Jan. 70(1):35-7. . Chiron P, Hornez E, Boddaert G, Dusaud M, Bayoud Y, Molimard B, et al. Grade IV renal trauma management. A revision of the AAST renal injury grading scale is mandatory. Eur J Trauma Emerg Surg . 2016 Apr. 42 (2):237-41. . Lee JN, Lim JK, Woo MJ, Kwon SY, Kim BS, Kim HT, et al. Predictive factors for conservative treatment failure in grade IV pediatric blunt renal trauma. J Pediatr Urol . 2015 Aug 5 (...) ureter with an element of obstruction. of 7 Tables Contributor Information and Disclosures Author Imad S Dandan, MD Trauma Medical Director, Scripps Memorial Hospital Imad S Dandan, MD is a member of the following medical societies: , , , , , Disclosure: Nothing to disclose. Coauthor(s) Walid A Farhat, MD, FRCS(C) Associate Professor, Department of Surgery, University of Toronto Faculty of Medicine; Staff Physician, Division of Urology, The Hospital for Sick Children, Canada Walid A Farhat, MD, FRCS

2014 eMedicine Emergency Medicine

8924. Ultrasonography, Abdominal (Follow-up)

injury?. JAMA . 2012 Apr. 307(14):1517-27. . Rubano E, Mehta N, Caputo W, Paladino L, Sinert R. Systematic review: emergency department bedside ultrasonography for diagnosing suspected abdominal aortic aneurysm. Acad Emerg Med . 2013 Feb. 20(2):128-38. . Sekiguchi H, Suzuki J, Daniels CE. Making paracentesis safer: a proposal for the use of bedside abdominal and vascular ultrasonography to prevent a fatal complication. Chest . 2013 Apr. 143(4):1136-9. . American Institute of Ultrasound in Medicine (...) . . Costantino TG, Bruno EC, Handly N, Dean AJ. Accuracy of emergency medicine ultrasound in the evaluation of abdominal aortic aneurysm. J Emerg Med . 2005 Nov. 29(4):455-60. . Nagdev AD, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC. Emergency Department Bedside Ultrasonographic Measurement of the Caval Index for Noninvasive Determination of Low Central Venous Pressure. Ann Emerg Med . 2009 Jun 25. . Blehar DJ, Dickman E, Gaspari R. Identification of congestive heart failure via respiratory

2014 eMedicine Emergency Medicine

8925. Tracheal Intubation, Rapid Sequence Intubation (Follow-up)

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

8926. Retinal Detachment (Follow-up)

Director, Department of Emergency Medicine, Sentara Norfolk General Hospital; Professor and Assistant Program Director, Core Academic Faculty, Department of Emergency Medicine, Eastern Virginia Medical School Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE is a member of the following medical societies: , , , , , , , , Disclosure: Nothing to disclose. Additional Contributors Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System Robert (...) E O'Connor, MD, MPH is a member of the following medical societies: , , , , , Disclosure: Nothing to disclose. Acknowledgements Gregory L Larkin, MD, MS, MSPH, FACEP Professor, Department of Emergency Medicine, Yale University School of Medicine Gregory L Larkin MD, MD, MS, MSPH, FACEP is a member of the following medical societies: , , , and Disclosure: Nothing to disclose. Douglas Lavenburg, MD Clinical Professor, Department of Emergency Medicine, Christiana Care Health Systems Douglas

2014 eMedicine Emergency Medicine

8927. Sarcoidosis (Follow-up)

, Akira M, Kitaichi M, et al. A case of combined sarcoidosis and usual interstitial pneumonia. Intern Med . 2012. 51(14):1893-7. . Chapelon-Abric C, de Zuttere D, Duhaut P, Veyssier P, Wechsler B, Huong DL, et al. Cardiac sarcoidosis: a retrospective study of 41 cases. Medicine (Baltimore) . 2004 Nov. 83(6):315-34. . Media Gallery Stage II sarcoidosis. Courtesy of Anthony Notino, MD, New York Hospital, Department of Radiology, Cornell Medical Center. Stage II sarcoidosis. Courtesy of Anthony Notino (...) Disclosure: Received salary from Medscape for employment. for: Medscape. Gino A Farina, MD, FACEP, FAAEM Professor of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine at Hofstra University; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center Gino A Farina, MD, FACEP, FAAEM 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

2014 eMedicine Emergency Medicine

8928. Replantation (Follow-up)

, FACEP, MHPE, RDMS is a member of the following medical societies: , , , , Disclosure: Nothing to disclose. Coauthor(s) Victor M Cisneros University of California, Irvine, School of Medicine Victor M Cisneros is a member of the following medical societies: , , , , Disclosure: Nothing to disclose. Gregory Rafijah, MD Assistant Clinical Professor, Hand, Wrist, Elbow, and Microvascular Surgery, Department of Orthopedic Surgery, Director, Microvascular Training Laboratory, University of California (...) and Surgery, University of Miami, Leonard M Miller School of Medicine; Clinical Professor of Surgery, Nova Southeastern School of Medicine Harris Gellman, MD is a member of the following medical societies: , , , , , , Disclosure: Nothing to disclose. Additional Contributors Assaad J Sayah, MD, FACEP Senior Vice President and Chief Medical Officer, Cambridge Health Alliance Assaad J Sayah, MD, FACEP is a member of the following medical societies: , Disclosure: Nothing to disclose. Acknowledgements

2014 eMedicine Emergency Medicine

8929. Review of Cardiac Tests (Follow-up)

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

8930. Smoke Inhalation (Follow-up)

, Department of Emergency Medicine, Kings County Hospital Center Sage W Wiener, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Denise Serebrisky, MD Associate Professor, Department of Pediatrics, Albert Einstein College of Medicine; Director, Division of Pulmonary Medicine, Lewis M Fraad Department of Pediatrics, Jacobi Medical Center/North Central Bronx Hospital; Director, Jacobi Asthma and Allergy Center for Children, Jacobi Medical Center Denise Serebrisky, MD (...) . Perform cricothyrotomy if airway obstruction is present or impending and an airway cannot be secured orally. Obtain a CO level at the scene if possible. In a consecutive case series of 18 patients, cardiac arrest complicating CO toxicity was uniformly fatal, despite administration of hyperbaric oxygen (HBO) therapy after the initial resuscitation. The prognosis of this condition should be considered when making triage decisions for these patients. [ ] Previous Next: Emergency Department Care Presently

2014 eMedicine Emergency Medicine

8931. Toxicity, Calcium Channel Blocker (Follow-up)

(Phila) . 2011 Nov. 49(9):801-9. . American College of Medical Toxicology. ACMT position statement: interim guidance for the use of lipid resuscitation therapy. J Med Toxicol . 2011 Mar. 7(1):81-2. . Varpula T, Rapola J, Sallisalmi M, Kurola J. Treatment of serious calcium channel blocker overdose with levosimendan, a calcium sensitizer. Anesth Analg . 2009 Mar. 108(3):790-2. . Kolcz J, Pietrzyk J, Januszewska K, Procelewska M, Mroczek T, Malec E. Extracorporeal life support in severe propranolol (...) Medicine, Texas A&M Health Sciences Center; CHRISTUS Spohn Emergency Medicine Residency Program Michael A Miller, MD is a member of the following medical societies: Disclosure: Nothing to disclose. Acknowledgements John G Benitez, MD, MPH Associate Professor, Department of Medicine, Medical Toxicology, Vanderbilt University Medical Center; Managing Director, Tennessee Poison Center John G Benitez, MD, MPH is a member of the following medical societies: , , , , , , and Disclosure: Nothing to disclose

2014 eMedicine Emergency Medicine

8932. Pregnancy, Postpartum Hemorrhage (Follow-up)

. Chief Editor Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE Medical Director, Department of Emergency Medicine, Sentara Norfolk General Hospital; Professor and Assistant Program Director, Core Academic Faculty, Department of Emergency Medicine, Eastern Virginia Medical School Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE is a member of the following medical societies: , , , , , , , , Disclosure: Nothing to disclose. Additional Contributors Assaad J Sayah, MD, FACEP Senior Vice President (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNzk2Nzg1LXRyZWF0bWVudA== processing > Postpartum Hemorrhage in Emergency Medicine Treatment & Management Updated: Jan 02, 2018 Author: Maame Yaa A B Yiadom, MD, MPH; Chief Editor: Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE Share Email Print Feedback Close Sections Sections Postpartum Hemorrhage in Emergency Medicine Treatment Approach Considerations If a patient is brought to a hospital without obstetric services, the emergency medicine providers should initiate resuscitation and transfer the patient

2014 eMedicine Emergency Medicine

8933. Pulmonary Embolism (Follow-up)

at risk must be identified, and safe and efficacious prophylactic modalities should be used. The QThrombosis algorithm is intended to identify currently asymptomatic adults at greatest future risk of venous thrombosis based on established risk factors. According to the study in which it was developed and validated, QThrombosis estimates the absolute risk of venous thrombosis at 1 year and 5 years into the future, information that can be used to guide prophylaxis and medication decisions. [ ] Previous (...) 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

8934. Renal Calculi (Follow-up)

, the presence of a ureteropelvic junction (UPJ) obstruction or a ureteral stricture could make passing even very small stones difficult or impossible. Most experienced emergency department (ED) physicians and urologists have observed very large stones passing and some very small stones that do not move. Aggressive medical therapy has shown promise in increasing the spontaneous stone passage rate and relieving discomfort while minimizing narcotic usage. Aggressive treatment of any proximal urinary infection (...) == processing > Nephrolithiasis Treatment & Management Updated: Jun 21, 2018 Author: Chirag N Dave, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS Share Email Print Feedback Close Sections Sections Nephrolithiasis Treatment Approach Considerations Treatment of nephrolithiasis involves emergency management of renal (ureteral) colic, including surgical interventions where indicated, and medical therapy for stone disease. In emergency settings where concern exists about possible renal failure, the focus

2014 eMedicine Emergency Medicine

8935. Thrombolytic Therapy (Follow-up)

are being adhered and aggregated. Aspirin, glycoprotein (GP) IIb/IIIa inhibitors, and clopidogrel have an inhibitory effect on platelet activation and aggregation. Plasminogen gathers in the fibrin matrix. Fibrin-bound plasminogen will be converted by thrombolytic drugs to plasmin, the rate-limiting step in thrombolysis. It should be kept in mind that the thrombolysis process works best on recently formed thrombi. Older thrombi have extensive fibrin polymerization that makes them more resistant (...) to treat a single patient. Urokinase is also commercially available in a form produced by tissue culture, and recombinant DNA techniques have been developed for urokinase production in E coli cultures. Urokinase was withheld from the market for some years because of manufacturer issues with the FDA but has since been reintroduced. The package insert was revised and now carries indications only for massive PE and PE accompanied by unstable hemodynamics. During the period when urokinase was not available

2014 eMedicine Emergency Medicine

8936. 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

8937. 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

8938. 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

8939. 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

8940. 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

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