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E/M Medical Decision Making

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8941. Abortion, Inevitable (Overview)

bleeding) to aid in making clinical decisions. This endovaginal ultrasonogram reveals an irregular gestational sac with an amorphic fetal pole. No fetal cardiac activity was noted. This image represents a missed miscarriage or fetal demise. of 6 Tables Contributor Information and Disclosures Author Slava V Gaufberg, MD Assistant Professor of Medicine, Harvard Medical School; Director of Transitional Residency Training Program, Cambridge Health Alliance Slava V Gaufberg, MD is a member of the following (...) M, Cuevas C, Moshiri M, Dubinsky T, Dogra VS. Sonography in first trimester bleeding. J Clin Ultrasound . 2008 Jul-Aug. 36(6):352-66. . Nakhai-Pour HR, Broy P, Sheehy O, et al. Use of nonaspirin nonsteroidal anti-inflammatory drugs during pregnancy and the risk of spontaneous abortion. CMAJ . 2011 Oct 18. 183(15):1713-20. . Daniel S, Koren G, Lunenfeld E, et al. Fetal exposure to nonsteroidal anti-inflammatory drugs and spontaneous abortions. CMAJ . 2014 Mar 18. 186(5):E177-82. . . Chen X, Chen

2014 eMedicine Emergency Medicine

8942. Abortion, Missed (Overview)

) to aid in making clinical decisions. This endovaginal ultrasonogram reveals an irregular gestational sac with an amorphic fetal pole. No fetal cardiac activity was noted. This image represents a missed miscarriage or fetal demise. of 6 Tables Contributor Information and Disclosures Author Slava V Gaufberg, MD Assistant Professor of Medicine, Harvard Medical School; Director of Transitional Residency Training Program, Cambridge Health Alliance Slava V Gaufberg, MD is a member of the following medical (...) , Moshiri M, Dubinsky T, Dogra VS. Sonography in first trimester bleeding. J Clin Ultrasound . 2008 Jul-Aug. 36(6):352-66. . Nakhai-Pour HR, Broy P, Sheehy O, et al. Use of nonaspirin nonsteroidal anti-inflammatory drugs during pregnancy and the risk of spontaneous abortion. CMAJ . 2011 Oct 18. 183(15):1713-20. . Daniel S, Koren G, Lunenfeld E, et al. Fetal exposure to nonsteroidal anti-inflammatory drugs and spontaneous abortions. CMAJ . 2014 Mar 18. 186(5):E177-82. . . Chen X, Chen M, Xu B, et al

2014 eMedicine Emergency Medicine

8943. Abortion, Incomplete (Overview)

bleeding) to aid in making clinical decisions. This endovaginal ultrasonogram reveals an irregular gestational sac with an amorphic fetal pole. No fetal cardiac activity was noted. This image represents a missed miscarriage or fetal demise. of 6 Tables Contributor Information and Disclosures Author Slava V Gaufberg, MD Assistant Professor of Medicine, Harvard Medical School; Director of Transitional Residency Training Program, Cambridge Health Alliance Slava V Gaufberg, MD is a member of the following (...) M, Cuevas C, Moshiri M, Dubinsky T, Dogra VS. Sonography in first trimester bleeding. J Clin Ultrasound . 2008 Jul-Aug. 36(6):352-66. . Nakhai-Pour HR, Broy P, Sheehy O, et al. Use of nonaspirin nonsteroidal anti-inflammatory drugs during pregnancy and the risk of spontaneous abortion. CMAJ . 2011 Oct 18. 183(15):1713-20. . Daniel S, Koren G, Lunenfeld E, et al. Fetal exposure to nonsteroidal anti-inflammatory drugs and spontaneous abortions. CMAJ . 2014 Mar 18. 186(5):E177-82. . . Chen X, Chen

2014 eMedicine Emergency Medicine

8944. Abortion, Complete (Overview)

) to aid in making clinical decisions. This endovaginal ultrasonogram reveals an irregular gestational sac with an amorphic fetal pole. No fetal cardiac activity was noted. This image represents a missed miscarriage or fetal demise. of 6 Tables Contributor Information and Disclosures Author Slava V Gaufberg, MD Assistant Professor of Medicine, Harvard Medical School; Director of Transitional Residency Training Program, Cambridge Health Alliance Slava V Gaufberg, MD is a member of the following medical (...) , Moshiri M, Dubinsky T, Dogra VS. Sonography in first trimester bleeding. J Clin Ultrasound . 2008 Jul-Aug. 36(6):352-66. . Nakhai-Pour HR, Broy P, Sheehy O, et al. Use of nonaspirin nonsteroidal anti-inflammatory drugs during pregnancy and the risk of spontaneous abortion. CMAJ . 2011 Oct 18. 183(15):1713-20. . Daniel S, Koren G, Lunenfeld E, et al. Fetal exposure to nonsteroidal anti-inflammatory drugs and spontaneous abortions. CMAJ . 2014 Mar 18. 186(5):E177-82. . . Chen X, Chen M, Xu B, et al

2014 eMedicine Emergency Medicine

8945. Coping With the Death of a Child in the ED (Overview)

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

8946. Back Pain, Mechanical (Follow-up)

are not recommended. Persistent disabling symptoms and degenerative spinal changes should prompt discussion and shared decision-making regarding surgery or interdisciplinary rehabilitation (evidence is insufficient to weigh the risks and benefits of vertebral disc replacement in these patients). Practice guidelines for persistent radiculopathy include the following: For patients with herniated discs, the use of epidural steroid injection should be discussed. For patients with herniated discs and disabling leg (...) Professor, Director of Prehospital Care Division, Department of Emergency Medicine, University of Virginia Health Sciences Center Debra G Perina, 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. Eric L Legome

2014 eMedicine Emergency Medicine

8947. Asthma (Follow-up)

-agonists and anticholinergics), theophylline, leukotriene modifiers, and more recent strategies such as the use of anti-immunoglobulin E (IgE) antibodies (omalizumab) and anti-IL-5 antibodies in selected patients. Relief medications include short-acting bronchodilators, systemic corticosteroids, and ipratropium. For all but the most severely affected patients, the ultimate goal is to prevent symptoms, minimize morbidity from acute episodes, and prevent functional and psychological morbidity to provide (...) should be reassessed in 2-4 weeks to make sure that control is maintained with the new treatment. A study by Bruzzese et al assessed the Asthma Self-Management for Adolescents (ASMA) approach, which is a school-based intervention for adolescents and medical providers. [ ] The study found that ASMA helped improve self-management and reduced morbidity and urgent health care use in low-income, urban, minority adolescents. Next: Environmental Control Environmental exposures and irritants can play

2014 eMedicine Emergency Medicine

8948. Anxiety (Follow-up)

of fluoxetine and placebo. The Fluoxetine Panic Disorder Study Group. Am J Psychiatry . 1998 Nov. 155(11):1570-7. . Uhlenhuth EH, Balter MB, Ban TA, Yang K. International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: VI. Trends in recommendations for the pharmacotherapy of anxiety disorders, 1992-1997. Depress Anxiety . 1999. 9(3):107-16. . Herrera-Arellano A, Jiménez-Ferrer E, Zamilpa A, Morales-Valdéz M, García-Valencia CE, Tortoriello J. Efficacy (...) . Acknowledgements Edward Bessman, MD Chairman, Department of Emergency Medicine, John Hopkins Bayview Medical Center; Assistant Professor, Department of Emergency Medicine, Johns Hopkins University School of Medicine Edward Bessman, 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, Case Medical Center, University Hospitals, Case Western

2014 eMedicine Emergency Medicine

8949. Aneurysm, Abdominal (Follow-up)

medical societies: and Disclosure: lippincott Royalty textbook royalty; wiley Royalty textbook royalty Jeffrey Lawrence Kaufman, MD Associate Professor, Department of Surgery, Division of Vascular Surgery, Tufts University School of Medicine Jeffrey Lawrence Kaufman, MD is a member of the following medical societies: , , , , , , , and Disclosure: Nothing to disclose. Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System Robert E O'Connor (...) , expansion, or leak. Next: Treatment of Unruptured Aneurysms Even patients who do not have symptoms from their AAAs may eventually require surgical intervention because the result of medical management in this population is a mortality of 100% over time as a consequence of rupture. In addition, these patients have a potential for limb loss from peripheral embolization. The decision to treat an unruptured AAA is based on operative risk, the risk of rupture, and the patient’s estimated life expectancy

2014 eMedicine Emergency Medicine

8950. Anemia, Acute (Follow-up)

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 Samuel M Keim, MD, MS Professor and Chair, Department of Emergency Medicine, University of Arizona College of Medicine Samuel M Keim, MD, MS is a member of the following medical societies: , , , , Disclosure (...) history while assessing the ABCs ( A irway, B reathing, C irculation) and initiating resuscitation. In the critically ill patient, the emergency physician should attempt to obtain a focused history per the mnemonic AMPLE ( A llergies; M edications, including over-the-counter drugs such as nonsteroidal anti-inflammatory drugs [NSAIDs]; P ast medical and surgical history; L ast meal; and E vents preceding incident). With noncommunicative patients, information should be sought from caretakers, paramedics

2014 eMedicine Emergency Medicine

8951. Abortion, Threatened (Follow-up)

with clinical presentation (spotting vs bleeding) to aid in making clinical decisions. This endovaginal ultrasonogram reveals an irregular gestational sac with an amorphic fetal pole. No fetal cardiac activity was noted. This image represents a missed miscarriage or fetal demise. of 6 Tables Contributor Information and Disclosures Author Slava V Gaufberg, MD Assistant Professor of Medicine, Harvard Medical School; Director of Transitional Residency Training Program, Cambridge Health Alliance Slava V (...) , Brocklehurst P, Porter R, Read M, Vyas S, Smith L. Management of miscarriage: expectant, medical, or surgical? Results of randomised controlled trial (miscarriage treatment (MIST) trial). BMJ . 2006 May 27. 332(7552):1235-40. . Dempsey A, Davis A. Medical management of early pregnancy failure: how to treat and what to expect. Semin Reprod Med . 2008 Sep. 26(5):401-10. . Coomarasamy A, Williams H, Truchanowicz E, et al. A Randomized Trial of Progesterone in Women with Recurrent Miscarriages. N Engl J Med

2014 eMedicine Emergency Medicine

8952. Abortion, Missed (Follow-up)

with clinical presentation (spotting vs bleeding) to aid in making clinical decisions. This endovaginal ultrasonogram reveals an irregular gestational sac with an amorphic fetal pole. No fetal cardiac activity was noted. This image represents a missed miscarriage or fetal demise. of 6 Tables Contributor Information and Disclosures Author Slava V Gaufberg, MD Assistant Professor of Medicine, Harvard Medical School; Director of Transitional Residency Training Program, Cambridge Health Alliance Slava V (...) , Brocklehurst P, Porter R, Read M, Vyas S, Smith L. Management of miscarriage: expectant, medical, or surgical? Results of randomised controlled trial (miscarriage treatment (MIST) trial). BMJ . 2006 May 27. 332(7552):1235-40. . Dempsey A, Davis A. Medical management of early pregnancy failure: how to treat and what to expect. Semin Reprod Med . 2008 Sep. 26(5):401-10. . Coomarasamy A, Williams H, Truchanowicz E, et al. A Randomized Trial of Progesterone in Women with Recurrent Miscarriages. N Engl J Med

2014 eMedicine Emergency Medicine

8953. Atrial Fibrillation (Follow-up)

(2.0-3.0). A risk-stratification scheme should be used by clinicians to help them decide which patients with nonvalvular AF would particularly benefit from anticoagulation therapy, but it should not be the definitive means of making such decisions. Postoperative and postdischarge anticoagulation therapy Anticoagulation prior to and during an elective surgery may be continued or stopped depending on the patient’s risk of bleeding and risk of thromboembolism. If the risk of thromboembolism is high (...) Atrial Fibrillation (Follow-up) Atrial Fibrillation Treatment & Management: Approach Considerations, Risk-Management Decisions, Management of New-Onset AF Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache

2014 eMedicine Emergency Medicine

8954. Abortion, Inevitable (Follow-up)

with clinical presentation (spotting vs bleeding) to aid in making clinical decisions. This endovaginal ultrasonogram reveals an irregular gestational sac with an amorphic fetal pole. No fetal cardiac activity was noted. This image represents a missed miscarriage or fetal demise. of 6 Tables Contributor Information and Disclosures Author Slava V Gaufberg, MD Assistant Professor of Medicine, Harvard Medical School; Director of Transitional Residency Training Program, Cambridge Health Alliance Slava V (...) , Brocklehurst P, Porter R, Read M, Vyas S, Smith L. Management of miscarriage: expectant, medical, or surgical? Results of randomised controlled trial (miscarriage treatment (MIST) trial). BMJ . 2006 May 27. 332(7552):1235-40. . Dempsey A, Davis A. Medical management of early pregnancy failure: how to treat and what to expect. Semin Reprod Med . 2008 Sep. 26(5):401-10. . Coomarasamy A, Williams H, Truchanowicz E, et al. A Randomized Trial of Progesterone in Women with Recurrent Miscarriages. N Engl J Med

2014 eMedicine Emergency Medicine

8955. Gastroenteritis (Follow-up)

Infect Dis . 2013 Nov. 19(11):1791-8. . . Chen Y, Liu B, Glass K, Du W, Banks E, Kirk M. Use of proton pump inhibitors and the risk of hospitalization for infectious gastroenteritis. PLoS One . 2016 Dec 20. 11 (12):e0168618. . Payne DC, Vinje J, Szilagyi PG, Edwards KM, Staat MA, Weinberg GA. Norovirus and medically attended gastroenteritis in U.S. children. N Engl J Med . 2013 Mar 21. 368(12):1121-30. . No authors listed. The inexorable progress of norovirus. Lancet Infect Dis . 2013 Feb. 13(2):97 (...) Shigella. Gram stain may be helpful in identifying an etiologic agent. This stain shows gram-negative bacilli, which could be Salmonella or Shigella with 2 polymorphonucleocyte cells (PMNs). of 6 Tables Contributor Information and Disclosures Author Arthur Diskin, MD Vice-President, Global Chief Medical Officer, Royal Caribbean Cruise Lines; Voluntary Associate Professor, University of Miami, Leonard M Miller School of Medicine Arthur Diskin, MD is a member of the following medical societies

2014 eMedicine Emergency Medicine

8956. Fracture, Mandible (Follow-up)

):1756-65. . Snell R, Smith M. The face, scalp, and mouth. Clinical Anatomy for Emergency Medicine . Mosby-Year Book; 1993. 206-41. Cillo JE Jr, Ellis E 3rd. Management of bilateral mandibular angle fractures with combined rigid and nonrigid fixation. J Oral Maxillofac Surg . 2014 Jan. 72(1):106-11. . Gutta R, Tracy K, Johnson C, James LE, Krishnan DG, Marciani RD. Outcomes of mandible fracture treatment at an academic tertiary hospital: a 5-year analysis. J Oral Maxillofac Surg . 2014 Mar. 72(3):550 (...) , but frequent suctioning is mandatory. Early intubation before swelling occurs makes airway control much easier, rather than waiting until a problem arises from obstruction. This is usually a clinical decision based on projected course. Before using paralytics in an intubation, carefully evaluate the ability to manage the airway with a bag and mask or laryngeal airway. If unable to manage the airway, do not paralyze the patient. Fiber optic guides or bronchoscopic-guided intubation may be an option

2014 eMedicine Emergency Medicine

8957. Fracture, Foot (Follow-up)

Versus Nonoperative Treatment of Jones Fractures: A Decision Analysis Model. Am J Orthop (Belle Mead NJ) . 2016 Mar-Apr. 45 (3):E69-76. . Hunt KJ, Goeb Y, Esparza R, Malone M, Shultz R, Matheson G. Site-Specific Loading at the Fifth Metatarsal Base in Rehabilitative Devices: Implications for Jones Fracture Treatment. PM R . 2014 May 28. . Lau S, Bozin M, Thillainadesan T. Lisfranc fracture dislocation: a review of a commonly missed injury of the midfoot. Emerg Med J . 2016 Mar 24. . Haapamaki VV (...) al. Calcaneal fractures in occupants involved in severe frontal motor vehicle crashes. Accid Anal Prev . 2007 Jul. 39(4):794-9. . Davis D, Newton E. Fracture, Calcaneus. 2017 Jun. . . Bohl DD, Ondeck NT, Samuel AM, Diaz-Collado PJ, Nelson SJ, Basques BA, et al. Demographics, Mechanisms of Injury, and Concurrent Injuries Associated With Calcaneus Fractures: A Study of 14 516 Patients in the American College of Surgeons National Trauma Data Bank. Foot Ankle Spec . 2016 Nov 28. . Snoap T, Jaykel M

2014 eMedicine Emergency Medicine

8958. Fournier Gangrene (Follow-up)

Tables Contributor Information and Disclosures Author Vernon M Pais, Jr, MD Associate Professor, Department of Surgery, Section of Urology, Dartmouth Medical School Vernon M Pais, Jr, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Coauthor(s) Thomas Santora, MD Professor and Vice-Chair for Clinical Affairs, Department of Surgery, Temple University Hospital, Temple University School of Medicine Thomas Santora, MD is a member of the following medical societies (...) : , , , , Disclosure: Nothing to disclose. Daniel B Rukstalis, MD Professor of Urology, Wake Forest Baptist Health System, Wake Forest University School of Medicine Daniel B Rukstalis, MD is a member of the following medical societies: , Disclosure: Nothing to disclose. Grace E Sollender Geisel School of Medicine at Dartmouth Disclosure: Nothing to disclose. Chief Editor Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern

2014 eMedicine Emergency Medicine

8959. Ultrasonography, Abdominal (Diagnosis)

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

8960. Tracheal Intubation, Rapid Sequence Intubation (Diagnosis)

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

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