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Emergency Medicine Treatment and Labor Act

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81. Normal and Abnormal Puerperium (Treatment)

blood count and coagulation studies (fibrinogen, prothrombin time/activated partial thromboplastin time) to exclude resulting anemia or coagulopathy, which may require further treatment with blood products. It is also important that any patient admitted to the labor and delivery unit have an active blood sample (type and screen) available if the need for urgent transfusion arises. A “clot observation test” has been used to detect coagulation problems prior to the return of laboratory studies (...) ) is an effective uterotonic agent for both prevention and treatment of a postpartum hemorrhage. Routine postpartum administration of oxytocin is recommended as a key measure in active management of the third stage of labor to reduce the average risk of maternal hemorrhage at birth and possibly shorten the third stage of labor. [ ] The rate of oxytocin administration can be increased to correct uterine atony however rapid infusion of high-dose oxytocin can be associated with significant risk of cardiovascular

2014 eMedicine.com

82. Neurologic Disease and Pregnancy (Treatment)

posterior leukoencephalopathy (RPLE) (see below) is occasionally seen on imaging studies. [ ] Brain images are usually normal. Treatment of seizures usually includes , but benzodiazepines or rapidly acting antiepileptic drugs (AEDs), such as , may be required. Generally, long-term AED treatment is not needed once the patient’s blood pressure has returned to normal and stabilized. However, no data are available to determine precisely how long short-term treatment should last; for the most part, local (...) is. [ ] CVT is often encountered after delivery. The main symptoms and findings are headache, stroke in a venous distribution, or both. The clinical challenges are as follows: To identify CVT in patients presenting with headache alone before it progresses To recognize CVT as the correct cause of stroke in a patient presenting in the peripartum period Without treatment, CVT may lead to emergence or progression of stroke, exacerbation of dysfunction, worsening of increased intracranial pressure (ICP

2014 eMedicine.com

83. Neurosyphilis (Treatment)

Neurosyphilis (Treatment) Neurosyphilis: Overview of Syphilis of the CNS, Pathophysiology of Syphilis, Epidemiology of Syphilis 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTE2OTIzMS1vdmVydmlldw== processing (...) ashamed to seek medical treatment from their regular clinicians. Some were so stigmatized and marginalized that they simply committed suicide. The recipes, of note, included a variety of everyday herbs and substances, such as incense, chamomile, earthworms, and chicken fat. Occasionally, more expensive and exotic ingredients, such as Artemisia dracunculus (tarragon), badger fat, bear fat, goose fat, or blood from a male pig, were used, especially if the case seemed particularly stubborn. The Italian

2014 eMedicine.com

84. Vaginal Birth After Cesarean Delivery (Treatment)

related to managing patients undergoing trials of labor after cesarean delivery, they are less likely to allow new patients to undergo a trial of labor. In addition, 1999 guidelines from the American College of Obstetricians and Gynecologists (ACOG) stated explicitly that patients undergoing TOLAC require the presence of an obstetrician, an anesthesiologist, and/or a staff capable of performing an emergency cesarean delivery throughout the patient’s active phase of labor. [ ] Whereas academic centers (...) studies on this issue, one out of Pennsylvania and the other out of the Maternal-Fetal Medicine Units. These large studies over the last decade have used multivariate statistics to examine risk factors. This means that other risk factors and confounding factors, such as birth weight, maternal age, obstetric history, and labor management, were controlled for in the analysis. In this article, factors associated with mode of delivery in the setting of a trial of labor and factors associated with uterine

2014 eMedicine.com

85. Toxicity, Cocaine (Treatment)

and treatment. JAMA . 1983 Sep 16. 250(11):1417-20. . Prosser JM, Perrone J. Cocaine and Amphetamines. In: Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline DM, eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide . 8th ed. NY: McGraw-Hill Education; 2016. 1256-59. Renzi FP. Cocaine poisoning. Harwood-Nuss AL, ed. The Clinical Practice of Emergency Medicine . 2nd ed. Philadelphia, Pa: Lippincott Raven Publishers; 1996. [Guideline] American Heart Association. Part 10: Special (...) al. Treatment of cocaine cardiovascular toxicity: a systematic review. Clin Toxicol (Phila) . 2016 Jun. 54 (5):345-64. . Thomas JJ, Brady WJ. Acute Coronary Syndrome. In: Walls RM, Hockberger RS, Gausche-Hill M, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 9th ed. Philadelphia, PA: Elsevier; 2018. 891-928. Chang AM, Walsh KM, Shofer FS, et al. Relationship between cocaine use and coronary artery disease in patients with symptoms consistent with an acute coronary

2014 eMedicine.com

86. Shoulder Dislocations (Treatment)

injury. Patients may return to noncontact sports with no overhead requirements after 3 months. Athletes may return to contact and overhead sports after 4 months. The success of this regimen largely depends on the patient's age at the time of the initial dislocation. Greater tuberosity fractures associated with dislocation and advanced age are good prognostic indicators for successful nonoperative treatment. Activity modification (eg, avoiding overhead work, heavy manual labor, and high-risk sports (...) -A (5):661-7. . Demehri S, Hafezi-Nejad N, Fishman EK. Advanced imaging of glenohumeral instability: the role of MRI and MDCT in providing what clinicians need to know. Emerg Radiol . 2017 Feb. 24 (1):95-103. . Wen DY. Current concepts in the treatment of anterior shoulder dislocations. Am J Emerg Med . 1999 Jul. 17(4):401-7. . Kirkley A, Griffin S, Richards C, Miniaci A, Mohtadi N. Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus

2014 eMedicine Surgery

87. Perianal Abscess (Treatment)

if the patient is elderly, febrile, hypotensive, or immunocompromised or has significant comorbidities. Transfer, if warranted, may be safely carried out if the patient is hemodynamically stable. Instability resulting from a concurrent condition or sepsis makes transfer to another institution inappropriate (and possibly illegal under the Emergency Medical Treatment and Active Labor Act [EMTALA]) unless transfer to allow delivery of a higher level of care is in the patient’s best interest. Next: Pharmacologic (...) , Rakel DP, eds. Textbook of Family Medicine . 8th ed. Philadelphia: Saunders; 2011. Novotny NM, Mann MJ, Rescorla FJ. Fistula in ano in infants: who recurs?. Pediatr Surg Int . 2008 Nov. 24(11):1197-9. . Hämäläinen KP, Sainio AP. Incidence of fistulas after drainage of acute anorectal abscesses. Dis Colon Rectum . 1998 Nov. 41(11):1357-61; discussion 1361-2. . Athanasiadis S, Köhler A, Nafe M. Treatment of high anal fistulae by primary occlusion of the internal ostium, drainage

2014 eMedicine Surgery

88. Blunt Chest Trauma (Treatment)

Blunt Chest Trauma (Treatment) Blunt Chest Trauma Treatment & Management: Approach Considerations, Chest-Wall Fractures, Dislocations, and Barotrauma, Blunt Injuries to Pleurae, Lungs, and Aerodigestive Tract 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 (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNDI4NzIzLXRyZWF0bWVudA== processing > Blunt Chest Trauma Treatment & Management Updated: Nov 09, 2018 Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: John Geibel, MD, DSc, MSc, AGAF Share Email Print Feedback Close Sections Sections Blunt Chest Trauma Treatment Approach Considerations Indications for operative intervention Operative intervention is rarely necessary in blunt thoracic injuries. In one report, only 8% of cases with blunt thoracic injuries required an operation. Most such injuries can be treated

2014 eMedicine Surgery

89. Abdominal Trauma, Penetrating (Treatment)

stabilizing surgical intervention. Obviously, if no surgeon is available, transfer may be the only course of action. Practitioners must be cognizant of Emergency Medical Treatment and Active Labor Act (EMTALA)/Consolidated Omnibus Budget Reconciliation Act (COBRA) violations and document accordingly (see ). This legislation was enacted with the intention of removing economic considerations from important medical decisions in the ED. Previous Next: Initial Emergency Department Care A team leader should (...) nonoperative management of gunshot wounds of the anterior abdomen. Arch Surg . 1997 Feb. 132(2):178-83. . Kelemen JJ 3rd, Martin RR, Obney JA, Jenkins D, Kissinger DP. Evaluation of diagnostic peritoneal lavage in stable patients with gunshot wounds to the abdomen. Arch Surg . 1997 Aug. 132(8):909-13. . Hedges JR, Roberts JR. Clinical Procedures in Emergency Medicine. Peritoneal procedures . 3rd ed. Philadelphia, Pa: WB Saunders; 1997. Simon RJ, Rabin J, Kuhls D. Impact of increased use of laparoscopy

2014 eMedicine Surgery

90. Schizophrenia (Treatment)

, the type of restraint used (eg, locked room vs 4-point leather), the maximum duration of restraint, and reasons for involuntary commitment. [ ] Follow all Consolidated Omnibus Budget Reconciliation Act (COBRA) regulations when transferring patients to another facility for psychiatric care. Be familiar with hospital and ED specific regulations, Health Insurance Portability and Accountability Act (HIPAA) rules, regional statutes, and Emergency Medical Treatment and Labor Act (EMTALA) requirements (...) -acting injectable antipsychotics. Ment Health Clin . 2016 Jun. 6 (3):134-141. . American Psychiatric Association. Practice guideline for the treatment of patients with schizophrenia. 2nd ed . Feb 2004;114. Douglass AM, Luo J, Baraff LJ. Emergency medicine and psychiatry agreement on diagnosis and disposition of emergency department patients with behavioral emergencies. Acad Emerg Med . 2011 Apr. 18(4):368-73. . Fischer BA, Buchanan RW. Schizophrenia: Clinical manifestations, course, assessment

2014 eMedicine Emergency Medicine

91. Toxicity, MDMA (Treatment)

. . Amoroso T. The Psychopharmacology of ±3,4 Methylenedioxymethamphetamine and its Role in the Treatment of Posttraumatic Stress Disorder. J Psychoactive Drugs . 2015 Nov-Dec. 47 (5):337-44. . Media Gallery of 0 Tables Contributor Information and Disclosures Author In-Hei Hahn, MD, FACEP, FACMT Attending Physician, Department of Emergency Medicine, NYU Langone-Cobble Hill In-Hei Hahn, MD, FACEP, FACMT is a member of the following medical societies: , , Disclosure: Nothing to disclose. Specialty Editor (...) Toxicity, MDMA (Treatment) MDMA Toxicity Treatment & Management: Prehospital Care, Emergency Department Care, Consultations 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvODIxNTcyLXRyZWF0bWVudA== processing > MDMA

2014 eMedicine Emergency Medicine

92. Toxicity, Cocaine (Treatment)

and treatment. JAMA . 1983 Sep 16. 250(11):1417-20. . Prosser JM, Perrone J. Cocaine and Amphetamines. In: Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline DM, eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide . 8th ed. NY: McGraw-Hill Education; 2016. 1256-59. Renzi FP. Cocaine poisoning. Harwood-Nuss AL, ed. The Clinical Practice of Emergency Medicine . 2nd ed. Philadelphia, Pa: Lippincott Raven Publishers; 1996. [Guideline] American Heart Association. Part 10: Special (...) al. Treatment of cocaine cardiovascular toxicity: a systematic review. Clin Toxicol (Phila) . 2016 Jun. 54 (5):345-64. . Thomas JJ, Brady WJ. Acute Coronary Syndrome. In: Walls RM, Hockberger RS, Gausche-Hill M, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 9th ed. Philadelphia, PA: Elsevier; 2018. 891-928. Chang AM, Walsh KM, Shofer FS, et al. Relationship between cocaine use and coronary artery disease in patients with symptoms consistent with an acute coronary

2014 eMedicine Emergency Medicine

93. Rhabdomyolysis (Treatment)

facility if necessary. Follow the guidelines of the Consolidated Omnibus Budget Reconciliation Act (COBRA) and the Emergency Medical Treatment and Labor Act (EMTALA). In natural disasters, patients often have to be evacuated out of affected areas and transported to locations that can provide dialysis services. [ ] Once they are well hydrated, patients with normal renal function, normal electrolyte levels, alkaline urine, and an isolated cause of muscle injury may be discharged and monitored (...) (8):587-91. . Song SH, Lee DW, Lee SB, Kwak IS. Rhabdomyolysis caused by strenuous computer gaming. Nephrol Dial Transplant . 2007 Apr. 22(4):1263-4. . Melli G, Chaudhry V, Cornblath DR. Rhabdomyolysis: an evaluation of 475 hospitalized patients. Medicine (Baltimore) . 2005 Nov. 84(6):377-85. . Wu CT, Huang JL, Lin JJ, Hsia SH. Factors associated with nontraumatic rhabdomyolysis and acute renal failure of children in Taiwan population. Pediatr Emerg Care . 2009 Oct. 25(10):657-60. . Chamberlain

2014 eMedicine Emergency Medicine

94. Toxicity, Chlorine Gas (Treatment)

, Dominici P, Aguilera E. Eye irrigation is more comfortable with a lidocaine: containing irrigation solution compared with normal saline. J Trauma . 2008 May. 64(5):1360-2. . Done AK. The toxic emergency, it's a gas. Emerg Med . 1976. 305-14. Vinsel PJ. Treatment of acute chlorine gas inhalation with nebulized sodium bicarbonate. J Emerg Med . 1990 May-Jun. 8(3):327-9. . Cevik Y, Onay M, Akmaz I, Sezigen S. Mass casualties from acute inhalation of chlorine gas. South Med J . 2009 Dec. 102(12):1209-13 (...) . . Nelson LS. Simple asphyxiants and pulmonary irritants. Goldfrank LR, ed. Goldfrank's Toxicologic Emergencies . 6th ed. Stanford, Conn: Appleton & Lange; 1998. 1523-38. Aslan S, Kandis H, Akgun M, Cakir Z, Inandi T, Görgüner M. The effect of nebulized NaHCO3 treatment on "RADS" due to chlorine gas inhalation. Inhal Toxicol . 2006 Oct. 18(11):895-900. . Kramer CG. Chlorine. J Occup Med . 1967 Apr. 9(4):193-6. . Chester EH, Kaimal J, Payne CB Jr, Kohn PM. Pulmonary injury following exposure to chlorine

2014 eMedicine Emergency Medicine

95. Corneal Abrasion (Treatment)

. . Waldman N, Densie IK, Herbison P. Topical tetracaine used for 24 hours is safe and rated highly effective by patients for the treatment of pain caused by corneal abrasions: a double-blind, randomized clinical trial. Acad Emerg Med . 2014 Apr. 21(4):374-82. . Ball IM, Seabrook J, Desai N, Allen L, Anderson S. Dilute proparacaine for the management of acute corneal injuries in the emergency department. CJEM . 2010 Sep. 12(5):389-96. . Weaver CS, Terrell KM. Evidence-based emergency medicine. Update: do (...) Corneal Abrasion (Treatment) Emergency Care of Corneal Abrasion: Overview, Clinical Evaluation, ED Treatment Considerations 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNzk5MzE2LW92ZXJ2aWV3 processing

2014 eMedicine Emergency Medicine

96. Gastroenteritis (Treatment)

if the diagnosis is uncertain. Manage complications. Transfer Transfer of the unstable patient is inappropriate under Emergency Medical Treatment and Active Labor Act (EMTALA) regulations unless benefits clearly outweigh risks. Unless the patient requires admission and has a complicated medical condition that would be better managed in another facility, transfer is neither necessary nor recommended. Next: Consultations A consultation with an infectious diseases specialist may be necessary for patients (...) Gastroenteritis (Treatment) Emergent Treatment of Gastroenteritis Treatment & Management: Emergency Department Care, Consultations, Outpatient Care 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

97. Pregnancy, Asthma (Treatment)

may cause a slight increase in congenital malformation (mainly clef lip), prematurity, low birth weight, preeclampsia, gestational diabetes, and neonatal insufficiency. [ , , , , , ] However, randomized trials have not been performed. A longer-acting beta2-adrenoreceptor agonist (eg, ), the bronchodilator effects of which last at least 12 hours, is an effective treatment for nocturnal asthma. Historically, methylxanthines and oral beta agonists have been used to treat asthma. Both have been shown (...) medication use by pregnant women. [ , ] Go to for more complete information on this topic. Previous Next: Hospital Care Prehospital asthma treatment Prior to arriving at the ED, address the patient’s airway status as needed. Provide early institution of beta-agonist inhalational therapy. Provide supplemental oxygen. Treatment in the emergency department Pregnant patients who present with typical mild exacerbations of asthma may be treated in the same way that a regular asthmatic patient with similar

2014 eMedicine Emergency Medicine

98. Renal Calculi (Treatment)

Renal Calculi (Treatment) Nephrolithiasis Treatment & Management: Approach Considerations, Emergency Management of Renal Colic, Surgical Care 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNDM3MDk2LXRyZWF0bWVudA (...) == 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

99. Perirectal Abscess (Treatment)

if the patient is elderly, febrile, hypotensive, or immunocompromised or has significant comorbidities. Transfer, if warranted, may be safely carried out if the patient is hemodynamically stable. Instability resulting from a concurrent condition or sepsis makes transfer to another institution inappropriate (and possibly illegal under the Emergency Medical Treatment and Active Labor Act [EMTALA]) unless transfer to allow delivery of a higher level of care is in the patient’s best interest. Next: Pharmacologic (...) , Rakel DP, eds. Textbook of Family Medicine . 8th ed. Philadelphia: Saunders; 2011. Novotny NM, Mann MJ, Rescorla FJ. Fistula in ano in infants: who recurs?. Pediatr Surg Int . 2008 Nov. 24(11):1197-9. . Hämäläinen KP, Sainio AP. Incidence of fistulas after drainage of acute anorectal abscesses. Dis Colon Rectum . 1998 Nov. 41(11):1357-61; discussion 1361-2. . Athanasiadis S, Köhler A, Nafe M. Treatment of high anal fistulae by primary occlusion of the internal ostium, drainage

2014 eMedicine Emergency Medicine

100. Pregnancy, Delivery (Treatment)

was passed as a part of a much larger bill, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). Consequently, the acronym COBRA was used frequently in medical literature when referring to the statute. This statute is also titled the Emergency Medical Treatment and Active Labor Act (EMTALA). Since the latter name is more specific and descriptive, it has become the preferred acronym for referring to the statute. The full text of the statute can be found in any public library's reference (...) Pregnancy, Delivery (Treatment) Labor and Delivery in the Emergency Department Treatment & Management: Prehospital Care, Emergency Department Care, Consultations 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

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