Emergency Medicine: Avoiding the Pitfalls and Improving the Outcomes
Format: PDF / Kindle (mobi) / ePub
Emergency Medicine is a brand new book focusing on the common pitfalls and mistakes that can occur when dealing with high-risk conditions during standard medical practice. Concise chapters focus on clinical relevance, addressing the mistakes, the consequences and the knowledge necessary to avoid high-risk mistakes. An essential book for all staff dealing with emergencies.
patients found that in most patients, a BAL Ͼ240 mg/dl did not reduce one’s GCS by more than 2–3 points . These studies suggest that intoxicated patients with BALs Ͻ200–240 mg/dl and a GCS of 13 or less should be evaluated for additional causes of altered mental status. For example, a patient with a GCS of 12 and a BAL of 80 mg/dl should be further evaluated for an alternative diagnosis or diagnoses. On the other hand, if a patient’s BAL is consistent with the degree of altered mental status,
pool when someone made the diagnosis. Second, ECG changes that resemble cardiac ischemia, especially T-wave inversions, can occur in patients with PE. Physicians should never rule in or rule out PE simply based on ECG finding. Pitfall | Failure to differentiate pericarditis from other chest syndromes On the surface, pericarditis seems as though it would be easy to recognize. Classically, pericarditis features the rather sudden onset of progressive, central, pleuritic chest pain that is worse
differential diagnosis. Yet compared to the abdomen, the chest contains relatively few structures (e.g., the heart, the lungs, the great vessels, the esophagus) to consider as the source of the complaint when evaluating a patient with chest pain. In these few structures, however, there exists the potential for several life-threatening maladies, some of which unfortunately occur rather commonly. In patients with chest pain, initial attention is often devoted to establishing the presence or absence
suggest the diagnosis (see Table 3.1). Acute superior mesenteric artery (SMA) embolus is more common in patients with underlying cardiac disease. The most common cardiac conditions that predispose 25 26 | Chapter 3 Table 3.1 Risk factors for mesenteric ischemia. Type of mesenteric ischemia Risk factors Special notes SMA embolus Cardiac disease • Atrial fibrillation or other arrhythmia • Valvular disease • Ventricular aneurysm • Cardiomyopathy One-third have a history of a previous
patient with chest pain to a GI cocktail should in any way direct the disposition decision. Pitfall | Assumption that a normal ECG rules out cardiac ischemia When working through the differential diagnosis of chest pain, it is often said that the patient cannot be having an MI if ECG is normal. This is not true; in fact, no historical complaint, physical finding, or ECG pattern has a negative predictive value of 100% for MI. The patient may be less likely to be experiencing an MI if the ECG is