Underwater and Scuba Diving Accidents
The evaluation and care of an injured scuba diver requires an understanding of the different types of underwater activities that may be deemed scuba diving. Such activities may range from the complex (eg, commercial or technical diving) all the way up to basic recreational scuba or snorkeling. A thorough physical examination should be completed as early as possible with a focus on specific areas at risk for injury and etiology, such as a detailed cardiopulmonary, skin, and neurologic examination. Serial reassessments and supportive care are as equally important as consultation with a dive medicine expert, especially one wi...
Source: Emergency Medicine Clinics of North America - March 15, 2024 Category: Emergency Medicine Authors: David Lambert, Mark Binkley, Zachary Gaskill Source Type: research

Spaceflight Environment
The safety and health of individuals who may be exposed to the spaceflight environment are first and foremost cared for through prevention. This environment, which encompasses microgravity, radiation, and alternobaric factors, can have physiologic impacts on every human system. Available medical care and resources in the spaceflight environment are currently limited by mass and volume constraints, with available medical resources thereby focusing on a patient ’s stabilization and evacuation. An understanding of the spaceflight environment and its possible effects is crucial for the treatment of individuals prior to, duri...
Source: Emergency Medicine Clinics of North America - March 15, 2024 Category: Emergency Medicine Authors: Samantha A. King, Craig J. Kutz, Natacha G. Chough Source Type: research

Managing Antimicrobial Resistance in the Emergency Department
(Basic awareness and understanding of antimicrobial resistance and prevailing mechanisms can aid emergency physicians in providing appropriate care to patients with infections due to a multidrug-resistant organism (MDRO). Empiric treatment of MDRO infections should be approached with caution and guided by the most likely pathogens based on differential diagnosis, severity of the illness, suspected source of infection, patient-specific factors, and local antibiotic susceptibility patterns. Newer broad-spectrum antibiotics should be reserved for critically ill patients where there is a high likelihood of infection with an MD...
Source: Emergency Medicine Clinics of North America - March 14, 2024 Category: Emergency Medicine Authors: Julianne Yeary, Larissa Hacker, Stephen Y. Liang Source Type: research

Cold Injury
Cold injury has been documented for centuries and remains a concern for military personnel, winter recreationalists, and urban homeless populations. Treatment advances in the last decades have included thrombolytic and prostaglandin therapies however the mainstay remains early recognition and rapid rewarming. This chapter focuses on frostbite, with a brief overview of other cold related conditions. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - March 14, 2024 Category: Emergency Medicine Authors: Jennifer Dow Source Type: research

Altitude-Related Illness
Altitude-related illness occurs as a result of inadequate acclimatization. The mainstay of prevention is a slow, graded ascent profile which gives the body time to respond to a low-oxygen environment. The diagnosis of these conditions is often difficult in resource-limited environments, so history and a physical exam are key in identifying patients who will require descent and evacuation. Treatment modalities such as supplemental oxygen, portable hyperbaric chambers, and medications, are all temporizing measures until the patient can be safely evacuated to a lower elevation. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - March 14, 2024 Category: Emergency Medicine Authors: Jessica Gehner Source Type: research

Drowning
is responsible for considerable morbidity and mortality worldwide, and it is estimated that 90% of drownings are preventable. Drowning is defined as “the process of experiencing respiratory impairment from submersion/immersion in liquid.” Emergency providers should focus on airway management and rapid delivery of oxygen to interrupt the drowning process and improve patient outcomes. Patients with minimal or no symptoms do not require any spe cific diagnostic workup, aside from physical examination and 4 to 6 hours of observation prior to discharge. Patients with more severe symptoms may present with rales and foamy se...
Source: Emergency Medicine Clinics of North America - March 14, 2024 Category: Emergency Medicine Authors: Christopher A. Davis, Stephanie Lareau Source Type: research

Animal Bites and Attacks
This text serves to familiarize readers with animal bites and attacks. Topics include appropriate management of animal bite wounds, postexposure prophylaxis for possible rabies exposures, and unique infectious diseases transmitted through animal vectors. Large mammal attacks are discussed, in addition to the management of smaller animal attacks and exposures. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - March 14, 2024 Category: Emergency Medicine Authors: Sarah Schlein, Andrew Park, Sameer Sethi Source Type: research

Heat-Related Illnesses
There is a growing incidence of heat-related illnesses due to rising global temperatures. Heat-related illnesses range from mild to severe, with heat stroke being the most critical. The wet bulb global temperature index considers humidity and solar intensity; its use is recommended to estimate heat stress on an individual and mitigate risk. Efficient cooling methods, such as cold water immersion, are essential in severe cases. Prevention is through hydration, appropriate clothing, recognition of high risk medications, and awareness of environmental conditions. Recognizing heat-related illnesses early in the clinical course...
Source: Emergency Medicine Clinics of North America - March 13, 2024 Category: Emergency Medicine Authors: Jonathan Bauman, Susanne Spano, Michelle Storkan Source Type: research

Optimizing Diagnosis and Management of Community-acquired Pneumonia in the Emergency Department
Pneumonia is split into 3 diagnostic categories: community-acquired pneumonia (CAP), health care-associated pneumonia, and ventilator-associated pneumonia. This classification scheme is driven not only by the location of infection onset but also by the predominant associated causal microorganisms. Pneumonia is diagnosed in over 1.5 million US emergency department visits annually (1.2% of all visits), and most pneumonia diagnosed by emergency physicians is CAP. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - March 12, 2024 Category: Emergency Medicine Authors: Katherine M. Hunold, Elizabeth Rozycki, Nathan Brummel Source Type: research

Optimizing Antimicrobial Stewardship in the Emergency Department
Antibiotic stewardship is a core component of emergency department (ED) practice and impacts patient safety, clinical outcomes, and public health. The unique characteristics of ED practice, including crowding, time pressure, and diagnostic uncertainty, need to be considered when implementing antibiotic stewardship interventions in this setting. Rapid advances in pathogen detection and host response biomarkers promise to revolutionize the diagnosis of infectious diseases in the ED, but such tests are not yet considered standard of care. Presently, clinical decision support embedded in the electronic health record and pharma...
Source: Emergency Medicine Clinics of North America - March 12, 2024 Category: Emergency Medicine Authors: Julia Sapozhnikov, Fritzie S. Albarillo, Michael S. Pulia Source Type: research

The Intersection of Substance Use Disorders and Infectious Diseases in the Emergency Department
Substance use disorders (SUDs) intersect clinically with many infectious diseases, leading to significant morbidity and mortality if either condition is inadequately treated. In this article, we will describe commonly seen SUDs in the emergency department (ED) as well as their associated infectious diseases, discuss social drivers of patient outcomes, and introduce novel ED-based interventions for co-occurring conditions. Clinicians should come away from this article with prescriptions for both antimicrobial medications and pharmacotherapy for SUDs, as well as an appreciation for social barriers, to care for these patients...
Source: Emergency Medicine Clinics of North America - March 12, 2024 Category: Emergency Medicine Authors: Erik S. Anderson, Bradley W. Frazee Source Type: research

Environmental Hypothermia
Although a rare diagnosis in the Emergency Department, hypothermia affects patients in all environments, from urban to mountainous settings. Classic signs of death cannot be interpreted in the hypothermic patient, thus resulting in the mantra, “No one is dead until they’re warm and dead.” This comprehensive review of environmental hypothermia covers the clinical significance and pathophysiology of hypothermia, pearls and pitfalls in the prehospital management of hypothermia (including temperature measurement techniques and advanced cardiac life support deviations), necessary Emergency Department diagnostics, availabl...
Source: Emergency Medicine Clinics of North America - March 9, 2024 Category: Emergency Medicine Authors: Cheyenne Falat Source Type: research

The Diagnosis and Treatment of Adult Urinary Tract Infections in the Emergency Department
Emergency medicine has been called the art of “making complicated clinical decisions with limited information.” This description is particularly relevant in the case of diagnosis and treatment of urinary tract infections (UTIs). Although common, UTIs are often challenging to diagnose given the presence of non-specific signs and symptoms and over-reliance on laboratory findings. This review provides an interdisciplinary interpretation of the primary literature and practice guidelines, with a focus on diagnostic and antimicrobial stewardship in the emergency department. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - March 7, 2024 Category: Emergency Medicine Authors: Robert Redwood, Kimberly C. Claeys Source Type: research

Fever and Rash
Infectious causes of fever and rash pose a diagnostic challenge for the emergency provider. It is often difficult to discern rashes associated with rapidly progressive and life-threatening infections from benign exanthems, which comprise the majority of rashes seen in the emergency department. Physicians must also consider serious noninfectious causes of fever and rash. A correct diagnosis depends on an exhaustive history and head-to-toe skin examination as most emergent causes of fever and rash remain clinical diagnoses. A provisional diagnosis and immediate treatment with antimicrobials and supportive care are usually re...
Source: Emergency Medicine Clinics of North America - March 7, 2024 Category: Emergency Medicine Authors: Richard Diego Gonzales Y Tucker, Aravind Addepalli Source Type: research

Infectious Disease Emergencies
“The greatest enemy we face in medicine is an enemy unseen.” These words were often repeated by many clinicians and researchers during the recent COVID-19 pandemic. The words were true 6000 years ago with the birth of the first human civilization, and they remain true today, despite all the mode rn advances in pharmacology and immunizations. The fact that nearly 7 million people globally have died of the COVID-19 virus in just the past 4 years attests to the fact that microorganisms and viruses truly are the greatest enemy we face in modern medicine. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - March 7, 2024 Category: Emergency Medicine Authors: Amal Mattu Tags: Foreword Source Type: research