Emergency Medicine Clinics of North America This is an RSS file. You can use it to subscribe to this data in your favourite RSS reader or to display this data on your own website or blog.

Emergency Department Care of the Patient with Suicidal or Homicidal Symptoms
Patients frequently present to the emergency department (ED) with acute suicidal and homicidal thoughts. These patients require timely evaluation, with determination of disposition by either voluntary or involuntary hospitalization or discharge with appropriate outpatient follow-up. Safety concerns should be prioritized for patients as well as ED staff. Patient dignity and autonomy should be respected throughout the process. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - August 3, 2023 Category: Emergency Medicine Authors: Chadd K. Kraus, James Ferry Source Type: research

Respiratory Acid –Base Disorders
Respiratory acid –base disorders are often not thought of as frequently as their metabolic cousins, which occur more frequently in the emergency department. Although most respiratory and acid-base disturbances are driven by lung pathology, central nervous system and other organ systems can and do play a role as we ll. Although managing the airway and appropriate mechanical ventilation may be necessary, it is akin to placing a band-aid on a large wound. It is crucial for the emergency clinician to discover the etiology of the disturbance as management depends on treating the underlying etiology to prevent wors ening acid�...
Source: Emergency Medicine Clinics of North America - August 2, 2023 Category: Emergency Medicine Authors: Alexander Arena, Emily Miller Source Type: research

Pediatric Psychiatric Emergencies
Pediatric psychiatric emergencies account for 15% of emergency department visits and are on the rise. Psychiatric diagnoses in the pediatric population are difficult to make, due to their variable presentation, but early diagnosis and treatment improve clinical outcome. Medical reasons for the patient's presentation should be explored. Both physical and emotional safety must be ensured. A multidisciplinary approach, utilizing local primary care and psychiatric resources, is recommended. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - August 2, 2023 Category: Emergency Medicine Authors: Purva Grover, Manya Kumar Source Type: research

Difficult Patients
Malingering is the intentional production of false or grossly exaggerated symptoms motivated by internal and external incentives. The true incidence of malingering in the emergency department is unknown because of the difficulty of identifying whether patients are fabricating their symptoms. Malingering is considered a diagnosis of exclusion; a differential diagnosis framework is described to guide emergency physicians. Several case studies are presented and analyzed from a medical ethics perspective. Practical recommendations include use of the NEAL (neutral, empathetic, and avoid labeling) strategy when caring for patien...
Source: Emergency Medicine Clinics of North America - August 2, 2023 Category: Emergency Medicine Authors: Artun K. Kadaster, Markayle R. Schears, Raquel M. Schears Source Type: research

Physiologic Effects of Substance Use
Physiologic and psychological effects of substance use are common occurrences. They may be the proximate purpose of the exposure or related to an unintended complication. Acute short-term exposure effects may not be the same as long-term effects. These effects are mediated by different receptors they act on and the homeostatic changes that occur due to repeat exposure. We review in this article the physiologic and psychological effects from exposure to commonly encountered drugs, ethanol, sedative hypnotics, cocaine, amphetamines, marijuana, opioids, nicotine, hydrocarbons (halogenated and non-halogenated), and nitrous oxi...
Source: Emergency Medicine Clinics of North America - August 2, 2023 Category: Emergency Medicine Authors: Brian Patrick Murray, Emily Anne Kiernan Source Type: research

Recognizing and Responding to Patients with Personality Disorders
Caring for patients with personality disorders and traits presents unique challenges for physicians and other providers. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, recognizes 10 personality disorders, which are organized into 3 clusters (A, B, and C) based on shared diagnostic features. Personality disorders or traits create difficulty in clinical and interpersonal interactions, promoting missed diagnosis or underdiagnosis, nonadherence to medical recommendations, or other dangerous outcomes. It is important to recognize patients with potential personality disorders and understand strategies ...
Source: Emergency Medicine Clinics of North America - July 31, 2023 Category: Emergency Medicine Authors: Jillian L. McGrath, Maegan S. Reynolds Source Type: research

Geriatric Psychiatric Emergencies
Geriatric patients, those 65 years of age and older, often experience psychiatric symptoms or changes in mentation as a manifestation of an organic illness. It is crucial to recognize and treat delirium in these patients as it is often under-recognized and associated with significant morbidity. Iatrogenic causes of altered mentation or delirium due to medication adverse reactions are common. Treatment of the underlying cause, creating an environment conducive to orientation, and minimizing agitation and discomfort are first-line interventions. Antipsychotics are first-line pharmacologic interventions if needed to preserve ...
Source: Emergency Medicine Clinics of North America - July 31, 2023 Category: Emergency Medicine Authors: Michelle A. Fischer, Monica Corsetti Source Type: research

Overview of Depression
Depressive disorders encompass a spectrum of diagnoses and are more common in women and transgender individuals. Diagnosis involves thorough history-taking and exclusion of underlying medical disorders. The emergency physician should assess the risk of self-harm and consider environmental and social factors prior to disposition. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - July 28, 2023 Category: Emergency Medicine Authors: Samantha Chao Source Type: research

Approach to the Hypoglycemic Patient
Hypoglycemia is commonly encountered in the emergency department. Patients can present with a myriad of symptoms and its presentation can mimic other more serious diagnoses. Despite the relative ease of its management, clinicians often miss the diagnosis or mismanage it even when discovered. Glucose is an important energy source for the brain and failing to recognize hypoglycemia or mismanaging it can lead to permanent neurologic disability or death. Although it is important to replenish glucose in a rapid fashion, it is equally important to discover and manage the underlying etiology to prevent further episodes of hypogly...
Source: Emergency Medicine Clinics of North America - July 27, 2023 Category: Emergency Medicine Authors: Molly Chang, George Willis Source Type: research

Thyrotoxicosis
Hyperthyroidism is a diagnosis existing along a spectrum of severity. Patients present with a variety of signs and symptoms: tachycardia, elevated heart rate, anxiety, changes in mental status, gastrointestinal disturbances, and hyperthermia. Management of subclinical hyperthyroidism and thyrotoxicosis without thyroid storm is heavily dependent on outpatient evaluation. Thyroid storm is the most severe form of hyperthyroidism with the highest mortality. Management of thyroid storm follows a stepwise approach, with resuscitation and detection of the precipitating cause being paramount. Special attention should be paid to ca...
Source: Emergency Medicine Clinics of North America - July 27, 2023 Category: Emergency Medicine Authors: Brannon L. Inman, Brit Long Source Type: research

Neonatal Endocrine Diseases
This article will give an overview of endocrine emergencies encountered in the neonatal period, including disorders of glucose metabolism, thyroid disorders, adrenal disorders, and pituitary disorders. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - July 27, 2023 Category: Emergency Medicine Authors: Marissa Cantu, Prianka Kandhal Source Type: research

Management of the Agitated Patient
The acutely agitated patient should be managed in a step-wise fashion, beginning with non-coercive de-escalation strategies and moving on to pharmacologic interventions and physical restraints as necessary. Face-to-face examination, monitoring, and documentation by the physician are essential. The emergency physician should be familiar with multiple pharmaceutical options, tailored to the individual patient. Use of ketamine, benzodiazepines and antipsychotics should be considered. Patient autonomy, safety, and medical well-being are paramount. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - July 27, 2023 Category: Emergency Medicine Authors: Carmen Wolfe, Nicole McCoin Source Type: research

Schizophrenia and Emergency Medicine
Schizophrenia is a chronic condition characterized by positive symptoms (auditory hallucinations, delusion), negative symptoms (avolition, social withdrawal), and disorganized thoughts/behaviors. Although the pathophysiology is incompletely understood, several neurobiological mechanisms have been proposed. Treatment usually involves antipsychotic medication as well as psychotherapy and supportive services. When evaluating patients in the emergency department, acute safety considerations are paramount. Patients should be assessed for suicide risk, violence risk, inability to care for self, and the risk of being the victim o...
Source: Emergency Medicine Clinics of North America - July 27, 2023 Category: Emergency Medicine Authors: Ryan E. Lawrence, Adam Bernstein Source Type: research

Diabetic Ketoacidosis
This article reviews the most current literature on diabetic ketoacidosis, including how to make the diagnosis and management. It discusses euglycemic diabetic ketoacidosis and the risk factors for this rare but dangerous disease process. Pertinent pearls and pitfalls encountered by the emergency physician when managing these patients are included. Because these patients often stay in the emergency department for prolonged periods, recommendations on transitioning to subcutaneous insulin are included, along with dosing recommendations. Finally, the article reviews how to disposition patients with diabetic ketoacidosis and ...
Source: Emergency Medicine Clinics of North America - July 24, 2023 Category: Emergency Medicine Authors: Bobbi-Jo Lowie, Michael C. Bond Source Type: research

Metabolic Acid-Base Disorders
Metabolic acid-base disturbances are frequently encountered in the emergency department, and many of these patients are critically ill. In the evaluation of patients with these maladies, it is important for the emergency clinician to determine the cause, which can usually be elicited from a thorough history and physical examination. There are several mnemonics that can be used to form an appropriate list of potential causes. Most of the time, the management of these patients requires no specific treatment of the acid-base status but, rather, requires treatment of the underlying disorder that is causing the acid-base distur...
Source: Emergency Medicine Clinics of North America - July 24, 2023 Category: Emergency Medicine Authors: Skyler A. Lentz, Daniel Ackil Source Type: research