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Adrenal Emergencies
The adrenal glands drive physiologic homeostasis, with dysregulation in any direction causing multisystem dysfunction. Adrenal excess states include hyperaldosteronism which manifests with refractory hypertension and electrolyte abnormalities including hypernatremia and hypokalemia. Paragangliomas including pheochromocytoma can cause multisystem end-organ dysfunction due to catecholaminergic storm, which require rapid blood pressure control with phentolamine and identification of lesions amenable to surgical resection. Adrenal insufficiency states in contrast can result in hypotension and decompensation refractory to vasop...
Source: Emergency Medicine Clinics of North America - July 22, 2023 Category: Emergency Medicine Authors: Rachel E. Bridwell, Michael D. April Source Type: research

Disorders of Sodium
Sodium imbalances are a common occurrence in the emergency department. Although recognition and diagnosis are relatively straightforward, discovering the cause and management should be approached systematically. The most important history items to ascertain is if the patient has symptoms and how long this imbalance has taken to develop. Treatment rapidity depends on severity of symptoms with the most rapid treatment occurring in only the severely symptomatic. Overcorrection has dire consequences and must be approached in a careful and systematic fashion in order to prevent these devastating consequences. (Source: Emergency...
Source: Emergency Medicine Clinics of North America - July 19, 2023 Category: Emergency Medicine Authors: Aaron Alindogan, Ryan Joseph Source Type: research

Resuscitation Strategies for Maximizing Survival
There is no single resuscitation strategy that will uniformly improve cardiac arrest outcomes. Traditional vital signs cannot be relied on in cardiac arrest, and the use of continuous capnography, regional cerebral tissue oxygenation, and continuous arterial monitoring are options for use early defibrillation are critical elements of resuscitation. Cardio-cerebral perfusion may be improved with the use of active compression –decompression CPR, an impedance threshold device, and head-up CPR. In refractory shockable arrest, if ECPR is not an option, consider changing defibrillator pad placement and/or double defibrillation...
Source: Emergency Medicine Clinics of North America - June 29, 2023 Category: Emergency Medicine Authors: Elisabeth K. McHale, Johanna C. Moore Source Type: research

Cardiac Arrest
EMERGENCY MEDICINE CLINICS OF NORTH AMERICA (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 29, 2023 Category: Emergency Medicine Authors: Amandeep Singh, William Brady Source Type: research

Copyright
ELSEVIER (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 29, 2023 Category: Emergency Medicine Source Type: research

Contributors
AMAL MATTU, MD (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 29, 2023 Category: Emergency Medicine Source Type: research

Contents
Amal Mattu (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 29, 2023 Category: Emergency Medicine Source Type: research

Emergency Medicine Clinics of North America
Endocrine and Metabolic Emergencies (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 29, 2023 Category: Emergency Medicine Source Type: research

Cardiac Arrest!
There is nothing more dramatic in emergency medicine or exemplary of our specialty than the management of cardiac arrest. This is nothing less than bringing the dead back to life! Management of these patients brings together all of the key principles of our specialty, such as emergency airway management; knowledge of emergency cardiology, pulmonology, neurology, and pharmacology; procedural and point-of-care ultrasound (POCUS) expertise; and team leadership. Television and other forms of popular media typically show cardiac arrest as a routine scenario in the emergency department. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 29, 2023 Category: Emergency Medicine Authors: Amal Mattu Tags: Foreword Source Type: research

Cardiac Arrest as a Public Health Issue
Sudden cardiac arrest has a large public health impact, especially, because its incidence continues to increase across the globe. Data for low-to-middle income countries is incomplete. CPR training and automatic external defibrillator availability are important points for focusing future efforts. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 5, 2023 Category: Emergency Medicine Authors: Ana Romero Vazquez, Amita Sudhir Source Type: research

Cardiac Arrest in Special Populations
Best practices in cardiac arrest depend on continuous high-quality chest compressions, appropriate ventilatory management, early defibrillation of shockable rhythms, and identification and treatment of reversible causes. Although most patients can be treated according to highly vetted treatment guidelines, some special situations in cardiac arrest arise where additional skills and preparation can improve outcomes. Situations covered in this section involve cardiac arrest in context of electrical injuries, asthma, allergic reactions, pregnancy, trauma, electrolyte imbalances, toxic exposures, hypothermia, drowning, pulmonar...
Source: Emergency Medicine Clinics of North America - June 2, 2023 Category: Emergency Medicine Authors: Ravi W. Sumer, William A. Woods Source Type: research

Current Management of the Cardiac Arrest Patient
You are in the emergency department (ED), halfway through your shift. You are informed that a patient has collapsed in the hospital lobby, only 20 feet away. The patient is being rapidly moved from the lobby area to a resuscitation room. You are presented with an adult male at the upper end of the middle age years; no signs of life are noted …he lacks a palpable pulse and you do not observe any respiratory activity. You note coarse ventricular fibrillation on the monitor. This patient has the dubious distinction of being the most critically ill patient in the ED with the most extreme time-sensitivity of any presentation ...
Source: Emergency Medicine Clinics of North America - June 2, 2023 Category: Emergency Medicine Authors: Amandeep Singh, William Brady Tags: Preface Source Type: research

The Pharmacologic Management of Cardiac Arrest
This article covers the current state of evidence for the effectiveness of the vasopressor epinephrine and the combination of vasopressin-steroids-epinephrine and antiarrhythmic medications amiodarone and lidocaine and reviews the role of other med ications such as calcium, sodium bicarbonate, magnesium, and atropine in cardiac arrest care. We additionally review the role of β-blockers for refractory pulseless ventricular tachycardia/ventricular fibrillation and thrombolytics in undifferentiated cardiac arrest and suspected fatal pulmonary em bolism. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - May 10, 2023 Category: Emergency Medicine Authors: Amandeep Singh, Megan Heeney, Martha E. Montgomery Source Type: research

Team Strategies and Dynamics During Resuscitation
Resuscitations are complex events that require teamwork to succeed. In addition to the technical skills involved, a host of nontechnical skills are critical for optimal medical care delivery. These skills include mental preparation; planning for tasks and roles; leadership to guide resuscitation progress; and clear, closed-loop communication. Concerns and error detection should be escalated in an established format. Debriefing after the event helps identify learning points to carry forward for the next resuscitation. Support of the team providing this intense form of care is crucial to protect the mental health and functio...
Source: Emergency Medicine Clinics of North America - May 3, 2023 Category: Emergency Medicine Authors: Caitlin H. Bailey, Julie D. Gesch Source Type: research

Focused Ultrasonography in Cardiac Arrest
Rapid diagnostic tools available to the emergency physician caring for cardiac arrest patients are limited. Focused ultrasound (US), and in particular, focused echocardiography, is a useful tool in the evaluation of patients in cardiac arrest. It can help identify possible causes of cardiac arrest like tamponade and pulmonary embolism, which can guide therapy. US can also yield prognostic information, with lack of cardiac activity being highly specific for failure to achieve return of spontaneous circulation. US may also be used to aid in procedural guidance. Recently, focused transesophageal echocardiography has been used...
Source: Emergency Medicine Clinics of North America - April 25, 2023 Category: Emergency Medicine Authors: Matthew Kongkatong, Jakob Ottenhoff, Christopher Thom, David Han Source Type: research