Emergency medicine clinics of North America
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The clinical presentations of chest wall and diaphragmatic disorders are extremely diverse, and the attention of the emergency physician is often directed to a more obvious problem. The common denominator of these disorders is their effect on respiratory mechanics, a discussion of which precedes the review of specific disorders.
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The employment of a ventilator adds flexibility to the treatment of hypoventilation and hypoxia in the emergency department. Understanding the advantages of spontaneous respiration, the effects of positive pressure ventilation and the use of CMV, IMV, and PEEP allows for optimal care for emergency respiratory problems.
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The interrelationships of several important factors contribute to the development of pulmonary edema. These factors include hydrostatic and osmotic forces, capillary membrane permeability, and lymphatic drainage capacity. Whether the pulmonary edema is cardiogenic or noncardiogenic, optimal management is facilitated by the improvement of ventilation and gas exchange within the lungs and the restoration of oxygen transport to peripheral tissues. The keystones in such therapy include the administration of oxygen, diuretics, and vasodilators; the use of mechanical ventilation; and the implementation of specific therapy directed toward underlying disorders.
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Emerg. Med. Clin. North Am. · Aug 1983
ReviewPneumothorax, hemothorax, and other abnormalities of the pleural space.
The clinical setting and treatment of various types of pneumothorax are detailed; chylothorax and hemothorax are also discussed. Tube thoracostomy, which can be performed with basic surgical skills if attention is paid to potential complications and optimal technique, is described.
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Acute hematologic-oncologic problems fall into two groups, those that require immediate assessment, diagnosis, and therapy, and those that require attention but are not life threatening if treated appropriately. Both types are considered in this article, which discusses hemorrhagic disorders; anemias, with special emphasis on patients with sickle cell disease; an approach to fever and infection in the immunocompromised child; and oncologic disorders that may be life threatening.