Articles: emergency-services.
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The emergency department (ED) evaluation of patients with potential acute coronary syndromes (ACS) has traditionally included initial cardiac marker testing for suspected acute myocardial infarction (AMI). While ED management decisions for patients with ACS have largely been based on history, physical examination, and a presenting 12-lead electrocardiogram (ECG), there is ample evidence that markers impact treatment decisions and provide risk stratification. Newer, more sensitive markers of myocardial necrosis have blurred the distinction between patients with and without classically defined AMI, and have focused attention on the continuum of ACS from angina to transmural Q-wave MI. ⋯ Such centers use serial cardiac marker testing as a mainstay for evaluation and risk stratification. Cost issues have driven many diagnostic patient evaluations from the inpatient setting to such ED observation units. As this becomes more common for low- to moderate-risk patients with chest pain, serial assessment of cardiac markers, and their interpretation by emergency physicians, will become essential.
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This article describes the history and current status of the practice of hospital-based accident and emergency (A&E) medicine in the United Kingdom of Great Britain and Northern Ireland. Included are comments on training and certification, the operations of the typical A&E department, and developments in research and academics. Also included are the authors' thoughts on issues of future importance to A&E medicine. As transatlantic links at all levels become increasingly common in this dynamic specialty, we clarify unfamiliar terminology and practices for international readers.
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To analyse the reliability of the obtained results in the identification of cases of asthma and chronic obstructive pulmonary disease (COPD) diagnosed in the medical records of the emergency rooms of the
of Valencia, Spain. ⋯ The consistency of the results is good for both observers, but better for the first observer, particularly for asthma. For the COPD category the results are more homogeneous, showing a good concordance for both observers. The results for the inter-observer study also show a good reliability. -
Noninvasive ventilation (NIV) is the provision of ventilatory support to a spontaneously breathing patient without endotracheal intubation. In this review, we detail concerns related to endotracheal intubation and summarize the physiologic effects and clinical application of NIV. We then address the use of NIV in 5 conditions of particular interest to the practitioner of emergency medicine: exacerbated chronic obstructive lung disease, severe asthma, patients who are not candidates for endotracheal intubation, pneumonia, and pulmonary edema.