بایگانی برچسب برای: Emergency

Interpretation.of.Emergency.Head.CT.A.[taliem.ir]

Interpretation of Emergency Head CT

In the early 1970s, Sir Godfrey Hounsfield’s research produced the first clinically useful computed tomography (CT) scans. • Original scanners took approximately 6 minutes to perform a rotation (one slice) and 20 minutes to reconstruct (Fig. 1a). Despite many technological advances since then, the principles remain the same. • On early scanners, the tube rotated around a stationary patient, with the table moving to enable a further acquisition. The machine rotated clockwise and counter-clockwise as power was supplied via a cable. • Modern-day helical or spiral scanners obtain power via slip ring technology, thus allowing continuous tube rotation as the patient moves through the scanner automatically (Fig. 1b). This allows a volume of data to be acquired in a single rotation, with the benefits of faster scanning, faster patient throughput and reduced patient movement artefacts. • New multi-slice scanners use existing helical scanning technology, but have multiple rows of detectors to acquire multiple slices per tube rotation. The faster imaging with multi-slice scanners allows a larger volume of coverage and multiphase scanning during intravenous contrast administration (Fig. 2). This, coupled with improved spatial resolution, allows organ- specific as well as vascular assessment, leading to the advent of CT angiography and virtual endoscopy. • Advanced computer processing power allows reconstructive techniques, such as threedimensional and multiplane reformatting, providing us with additional tools with which to improve diagnostic accuracy and aid clinical management.
Emergency.Dermatology.Second.[taliem.ir]

Emergency Dermatology

When cells are damaged, as often occurs during trauma and metabolic stress, the organism has to choose whether to repair the damage by promoting cell survival or to remove irreparably injured cells. Cell injury occurs when an adverse stimulus reversibly disrupts the normal, complex homeostatic balance of the cellular metabolism. In this case, after injury the cellsattempt to seal breaks in their membranes, chaperone the removal or refolding of altered proteins, and repair damaged DNA. On the contrary, when cell injury is too extensive to permit reparative responses, the cell reaches a “point of no return,” and the irreversible injury culminates in programmed cell death (PCD). Specific properties or features of cells make them more or less vulnerable to external stimuli, thus determining the kind of cellular response. In addition, the characteristics of the injury (type of injury, exposure time, or severity) will affect the extent of the damage. We present a short overview of the best-known PCD pathways. We emphasize the apoptotic pathway, considered for years the hallmark of PCD, and the different stimuli that produce cell injury.
Big.Book.of.Emergency.Department.[taliem.ir]

Big Book of Emergency Department Psychiatry

Te ideas in this chapter are my own experiences and opinions on different topics within the arena of emergency psychiatry. My frst experience working in an emergency department (ED) in America was a claustrophobic one. Te ED that I frst worked in by New York City standards was small, and therefore by every other standard was tiny. Te psychiatric ED was simply a small room flled with nurses, psychiatry residents, medical students, psychiatric technicians, and a few attending psychiatrists. Te space was so small that we only had one square yard to walk around in. In the middle of this small room was an ominous and intimidating secretary who yelled at anyone who asked her for something. Calling her “scary” would be an understatement. Over time, as I became used to the smallness of the psychiatric ED, psychologically it felt larger. Tere appeared to be more room to move around than I initially thought, and I was not afraid to respond when the phone was ringing. Ultimately, even the scary secretary became less terrifying and we became a functional team that worked well together. Before I knew it, my frst year of psychiatry residency training had come to an end. Years passed, and toward the middle of my third year of residency, I was asked to be the chief of the psychiatric ED. At that hospital, it was called the psychiatric observation suite (POS). I accepted the offer of that position, mostly because no one had offered me any other position. I also happened to look up to the director of the ED, as he is one of the best ED psychiatrists I have ever known.
Emergency Department...[taliem.ir]

Emergency Department Management of Obstetric Complications

Pregnant patients often present to the emergency department (ED) with chief complaints of abdominal pain and/or vaginal bleeding in the frst trimester .Women presenting to the ED in early pregnancy may not be aware of their pregnancy status; it is critical that emergency clinicians test for pregnancy in any woman of childbearing age with abdominal pain or vaginal bleeding. Helpful historical clues include date of last menstrual period (LMP) and, for patients who are aware they are pregnant, whether or not they have had an ultrasound with this pregnancy. Complications such as pain and bleeding in early pregnancy are common. Indeed, one fourth of women will have vaginal bleeding or spotting in the frst few weeks of pregnancy, and one half of those patients will miscarry . Ultimately these patients will receive a diagnosis of threatened miscarriage, miscarriage, pregnancy of unknown location, ectopic pregnancy, or, rarely, heterotopic pregnancy. Some complications such as ectopic pregnancy may be life threatening; others are emotionally devastating and may impact future fertility. Emergency physicians must be prepared to evaluate and manage the various complications of early pregnancy.
Emergency Clinical..[taliem.ir]

Emergency Clinical Diagnosis

The demands on emergency departments are rising worldwide. Simultaneously, the scope of practice of emergency medicine continues to expand. This is fuelled by an ageing population, complex medical presentations, rising patient expectations, diffculties with access to primary care facilities, and the desire for second opinions in the case of diagnostic delay or failure in primary care settings. Diagnostic failure is the leading source of clinical complaints and of medico-legal litigation involving emergency departments. The emergency practitioner not only needs to be profcient in the evaluation of common highstakes conditions, but also has to be aware of malignant disease and rarer conditions that can present to the emergency department and facilitate their diagnosis and subsequent management. This ensures more effective communication with specialists receiving referrals. In particular, the new diagnosis of cancer is increasingly being made in the emergency setting. Once the correct diagnosis is made, it is recognised that treatment protocols and referral pathways can vary widely and that local guidance is more appropriate. Diagnostic accuracy, however, remains a universal common concern. This book aims to provide the emergency practitioner with diagnostic aide-memoires and checklists as part of the front-line diagnostic armamentarium.