Supraventricular Tachycardia

2020 ◽  
Author(s):  
Annalee M Baker
Keyword(s):  
Supraventricular Tachycardia ◽  
Valsalva Maneuver ◽  
Atrioventricular Node ◽  
Therapeutic Interventions ◽  
Channel Blockers ◽  
P Waves ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
Regular Rhythm ◽  
Pharmacologic Agents

Supraventricular tachycardia (SVT) is a category of arrhythmias that originate at or above the atrioventricular node. These are typically narrow complex QRS arrhythmias, without discernible P waves, with a regular rhythm and rapid rate. SVT is relatively common, occurring in 2.25 cases per 1,000 persons. Therefore, understanding the pathophysiology and method of treatment of SVT is an important skill for the emergency medicine physician to master. Therapeutic interventions include vagal maneuvers or pharmacologic agents, such as adenosine or calcium channel blockers, for the stable patient and synchronized cardioversion for the unstable patient. Stable patients with minimal comorbidities whose sinus rhythm is converted back in the emergency department can be safely discharged with a close follow-up by a cardiologist. However, admission is often required for the patient who presents with unstable SVT or has multiple comorbidities and requires further work-up.   This review contains 10 figures, 3 tables, and 48 references. Keywords: ablation, adenosine, cardioversion, supraventricular tachycardia, valsalva maneuver, Wolff-Parkinson-White syndrome

Harnessing the Chaplain’s Capacity to Identify Unmet Palliative Needs of Vulnerable Older Adults in the Emergency Department

2021 ◽  
pp. 082585972110033
Author(s):  
Elizabeth Hamill Howard ◽  
Rachel Schwartz ◽  
Bruce Feldstein ◽  
Marita Grudzen ◽  
Lori Klein ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
End Of Life Care ◽  
Older Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Life Care ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
One Year

Objective: To explore chaplains’ ability to identify unmet palliative care (PC) needs in older emergency department (ED) patients. Methods: A palliative chaplain-fellow conducted a retrospective chart review evaluating 580 ED patients, age ≥80 using the Palliative Care and Rapid Emergency Screening (P-CaRES) tool. An emergency medicine physician and chaplain-fellow screened 10% of these charts to provide a clinical assessment. One year post-study, charts were re-examined to identify which patients received PC consultation (PCC) or died, providing an objective metric for comparing predicted needs with services received. Results: Within one year of ED presentation, 31% of the patient sub-sample received PCC; 17% died. Forty percent of deceased patients did not receive PCC. Of this 40%, chaplain screening for P-CaRES eligibility correctly identified 75% of the deceased as needing PCC. Conclusion: Establishing chaplain-led PC screenings as standard practice in the ED setting may improve end-of-life care for older patients.

scholarly journals Subarachnoid hemorrhage in the emergency department

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Sima Patel ◽  
Amay Parikh ◽  
Okorie Nduka Okorie
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Subarachnoid Hemorrhage ◽  
Early Management ◽  
Vast Number ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
Diagnostic Modalities ◽  
Poor Outcomes ◽  
Subarachnoid Hemorrhages

Abstract Background Subarachnoid hemorrhage accounts for more than 30,000 cases of stroke annually in North America and encompasses a 4.4% mortality rate. Since a vast number of subarachnoid hemorrhage cases present in a younger population and can range from benign to severe, an accurate diagnosis is imperative to avoid premature morbidity and mortality. Here, we present a straightforward approach to evaluating, risk stratifying, and managing subarachnoid hemorrhages in the emergency department for the emergency medicine physician. Discussion The diversities of symptom presentation should be considered before proceeding with diagnostic modalities for subarachnoid hemorrhage. Once a subarachnoid hemorrhage is suspected, a computed tomography of the head with the assistance of the Ottawa subarachnoid hemorrhage rule should be utilized as an initial diagnostic measure. If further investigation is needed, a CT angiography of the head or a lumbar puncture can be considered keeping risks and limitations in mind. Initiating timely treatment is essential following diagnosis to help mitigate future complications. Risk tools can be used to assess the complications for which the patient is at greatest. Conclusion Subarachnoid hemorrhages are frequently misdiagnosed; therefore, we believe it is imperative to address the diagnosis and initiation of early management in the emergency medicine department to minimize poor outcomes in the future.

scholarly journals Ingestion and Pharyngeal Trauma Causing Secondary Retropharyngeal Abscess in Five Adult Patients

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Sudhir B. Sharma ◽  
Paul Hong
Keyword(s):  
Emergency Medicine ◽  
Foreign Body ◽  
Clinical Features ◽  
Case Series ◽  
Adult Patients ◽  
Retropharyngeal Abscess ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
Local Trauma ◽  
Pertinent Information

Retropharyngeal abscess most commonly occurs in children. When present in adults the clinical features may not be typical, and associated immunosuppression or local trauma can be part of the presentation. We present a case series of five adult patients who developed foreign body ingestion trauma associated retropharyngeal abscess. The unusual pearls of each case, along with their outcomes, are discussed. Pertinent information for the emergency medicine physician regarding retropharyngeal abscess is presented as well.

Abstract TP241: Neurologists' Role in Telestroke; How Essential Are We?

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Amelia Adcock ◽  
Justin Choi ◽  
Ashley Petrone
Keyword(s):  
Emergency Medicine ◽  
Acute Stroke ◽  
Final Diagnosis ◽  
Stroke Patients ◽  
Provider Group ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
Significant Difference ◽  
Hemorrhagic Complications ◽  
Trained Provider

Background: Telestroke networks have effectively increased the number of ischemic stroke patients who have access to acute stroke therapy. However, the availability of a dedicated group of stroke subspecialists is not always feasible. Hypothesis: Rates of tPA recommendation, accuracy of final diagnosis and post-tPA hemorrhagic complications do not differ significantly between neurologists and an emergency-medicine physician during telestroke consultations. Methods: Retrospective review of all telestroke consults performed at a comprehensive stroke center during one year. Statistical analysis: Chi squared test. Results: 303 consults were performed among 6 spoke sites. 16% (48/303) were completed by the emergency medicine physician; 25% (76/303) were performed by non stroke-trained neurologists, and 60% (179/303) were completed by a board-certified Vascular Neurologist. Overall rate of tPA recommendation was 40% (104/255), 38% (18/48), 41% (73/179), and 41% (31/76) among the all neurology-trained, emergency medicine- trained, stroke neurology-trained and other neurology- trained provider groups respectively (p = .427). Accuracy of final stroke diagnosis was 77% (14/18) and 72% (75/104) in the emergency-medicine trained and neurology-trained provider groups (p = 0.777) No symptomatic hemorrhagic complications following the administration of tPA via telestroke consultation occurred in any group over this time period. One asymptomatic intracerebral hemorrhage was observed (0.96% or 1/104) in the neurology-trained provider group. Conclusion: Our results did not illustrate any statistically significant difference between care provided by an Emergency Medicine-trained physician and neurologists during telestroke consultation. While our study is limited by its relatively low numbers, it suggests that identifying a non-neurologist provider who has requisite clinical experience with acute stroke patients can safely and appropriately provide telestroke consultation. The lack of formerly trained neurologists, therefore may not need to serve as an impediment to building an effective telestroke network. Future efforts should be focused on illuminating all strategies that facilitate sustainable telestroke implementation.

Atrial premature beats

ESC CardioMed ◽  
2018 ◽  
pp. 2050-2052
Author(s):  
Tatjana Potpara
Keyword(s):  
Heart Disease ◽  
Sinus Node ◽  
Pulmonary Veins ◽  
Atrioventricular Node ◽  
Structural Heart Disease ◽  
Class Iii ◽  
P Waves ◽  
Asymptomatic Patients ◽  
Narrow Qrs Complex ◽  
Premature Beats

Atrial premature beats (APBs), also referred to as atrial or supraventricular extrasystoles, represent premature atrial depolarization occurring earlier than the next expected regular sinoatrial activation, usually from a site outside the sinus node. Premature depolarizations originating from the atrioventricular node or His bundle are termed atrioventricular junctional premature beats. In general, APBs occur in adults of any age, with or without structural heart disease. Increased atrial volume and/or pressure, or increased sympathetic tone are associated with increased frequency of APBs, while in individuals without structural heart disease APBs often originate from the pulmonary veins and may precipitate atrial fibrillation. Patients with APBs are often asymptomatic, or experience palpitations, dizziness, or even presyncope. Significant haemodynamic compromise due to APBs is uncommon. Physical examination may reveal pulse irregularity, and surface electrocardiograms (ECGs) usually show premature P waves which differ from the sinus P morphology, followed by a normal, shortened, or prolonged PR interval (depending on the APB site of origin) and narrow QRS complex. Ambulatory ECG (Holter) monitoring helps to establish the diagnosis when symptoms are sporadic or to quantify the frequency of APBs. Counselling and reassurance would suffice in most minimally symptomatic or asymptomatic patients with APBs, but any underlying cardiovascular disorder must be treated. Beta blockers or class III antiarrhythmic drugs (or class IC in patients without significant structural heart disease) can be used to attenuate symptoms or suppress the APBs facilitating other tachyarrhythmias. Catheter ablation could be considered in selected patients.

The Utilization of Quality Assurance Methods in Emergency Medical Services

1993 ◽  
Vol 8 (2) ◽  
pp. 127-132 ◽  
Author(s):  
Eric A. Davis ◽  
Anthony J. Billitier
Keyword(s):  
Emergency Medicine ◽  
Quality Assurance ◽  
Emergency Medical Services ◽  
Medical Director ◽  
Medical Services ◽  
Residency Programs ◽  
Medical Control ◽  
Emergency Medical ◽  
Emergency Medicine Physician ◽  
Medicine Physician

AbstractObjective:The concept of the necessity of a good quality assurance (QA) plan for emergency medical services (EMS) is well-accepted; guidelines as how best to achieve this and how current systems operate have not been defined. The purpose of this study was to survey EMS systems to discover current methods used to perform medical control and QA and to examine whether the existence of an emergency medicine residency affected these components.Methods:A survey was mailed in 1989 to the major teaching hospitals associated with all of the emergency medicine residency programs (n = 79) and all other hospitals with greater than 350 beds within the 50 largest United States metropolitan areas (n = 172). If no response was received, a second request was sent in 1990. The survey consisted of questions concerning four general EMS-QA categories: 1) general information; 2) prospective; 3) immediate; and 4) retrospective medical control.Results:Completed surveys were received from 78.5% of residency and 50% of non-residency programs. The majority had an emergency medicine physician as medical director (80.1% vs 61.5%, p = .03). While both residency and non-residency hospitals participated in initial public and prehospital personnel education, academic programs were more likely to be involved in continuing medical education (98.2% vs 82.3%, p = .009). On-line (direct) supervision was more likely to be provided by residency institutions (96.4% vs 81.0%, p = .017) which was provided by a physician in 88.3%. Trip sheet review was utilized by 62.0% of non-residency and 75.5% of residency programs responding, and utilized the paramedic coordinator (44.5% vs 46.1%) or medical director (35.7% vs 34.5 %) primarily.Conclusion:This survey characterizes some of the current methods utilized nationwide in EMS-QA programs. Further research is needed to determine the effectiveness of these various methods, and to develop a model program.

scholarly journals Emergency medicine physician burnout and wellness in Canada before COVID19: A national survey

CJEM ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 603-607 ◽  
Author(s):  
Rodrick Lim ◽  
Kristine Van Aarsen ◽  
Sara Gray ◽  
Louise Rang ◽  
Jada Fitzpatrick ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
High Risk ◽  
Final Analysis ◽  
Maslach Burnout Inventory ◽  
Health And Wellness ◽  
Physician Burnout ◽  
The Past ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
Baseline Information

ABSTRACTIntroductionEmergency medicine (EM) is a high-risk specialty for burnout. COVID-19 has had and will continue to have important consequences on wellness and burnout for EM physicians in Canada. Baseline data are crucial to monitor the health of EM physicians in Canada, and evaluate any interventions designed to help during and after COVID-19.ObjectivesTo describe the rates of burnout, depression, and suicidality in practicing EM physicians in Canada, just before the COVID-19 pandemic.MethodsA modified snowball method was used for survey distribution. Participants completed the Maslach Burnout Inventory – Health Services Tool (MBI-HSS), a screening measure for depression (PHQ-9), and a question regarding if the physician had ever or in the past 12 months contemplated suicide.ResultsA total of 384 respondent surveys were included in the final analysis: 86.1% (329/382) met at least one of the criteria for burnout, 58% (217/374) scored minimal to none on the PHQ-9 screening tool for depression, 14.3% (53/371) had contemplated suicide during their staff career in EM, and of those, 5.9% (22/371) had actively considered suicide in the past year.ConclusionCanadian EM physicians just before the COVID-19 pandemic had an alarming number of respondents meet the threshold for burnout, confirming EM as a high-risk specialty. This important baseline information can be used to monitor the physical and mental risks to EM physicians during and after COVID-19, and evaluate support for mental health and wellness, which is urgently needed now and post pandemic.

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