1/24. Medicolegal aspects of acute myocardial infarction.Emergency physicians face significant liability in the diagnosis and management of patients with acute coronary syndromes. Newer diagnostic and therapeutic modalities continue to add to the tools that assist in sorting through the complexities of this group of patients. Nonetheless, the legal pitfalls continue unabated. Prudent patient care dictates vigilance in recognizing the atypical presentations, streamlining policies and procedures in the ED that impact on the management of these patients, and remembering that managed care policies affect payment, and not patient care.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/24. Acute pleuritic chest pain.BACKGROUND: The differential diagnosis of acute pleuritic chest pain is large and includes a number of life threatening conditions. Clinical suspicion plays a major role in the choice of investigation and the interpretation of the results. OBJECTIVE: To outline the clinical features and diagnostic workup of three acute causes of pleuritic chest pain--acute pulmonary embolism, pneumothorax and acute pericarditis. DISCUSSION: The general practitioner plays an important role in the initiation of the investigative pathway for these conditions. Appropriate referral for ongoing assessment and care requires the primary care physician to be aware of the available investigations and their limitations.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/24. Rescue of a patient out of a grain container: the quicksand effect of grain.Grain storage containers not only present inherent dangers to the operators, but also to the rescuers if someone falls in. Here we report the rescue of a patient from a grain container using a novel technique involving a cylinder placed around the patient. This allowed the grain to be sucked out from around the patient and enabled his rescue uninjured. The rescue action was complicated by acute chest pain in the patient while he was submerged in the grain, and a severe asthma attack in the emergency physician. The rescue and the dilemmas encountered are described together with a review of the relevant literature.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/24. Clinical case of the month. chest pain, diaphoresis, and dyspnea in a hypertensive 53-year-old man.Aortic dissection is a life-threatening condition requiring urgent diagnosis and treatment. The initial challenge for the physician lies in distinguishing aortic dissection from more common conditions such as myocardial infarction that also are characterized by chest pain. Subsequent management depends on imaging techniques that define whether just the descending aorta is affected or its more proximal portions as well. mortality and morbidity are high, especially when the ascending aorta is involved.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/24. Adverse reaction characterized by chest pain, shortness of breath, and syncope associated with verteporfin (visudyne).PURPOSE: To report a serious adverse reaction associated with verteporfin infusion. DESIGN: Observational case report. methods: Case report of a single individual undergoing photodynamic therapy (PDT) with verteporfin. RESULTS: A 77-year-old man with long-standing asymptomatic atrial fibrillation, but no known coronary artery disease experienced severe chest and neck pain, shortness of breath, and syncope while undergoing a fourth photodynamic therapy (PDT) treatment with verteporfin. This infusion had been preceded by three prior infusions; the first two were uneventful, and the third was associated with milder, but similar symptoms. Evaluation demonstrated that the chest pain was noncardiac in origin. CONCLUSION: As verteporfin continues to be used around the world, physicians must be alert to the possibility of serious adverse side effects associated with its use.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/24. chest pain evaluation.chest pain is one of the frequent complaints in patients presenting to emergency rooms and ambulatory care clinics. For the primary care physician evaluating these patients, there are three essential steps in the evaluation of chest pain. The first step is to determine whether the chest pain is cardiac in origin or not. If the pain is suspected to be cardiac, then the next step would be to determine if the chest pain is secondary to an acute coronary syndrome (acute myocardial infarction or unstable angina) that requires immediate referral to an emergency room to initiate therapy and admit to the hospital. If the pain is not considered to be due to an acute coronary syndrome, then we proceed with a systematic approach to try to determine the likelihood that a particular patient has significant coronary artery disease (CAD). This is determined based on the patient's history, risk factors and electrocardiogram. Once the likelihood is assessed, this will determine what further invasive or non-invasive tests would be required to complete the patient's evaluation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/24. ST. segment elevation: is it a possible infarct?In patients with acute substernal pain seen at Emergency Departments, ST segment elevations are considered the hallmark of an acute myocardial infarct. Acute substernal pain associated with ST segment elevations is the inclusion criteria for thrombolytic therapy. However, there are other conditions, which may present with ST segment elevation in which thrombolytic therapy is not indicated. Acute pericarditis and ECG variants of normal must also be considered in the differential diagnosis. Three cases are presented that illustrate this ECG presentation. It is of paramount importance, that the Emergency Department physician who does the triage for these patients be able to identify the various causes of ST segment elevation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/24. Uncommon cause of a common disease.myocardial infarction is a common life-threatening condition. Multiple agents can be used to treat acute coronary syndrome (ACS). These therapeutic agents pose potential life-threatening complications when used outside the realm of the acute coronary syndrome. Hypertrophic cardiomyopathy (HCM) is a common inherited cardiac disorder, occurring in 1 in 500 individuals, which may mimic ACS. The hypertrophy most typically involves the septum in patients with HCM. As many as 25% of Japanese patients with HCM have predominately apical involvement. Apical hypertrophic cardiomyopathy (AHC) occurs in only 1 to 2% of the non-Japanese population. Despite its low incidence, physicians caring for patients with chest pain need to consider AHC in their differential diagnosis. We present the case of a patient with chest pain and electrocardiographic changes suggestive of ACS who was later found to have AHC.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/24. Two years of debilitating pain in a football spearing victim: slipping rib syndrome.INTRODUCTION: Blunt chest trauma can occur in a variety of sports, and lead to rib fractures and less commonly known and diagnosed injuries. We report the case of a 14-yr-old student athlete who was speared (helmet tackled) in a practice scrimmage sustaining a painful injury that eluded diagnosis and treatment for more than 2 yr. methods: The case history of pain treatments and radiological evaluations is presented. RESULTS: Ultimately, a definitive diagnosis of "slipping rib syndrome" was achieved through a simple clinical manipulation (the hooking maneuver), combined with a history of symptomatic relief provided with costochondral blockade. Surgical resection of the slipping rib provided total resolution of the problem. CONCLUSION: Very few clinicians are aware either of the syndrome or the maneuver used to diagnose this condition. Although spearing has been outlawed in American football for years, it remains a commonplace occurrence, and sports physicians should be aware of the potential consequences to the victim as well as those to the perpetrator.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/24. High-altitude decompression illness: case report and discussion.decompression illness (DCI) can occur in a variety of contexts, including scuba diving and flight in nonpressurized aircraft. It is characterized by joint pain, neurologic injury, and respiratory or constitutional symptoms. To prepare flight crews for accidental decompression events, the Canadian Armed Forces regularly conducts controlled and supervised depressurization exercises in specialized chambers. We present the cases of 3 Canadian Armed Forces personnel who successfully completed such decompression exercises but experienced DCI after they took a 3-hour commercial flight 6 hours after the completion of training. All 3 patients were treated in a hyperbaric oxygen chamber. The pathophysiology, diagnosis and management of DCI and the travel implications for military personnel who have undergone such training exercises are discussed. Although DCI is relatively uncommon, physicians may see it and should be aware of its presentation and treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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