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Cardiovascular Emergencies, An Issue of Emergency Medicine Clinics of North America, E-Book

Cardiovascular Emergencies, An Issue of Emergency Medicine Clinics of North America, E-Book

Semhar Z. Tewelde

(2015)

Additional Information

Abstract

Drs. Tewelde and Reynolds have put together an excellent issue on Cardiovascuar Emergencies. Articles include:Pregnancy Related Coronary Artery Disease, Decompensated Cyanotic Heart Disease, Blunt Cardiac Injury, Blunt Cardiac Injury, STEMI Chameleons, Hypertensive Emergency, Troubleshooting the Pacer/ICD, Cardiogenic Shock, Cardiac Arrest, and more!

Table of Contents

Section Title Page Action Price
Front Cover Cover
Cardiovascular Emergencies\r i
Copyright\r ii
Contributors iii
Contents vii
Emergency Medicine Clinics Of North America\r xi
Foreword\r xv
Preface\r xvii
Cardiovascular Catastrophes in the Obstetric Population 483
Key points 483
Introduction 483
Hypertensive emergencies 484
Acute coronary syndrome 486
Cardiomyopathy 490
Dysrhythmias 491
Coronary Artery and Aortic Dissection 492
Thromboembolism 493
Cardiac arrest 494
Summary 495
References 495
The Critically Ill Infant with Congenital Heart Disease 501
Key points 501
Introduction 501
Epidemiology 503
Screening 503
Cyanosis 504
Presentation 505
Diagnosis 505
Hyperoxia Test 507
Physical Examination 507
Electrocardiography 508
Voltage criteria for hypertrophy 509
Laboratory analysis 509
Imaging 509
Echocardiography 510
Emergency department evaluation 510
Medical Management 512
Special considerations 514
Summary 515
References 516
Blunt Cardiac Injury 519
Key points 519
Epidemiology 519
Mechanisms and injury patterns 520
Cardiac Concussion (Also Called Cardiac Contusion) 520
Commotio Cordis 521
Cardiac Rupture 521
Valvular Injury 521
Coronary Artery Injury 522
Pericardial Injury 522
Dysrhythmias 522
Diagnosis 522
Treatment 524
Summary 525
References 525
Chameleons 529
Key points 529
Introduction 529
Left ventricular hypertrophy 530
Early repolarization 531
Left bundle branch block 532
Myopericarditis 532
Brugada syndrome 533
Prominent T waves 533
Hyperkalemia 534
Early Repolarization 534
Takotsubo or stress-related ST-segment elevation 534
Ventricular aneurysm 535
Summary 535
References 535
Hypertensive Emergencies in the Emergency Department 539
Key points 539
Introduction 539
Definition 540
Evaluation 541
History 541
Physical Examination 542
Diagnostic Testing 543
Management of hypertensive emergencies 543
Hypertensive Encephalopathy 543
Pulmonary Edema 544
Myocardial Ischemia 545
Aortic Dissection 545
Acute Renal Failure 548
Sympathomimetic Crisis 548
Hypertensive Emergency in Pregnancy 548
Summary 549
References 549
Congestive Heart Failure 553
Key points 553
Introduction 553
Pathophysiology 554
Classification 554
Causes 555
Symptoms and signs 555
Diagnostic testing 555
Electrocardiogram 555
Chest Radiography 555
Echocardiography 556
Laboratory Testing 556
Emergency department treatment 557
Noninvasive Positive-Pressure Ventilation 558
Pharmacologic Therapy 558
Mechanical Assistance 560
Summary 560
References 561
Cardiotoxicodynamics 563
Key points 563
Basic cardiac electrophysiology 563
Ion Channels and the Myocardial Cell Action Potential 563
Cardiac Dysrhythmia Initiation and Propagation 564
Antidysrhythmics 566
Introduction 566
Pathophysiology 567
Clinical Effects 568
Sodium channel blockers 568
Potassium channel blockers 569
Management 569
β-blockers and calcium channel blockers 572
Background 572
Pathophysiology 573
β-blockers 573
Calcium channel blockers 573
Clinical Effects 574
Cardiovascular 574
Central nervous system 575
Endocrine 575
Final common pathway 575
Management 575
Cardioactive steroids 578
Introduction 578
Pathophysiology 578
Clinical manifestations 578
Overview 578
Acute toxicity 579
Chronic toxicity 579
Diagnostics 579
Management 581
Gastrointestinal decontamination 581
Fluid and electrolyte therapy 581
Volume depletion 581
Advanced management 581
β-agonists and methylxanthines 582
Background 582
Pathophysiology 583
Clinical Manifestations 584
Cardiovascular 584
Central nervous system 585
Gastrointestinal 585
Metabolic 585
Management 585
Central α2-agonists 587
Introduction 587
Pathophysiology 587
Clinical Manifestations 589
Special considerations 589
Management 589
Acknowledgments 590
References 590
Atrial Fibrillation 597
Key points 597
Overview 597
Causes 598
Diagnosis 599
Management 599
Rate Control 600
Rhythm Control 601
Anticoagulation 604
Vitamin K antagonists 606
Direct thrombin inhibitors 606
Factor Xa inhibitors 606
Antiplatelet therapy 607
Human Immunodeficiency Virus Infection–Related Heart Disease 613
Key points 613
Introduction 613
Definitions 614
Coronary artery disease and acute coronary syndrome 614
Arrhythmias 616
Myocarditis and cardiomyopathy 617
Pericardial effusion 618
Valvular disease 619
Summary 619
References 620
Management of Crashing Patients with Pulmonary Hypertension 623
Key points 623
Introduction 623
Classification 624
Right ventricular dysfunction 626
Emergency department presentation 627
Diagnostic studies 628
Laboratory Testing 628
Electrocardiogram 628
Chest Radiography 629
Computed Tomography 629
Echocardiography 629
Initial management 632
Preload and Volume Status 632
Optimize Right Ventricular Systolic Function 633
Maintain Right Coronary Artery Perfusion 634
Reduce Right Ventricular Afterload 634
Nitric oxide 635
Prostanoids 635
Phosphodiesterase inhibitors 636
Additional considerations 636
Dysrhythmias 636
Anemia 636
Anticoagulation 636
Mechanical Circulatory Support 637
Summary 637
Acknowledgments 637
References 637
Cardiogenic Shock 645
Key points 645
Introduction 645
Pathophysiology 646
Treatment strategies 647
Medical management 647
Digitalis 647
Adrenergics 647
Phosphodiesterase Inhibitors 648
Calcium Sensitizers 648
Other Considerations 648
Mechanical support 648
Intra-aortic Balloon Pump 649
Ventricular-Assist Device 649
Extracorporeal Membrane Oxygenation 649
Summary 650
References 650
Emergency Care of Patients with Pacemakers and Defibrillators 653
Key points 653
Introduction 653
Permanent pacemakers 654
Indications for pacemaker placement 654
Pacemaker malfunction 655
Failure to Pace 656
Failure to Capture 656
Failure to Sense: Oversensing and Undersensing 656
Components of the pacemaker 656
Pulse Generator 657
Pacemaker Leads 657
Pacemaker Lead/Myocardium Interface 657
Emergency department approach to pacemaker malfunction 658
Investigation and Work-up 658
Management 658
Pacemaker-induced dysrhythmias and syndromes 659
Pacemaker-mediated Tachycardia 659
Runaway Pacemaker 659
Pacemaker Syndrome 660
Advanced cardiac life support 660
Implantable cardioverter-defibrillators 660
Indications for implantable cardioverter-defibrillators 660
Approach to the implantable cardioverter-defibrillator that has fired a single time 661
Approach to the implantable cardioverter-defibrillator that has fired multiple times 661
Inappropriate Shocks 662
Appropriate Shocks 662
Electrical Storm 662
Treatment 662
Checking cardiac biomarkers after defibrillation 663
Cardiac arrest in patients with implantable cardioverter-defibrillators 663
Pad Placement 663
Chest Compressions 663
Use of Magnets 663
Complications associated with device insertion: pacemakers and implantable cardioverter-defibrillators 663
Pocket Hematoma 663
Pocket Infections 664
Lead Infections 664
Pericardial Effusion 664
Pneumothorax 664
Thrombosis/Superior Vena Cava Syndrome 664
Summary 665
References 665
Cardiac Arrest Resuscitation 669
Key points 669
Introduction 669
General management considerations 670
Pit Crew Cardiopulmonary Resuscitation 670
Circulatory support 671
Mechanical Cardiopulmonary Resuscitation 671
Compression-Only Cardiopulmonary Resuscitation 671
Continuous Versus 30:2 672
Defibrillation 672
Energy Selection and Delivery Method 672
Timing of Shock Delivery 673
The Peri-Shock Pause 673
Airway 674
Adjuncts 674
Cricoid Pressure 674
Advanced Airways 674
Oxygenation 675
Ventilation 676
Pharmacotherapy 676
Advanced Cardiac Life Support Drugs: General Principles 676
Epinephrine 676
Vasopressin 677
Atropine 677
Antiarrhythmics (Amiodarone or Lidocaine) 677
Devices 678
Mechanical Chest Compression Devices 678
Active Chest Compression-Decompression 678
Impedance Threshold Device 678
A universal termination of resuscitation rule 678
Novel future directions 678
Dispatching Lay Rescuers Via Short Message Service (SMS) Mobile Phone Messages 679
Geographic Mapping of Automated External Defibrillators 679
Extracorporeal Life Support 679
References 680
Appendix 690
Postcardiac Arrest Management 691
Key points 691
Overview and goals of care 691
Determining the cause and extent of injury after cardiac arrest 691
History and Physical Examination 691
Baseline Neurologic Examination 692
Diagnostic Testing 692
Electrocardiogram 692
Laboratory testing 694
Imaging 694
Postcardiac Arrest Illness Severity 695
Management of the postarrest patient 695
Minimize Ongoing Brain Injury 696
Neurologic Prognostication 697
Airway 697
Oxygenation 698
Ventilation 698
Hemodynamic Considerations: End-Organ Perfusion 698
Myocardial Dysfunction 699
Coronary Revascularization 699
Temperature Management 700
Indications and Contraindications 700
Timing, Goal, and Duration 700
Methods for Induction/Maintenance 701
Sedation and Shivering 702
Rewarming 702
Side Effects 702
General Clinical Care 703
Regionalization of care 703
Summary 705
References 705
Appendix 712
Index 713