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Headache is a common chief complaint encountered by emergency physicians (EPs). It may be a symptom of benign diseases such as migraine headaches or a common virus. Unfortunately, it also may represent other, more life-threatening illnesses, including subarachnoid hemorrhage. Delineating which patients need radiologic imaging, spinal fluid testing, and even angiography is part of the challenge encountered by the EP. This issue will outline strategies for reducing risk in the headache patient. Specifically, diagnosis and management of subarachniod hemorrhage will be detailed.
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This article points out the disadvantages of partial DNR ordersfor both clinicians and patientsand offers clear steps for mitigating the problem by developing a supplemental patient care plan for patients who are less than full code.
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In this randomized, controlled trial, European investigators looked at the role of vasopressin in treating out-of-hospital cardiac arrest. Although the study did not show any benefit of using vasopressin when compared to epinephrine in terms of survival to hospital, this study nonetheless makes a weak argument to use vasopressin in cardiac arrest patients with asystole.
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Documentation requirements for every patient encounter have increased, leaving less time for the actual practice of medicine. While documentation is a burden to physicians and nurses, it does have unlimited value. Documentation allows for appropriate billing for the time and efforts of the physician, nurse, and other medical specialists. Thorough documentation allows for maximum reimbursement without fear of subsequent legal retribution from various government programs. Furthermore, the medical record is an essential historical document of the patients previous medical encounters. Documentation of the patient encounter and treatment will provide a defense to potential subsequent litigation that may ensue. The emergency physician may be unaware that a medical expert is reading a case of a previous patient encounter right now. The documentation of the care provided may preclude the plaintiffs expert from making assumptions and opinions adverse to the physician. This months issue will detail the importance of documentation and outline strategies for reducing risk.
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The first part of this two-part series addressed the use of US for complications of early pregnancy in adolescent females and for testicular complaints in pediatric and adolescent males. This issue focuses on the use, role, and limitations of US in the evaluation of cardiac, abdominal, and renal disease processes.
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Positive Alendronate Data in Osteoporosis; NSAIDs For Myocardial Infarction; Four-Hour Window for CAP Patients; FDA Actions.
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Over the past 50 years, our understanding of the acute respiratory distress syndrome (ARDS) has evolved, not only with respect to the pathophysiology of lung injury and hypoxemia, but also with the definition of this syndrome and its treatment. We still have a long way to go in our understanding about the variability in pulmonary gas exchange in patients with ARDS.
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