ABSTRACT
Raynaud's phenomenon manifests as triphasic color changes of the digits, induced by exposure to low temperature or emotional stress. It is a relatively common disorder, estimated to affect 5% to 10% of the general population and 25% to 30% of otherwise healthy women. Although usually self-limiting, it can be severely painful and debilitating, and complicated by ulcerations and tissue necrosis. For the emergency physician treating a patient with an acute presentation of the phenomenon, the main challenges are to achieve adequate pain control, reverse vasospasm, and maintain viable tissue. Emergency treatment can also extend to patient education and arrangement of appropriate referrals and follow-up care.
Subject(s)
Raynaud Disease , Emergencies , Female , Humans , Raynaud Disease/diagnosis , Raynaud Disease/physiopathology , Raynaud Disease/therapy , Vasoconstriction/physiologyABSTRACT
Malaria is a health problem of growing concern to the emergency physician. Plasmodium vivax, P ovale, and P malaria infections are relatively benign and can be treated in an outpatient setting with oral chloroquine or amodiaquine. In contrast, P falciparum can present fulminantly, often resulting in death with multiple organ system failure. Although quinine historically has been the mainstay of therapy for severe falciparum malaria in the United States, and still is outside the U.S., quinidine gluconate as a continuous infusion is currently recommended as the agent of choice for severe P falciparum infection. In addition to the rapid administration of appropriate chemotherapeutic agents and the institution of aggressive supportive care, exchange transfusion may be utilized as a means of rapidly reducing the parasitemia and consequently, the mortality.
Subject(s)
Emergency Medicine/methods , Malaria , Adult , Antimalarials/pharmacology , Antimalarials/therapeutic use , Child , Clinical Protocols , Diagnosis, Differential , Drug Resistance , Exchange Transfusion, Whole Blood , Humans , Malaria/diagnosis , Malaria/mortality , Malaria/parasitology , Malaria/physiopathology , Malaria/therapyABSTRACT
Esophageal injuries are potentially serious disorders requiring prompt recognition and management. In addition to the well-recognized Mallory-Weiss and Boerhaave's syndromes, there exists a condition of spontaneous intramural esophageal hemorrhage: esophageal apoplexy. A case of esophageal apoplexy is presented as well as an evaluation of clinical presentations based on a collected review of the 66 cases previously reported. In addition, esophageal apoplexy is contrasted with the Mallory-Weiss and Boerhaave's syndromes, focusing on distinguishing attributes of utility to the emergency practitioner.
