Issue 4 • 1000108 Emergency Medicine ISSN: 2165-7548 EGM, an open access journal Al Aseri

Abstract Background: The outcome of shock depends on early intervention and management of patient's arrival at the hospital. Managing these patients in the emergency department (ED) can be challenging because of the complex nature and various causes of the disease. This review discusses the indices that can be used by ED staff in approaching diagnosis and the management for shock particularly circulatory shock in the ED

Assessment and Management of Hypoperfusion in Sepsis and Septic Shock

Diagnosis of organ hypoperfusion in patient with sepsis is not always straightforward which makes septic shock definition, diagnosis, and early treatment are major challenges that emergency physicians and intensivist must deal with in their daily practice. Normal blood pressure does not always mean good organ perfusion, which means patient might develop septic shock, yet they are not hypotensive. There are several indices that could be used in combination to diagnose and manage hypoperfusion in patients with septic shock. Fluid resuscitation and vasopressor administration along with infection sources control are the cornerstones in septic shock management. This chapter will cover indices that can be used to diagnose hypoperfusion, type and amount of fluid and vasopressor that can be used in resuscitating septic shock patients

Keeping a high index of suspicion: lessons learned in the management of methanol ingestion

Methanol ingestion is an uncommon form of poisoning that can cause severe metabolic disturbances and potentially fatal and often irreversible organ/tissue damage. The diagnosis is sometimes elusive and requires a high index of suspicion. Because extent and irreversibility of the damage caused by formic acid is time sensitive, methanol poisoning should be recognised promptly so that it can be treated. Metabolic acidosis associated with an increased anion gap and osmolar gap is an important laboratory finding but is not always present. A case of severe methanol poisoning is presented that demonstrates the unique challenges in the diagnosis and management, and the lack of readiness of the health care system for such cases. We highlight some of the diagnostic difficulties associated with treating a patient with a reduced level of consciousness and severe metabolic acidosis. We also review the pitfalls of using laboratory tests to rule out alcohol ingestion and discuss the definitive management of methanol poisoning

Behavioural induced severe hypernatremia without neurological manifestations

Hypernatremia is a relatively common entity and is more prevalent among the elderly and critically ill. A number of medical conditions are commonly associated with hypernatremia, and these differ substantially among children and adults. Severe hypernatremia is usually associated with central nervous system manifestations and carries a high mortality rate. We report a case of a female patient who presented to the emergency department of the King Khalid University Hospital, Riyadh, Saudi Arabia with severe hypernatremia and without any associated co-morbid conditions or neurological manifestations. We did not find any etiological background despite extensive eva-luation other than under hydration due to decreased fluid intake, which was secondary to beha-vioural causes

ST segment elevation in a patient presenting with renal colic pain

ST segment elevation of more than 1 mm from the baseline is an electrocardiographic presentation of acute myocardial injury. This phenomenon is not confined only to ischemic injury, and various other etiological factors have been described in relation to ST segment elevation. We report the case of a young man who presented in the emergency department complaining of loin pain. He was subsequently found to have transient ST segment elevation, but a thorough evaluation showed no evidence of coronary artery disease. ST segment elevation is one of the best tools for diagnosing acute myocardial infarction, of which reperfusion therapy is the treatment of choice thus making it important to make the diagnosis as quickly as possible. It is equally important, however, not to misdiagnose acute myocardial infarction, as there are other causes of ST segment elevation. Therefore, we report this unique case of renal pain due to stone causing ST segment elevation

Níveis de PCR são maiores em pacientes com síndrome coronariana aguda e supradesnivelamento do segmento ST do que em pacientes sem supradesnivelamento do segmento ST

FUNDAMENTO: Há grande interesse no uso de proteína C-reativa de alta sensibilidade (PCR-as) para avaliação de risco. Altos níveis de PCR-as no início da síndrome coronária aguda (SCA), antes da necrose tecidual, pode ser um marcador substituto para comorbidades cardiovasculares. OBJETIVO: Dessa forma, nosso objetivo foi estudar diferentes medidas de seguimento de níveis de PCR-as em pacientes com SCA e comparar as diferenças entre infarto do miocárdio sem elevação do segmento ST (NSTEMI) com pacientes apresentando elevação do segmento ST (STEMI). MÉTODOS: Este é um estudo observacional. Dos 89 pacientes recrutados, 60 apresentavam infarto agudo do miocárdio (IAM). Três níveis seriados de PCR-us, a nível basal na hospitalização antes de 12 horas após inicio dos sintomas, níveis de pico 36-48 horas após hospitalização e níveis de acompanhamento após 4 a 6 semanas foram analisados e comparados entre pacientes com (IAMCSST) e sem supradesnivelamento do segmento ST (IAMSSST). RESULTADOS: Pacientes com IAMCSST tinham IMC significantemente mais alta quando comparados com pacientes IAMSSST. Os níveis de creatino quinase fração MB (CK-MB) e aspartato aminotransferase (AST) eram significantemente mais altos em pacientes com IAMCSST quando comparados com pacientes com IAMSSST (p<0,05). Os níveis de PCR a nível basal e no acompanhamento não diferiram de forma significante entre os dois grupos (p=0,2152 e p=0,4686 respectivamente). Houve uma diferença significante nos níveis de pico de PCR entre os dois grupos. No grupo de pacientes com IAMCSST os níveis foram significantemente mais altos quando comparados aos pacientes com IAMSSST (p=0,0464). CONCLUSÃO: Pacientes com IAMCSST apresentam picos significantemente mais elevados de PCR quando comparados a pacientes IAMSSST. Esses dados sugerem que o processo inflamatório tem um papel independente na patogênese do infarto do miocárdio. Dessa forma, os níveis de PCR podem ajudar na estratificação de risco após o infarto do miocárdio