In the United States trauma is the leading cause of death in people aged 1 through 44. Blunt trauma accounts for the majority of trauma mortality overall, but in urban settings penetrating trauma, including firearm-related injuries, accounts for an increased…
Cardiopulmonary resuscitation (CPR) can be lifesaving for a patient in cardiac arrest, particularly in conjunction with other therapies such as defibrillation or delivery of medications. In several large clinical studies, data have shown that prompt delivery of CPR serves as…
Definition Pericardial effusion, the presence of fluid within the pericardial space, has a number of causes. As fluid accumulates, a critical point is reached at which pericardial pressure negatively affects cardiac filling and causes circulatory insufficiency. This is called pericardial…
The purpose of cardiac pacing is to restore or ensure effective cardiac depolarization. Emergency cardiac pacing may be instituted either prophylactically or therapeutically. Prophylactic indications include patients with a high risk for atrioventricular (AV) block. Therapeutic indications include symptomatic bradyarrhythmias…
Introduction The electrocardiogram (ECG) is a graphic recording of the electrical activity of the heart. The standard ECG is obtained by applying electrodes over the chest and limbs to record the electrical activity of the cardiac cycle. Developed over 100…
Patients with implanted pacemakers or automatic implantable cardioverter defibrillators (AICDs) are commonly seen in the emergency department (ED). Fortunately, the increased reliability of these devices has precluded a marked increase in patients with true emergencies related to device malfunction, but…
Introduction Defibrillation is an emergency procedure performed to terminate ventricular fibrillation (VF) ( Fig. 12.1 A ). VF is a potentially lethal, but survivable, rhythm commonly found in victims of sudden cardiac arrest (SCA). VF can be caused by myocardial…
Introduction Patients in the emergency department frequently complain of palpitations, heart fluttering, or a rapid heartbeat, which is often coupled with weakness, chest pain, or dizziness. The physician must determine the exact rate, rhythm, origin, and cause of the tachycardia…
Tube thoracostomy is a procedure used to evacuate an abnormal accumulation of fluid or air from the pleural space and can be performed on an elective, urgent, or emergent basis. Air or fluid can accumulate in the pleural space as…
Thoracentesis is a percutaneous procedure during which a needle is inserted into the pleural space to remove fluid for diagnostic or therapeutic purposes. When performed using real-time ultrasound (US) guidance, thoracentesis has an extremely low rate of complications. Anatomy The…