Key Concepts Pacemaker malfunction soon after implantation (within 6 to 8 weeks) is usually a result of a lead problem, such as a lead displacement, or a pacemaker programming issue, such as a pacing rate too slow for the patient’s…
Key Concepts Electrical therapy is appropriate for unstable patients in whom a dysrhythmia is the cause of symptoms—pacing if the heart rate is slow, countershock with sedation if fast. Any regular new-onset, symptomatic, wide-complex tachycardia should be assumed to be…
Key Concepts Symptoms of acute coronary syndrome (ACS) are variable. Clinicians must consider ACS in a broad range of presentations, especially in patients prone to subtle or non-chest pain presentations (for example, women, older patients, or those with comorbidities such…
Key Concepts Point of care thoracic ultrasound can be used to rule out pneumothorax with high sensitivity. For healthy young patients with a small primary spontaneous pneumothorax, observation with supplemental oxygen is an appropriate treatment option. For larger symptomatic primary…
Key Concepts Empirical antimicrobial therapy should be started in the emergency department (ED) for patients admitted with pneumonia. Streptococcus pneumoniae is the most commonly encountered pathogen in hospitalized patients, especially those requiring the intensive care unit. No characteristic radiographic pattern…
Key Concepts Viral infections cause most cases of pharyngitis. Patients should not be treated with antibiotics based on symptoms and exam alone. Patients with a Centor criteria score of 0 or 1 do not require further testing or treatment. Those…
Key Concepts Chronic obstructive pulmonary disease (COPD) is “a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway or alveolar abnormalities usually caused by significant exposure to noxious particles…
Key Concepts Inhaled and systemic steroid medications are effective in controlling airway inflammation and have important roles in the management of asthma exacerbations. Inhaled bronchodilators and systemic corticosteroids remain the mainstays of management for most acute asthma exacerbations. Acute severe…
Key Concepts Otitis Media Otitis media is caused by eustachian tube inflammation and dysfunction leading to fluid accumulation in the middle ear and proliferation of nasopharyngeal bacteria, most commonly Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Diagnosis of acute otitis…
Key Concepts Prophylactic topical antibiotics are not indicated for the treatment of corneal abrasions, and eye patches are not recommended because they can mask a worsening infection. Eyelid lacerations that may require referral to a plastic or ophthalmic surgeon include…