Emergency Medicine Practice
Transient Global Amnesia: Emergency Department Evaluation And Management
Transient global amnesia is a clinically distinct syndrome characterized by the acute inability to form new memories. It can last up to 24 hours. The diagnosis is dependent on eliminating other more serious etiologies including toxic ingestions, acute strokes, complex partial seizures, and central nervous system infections. Transient global amnesia confers no known long-term risks; however, when abnormal signs or symptoms are present, they take precedence and guide the formulation of a differential diagnosis and investigation. In witnessed transient global amnesia with classic features, a minimalist approach is reasonable, avoiding overtesting, inappropriate medication, and medical interventions in favor of observation, ensuring patient safety, and reassuring patients and their families.
Transient global amnesia (TGA) is a clinical syndrome defined by the acute onset of profound anterograde amnesia (the inability to form new memories) lasting up to 24 hours (mean duration of symptoms 4-6 hours) in the absence of other neurulogic deficits or changes in alertness and cognition.
Other diagnoses are not excluded if there was no witness to corroborate the onset of the attack.
Pediatric Emergency Medicine Practice
Acute Rheumatic Fever: An Evidence-Based Approach To Diagnosis And Initial Management
Acute rheumatic fever is an inflammatory reaction involving the joints, heart, and nervous system that occurs after a group A streptococcal infection. It typically presents as a febrile illness with clinical manifestations that could include arthritis, carditis, skin lesions, or abnormal movements. Of these, the cardiac manifestations of acute rheumatic fever are most concerning, as children may present in acute heart failure and may go on to develop valvular insufficiency or stenosis. Because this is a rare presentation to emergency departments in developed countries, it is crucial for clinicians to keep a broad differential when presented with clinical presentations suspicious for acute rheumatic fever. This issue focuses on the clinical evaluation and treatment of patients with acute rheumatic fever by offering a thorough review of the literature on diagnosis and recommendations on appropriate treatment.