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Hepatic Failure: An Evidence- Based Approach In The Emergency Department - $30.00
This issue includes 4 AMA PRA Category 1 CreditsTM; 4 ACEP category 1; 4 AAFP Prescribed credits; and 4 AOA Category 2B CME credits.
Authors
Caitlin Bailey, MD
Caitlin Bailey, MD
Alameda County Medical Center, Highland General Hospital,
Oakland, CA
H. Gene Hern, Jr. MD, MS, FACEP, FAAEM
H. Gene Hern, Jr. MD, MS, FACEP, FAAEM
Program Director, Alameda County Medical Center, Highland
General Hospital, Oakland, CA
Peer Reviewers
Rae Lynn Ortega, MD
Peer Reviewers
Rae Lynn Ortega, MD
Attending Physician, Department of Emergency Medicine,
Our Lady of Lourdes Medical Center, Camden, NJ
Alfred Sacchetti, MD, FACEP
Alfred Sacchetti, MD, FACEP
Chief of Emergency Services, Our Lady of Lourdes Medical
Center, Camden NJ. Assistant Clinical Professor, Department
of Emergency Medicine, Thomas Jefferson University,
Philadelphia, PA
Reuben Strayer, MD
Reuben Strayer, MD
Assistant Professor of Emergency Medicine, Mount Sinai
School of Medicine, New York, NY
Publication Date: April 1, 2010; Volume 12, Number 4
Excerpt from the issue...
On a typical swing shift, your ED is full of patients with a chief complaint listed as “abdominal pain.” You go in to see one such patient, a 40-year-old male, after his nurse tells you he “does not look very good.” He states that he has had gradually worsening abdominal pain for over a week, and that today he felt so fatigued he was unable to go to work. Before this, he was otherwise healthy, and no one around him has been sick. On further history, he reveals that 6 weeks ago he was started on isoniazid for a positive PPD (tuberculosis) test in the absence of active chest disease. Other than mild tachycardia (to 112 beats per minute), his vital signs are normal. Physical examination reveals that his sclerae are yellow and detects marked tenderness of the right upper quadrant with mild hepatomegaly. His wife tells you she is concerned because he seems confused.
You are interrupted by a call to the resuscitation bay to evaluate a patient whose blood pressure is 78/37 mm Hg. You recognize him because of his frequent visits to the ED for tense ascites requiring large-volume paracenteses. EMS reports that twice during transit he vomited dark-red blood. He is pale and diaphoretic. This patient is obviously critically ill, and it is clear your next steps will determine his outcome.
On a typical swing shift, your ED is full of patients with a chief complaint listed as “abdominal pain.” You go in to see one such patient, a 40-year-old male, after his nurse tells you he “does not look very good.” He states that he has had gradually worsening abdominal pain for over a week, and that today he felt so fatigued he was unable to go to work. Before this, he was otherwise healthy, and no one around him has been sick. On further history, he reveals that 6 weeks ago he was started on isoniazid for a positive PPD (tuberculosis) test in the absence of active chest disease. Other than mild tachycardia (to 112 beats per minute), his vital signs are normal. Physical examination reveals that his sclerae are yellow and detects marked tenderness of the right upper quadrant with mild hepatomegaly. His wife tells you she is concerned because he seems confused.
You are interrupted by a call to the resuscitation bay to evaluate a patient whose blood pressure is 78/37 mm Hg. You recognize him because of his frequent visits to the ED for tense ascites requiring large-volume paracenteses. EMS reports that twice during transit he vomited dark-red blood. He is pale and diaphoretic. This patient is obviously critically ill, and it is clear your next steps will determine his outcome.
Derek Kelly, MD - 06/15/2010
Great Review. Learned applicable data.
Great Review. Learned applicable data.