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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3970_Библиотеки_им_академика_М_И_Перельмана.pdf
INDEX
385
broadly-defi ned syndrome, 78
“broken heart” syndrome, 63
Bruce protocol, 21
bypass graft surgical techniques, 125
calcium channel blockers, 84, 91, 97, 100, 133
blocking agents, 106
in drug-induced heart disease, 251
calcium chloride, 126
calcium sensitizer, 178
cancer-related pericarditis, 233
cannon, 153
capnography, 129
carbon monoxide (CO), 61
poisoning, historical clues for, 62
carboxyhemoglobin (CoHb), 61
cardiac arrest, 123–35
advanced life support and emergency care for, 131
antidysrhythmics, 131–2
background, 128
basic life support (BLS), 130–1
case discussion, 123–8
case presentation, 123
case resolution, 127–8
decision making, 134–5
epidemiology, 128
future directions in care, 134
initial patient assessment, 128–30
out-of-hospital cardiac arrest (OOHCA), 130–1
post-cardiac arrest ED care, 133–4
protocol, out-of-hospital termination, 135
specifi c clinical situations, 132–3
vasopressors, 132
cardiac auscultation, 153, 202
cardiac biomarkers, 46
cardiac catheterization, 56, 58, 63, 64
laboratory, 47
cardiac computed tomography (CCT) angiography,
354–5
advantages, 358
sensitivity of, 356
utility, 356
cardiac dysrhythmia, 186
cardiac echocardiogram, 56
cardiac emergency, 87
cardiac examination, 147
cardiac infarction
treatment for, 60
cardiac ischemia, 305, 311
nonatherosclerotic, cause of, 59
treatment of, 62
atropine, 76
auscultation, 203
automatic external defi brillators (AED), 139, 140
effi cacy of, 145
home placement, 140
use of, 142
automatic implantable cardioverter defi brillator
(AICD), 150
AV reentry tachycardia (AVNRT), 98, 103
A-waves, 153
bacteremia, 202, 204
basic life support (BLS), 124
battery depletion, 153
Behçet’s syndrome, 78
beta-adrenergic blockers, in drug-induced heart disease,
250–1
beta-adrenergic receptors
concentrations, 63
beta-agonists, 99
beta-blockers, 6, 28, 41, 73, 100, 293, 355, 364
benefi ts of, 28
dose, 23
therapy, 28
toxicity, 133
use, 23
bicuspid aortic valve, 202
biomarkers, 21, 349, 352
blood pressures, 148, 186, 190
drops, 76
on infant, 372
blurred vision, 191
BNP levels, 156
Boerhaave’s syndrome, 9
bradycardia, 150
defi nition, 76
extrinsic causes of, 78, 79
bradydysrhythmias, 49, 71–84, 150
background/epidemiology, 76–7
case presentation, 71–6
case resolution, 76
common symptoms of, 72
decision making, 84
disposition, 83–4
etiologies/differential diagnosis, 77–9
initial workup history and physical, 77
management of, 83
pharmacologic doses in, 84
testing, 79–83
bradydysrythmia, 77
British Pacing and Electrophysiology Group (BPEG), 152
INDEX
386
cardiac tamponade, 9
case presentation, 3–6
CD4 count, 4
chest X-ray study, 10–11
decision making, 13
diagnostic imaging studies, 11–12
electrocardiogram (EKG), 10
emergency department patients, disposition of, 13
esophageal rupture, 9–10
evaluation of, 3
HIV history of patient, 4
hypertension history of patient, 5
initial chest pain workup, 7
isometric exercise for, 4
laboratory studies, 12–13
patients with, testing for, 10
pleuritic, 8
pulmonary embolism, 8–9
tension pneumothorax, 9
chest radiography, 46, 82, 157
chest X-ray, 148
imaging, 12
sensitivity, 11
studies, 5, 9, 24, 129
Chicago’s HeartSave Program, 144
chronic obstructive pulmonary disease (COPD), 98,
197, 289, 368
chylous effusions, 234
CK-MB, 234, 332
class IA antidysrhythmic agents, in drug-induced heart
disease, 252
clevidipine, in the treatment of hypertensive emergency,
305
clonidine, for hypertensive emergency management, 304
clopidogrel, 48
benefi ts of, 28
ClOpidogrel and Metoprolol in Myocardial Infarction
Trial (COMMIT), 28
cocaine causing atrial dysrhythmias, 244
colchicine, 234
complete valvular dysfunction, 203
computed tomography (CT)
imaging, 11
scan, 59
tube voltage, 11
venography, 13
computed tomography angiogram (CTA), 5, 22,
56, 57
coronary angiogram, 353
concomitant infectious process, 75
concomitant symptomatology, 100
cardiac markers, 4, 12, 326
cardiac troponins, 332–4
case discussion, 327–31
case presentation, 326–7
case resolution, 331
CK-MB, 332
creatine kinase, 332, 334
decision making, 335
relative risk and, 334
cardiac risk-stratifi cation testing, 357
cardiac stress testing, 344
cardiac tamponade, 192, 280
cardiac toxins. See drug-induced heart disease
cardiac transplantation, 245
cardiac troponins, 64
troponin-I, 27, 147
troponins T, 27
cardiocerebral resuscitation, 131
protocols, 134
cardiogenic shock, 51, 55
description of, 55
cardiomyopathy, 258, 265
background, 264
case discussion, 258–63
case presentation, 258
case resolution, 263–4
decision making, 265
disposition of patients with, 265
etiologies, 264
history, 264
physical examination, 264
testing, 264–5
cardiopulmonary resuscitation (CPR), 123, 124, 138
cardiotoxicity, 252
carotid-sinus syncope, 191
catheterization, 340
laboratory, 5, 40, 41
Caucasian ethnicity, 26
CCA-treated wood and in drug-induced heart disease, 248
cell surface ADP-receptors, 28
cellular phones, 154
central venous pressure (CVP), 87
cerebral hypoperfusion, 77
CHADS2 scoring system, 93, 94
chelation therapy, 248
chemotherapeutic agents, 233
chest pain, 3
acute coronary syndrome (ACS), 7
aortic dissection, 7–8
aspirin affects of, 6
background, 6–7
INDEX
387
D-dimer, 276
for acute aortic dissection, 277
assay, 8
testing, 13
deep venous thrombosis (DVT), 8, 189
clinical signs/symptoms, 8
defi brillation, 125
dehiscence, 367
depolarization, 154
digitalis, in drug-induced heart disease, 250
digoxin, 88, 107, 156, 261
use of, 93
diltiazem, 93, 99
2,3-dimercaptopropanol-sulfonic acid, 248
direct thrombin inhibitors (DTI), 30
dobutamine, for acute valvular heart disease, 205
door-to-balloon (DTB) time, 46, 56
“door-to-needle” time, 47
dopamine, for acute valvular heart disease, 205
doxorubicin, 233
Dressler’s-like pericarditis, 369
Dressler’s syndrome, 52, 233, 366
drug-induced heart disease, 237
anti-cancer chemotherapeutic agents, 252
beta-adrenergic blockers, 250–1
calcium channel blockers, 251–2
case discussion, 237–41
case presentation, 237
case resolution, 241–2
chemotherapeutic cardiac toxins, 252
class IA antidysrhythmic agents, 252
decision making, 253
digitalis, 250
environmental toxins, 247
antimony, 247–8
arsenic, 248
cobalt, 247
lead, 247
mercury, 247
organic solvents, 248
thallium, 248
medicinal toxins
cardiac agents, 250
medication-induced QT prolongation, 249–50
phosphodiesterase 5 inhibitors, 248–9
recreational toxins, 242
alcohol, 244–6
amphetamine, 246–7
cocaine, 242–4
drug-induced QT prolongation, 249
dual-chamber pacemakers, 149
congenital coronary artery anomalies, 61
congenital heart disease, 202, 373
in infants, 373
congenital heart lesion, 374
congestive heart failure (CHF), 192, 203, 305, 367
conventional angiography, 278
conventional coronary angiography
resolution, 351
cooling method, 133
copper chromium arsenate, 248
coronary angiography, 43, 59, 60, 63
coronary arteries (CA), 356
calcifi cation, 352
dissection, clinical presentation in, 60
occlusion, 61
coronary artery bypass graft surgery (CABG), 20, 42,
61, 367
related bleeding, 28
coronary artery disease (CAD), 22
long-term predictors for, 25
risk factors, 7
risk factors for, 25
coronary care unit (CCU), 20, 75
coronary computed tomography, 349–58, 351
cardiac computed tomography (CCT) angiography,
354–5
case discussion, 349–54
case presentation, 349
case resolution, 354
CCT use in ED populations, scientifi c basis for, 356–7
decision making, 358
disadvantages, 351
ideal diagnostic test, characteristics, 354
image acquisition and interpretation, 355–6
problem scope, 354
unresolved issues regarding CCT in ED populations,
357–8
coronary spasm, 63
coronary vasospasm. See Prinzmetal’s angina
corticosteroid, 234
C-reactive protein (CRP) levels, 91
creatine kinase, 332
creatine kinase-MB fraction (CK-MB), 12
crescendo angina, 311
CURB-65 score, 13
current cardiopulmonary resuscitation (CPR)
recommendations, 140
current leakage and inability, 154
Cushing’s syndrome, 79
cyclosporine, for hypertensive emergency management, 304
cytomegalovirus, 233
INDEX
388
beta-agonist effect, 132
use of, 132
epistaxis, 247
eptifi batide
benefi ts of, 29
erythropoietin, for hypertensive emergency
management, 304
esmolol, for hypertensive emergency management,
304
esophageal rupture
cause of, 9
European Resuscitation Council guidelines, 90
external defi brillation, 154
external pacing, 152
factor V Leiden, 8
FAST window, 129
subxiphoid ultrasound window, schematic
presentation, 129
febrile illness, 154
fenoldopan, acts at peripheral D1 receptors, 304
fi brinolytic agents, 47
fi brinolytic therapy, 40, 41, 47, 51
absolute contraindications to, 47
EKG criteria for, 47
relative contraindications to, 47
fi brin-specifi c agent, 48
fi brin-specifi c fi brinolytic therapy, 49
fi bromuscular dysplasia, 303
fi rst-degree atrioventricular block, 81
fl uid drainage, 234
fl uoroscopy, 149
Framingham study, 91
Frank-Starling curve, 204
Frank T-wave inversions, 6
Frog sign, 102
Glasgow Coma Scale (GCS), 62
glucagon, 84
glycoprotein (GP)
2b-3a receptors, 43
IIb/IIIa inhibitors, 29, 30
inhibitor, 20
GRACE registry, 42
HACEK organisms, 203
Hamman’s crunch, 10
harsh systolic murmur, 51
heart failure
evidence of, 153
symptoms, 373
dyshrhythmias, 154
dyspnea, 276
dysrhythmias, 89, 100, 110, 120, 127, 186, 188, 245,
368–9, 370
dysrhythmic arrest, 126
dysrythmia, 93
Ebstein’s anomaly, 102
echocardiogram (ECHO), 6, 43, 58
echocardiography, 52, 57, 234, 366
Ehlers-Danlos syndrome, 8, 273
ejection fractions (EF), 39
elderly patients, 72
electrical cardioversion/defi brillation, 152
electrical storm, 155
electrocardiogram
12-lead, 155, 156
electrocardiogram (EKG), 10, 19, 22, 24, 26, 38, 44,
54, 58, 73, 79, 86, 89, 90, 350
diagnostic value, 26
gated protocols, 11
12-lead, 44–6, 50, 119, 124, 155
for case patient presenting with chest pain, 227
paramedic performance of, 39
repeat 12-lead, 101
tube current modulation, 355
electrocardiographic features, 116
electrocardiographic manifestations, 65
electrocardiographic rhythm, 77
electrode-myocardial interface, 154
electrolyte abnormalities, 132
electrolyte derangements, 154
electrophysiology (EP), 100
centers, 115
Elisa D-dimer, 57
emergency department (ED), 147, 163, 185
emergency echocardiography
diagram of, 130
emergency physician (EP), 112
EMS systems, 39, 131, 142, 144, 364
agencies, 99
personnel, 126
encounter refractory myocardium, 89
endless loop, 154
endocarditis, 6, 202–3
Duke criteria for diagnosing, 205
management, fl owchart for, 207
end-of-life of the unit (EOL), 149
enoxaparin, 49
environmental electrical activity, 153
epinephrine (EPI)
INDEX
389
in-hospital cardiac arrest, 124
interventricular septum, 78
intraluminal thrombus, 289
intrauterine pregnancy (IUP), 186
intravenous cocaine and endocarditis, 244
Intravenous drug abuse (IVDA), 202, 203
intravenous magnesium sulfate, 249
intubation, 203
ischemia, 154, 332
Ischemic coronary syndrome, 350
ischemic myocardium
sympathetic stimulation of, 49
Ischiorectal abscess, 366
isoproterenol, 76
isoproteronol, 250
IV amiodarone
use of, 93
IV beta-blocker therapy
risks, 40
jugular venous distention (JVD), 304
jugular venous pressure (JVP), 9, 203
junctional ectopic tachycardia, 103
Korotkoff sound, 232
labatolol, for hypertensive emergency management, 304
lamifi ban, 29
left anterior descending artery (LAD), 45, 60
left bundle branch block, 321–3
left ventricular assist device (LVAD), 367, 370
left ventricular hypertrophy (LVH), 186, 333
leishmaniasis, 247
levosimendan, 178
life-threatening pacemaker-mediated tachycardias, 156
lightheadedness, 153
lithium-iodine batteries, 153
long QT syndrome, 151, 154
low molecular weight heparins (LMWH), 29, 30, 49
magnetic resonance imaging, 12
major adverse cardiac events (MACE), 357
Marfan’s syndrome, 8, 203, 276, 280
MAST suit, 99
maximum intensity projection (MIP), 355
metabolic abnormalities, 149
metoprolol, 76
therapy, 367
milrinone, 178
mitral regurgitation (MR), 51, 202
mitral valve prolapse, 202
hemodynamic compromise, 152, 156
heparin-induced thrombocytopenia (HIT)
history of, 49
hepatojugular refl ux, 261
high dosages of epinephrine (HDE), 132
His-Purkinje system, 82, 118
HIV-related pericardial disease, 233
hydralazine, in the treatment of hypertensive
emergency, 305
hyperglycemia, 23
hyperkalemia, 132, 154
associated tachycardia, 120
high risk for, 133
hyperlipidemia, 197
hypertension (HTN), 8, 86, 197, 280, 302
hypertensive emergencies, 297
background, 302–3
case discussion, 297–302
case presentation, 297
case resolution, 302
decision making, 305
defi ned, 303
epidemiology, 302–3
history, 303–4
hypertensive emergencies by organ system, 303
pathophysiology, 303
pharmacological management, 306
physical examination, 303–4
special cases, 305
aortic dissection, 305
congestive heart failure, 305
disposition, 305
treatment, 304–5
unique etiologies, 303
hypertrophic cardiomyopathy, 187, 192
hypertrophy of cardiac muscles, 265
hypoglycemia, 374
hypokalemia, 149
hypokinesis, 64
hypomagnesemia, 245
hypotension, 8, 64, 232, 280
hypothyroidism, 154
hypovolemia, 191
hypoxemia, 154
hypoxia, 373
idioventricular rhythm, 79, 80
implantable cardioverter-defi brillators (ICDs), 151
malfunction, 155
infarct-related artery (IRA), 44
infi ltrative/infl ammatory myocardial processes, 27
INDEX
390
testing, 216–20
treatment, 220–1
myoglobin, 333
myopericarditis, 230
native cardiac depolarizations, 153
nausea, 191
neoplastic-related pericarditis, 233
neurally-mediated hypotension, 191
neurological syncope, 191
nitroglycerin, 27, 62, 243
co-administration, 59
intravenous infusion, 49
nitroprusside
for acute valvular heart disease, 205
therapy in hypertensive emergencies, 305
nodal blocking agents, 79
nonatherosclerotic
cause of cardiac ischemia, 59
noncardiogenic pulmonary edema, 247
nonsteroidal antinfl ammatory agents (NSAIDS),
229, 234
non-ST segment elevation myocardial infarction
(NSTEMI), 10, 18–30, 25, 311, 334
background, 19–30
case discussion, 18–24
case presentation, 18
decision making, 30
North American Society of Pacing and
Electrophysiology (NASPE), 152
NPD code
for ICDs, 157
NPG code, 152
for pacemakers, 157
nursing home records, 147
Ontario Prehospital Advanced Life Support (OPALS),
130, 141
study group, 126
OOHCA survivors, 131
out-of-hospital cardiac arrest strategies, 138–58
barriers to early therapy, 144–5
case discussion, 138–40
case presentation, 138
case resolution, 140
decision making, 145
EMS timely response, challenge, 142
public access defi brillation, 142–3
public access defi brillation programs, 143–4
sudden cardiac arrest
importance of early therapy, 141–2
Mobitz type 1 block, 81
Mobitz type 2 block, 81
Mobiz type 2 (2:1) block, 82
monomorphic ventricular tachycardia, 114
morphine sulfate, 49
multidetector CT (MDCT) scanner, 355
coronary angiography, 279
multifocal atrial tachycardia (MAT), 109
multi-planar reformations (MPR), 355
Mycobacterium tuberculosis, 231, 233
myocardial infarctions (MIs), 5, 21, 59, 91,
226, 369
acute, 38
chemical diagnosis of, 332–5
clinical classifi cation, 333
clinical classifi cation of, 26
diagnosis of, 64
pain treatment of, 41
rule-out, 12
myocardial ischemia, 190
aortic dissection with coronary occlusion, 61
carbon monoxide poisoning, 61–2
case discussion, 54–9
case presentation, 54
case resolution, 59
congenital coronary artery anomalies, 61
coronary artery dissection, 60–1
coronary embolism, 59–60
coronary vasospasm, 62–3
decision making, 65
Takotsubo cardiomyopathy, 63–5
thyrotoxicosis, 63
unusual causes of, 54–65
myocardial perfusion testing, 345
myocardial rupture, 51
myocarditis
background, 213
case discussion, 209–13
case presentation, 209
causative agents, 215
decision making, 223
disposition of patients with, 222
epidemiology, 214
etiologies of, 214
high dose gamma globulin (IVIG) therapy, 221
history and physical examination, 216
pathophysiology, 215–16
prognosis, 221–2
special presentations, 216
specifi c therapies
in certain populations, 221
INDEX
391
differential diagnosis, 232–3
disposition, 234–5
epidemiology, 230–1
etiologies, 232–3
hospitalization for patients, indications for
with acute pericarditis, 235
initial workup history, 231–2
physical examination, 231–2
testing, 233–4
perimyocarditis, 230
peripheral edema, 261
pharmacologic stress testing, 345
phosphodiesterase inhibitors (PDEIs), 177–8
phosphodiesterase 5 inhibitors, in drug-induced heart
disease, 248
physical examination, 153
fi ndings of alcoholic cardiomyopathy, 244
of STEMI patient, 227
PIOPED II investigators, 13
platelet inhibitors, 48
polyarteritis nodosa, 303
PORT score/pneumonia severity index, 13
postarrest/therapeutic hypothermia (TH) induction
protocol for, 134
post-CABG chest radiograph, 369
postcardiac surgery emergencies, 363–71
background and epidemiology, 367–8
case discussion, 364–7
case presentation, 363–4
case resolution, 367
decision marking, 371
dysrhythmias, 368–9
infections, 369
left ventricular assist devices, 370
myocardial infarction, 369
neurological complications, 368
pericardial effusion, 369
valvular surgery, 370–1
postop cardiac patients
fever, causes of, 369
postoperative myocardial infarction (MI), 365
postpericardiotomy syndrome, 233
preexcitation syndrome, 106
premature atrial contractions (PACs), 73
premature ventricular contraction (PVC), 73
pre-syncope, 153
Prinzmetal’s angina, 62, 63
procainamide, 110, 121, 132
propranolol, for hypertensive emergency management,
304
propylthiouracil (PTU), 89
problem, 140
therapies of value, 140–1
pacemaker-mediated tachycardias (PMTs), 154
pacemakers, 75
and ICDs, 152
malfunction, 153, 154, 157
patients with dysfunction, 152
background, 151–2
case discussion, 147–51
case presentation, 147
decision making, 157–8
differential diagnosis, 153–5
disposition, 156–7
etiologies, 153–5
history and physical examination, 152–3
testing, 155–6
syndrome, 155
wires, 366
pacemaker-sensing threshold, 154
pain
chest (See chest pain)
“ripping”/“tearing,” 7
palpitations, 191
of the chest, 203
panic disorders, 192
paroxysmal atrial tachycardia (PAT), 110
pediatric cardiac emergencies, 372–80
atrial fi brillation, rate control medications for, 380
case discussion, 372–6
case resolution, 376–7
concepts of
background/epidemiology, 377
disposition, 378–9
etiologies/differential diagnosis, 378
initial workup, history and physical, 377–8
management, 378
testing, 378
decision making, 379–80
percutaneous coronary interventions (PCIs), 10, 21, 39,
46, 134, 312
availability of, 41
pericardial effusion, 369
pericardiocentesis, 234, 280
pericarditis
acute vs. coronary syndromes, 235
background, 230–1
case discussion, 226–30
case presentation, 226
causes of acute pericarditis, 231
decision making, 235
INDEX
392
sensor-induced tachycardias, 154
serial cardiac biomarkers, 112
serial cardiac enzymes, 76
serologic test’s markers of acute infl ammation, 234
serum electrolytes, 157
“shockable rhythm” concept, 141
sick sinus syndrome, 78
sildenafi l, 248
sino-atrial (SA) node, 77
sinus bradycardia, 79
sinus tachycardia (ST), 109, 115
Sjogren’s syndrome, 78
skeletal muscle fasciculations, 153
skeletal muscle myopotentials, 153
sodium channel blocker, 133
toxicity, 252
solvent abuse, 248
somatization disorder, 192
standard antipotassium pharmacologic therapy, 125
standard dosages of epinephrine (SDE), 132
Stanford type A aortic dissection, 61
Staphylococcus aureus, 204
infections, 202
ST-elevation myocardial infarction (STEMI),
25, 124
EKG evidence, 127
steroids, 229
streptokinase, 41, 322
use of, 42
stress, 337
background, 343
case discussion, 338–43
case presentation, 337–8
case resolution, 343
decision making, 347
differential diagnosis, 343–4
disposition, 345–6
etiology, 343–4
management, 346
test, 4, 5, 21, 23, 98, 353
testing, 344–5
stroke-like syndromes, 8
ST-segment depression, 40
ST-segment deviation, 92
ST-segment elevation, 62, 151, 234
in ischemia, 233
ST-segment elevation myocardial infarction (STEMI),
10, 138, 227, 300, 334
case discussion, 38–43
case presentation, 38
case resolution, 42–3
protein synthesis, 245
PR-segment depression, 234
psychiatric disorders, 192
public access defi brillation (PAD) approach, 139
initiative, 141
programs, 143–4
strategy, 142–3
pulmonary edema, 203
pulmonary embolism (PE), 5, 8, 10, 57, 87
poor specifi city for, 8
symptoms of, 8
pulmonary embolism rule-out criteria (PERC) rule,
8, 9
pulmonary embolus (PE), 188
pulse rate, 147
P wave, 149, 155
QRS complexes, 78, 79, 82, 97, 98, 103, 104, 110,
112, 116, 119, 121, 149, 151, 155, 245, 252,
321, 322
QRS voltage, 51
QT syndrome, 250
radiation therapy, 233
rapid imaging, 9
rapid sequence intubation (RSI), 374
rapid sinus tachycardia, 102
regular, narrow QRS complex tachycardia
initial 12-lead EKG demonstrating, 98
respiratory distress, 203
respiratory management drugs, 76
respiratory syncytial virus (RSV), 373
resuscitation, 156
resveratrol decreases arterial damage, 246
retavase plasminogen activator (r-PA), 48
return of spontaneous circulation (ROSC),
128, 132
revascularization treatment, 48
revised Geneva score (RGS), 8
rheumatic heart disease, 203
rheumatologic diseases, 78
right coronary artery (RCA), 45, 60
right ventricular (RV)
infarction, 45, 51
paced rhythm, 323
risk-stratifi cation scores, 357
Roth spots, 202
salvage angioplasty, 41
scanning techniques, 11
schistosomiasis, 247
INDEX
393
systemic lupus erythematosus, 233
systemic vascular resistance, 178
tachycardia, 73, 98, 108, 150, 232
tachydysrhythmias, 50
differential diagnosis for, 106
TACTICS trial, 20
tadalafi l, 248
Takotsubo cardiomyopathy (TC), 27, 58, 63–5.
See also apical ballooning syndrome
diagnosis of, 59
EKG in, 64
management of, 65
Mayo Clinic criteria for, 64
telemetry, 157
tenecteplase (TNK), 48
tension pneumothorax, 9
termination of resuscitation (TOR), 134
rules, 134
therapeutic hypothermia (TH), 133
thiamine defi ciency, 245
third-degree atrioventricular block, 83
thyrotoxicosis, 63, 261
time-tested interventions, 128
TIMI risk scores, 29, 352, 357
tissue plasminogen activator (t-PA), 48, 322
Torsades de pointes, 249
transesophageal echocardiogram (TEE), 12, 92, 94,
204, 278
transient global amnesia, 191
transient ischemic attack (TIA), 54
trans-thoracic echocardiography (TTE), 9, 204,
234, 276
traumatic coronary artery dissection, 60
treadmill, 337
triage vital signs, 147
tricyclic antidepressant (TCA) drugs, 112, 133
triglycerides, 234
troponins, 92, 234, 333, 334
troponin I testing, 12
troponin T
role, 12
T wave, 155
inversions, 151
UA/NSTEMI
aspirin administration for, 28
bleeding for, 30
management, 28
therapy for, 27
TIMI risk score for, 29
clinical criteria for, 43
clinical presentation in, 43–4
complication of, 51
complications of, 44, 49–52
decision making of, 52
emergency department diagnosis, 44–6
epidemiology and pathophysiology, 43
pathophysiology of, 43
pharmacological therapy for, 48
prognosis of, 49
reperfusion era, 43
treatment of, 46–9, 57
ST/T ratio, 234
subcutaneous emphysema, 10
succinylcholine, 76
sudden cardiac arrest (SCA), 140
majority, 140
sudden death, 190
superventricular tachycardia, 97–107
background/epidemiology, 101–2
case discussion, 97–101
case presentation, 97
case resolution, 101
decision making, 106–7
etiologies, 102–3
initial workup history and physical examination,
102
testing, 103–5
treatment and disposition, 105–6
supraventricular tachycardia (SVT), 98, 112, 115
defi nition, 101
emergency department interventions for patients, 107
forms, 103
“lone” paroxysmal, 101
oxygen saturation, 373
syncope, 102, 153
background, 189–90
case discussion, 185–9
case presentation, 185
case resolution, 189
decision making, 194
disposition of patients with, 194
Boston syncope guidelines, 194
risk factors and disposition, 193
San Francisco syncope rule, 194
in elderly patients, 192
etiologies of, 191–2
history and physical examination, 190–1
management, 194
testing in, 192–4
vs. seizure, 190
INDEX
394
ventricular dysrhythmia, 192
ventricular escape rhythm, 79. See also idioventricular
rhythm
ventricular fi brillation (VF), 51, 124
arrest, 141
ventricular pacing, 147
ventricular septal defect (VSD), 51
ventricular tachycardia (VT), 22, 51, 108–22, 113, 117,
118, 124, 151, 192
viral-induced effusions, 232
volume-rendered techniques (VRT), 355
VQ scan, 188–9
VVI pacemakers, 151, 153, 155
weakness, 153
Wegener’s granulomatosis, 78
Wellens’ sign. See Wellens’ syndrome
Wellens’ syndrome, 10
Well’s score, 8
wide complex tachycardia (WCT)
case discussion, 108–12
case presentation, 108
case resolution, 112
clinical presentation in, 115–20
decision making, 121–2
differential diagnosis, 108–22
hemodynamically-stable, 122
management, 120–1
wide QRS complex tachycardia
electrocardiographic rhythm, 113
Wolfe-Parkinson-White syndrome (WPW), 90, 100,
105, 110, 119, 121, 132
rhythm disturbance, 112
in wide QRS complex tachycardia, 120
X-ray source, 355
X-ray studies, 12
UK National Institute for Health and Clinical
Excellence, 90
ultrasound, 74
probe, 74
unfractionated heparin (UFH), 47, 48, 49
dose of, 49
inhibits factor Xa, 29
route of administration, 29
therapy, 29
unstable angina (UA), 25, 311
uremia, 233
vagal maneuvers, 99, 105
valsalva maneuver, 99
valvular abnormality, 202
valvular heart disease
background, 202
case discussion, 197–201
case presentation, 197
case resolution, 201–2
decision making, 208
differential diagnosis, 203–4
disposition of patients with valvular disease, 208
etiologies, 203–4
history and physical examination, 202
actue valvular regurgitation, 203
fl owchart for, 206
endocarditis, 202–3
Duke criteria for diagnosing, 205
management, fl owchart for, 207
testing in, 204
treatment of patients with, 205–8
vardenafi l, 248
vasopressors, 132
vasospasm, 63
vasovagal syncope, 191, 192
ventilation-perfusion scans, 12