Managing suicidal emergencies: Recommendations for the practitioner.

All practicing psychologists with an active caseload occasionally encounter a patient or client whom they consider to be a suicidal emergency. Few psychologists, however, have had education or training focused on managing such cases. The current article conceptualizes what a "behavioral emergency" is, gives recommendations for containing the emergency client's emotional turmoil, and sets forth an evidence-based approach, using diagnosis-specific risk factors, for improving the clinician's ability to estimate suicide risk. Recommendations are also given for appropriate responses to the patient or client on the basis of the level of estimated risk. Having such an algorithm or plan for dealing with the suicidal client is essential to good practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managing diabetes during glucocorticoid therapy. How to avoid metabolic emergencies

Although glucocorticoid therapy carries a risk of promoting or exacerbating hyperglycemia, there are currently no established medical guidelines for detecting or managing diabetes in patients starting such therapy. The authors use three case reports to illustrate a relatively simple strategy that can be used to manage preexisting and new-onset diabetes in the primary care setting.     

医学信息服务在突发公共卫生事件中的地位与作用

突发公共卫生事件是指已经发生或者可能发生的、对公众健康造成或者可能造成重大损失的传染病疫情和不明原因的群体性疫病,还包括重大食物中毒和职业中毒,以及其他危害公共健康的突发公共事件[1],它具有突发性、危害性、不可重复性、难以预防等特性,但这并不意味着人们必须等到事件发生后才能去慌忙应对.     

Children's memory for medical emergencies: 2 years later.

Long term recall of medical emergencies (including both injury and hospital treatment) by 2- to 13-year olds was assessed 2 yrs after injury. Event identity was important: Children recalled injury details better than hospital treatment. Ninety-six children were interviewed 3 times prior to the 2-year recall; amount recalled decreased only for hospital treatment details, although accuracy of recall decreased for both injury and treatment. Twenty-one children were interviewed only twice prior to the 2-year interview. An extra interview 1 year after their injury had little effect on how much older children recalled about injury details, but it helped younger children recall the less memorable hospital event. The extra interview also helped all children maintain accuracy when recalling hospital details, but was unnecessary for the more memorable injury event. Implications for children's testimony are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managing esophageal achalasia: medical and nursing implications

Achalasia is a motility disorder of the esophagus characterized by total loss of esophageal peristalsis and by defective lower esophageal sphincter function. The etiology of achalasia is poorly understood. Achalasia occurs across the lifespan, but is uncommon in children. Most patients have progressive dysphagia for both liquids and solids. This article describes the symptoms of achalasia, its diagnosis, and treatment. The emphasis is on primary achalasia. Case studies illustrate common findings in patients with achalasia. The importance of patient education for effective management of this chronic illness is discussed.     

Memory for medical emergencies experienced by 1- and 2-year-olds

Children (13-18 months, 20-25 months, and 26-34 months) who had experienced trauma injuries were recruited in a hospital Emergency Room and subsequently interviewed about them within days (if verbal) and after 6, 12, and 18 or 24 months. The youngest children demonstrated little long-term verbal recall, whereas a few children in the intermediate group, who could not narrate about past events at time of injury, could verbally recall the target events 18 months later. Most of the oldest children, who had narrative skills at time of injury, demonstrated good verbal recall 2 years later. Illustrative case histories were described. Accuracy of recall was low for the youngest children, and although the majority of older children's recalled information was accurate, there were still many errors.     

Splenic emergencies

Of medical and surgical emergencies in the pediatric abdomen, those involving the spleen are relatively less common than other abdominal organs, though equally important to recognize. A more sophisticated clinical understanding of the important role of the spleen in immunocompetence has developed in parallel with advancements in imaging. A healthy respect for the preservation of splenic tissue has emerged, altering traditional surgical management of splenic emergencies. Non-invasive imaging has come to play a vital role in depicting acute abnormalities and in determining the need for conservative, interventional, or surgical management.     

Diving-related emergencies

The proliferation of sport or recreational divers over the last several decades has resulted in significant increases in the number of patients treated for diving-related emergencies. The treatment of these individuals is no longer confined to a small group of physicians with special training or experience. Rather, community emergency physicians and physicians engaged in the practice of travel medicine are increasingly called on to treat such patients. This article discusses general physical principles relating to diving medicine and common presentations and treatment of diving-related emergencies.     

Hematologic emergencies

The most common life-threatening hematologic emergencies include hemorrhage and severe anemia. Successful treatment of these conditions depends on the emergency veterinarian having a thorough understanding of the possible etiologies of these conditions, and a systematic approach to diagnosis and therapy. Use of blood component therapy can be a life-saving technique in these patients. The goal of this article is to familiarize the emergency veterinarian with a systematic approach to the diagnosis and treatment of hematologic emergencies.     

Hysterical emergencies

Most probably common in emergency departments, but still not well studied in this context, the disorders formerly called "hysteria" are now included in the group "Somatization, undifferentiated somatoform, conversion and dissociative disorders" (SSCD disorders) DSM IV. Their common presentation is that of idiopathic somatic symptoms linked with mental disorders. In the emergency department these symptoms confront physicians who generally do not have extensive psychiatric training. The symptoms occur, and disappear, undetermined by the patients, who are genuinely ill and not malingering. Aside from the somatisation disorder, which by definition is chronic, invalidating and rare, the other disorders (SCD) can: be contingent on the picture of another acute, easily recognisable mental disorder; or, on the other hand, be highly reactional and transient; or constitute the "somatic presentation" of an anxious disorder, the panic attack, well known in somatic emergencies. Management is based on diagnostic considerations and by the difficulties of the patient to accept a psychic cause of the symptoms whereas he is experiencing an organic disorder. The possibilities of discussing such psychogenesis in the context of the emergency department are slight, and the best course is often to adopt a pragmatic and prudent medical approach. An essential point is respect of the patient and his ideas. The legal provision, which already exists, for the presence of psychiatrists in emergency departments should lead to physician-psychiatrist cooperation that would be beneficial for these patients.     

Urological emergencies

Every general practitioner has to deal with urologic emergencies. The most frequent illnesses are urinary retention, acute scrotum, priapism, macrohematuria, nephritic colic, obstructive pyelonephritis and pyonephrosis. Whereas urinary retention, as well as acute ureteric stone colic must generally be treated by the practitioner, the urologist must often be consulted in case of an acute scrotum or for priapism. Testicular torsion is one situation, where surgical treatment needs to be performed within 6 hours. Of utmost importance is his timely assistance with the obstructive pyelonephritis and pyonephrosis. These are initially often not recognized, especially because the first ultrasound examination of the intrarenal pyelone may not show a dilatation of the collecting system despite obstruction. If the adequate treatment with drainage and antibiotics is applied too late, this can result in serious and potentially lethal consequences.     

Vascular emergencies

This article reviews the initial assessment and emergent management of several common as well as uncommon vascular emergencies. Aortic dissection, aneurysms, and arterial occlusive disease are familiar but challenging clinical entities. Less frequently encountered conditions are also discussed including an aortic enteric fistula, mesenteric venous thrombosis, phlegmasia alba dolens, and subclavian vein thrombosis.