Gregory M. Booth (editor) - Managing Emergencies in the Outpatient Setting: Pearls for Primary Care

This Springer imprint is published by the registered company Springer Nature Switzerland AG

The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

This book is for providers in the field of primary care. Primary care clinics and urgent care centers are presented with challenging patients on a regular basis that cannot be discharged safely to home. Sometimes these patients have obvious presentations based on extreme pain, fevers, unstable vital signs, etc. However, occasionally the presentation is ambiguous or even difficult to discern. This book is meant to provide useful information in these cases where it is unclear when the patient needs to be managed in the emergency department or hospital. The decision to hospitalize often depends on local resources and availability of quick specialist input. Oftentimes, urgent referral for specialist input can obviate the need for an ED visit, though time constraints on clinicians make this impossible in many cases.

Doctor William Osler once said that medicine is the science of uncertainty and the art of probability. In this regard, this book gives basic information on the incidence and risk factors associated with the condition in question in order to ascertain its probability. Pertinent details about the history and physical examination will also be provided. Diagnostics in the forms of point-of-care testing (urinalysis, EKG) and also various laboratory and radiology studies will be discussed.

Several themes will be apparent upon review of this work. The immunosuppressed, especially diabetics and those on corticosteroids, are especially vulnerable and great care should be utilized when managing these patients. Additionally, it goes without saying that vital signs are vital. Anytime a fever, tachycardia, hypotension, or orthostasis is encountered, a red flag is raised. Finally, overreliance on diagnostics can lead to underdiagnosis and overdiagnosis. Studies should be ordered to help confirm the diagnosis and should be interpreted cautiously within the clinical presentation.

Although this book does not cover every possible situation, information on the most commonly encountered scenarios in primary care is discussed. Hopefully by reading and having access to this material, you will be able to quickly identify and manage emergencies in the outpatient setting.

The editors would like to thank Emily Ball for help editing the manuscript and Olivia Welling for designing the illustrations.

Special thanks to Susan Tsu Thai for her careful reading of the manuscript and her constructive comments.

The following work is meant to aid in medical decision making and does not replace clinical judgment. The authors are not responsible for any uses of this material. This material does not address every potential situation that the clinician may encounter in practice. All clinical decision making must be weighed individually within the context of the patients overall presentation.

Cardiovascular disease is one of the most commonly encountered groups of conditions encountered in primary care. Atherosclerotic disease in the form of coronary artery disease (CAD), peripheral vascular disease, and diseases of the aorta will be covered in separate areas of the chapter, with special attention to chest pain and CAD. Congestive heart failure and disorders of rate and rhythm will briefly be discussed. The thrombotic disorders of pulmonary embolism (PE) and deep vein thrombosis (DVT) will be discussed in detail. The commonly encountered syndrome of syncope will also be discussed in detail. Hypertensive urgency and emergency and its management will be addressed at the end of the chapter.