E-Book Overview
The specialty of emergency medicine effects most primary care practices daily by having to diagnose and treat acute patient complaints. New diagnostic and treatment methods in the areas of airway management, chest pain, DVT/PE and asthma, as well as cost effective use of the laboratory should become common knowledge for the emergency and primary care physician. Therefore, primary care providers nationally need to review and update their knowledge in the areas of emergency medicine .Dr. Robert Rogers is the director of Medical Student Education, Associate Residency Director of Emergency Medicine, as well as an Assistant Professor of Surgery at the University of Maryland School of Medicine.Dr. Joseph Martinez is an Assistant Professor of Surgery, as well as an Assistant Medical Director at the University of Maryland School of Medicine.
E-Book Content
Prim Care Clin Office Pract 33 (2006) xi–xii
Preface
Robert L. Rogers, MD Joseph P. Martinez, MD Guest Editors
Primary Care physicians (PCPs) are on the front lines of patient care. In addition to treating patients with chronic illnesses, they also evaluate and treat patients with acute complaints. This includes patients with complaints that may be potentially life-threatening, such as headache, chest pain, and abdominal pain. Most of these patients will not have a life-threatening cause of their symptoms. The astute PCP must always be vigilant for that patient who presents with serious disease masquerading as a benign illness. This issue of Primary Care: Clinics in Office Practice focuses on disease entities that absolutely must be recognized by PCPs. While providing a general review of each topic, the guest editors’ goal is to focus on atypical presentations and high-risk patient populations. Most outpatient practice facilities do not have the capability to perform extensive testing to rule out all of these life-threatening conditions. The aim of this issue is to increase awareness of some of these ‘‘masqueraders’’ and to encourage PCPs to always consider the worst case first. In some cases, the worst case may be ruled out simply by considering it and discarding it as a possibility, at which point more benign diagnoses may be considered. An example is the patient who presents with headache. A focused history and physical may be all that is required to rule out subarachnoid hemorrhage, meningitis, temporal arteritis, acute glaucoma, and stroke. At this point, more benign causes such as tension headache or migraine (which are much more common etiologies of headache) may be entertained. Conversely, if a patient’s headache is labeled ‘‘tension’’ or ‘‘migraine,’’ and subarachnoid hemorrhage is never even thought of, you may not get a second chance to make the diagnosis!
0095-4543/06/$ - see front matter Ó 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.pop.2006.06.011 primarycare.theclinics.com
xii
PREFACE
We have all been taught that diagnoses such as pulmonary embolus present very dramatically. This is unequivocally false. As this issue highlights, many serious, life-threatening diseases present quite subtly. Knowledge of risk factors for various diseases and an idea of their atypical presentations will serve the astute clinician well. The job of a PCP is undeniably difficult. As noted above, most patients who present with symptoms of potentially life-threatening disease will actually have a more benign entity. It is simply not feasible or prudent to refer every patient with abdominal or chest pain to the emergency department or a subspecialist. A busy PCP may go days, weeks, or even months without seeing a true emergency. The trick is to avoid becoming complacent to the point that when a patient does have an emergent condition, it is missed. The guest editors sincerely hope that this issue of Primary Care: Clinics in Office P