Challenging and Emerging Conditions in Emergency Medicine

Challenging and Emerging Conditions in Emergency Medicine

Product code :479818

With growing numbers of chronically ill patients surviving longer and receiving novel medical and surgical treatments, emergency departments are increasingly the venue for associated acute presentations. How can emergency physicians respond to these challenging and emerging conditions?

This book focuses on the unusual and complex disease presentations not covered in detail in the standard textbooks, helping you manage patients with conditions such as congenital heart disease, cystic fibrosis, morbid obesity, intellectual disability, and intestinal failure.

Not only does this book provide guidance on evaluation and diagnosis, but it also addresses the practical issues of acute management and continuing referral. The individual chapters are written by high-profile emergency physicians, in conjunction with appropriate specialists, and include authoritative evidence to back up the clinical information.

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Arvind Venkat, MD, FACEP
Director of Research,
Department of Emergency Medicine and Ethics Consultant,
Allegheny General Hospital
Associate Professor of Emergency Medicine,
Drexel University College of Medicine
List of contributors
Chapter 1 Introduction,
Arvind Venkat
Chapter 2 The post-cardiac arrest patient,
Ankur A. Doshi and Clifton W. Callaway
Chapter 3 Adults with congenital heart disease,
Kara M. Iskyan and Craig R. Cohen
Chapter 4 The renal transplant patient,
Joseph B. Miller and K. K. Venkat
Chapter 5 The end-stage renal disease patient on dialysis,
K. K. Venkat and Arvind Venkat
Chapter 6 Adults with cystic fibrosis,
Arvind Venkat and Joseph M. Pilewski
Chapter 7 Adults with sickle-cell disease: implications of increasing longevity,
Ward Hagar and Claudia R. Morris
Chapter 8 HIV-positive adults on HAART,
Arvind Venkat and Sukhjit S. Takhar
Chapter 9 Adults receiving chemotherapeutic regimens,
Moira Davenport and Mary Ann Howland
Chapter 10 The bariatric surgery patient,
Melissa B. Bagloo and Alfons Pomp
Chapter 11 The obese patient,
Andra L. Blomkalns and David W. Silver
Chapter 12 The geriatric trauma patient,
John M. O’Neill and Elan Jeremitsky
Chapter 13 Children with intestinal failure and complications from visceral transplant,
Melissa A. Vitale, Jeffrey A. Rudolph and Richard A. Saladino
Chapter 14 Family violence,
Daniel M. Lindberg and Esther K. Choo
Chapter 15 The intellectually disabled patient,
Jonathan S. Anderson and Shamai A. Grossman
Chapter 16 Adults with conditions causing chronic pain,
Victoria L. Thornton and Lauren T. Southerland
Published  John Wiley & Sons 
Published: 2011
Pages: 376
Format:: Softcover   
Dimensions:  6 x 9 
"When every second matters, bureaucracy needs to be shoved aside. Challenging and Emerging Conditions in Emergency Medicine discusses the important issues that emerge in serious issues that have life and death connotations on the line for it all. As the population ages, and new techniques emerge in medical science, and conditions lead to multiple emergency treatments as people live with heart disease, obesity, and other long term conditions. Discussing evaluation and diagnosis with essays from many long term emergency physicians and more, Challenging and Emerging Conditions in Emergency Medicine is a vital discussion of this very important aspect of modern medicine and the high complexity in this incredibly vital situations."
Midwest Book Review

Newly published monographs exist on borrowed time. Most are outdated before they are even brought to press and online education is changing the playing field for medical education. If a monograph is going to retain relevance in this new generation, then it needs to move away from the staid formula of regurgitating the entirety of a subject and instead it must explore the interesting little crevices. That is just the approach taken by Challenging and Emerging Conditions in Emergency Medicine. The editor, Arvind Venkat, has assembled a group of experts to write about the very subjects that emergency and critical care medicine specialists most want to read—the ones they see only infrequently.

The book consists of 16 short chapters with black and white photographs and line drawings. I would have liked to see even more of these line drawings in the work and it may have benefited from the addition of summary tables outlining key points in each chapter. This is a small format book, which will easily fit in the pocket of a laboratory coat allowing ready accessibility for on-call reading. The chapters are well-referenced and their brevity (each chapter ranges from approximately 20 to 30 pages) makes the text an easy read.

The postcardiac arrest patient chapter was particularly excellent and has become the introductory reading I offer to new rotating residents. In future editions, I hope that the editors can find room for a chapter on left ventricular assist devices, a subject that fits the bill of both challenging and emerging.

This book was written for emergency medicine practitioners; however, there are large swathes that are relevant for critical care medicine as well. This book is ideal supplementary reading for residents, fellows, and attending physicians in both emergency medicine and critical care.
Critical Care Medicine

Each chapter starts with an Introduction and epidemiology (the sum of factors that control the incidence, presence or absence of a disease). The topic headings are then presented along pertinent discussions. The number of topics and length of discussions vary in each chapter depending on how much depth the authors choose to get into.

The chapter ends with a short conclusion and a reference list which is typically quite large. This resource is for the benefit of the reader to gain additional information and insight and more specialized knowledge. Some charts, tables and computer tomography (CT) scans are also presented in each chapter to aid in learning.

The 16 chapters cover quite a broad range of conditions, complications and diseases that patients are afflicted with which require emergency treatment and surgery to remedy the problems. The variety of cases is large. For example, it varies from patients that have congenital heart disease or have had a cardiac arrest to those who have had a kidney transplant or have life-threatening renal disease.

All in all, this is a good book put together by Dr. Arvind Venkat as its editor. A fairly large variety of problems encountered in emergency rooms by doctors are covered in it. If you have had insufficient exposure to such cases in your medical and surgical textbooks, this is the book that can fill the gaps for you.

As the numbers of chronically ill patients presenting acutely to an ED increase, finding information about their care becomes challenging. This multi-author handbook covers those unusual and complex disease manifestations not regularly discussed in standard emergency textbooks. It includes a total of 16 chapters covering conditions as varied as cystic fibrosis, congenital heart disease and the bariatric surgery patient to adults with sickle cell disease, children with intestinal failure, family violence and the intellectually disabled patient.


Each chapter follows a consistent layout, with an introduction, epidemiology, pathophysiology, clinical associations, interventions, disease progression and management. These are followed by a section entitled ‘The next five years’ and a conclusion plus references, some from as recently as 2010. There is good use of tables, and occasional black and white diagrams, figures and X-rays.

The structured style of each chapter makes the book an easy read. The content not only clearly focuses on the ED presentation and management, but also includes fascinating additional snippets of information. Despite being written by high-profile North American emergency physicians and appropriate other medical specialists, most of the treatment and management recommendations are readily transferable to the Australasian setting. However, it is interesting to ponder how relevant some content will still be in the near future, particularly concerning rapidly changing areas, such as the complicated drug regimens in chapters like ‘HIV-positive adults on HAART’ and ‘Adults receiving chemotherapeutic regimens’.

This practical book is full of pearls that would otherwise be difficult to find. It would appeal to the emergency medicine advanced trainee and specialist physician who wanted to review the literature around unusual or unfamiliar situations. It is a really useful book to ‘dip into’, but is not intended as a ‘core’ textbook for standard knowledge. However, many will enjoy its fascinating content.
Emergency Medicine Australasia (2011) 23
, 785

Patients with severe illness and significant physical and social pathologies that were once perceived as life shortening are now living longer and in some cases, surviving into old age. As a consequence it is likely that patients with conditions that were once a rarity will be seen more frequently in the emergency department (ED) with either complications of their condition or co-morbidities. The need for specialist input with such patients is imperative, but there is also a requirement for ED staff to be familiar with the nature, presentation and progression of these conditions and current treatment strategies in order to meet the immediate needs of patients.


Venkat’s book provides an insight into some of the once unusual conditions that are now being seen in EDs, ranging from the more commonplace post-cardiac arrest patient, complications of obesity and those with chronic pain, to the esoteric problems of children with intestinal failure and complications of visceral transplantation. Each chapter gives an overview of the condition and its progression and the complications that might lead the patient to present to the ED, and a review of immediate management and current therapies. The chapters end with an interesting glance into the future, with projections of potential changes in treatment options and patient outcomes over the next 5 years.

The sections are readily digestible with easily accessible text and clear diagrams. Key therapies are presented in tables and lists, with clear referencing to current literature.

All of the contributors are based in the United  States (US) and as such much of the data on prevalence and treatment modalities have a US focus. However the unusual range of conditions covered and the guidance on immediate support and therapy make this an interesting and helpful resource for doctors, practitioners and nurses working in any ED.
International Emergency Nursing


With increasing numbers of complex cases coming through emergency room doors, this book will be invaluable in helping clinical teams manage patients with challenging conditions. These patients need to be diagnosed quickly and treated promptly as they are often at high risk and extremely poorly.

Increasing numbers of patients are presenting with a high body mass index, which is challenging when surgery is required. The book addresses the need to ensure that diagnostic and treatment plans are in place for the obese patient. Other conditions discussed include renal complications, chemotherapy and congenital heart disease.

This well-researched book is written by clinicians in the United States, but the content is relevant to nursing and clinical teams in the UK. There are excellent chapters on epidemiology, emergency department principles and radiology images, all illustrated with diagrams and tables.

I particularly enjoyed the predictions for the next five years, as people live longer with complex, chronic conditions.
Royal College of Nursing, Jane Brown


THE SPECIALTY OF EMERGENCY MEDICINE HAS EXPANDED IN many dimensions over the past 50 years. First and most dramatic is simply the magnitude of care that emergency departments (EDs) now provide. The volume of patients visiting EDs in the United States has increased to more than 117 million per year (39.4 per 100 population).1 The duration and extent of care provided in EDs are likewise increasing as hospital inpatient capacity is reached and patients in EDs receive prolonged care while awaiting inpatient beds. In addition, the constraints on the health care system continue to increase and the ED, which is always open and will necessarily see all comers, is becoming the portal of entry for a wider spectrum of patients.


The scope of practice in emergency medicine is expanding, with an ever-increasing number of subspecialty fellowships offered and increasingly advanced research and procedures being performed. Simultaneously, medical care has advanced, promoting vastly increased longevity for patients with diseases or congenital disorders that previously would have precluded their survival to adulthood. This increased longevity now leads to ED visits for complications of chronic diseases not seen by prior generations of emergency medicine physicians. Concurrently, with the increase in time patients spend in EDs comes a correlative increase in the duration that these patients are cared for in the ED. Moreover, new disease entities and treatment modalities have emerged, further expanding the breadth of cases presenting to EDs.



Challenging and Emerging Conditions in Emergency Medicine
has a stated goal of offering emergency physicians a resource when addressing patients with increased longevity despite chronic or congenital diseases, those receiving novel treatment modalities, and those with complications of social pathologies and lack of medical resources. The book nicely fills a wide gulf between standard textbooks in emergency medicine and the subspecialty literature and focuses on issues critical to the emergency medicine physician who will necessarily care for these patients. Edited by Arvind Venkat and written by notable experts, the book includes a compelling index listing topics that every emergency medicine physician will recognize as new challenges in the field. It is a welcome addition to the emergency medicine armamentarium, an up-to-date resource that deals with topics ranging from those increasingly common but always frightening cases of the adult with congenital heart disease to the all-too-common but exceedingly challenging issues of the obese patient with a medical or traumatic issue.


The structure of the individual chapters allows the opportunity to understand the epidemiology, procedural interventions, and disease presentation and management of each disease process. Each chapter includes a section titled “The Next Five Years” that provides an interesting view into the effects of the disease on the future of emergency medicine practice.

The book is more than complete enough to serve as a general reference yet concise enough to allow it to be used for general reading. It will serve as a superb study guide for emergency medicine residents and provide tremendous opportunity for practicing emergency medicine physicians to update their skill sets. Timely, highly relevant and well written,



Challenging and Emerging Conditions in Emergency Medicine should have a place on every emergency medicine physician’s reading list. @Henry Ford Health System









Emergency medicine textbooks are generally divided into two types: the general, which attempts to cover all of emergency medicine, and the specific, which covers a particular area such as gastrointestinal emergencies or neurologic emergencies. Although many of these texts mention common problems, few cover in any detail the rare, unusual, or emerging problems that we commonly encounter. Recently I have seen patients status postbariatric surgery, patients on human immunodeficiency virus (HIV) therapy, geriatric trauma patients, and patients on complex chemotherapeutic protocols.


Patients have become more complex and are living longer with diseases such as sickle cell anemia and cystic fibrosis who formerly would not survive until adulthood. Postresuscitation-induced hypothermia has been shown to be the most beneficial care we can offer, but many emergency physicians don’t initiate it. Dr. Venkat and his 27 contributors have selected a number of these conditions and have presented an approach to managing them. Nationally recognized emergency medicine experts such as Clifton Callaway, Andra Blomkalns, and Mary Ann J. Howland have authored chapters, and Dr. Venkat has recruited non-emergency medicine subject matter authorities for the specific areas covered.

The 16 chapters are not organized in a traditional manner, but rather by medical, surgical, and psychiatricconditions. Each chapter has a short description of the various problems that might be encountered, then a final section entitled ‘‘The Next Five Years.’’ This section was most fascinating in that it described many of the research horizons in that particular area. For example, gene therapy for cystic fibrosis, single-dose therapy for HIV, bariatric surgery for diabetes, and intestinal transplantation. The psychiatric chapters were quite informative, and we don’t get enough training in these areas even though we see a large number of patients with these problems. The intellectually disabled patient, family violence, and chronic pain patients are some of the most difficult patients that we encounter, and sometimes we have no solutions for them. The chapter on post-cardiac arrest is particularly well organized and lends itself to being a good resource for emergency department and intensive care unit guidelines.

In summary, I found this to be a quite interesting and informative work, not just for casual reading, but for developing standards and lectures in these challenging areas. I recommend this as required reading for both physicians in training and those of us who need a good way to keep up with the ever-changing field of emergency medicine.
Journal of Emergency Medicine








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