lem for each patient should be searched for and assumed to be present (7:4). Such an approach makes the immediate delivery of health care the main priority (7:4).
Next, the physician should try to determine the severity of the patient's illness (7:4). In emergency medicine, the automatic assumption should be that the patient is very ill (7:4). Not only does such an attitude increase the physician's diligence, but it focuses him on ruling out the most serious diagnosis (7:5).
Typically, a multitude of medical problems are encountered in the emergency department (7:12). Most emergency physicians, however, actually treat fewer patients and use fewer medications to do so than many other medical specialists (8:35). It is only when the acutely ill patient does come in, that therapies tend to be rapid, specific, and aggressive (8:35). In fact, quite often there is even a tendency to underdose (8:35): the extreme circumstances encountered in the field may, at times, necessitate unduly radical countermeasures.
Of the drugs commonly used, perhaps epinephrine hydrochloride is the most essential. It has a variety of important applications. An endogenous catecholamine with both alpha and beta adrenergic activity, epinephrine is the vasopressor of choice during cardiopulmonary resuscitation (6:26). It prevents arterial collapse, increases peripheral vasoconstriction, and raises aortic diastolic pressure without significantly constricting coronary or cerebral blood vessels (6:26). Its alpha adrenergic effects are important for the restoration of spontaneous circulation from VF, asystole, and electromechanical dissociation (6:27).
Epinephrine is also useful in the treatment of shock. With cardiogenic shock i.e., that due to ventricular dysfunction (9:294) the drug is typically a second or third line agent (6:51). Its drawback is that it can be difficult to determine the dosage at which induced vasoconstriction and syst...