Intended for healthcare professionals

Clinical Review

Recent advances: Accident and emergency medicine

BMJ 1998; 316 doi: (Published 04 April 1998) Cite this as: BMJ 1998;316:1071
  1. Sarah A Stahmer, associate residency program director (
  1. Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104-4283, USA
  1. Correspondence to:
  • Accepted 10 September 1997

Emergency medicine is rapidly evolving as a medical specialty. It provides immediate and universal care to over 90 million patients a year in the United States alone. In addition to life saving treatment, the emergency department provides a safety net, giving unrestricted care to people with little or no access to other types of health care. Recent developments reflect the varied nature of emergency medicine. These include improvements in emergency management of acute cardiac ischaemia, identification of victims of domestic violence, and the use of diagnostic tools such as ultrasound examination by specialists in emergency medicine.


Topics were chosen after reviewing articles published during the past two years in those peer reviewed journals commonly referred to by specialists in emergency medicine. Selection was based on the number of quality studies published on a particular topic and the topic's actual or potential impact on clinical practice in emergency medicine. A Medline search was performed using the terms cardiac markers, domestic violence, ultrasound, and emergency medicine.

Screening for acute cardiac ischaemia

In the United States alone, over six million patients each year present to the emergency department with chest pain. The goals of the doctor are to identify rapidly those patients who are candidates for thrombolytic treatment; to differentiate between patients with chest pain caused by acute coronary ischaemia and chest pain from other causes in order to avoid unnecessary admission to hospital; and to stratify those patients with possible ischaemic chest pain into risk groups.

In addition to the routine medical history, physical examination, and 12 lead electrocardiography, the specialist in emergency medicine now has access to a growing number of ancillary tests and technologies that can help in the management of patients with chest pain. Those which seem particularly promising include new markers of cardiac ischaemia, stress testing, and acute perfusion imaging with technetium-99m labelled …

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