BOOK
Roberts and Hedges’ Clinical Procedures in Emergency Medicine E-Book
James R. Roberts | Jerris R. Hedges
(2013)
Additional Information
Book Details
Abstract
Roberts and Hedges’ Clinical Procedures in Emergency Medicine continues its long tradition of being the most well-known and trusted procedures manual in emergency medicine. The newly revised 6th edition of this classic medical reference has been thoroughly updated with step-by-step Review, Procedure, and Ultrasound Boxes covering the latest equipment, devices, drug therapies, and techniques you need to know for effective practice of emergency medicine. You'll access complete and detailed guidance on exactly when, how, and why to perform all of today’s common and uncommon procedures and get the best results.
- Understand the ins and outs of every procedure you're likely to consider, such as how, why, when to, and when not to perform them, in addition to other emergency procedures that may be an option.
- Rapidly review the entire contents online, including brand-new videos of common and complex procedures, at Expert Consult.
- See entire procedures at a glance with the addition of new Procedure Boxes, which offer step-by-step visual instruction on over 250 emergency techniques. Ideal for point-of-care reference, these Procedure Boxes also serve as a comprehensive mini atlas and are especially useful for less-encountered procedures or those that require complex equipment.
- Easily apply the latest emergency ultrasound techniques through new Ultrasound Boxes, all of which are expertly written and richly illustrated with photographs of the technique as well as screen captures of the US images.
- Master today's hottest new procedures including ultrasound for diagnosis of pneumothorax; loop abscess drainage; pediatric fluid resuscitation; and video-assisted intubation.
- Clearly and efficiently visualize all emergency procedures with a complete overhaul of figures, now nearly all in full color; new diagnostic images representing multiple modalities; and online-only procedural videos demonstrating key techniques.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Expert Consult Page | IFC2 | ||
| Half-title page | i | ||
| Associate Editors | ii | ||
| Roberts & Hedges' Clinical Procedures in Emergency Medicine, 6/e | iii | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| How this Medical Textbook Should be Viewed by the Practicing Clinician and the Judicial System | vi | ||
| Contributors | vii | ||
| Video Contributors | xv | ||
| Preface | xix | ||
| Foreword | xxi | ||
| Acknowledgments | xxii | ||
| Table Of Contents | xxiii | ||
| Video Contents | xxvii | ||
| Special Features | ei | ||
| Procedure Boxes | ei | ||
| Ultrasound Boxes | eiii | ||
| I Vital Signs and Patient Monitoring Techniques | 1 | ||
| 1 Vital Signs Measurement | 1 | ||
| Background | 1.e1 | ||
| Normal Values | 1 | ||
| Respiration | 3 | ||
| Indications and Contraindications | 3 | ||
| Procedure | 3 | ||
| Interpretation | 3 | ||
| Respiratory Rate | 3 | ||
| Respiratory Pattern and Amplitude | 3 | ||
| Pulse | 4 | ||
| Physiology | 4 | ||
| Indications and Contraindications | 5 | ||
| Procedure | 5 | ||
| Interpretation | 5 | ||
| Pulse Rate | 5 | ||
| Heart Rhythm | 5 | ||
| Pulse Amplitude and Contour | 5 | ||
| Pulses during Cardiopulmonary Resuscitation | 6 | ||
| Arterial Blood Pressure | 6 | ||
| Physiology | 6 | ||
| Indications and Contraindications | 6 | ||
| Equipment | 6 | ||
| Cuff Type | 6 | ||
| Procedure | 7 | ||
| Complications | 8 | ||
| Interpretation | 8 | ||
| Hypertension | 8 | ||
| Measurement Errors | 9 | ||
| Pulse Pressure | 9 | ||
| Differential Brachial Artery Pressure | 9 | ||
| Pulsus Paradoxus | 10 | ||
| Shock Index | 10 | ||
| Doppler Ultrasound for Evaluation of Pulse and Blood Pressure | 11 | ||
| Principles of Doppler Ultrasound | 11 | ||
| Indications and Contraindications | 11 | ||
| Equipment | 11 | ||
| Procedure | 11 | ||
| Interpretation | 12 | ||
| Vital Sign Determination of Volume Status | 12 | ||
| Orthostatic Vital Signs Measurement | 13 | ||
| Physiologic Response to Hypovolemia | 13 | ||
| Physiologic Response to Changes in Posture | 14 | ||
| Variables Affecting Orthostatic Vital Signs | 14 | ||
| Indications and Contraindications | 16 | ||
| Technique | 16 | ||
| Interpretation | 16 | ||
| Capillary Refill | 16 | ||
| Indications and Contraindications | 17 | ||
| Procedure | 17 | ||
| Interpretation | 17 | ||
| Temperature | 17 | ||
| Physiology | 17 | ||
| Indications and Contraindications | 18 | ||
| Measurement Sites | 18 | ||
| Core Body Temperature | 18 | ||
| Peripheral Body Sites Approximating Core Temperature | 18 | ||
| Procedure | 19 | ||
| Interpretation | 19 | ||
| Pain as a Vital Sign | 20 | ||
| Background | 20 | ||
| Procedure/Interpretation | 21 | ||
| Overview of Visual Analog Pain Scales | 22 | ||
| Overall Goal of Pain Relief | 22 | ||
| References | 22.e1 | ||
| 2 Devices for Assessing Oxygenation and Ventilation | 23 | ||
| Spirometry | 23 | ||
| Indications | 23 | ||
| Evaluation of Acute Asthma Attacks | 23 | ||
| Evaluation of Exacerbations of COPD | 23 | ||
| Differentiating Causes of Dyspnea | 23 | ||
| Evaluation of Neuromuscular and Chest Wall Disease | 23 | ||
| Contraindications | 23 | ||
| Need for Immediate Intervention | 23 | ||
| Conditions That May Be Worsened by Increased Intrathoracic Pressure | 23 | ||
| Equipment | 23 | ||
| Procedure | 24 | ||
| Interpretation | 24 | ||
| Noninvasive Oxygenation Monitoring: Pulse Oximetry | 26 | ||
| Technology | 26 | ||
| Physiology | 27 | ||
| Clinical Utility | 27 | ||
| Indications | 27 | ||
| Procedure | 27 | ||
| Interpretation | 28 | ||
| Sources of Interference | 29 | ||
| Effects of Dyshemoglobinemias | 29 | ||
| Fetal Hemoglobin | 29 | ||
| Low Perfusion | 29 | ||
| Intravenous Dyes | 29 | ||
| Bilirubin | 29 | ||
| Skin Pigmentation | 29 | ||
| Nail Polish | 30 | ||
| High Saturation | 30 | ||
| Venous Pulsations | 30 | ||
| Anemia | 30 | ||
| Ambient Light | 30 | ||
| Motion | 30 | ||
| Probe Site | 30 | ||
| Electrocautery | 30 | ||
| Conclusions | 30 | ||
| CO2 Monitoring | 30 | ||
| Terminology | 31 | ||
| Technology | 31 | ||
| Physiology | 32 | ||
| Indications for Intubated Patients | 32 | ||
| Verification of ET Tube Placement | 32 | ||
| Monitoring Tube Position during Transport | 33 | ||
| Gauging the Effectiveness of Cardiopulmonary Resuscitation | 33 | ||
| Indicator of ROSC | 33 | ||
| Assessing Prognosis after Initiation of Cardiac Arrest Resuscitation | 33 | ||
| Identifying the Cause of Cardiac Arrest | 33 | ||
| Titrating ETco2 in Patients with Suspected Increased Intracranial Pressure | 33 | ||
| Indications for Capnography in Spontaneously Breathing Patients | 34 | ||
| Assessment of Critically Ill, Injured, or Seizing Patients | 34 | ||
| Assessment and Triage of Victims of Chemical Terrorism and Mass Casualty | 34 | ||
| Gauging Severity and Response to Treatment of Patients in Acute Respiratory Distress | 34 | ||
| Procedural Sedation and Analgesia | 34 | ||
| Determining the Adequacy of Ventilation in Patients with Altered Mental Status | 35 | ||
| Detection of Metabolic Acidosis | 35 | ||
| Limitations | 38 | ||
| Conclusion | 38 | ||
| References | 38.e1 | ||
| Suggested Readings | 38 | ||
| Pulse Oximetry | 38 | ||
| CO2 Monitoring | 38 | ||
| II Respiratory Procedures | 39 | ||
| 3 Basic Airway Management and Decision Making | 39 | ||
| The Challenge of Emergency Airway Management | 39 | ||
| Basic Airway Management Techniques | 39 | ||
| Opening the Airway | 39 | ||
| Manual Airway Maneuvers | 39 | ||
| The Head-Tilt/Chin-Lift Maneuver | 40 | ||
| The Jaw-Thrust Maneuver | 40 | ||
| The Triple Airway Maneuver | 40 | ||
| Patient Positioning | 40 | ||
| Foreign Body Airway Obstruction | 41 | ||
| Abdominal Thrusts (Heimlich Maneuver), Chest Thrusts, and Back Blows (Slaps) | 41 | ||
| Suctioning | 42 | ||
| Oropharyngeal and Nasopharyngeal Artificial Airways | 43 | ||
| Indications and Contraindications | 43 | ||
| Artificial Airway Placement | 43 | ||
| Complications | 45 | ||
| Oxygen Therapy | 45 | ||
| Indications and Contraindications | 45 | ||
| Oxygen Administration during Cardiac Arrest and Neonatal Resuscitation | 45 | ||
| Oxygen Delivery Devices | 45 | ||
| Procedure | 47 | ||
| Preoxygenation for Rapid-Sequence Intubation | 48 | ||
| Oxygen Therapy during Apnea | 48 | ||
| Nasal High-Flow Oxygen | 48 | ||
| Complications of Oxygen Therapy | 48 | ||
| Bag-Mask Ventilation | 49 | ||
| Indications and Contraindications | 49 | ||
| Bag-Mask Ventilation Technique | 49 | ||
| Complications | 51 | ||
| Cricoid Pressure: Sellick’s Maneuver | 51 | ||
| Extraglottic Airway Devices | 51 | ||
| LMAs | 52 | ||
| Background | 52 | ||
| Anatomy and Physiology | 52 | ||
| Pathophysiology | 53 | ||
| Indications | 53 | ||
| Contraindications | 53 | ||
| Procedure | 53 | ||
| LMA Fastrach | 53 | ||
| LMA Classic (or Single-Use LMA Unique) | 55 | ||
| Aftercare | 57 | ||
| Complications | 57 | ||
| Retroglottic Airway Devices | 57 | ||
| King LT | 57 | ||
| Indications and Contraindications | 58 | ||
| Placement of the King LT | 58 | ||
| Complications | 58 | ||
| Combitube and EasyTube | 58 | ||
| Indications and Contraindications | 59 | ||
| Placement of the Combitube | 59 | ||
| Complications | 59 | ||
| Decision Making in Emergency Airway Management | 60 | ||
| Rapid-Sequence Intubation | 60 | ||
| Difficult Airways, Failed Intubation, and When to Avoid Rapid-Sequence Intubation | 60 | ||
| Emergency Airway Management Algorithm | 61 | ||
| Conclusion | 61 | ||
| Acknowledgment | 61 | ||
| References | 61.e1 | ||
| 4 Tracheal Intubation | 62 | ||
| General Approach to Emergency Intubation | 62 | ||
| Airway Anatomy | 62 | ||
| Preparation | 62 | ||
| Preoxygenation | 64 | ||
| Assessing for a Difficult Airway | 65 | ||
| Direct Laryngoscopy | 66 | ||
| Indications and Contraindications | 66 | ||
| Equipment | 67 | ||
| Laryngoscope | 67 | ||
| Tracheal Tubes | 67 | ||
| Optimal Patient Positioning for Direct Laryngoscopy | 68 | ||
| Procedure and Technique of Direct Laryngoscopy | 69 | ||
| Adults | 69 | ||
| Infants and Children | 72 | ||
| Sellick’s Maneuver, External Laryngeal Manipulation, Bimanual Laryngoscopy, and BURP | 72 | ||
| Sellick’s Maneuver | 72 | ||
| External Laryngeal Manipulation, Bimanual Laryngoscopy, and BURP | 74 | ||
| Passing the Tube | 75 | ||
| Tracheal Tube Introducer (Bougie) | 75 | ||
| Laryngospasm | 77 | ||
| Positioning and Securing the Tube | 77 | ||
| Confirmation of Tracheal Tube Placement | 77 | ||
| Clinical Assessment | 77 | ||
| Esophageal Detector Device | 80 | ||
| End-Tidal CO2 Detector Devices | 80 | ||
| Ultrasound Detection of Tracheal Tube Location | 81 | ||
| Comparison of Detector Devices | 81 | ||
| Complications of Intubation | 81 | ||
| Conclusion | 82 | ||
| Video and Optical Laryngoscopes | 82 | ||
| Video Laryngoscopes with Standard Macintosh Blades | 82 | ||
| Background | 83 | ||
| Anatomy and Physiology | 83 | ||
| Pathophysiology | 83 | ||
| Indications | 83 | ||
| Contraindications | 84 | ||
| Procedure | 84 | ||
| Complications | 84 | ||
| Video Laryngoscopes with Angulated Blades | 84 | ||
| Background | 84 | ||
| Indications | 85 | ||
| Contraindications | 85 | ||
| Procedure and Technique | 85 | ||
| Complications | 85 | ||
| Summary | 85 | ||
| Video and Optical Laryngoscopes with a Tube Channel | 87 | ||
| Background | 87 | ||
| Anatomy and Physiology | 87 | ||
| Indications | 87 | ||
| Contraindications | 88 | ||
| Procedure | 88 | ||
| Aftercare | 88 | ||
| Complications | 88 | ||
| Intubating Laryngeal Mask Airways | 88 | ||
| Indications | 89 | ||
| Contraindications | 89 | ||
| Intubation through the LMA Fastrach | 89 | ||
| Procedure and Technique | 90 | ||
| Using a Standard ET Tube | 90 | ||
| Fiberoptic Intubation through the LMA Fastrach | 90 | ||
| LMA Fastrach Removal | 90 | ||
| Intubation through the LMA Classic | 92 | ||
| Fiberoptic Intubation through the LMA Classic | 92 | ||
| Complications When Intubating through LMAs | 92 | ||
| Summary | 92 | ||
| Flexible Fiberoptic Intubation | 92 | ||
| Indications and Contraindications | 92 | ||
| Procedure and Technique | 93 | ||
| Nasal Approach | 94 | ||
| Oral Approach | 94 | ||
| Complications | 96 | ||
| Summary | 96 | ||
| Optical Stylets | 96 | ||
| Indications and Contraindications | 96 | ||
| Procedure and Technique | 96 | ||
| Summary | 97 | ||
| Lighted Stylet Intubation | 97 | ||
| Indications and Contraindications | 97 | ||
| Procedure and Technique | 97 | ||
| Complications | 98 | ||
| Summary | 98 | ||
| Blind Nasotracheal Intubation | 98 | ||
| General Indications and Contraindications | 98 | ||
| Blind Placement | 99 | ||
| Indications and Contraindications | 99 | ||
| Procedure and Technique | 99 | ||
| Technical Difficulties | 99 | ||
| Anterior to the Epiglottis | 100 | ||
| Arytenoid Cartilage and Vocal Cord | 100 | ||
| Piriform Sinus | 100 | ||
| Esophageal Placement | 100 | ||
| Laryngospasm | 101 | ||
| Complications | 101 | ||
| Summary | 101 | ||
| Digital Intubation | 101 | ||
| Indications and Contraindications | 101 | ||
| Procedure and Technique | 101 | ||
| Complications | 102 | ||
| Summary | 102 | ||
| Retrograde Intubation | 102 | ||
| Indications and Contraindications | 102 | ||
| Equipment | 103 | ||
| Procedure and Technique | 103 | ||
| Complications | 104 | ||
| Summary | 105 | ||
| TRACHEAL INTUBATION WITH A LARYNGEAL TUBE OR COMBITUBE IN PLACE | 105 | ||
| Changing Tracheal Tubes | 105 | ||
| Procedure and Technique | 105 | ||
| Preventing Unplanned Extubation | 105 | ||
| Conclusion | 105 | ||
| Acknowledgment | 106 | ||
| References | 106.e1 | ||
| 5 Pharmacologic Adjuncts to Intubation | 107 | ||
| Overview of Rapid-Sequence Intubation | 107 | ||
| Pretreatment: preventing the Complications of Intubation | 107 | ||
| The Pressor Response | 109 | ||
| Intracranial Hypertension | 110 | ||
| Induction Agents | 110 | ||
| Barbiturates: Thiopental and Methohexital | 110 | ||
| Etomidate | 111 | ||
| Ketamine | 112 | ||
| Propofol | 114 | ||
| Benzodiazepines (Midazolam) | 114 | ||
| Opioids (Fentanyl) | 115 | ||
| Neuromuscular Blocking Agents | 115 | ||
| Succinylcholine | 115 | ||
| Nondepolarizing Agents | 117 | ||
| Long-Acting Agents: Pancuronium | 117 | ||
| Intermediate-Acting Agents: Vecuronium, Atracurium, Mivacurium, and Rocuronium | 117 | ||
| The “Sedated Look” Evaluation of the Airway before Rapid-Sequence Intubation | 118 | ||
| Awake Intubation | 118 | ||
| Direct Application | 118 | ||
| Cricothyroid Membrane Puncture | 119 | ||
| Nebulized Anesthesia | 119 | ||
| Sedation for Awake Intubation | 119 | ||
| Acknowledgment | 119 | ||
| References | 119.e1 | ||
| 6 Cricothyrotomy and Percutaneous Translaryngeal Ventilation | 120 | ||
| Anatomy | 120 | ||
| Surgical Cricothyrotomy | 120 | ||
| Indications and Contraindications | 120 | ||
| Equipment | 123 | ||
| Procedure | 123 | ||
| Traditional Technique | 123 | ||
| Rapid Four-Step Technique (Brofeldt) | 125 | ||
| Melker Percutaneous Cricothyrotomy Technique | 126 | ||
| Complications | 127 | ||
| Success Rates | 129 | ||
| Percutaneous Translaryngeal Ventilation | 130 | ||
| Indications and Contraindication | 130 | ||
| Equipment | 130 | ||
| Procedure | 131 | ||
| Complications | 133 | ||
| Conclusion | 133 | ||
| References | 133.e1 | ||
| 7 Tracheostomy Care | 134 | ||
| Introduction | 134 | ||
| Background | 134 | ||
| Tracheal Anatomy and Physiology | 134 | ||
| Evaluation of Tracheostomy Patients | 134 | ||
| General Equipment for Tracheostomy Patients | 135 | ||
| Routine Tracheostomy Maintenance | 135 | ||
| Ventilating Tracheostomy Patients | 136 | ||
| Tracheal Suctioning | 136 | ||
| Indications | 136 | ||
| Equipment | 137 | ||
| Procedure and Technique | 138 | ||
| Complications of Suctioning | 139 | ||
| Minitracheostomy Suctioning Procedure | 139 | ||
| Changing a Tracheostomy Tube | 139 | ||
| Indications | 139 | ||
| Equipment | 140 | ||
| Sizing | 140 | ||
| Components | 141 | ||
| Procedure | 141 | ||
| Complications of Tracheostomy | 143 | ||
| Obstruction and Complications from Tube Changes | 143 | ||
| Preparation | 143 | ||
| Interventions | 143 | ||
| Dislodgment | 143 | ||
| Preparation | 144 | ||
| Interventions | 144 | ||
| False Passage | 144 | ||
| Equipment Failure | 145 | ||
| Fracture | 145 | ||
| Tracheal Cuff Complications | 145 | ||
| Infection | 145 | ||
| Tracheal Stenosis and Tracheomalacia | 145 | ||
| III Cardiac Procedures | 213 | ||
| 11 Techniques for Supraventricular Tachycardias | 213 | ||
| Introduction | 213 | ||
| Overview and Significance: Anatomy and Physiology of Supraventricular Tachycardia | 213 | ||
| Vagal Maneuvers | 217 | ||
| Background Anatomy and Physiology | 217.e1 | ||
| Indications for Vagal Maneuvers | 217 | ||
| Equipment and Setup | 218 | ||
| Carotid Sinus Massage | 219 | ||
| Contraindications | 220 | ||
| Technique | 221 | ||
| Complications | 221 | ||
| Valsalva Maneuver | 221 | ||
| Contraindications | 222 | ||
| Technique | 222 | ||
| Apneic Facial Exposure to Cold (“Diving Response,” Diving Bradycardia): Technique | 222 | ||
| Selected Pharmacologic Agents | 223 | ||
| Adenosine | 223 | ||
| Indications and Contraindications | 223 | ||
| Dosage | 223 | ||
| Calcium Channel Blockers | 223 | ||
| Diltiazem | 223 | ||
| IV Vascular Techniques and Volume Support | 341 | ||
| 19 Pediatric Vascular Access and Blood Sampling Techniques | 341 | ||
| Patient Preparation and Restraint | 341 | ||
| Anesthesia | 341 | ||
| Blood Sampling Techniques | 341 | ||
| Capillary Blood Sampling | 341 | ||
| Indications and Contraindications | 341 | ||
| Equipment and Setup (Box 19-1) | 342 | ||
| Technique | 342 | ||
| Complications | 342 | ||
| Interpretation | 342 | ||
| Venipuncture | 342 | ||
| Indications and Contraindications | 342 | ||
| Equipment and Setup (Box 19-2) | 342 | ||
| Technique | 344 | ||
| Complications | 346 | ||
| Arterial Blood Sampling | 346 | ||
| Indications and Contraindications | 346 | ||
| Equipment and Setup (Box 19-3) | 347 | ||
| Technique | 347 | ||
| Complications | 348 | ||
| Vascular Line Placement: Venous and Arterial | 348 | ||
| Peripheral Venous Catheterization: Percutaneous | 348 | ||
| Indications and Contraindications | 348 | ||
| Equipment and Setup (Box 19-4) | 348 | ||
| Vein Imaging Devices | 348 | ||
| Technique | 349 | ||
| External Jugular Venous Catheterization | 350 | ||
| Technique. | 350 | ||
| Complications | 351 | ||
| Peripheral Venous Catheterization: Venous Cutdown | 351 | ||
| Indications and Contraindications | 351 | ||
| Equipment and Setup (Box 19-5) | 351 | ||
| Technique | 351 | ||
| Mini-Cutdown | 353 | ||
| Complications | 353 | ||
| Central Venous Catheterization: Percutaneous | 353 | ||
| Indications and Contraindications | 353 | ||
| Equipment and Setup (Box 19-6) | 354 | ||
| Techniques | 354 | ||
| Femoral Catheterization | 354 | ||
| Technique. | 354 | ||
| Internal Jugular Venous Catheterization | 355 | ||
| Technique. | 355 | ||
| Subclavian Venous Catheterization | 356 | ||
| Technique. | 356 | ||
| Complications | 357 | ||
| Emergency Vascular Access | 357 | ||
| Umbilical Vein Catheterization | 357 | ||
| Indications and Contraindications | 357 | ||
| Equipment and Setup | 357 | ||
| Technique | 357 | ||
| Complications | 359 | ||
| Umbilical Artery Catheterization | 359 | ||
| Indications and Contraindications | 359 | ||
| Equipment and Setup | 359 | ||
| Technique | 359 | ||
| Complications | 360 | ||
| Percutaneous Arterial Catheterization | 360 | ||
| Indications and Contraindications | 360 | ||
| Equipment and Setup | 361 | ||
| Technique | 361 | ||
| Complications | 361 | ||
| Arterial Cutdown Catheterization | 361 | ||
| Indications and Contraindications | 361 | ||
| Equipment and Setup (Box 19-8) | 362 | ||
| Technique | 362 | ||
| Complications | 362 | ||
| Rehydration Techniques in Infants and Children | 364 | ||
| Approach to Dehydration | 364 | ||
| Oral Rehydration | 364 | ||
| Laboratory Tests | 365 | ||
| Parenteral Rehydration | 365 | ||
| Nasogastric Tube Rehydration | 366 | ||
| Subcutaneous Rehydration | 366 | ||
| Discharge | 367 | ||
| References | 367.e1 | ||
| 20 Arterial Puncture and Cannulation | 368 | ||
| Historical Perspective | 368 | ||
| Indications and Contraindications | 369 | ||
| Arterial versus Venous Analysis | 369 | ||
| Equipment: Arterial Puncture | 369 | ||
| Arterial Puncture with a Needle/Syringe | 369 | ||
| Continuous Monitoring via Arterial Catheter | 370 | ||
| Preparation for Arterial Cannulation | 370 | ||
| Site Selection | 371 | ||
| Techniques | 371 | ||
| Arterial Puncture | 371 | ||
| Percutaneous Technique for Arterial Cannulation | 373 | ||
| Direct Over-the-Needle Catheter Cannulation | 373 | ||
| Guidewire Techniques for Arterial Cannulation | 376 | ||
| Seldinger Technique | 377 | ||
| Cutdown Technique for Arterial Cannulation | 378 | ||
| Local Puncture Site and Catheter Care | 378 | ||
| Fluid-Pressurized Systems | 378 | ||
| Selection of Arteries for Cannulation | 379 | ||
| Radial and Ulnar | 379 | ||
| Brachial | 380 | ||
| Dorsalis Pedis | 380 | ||
| Femoral | 381 | ||
| Umbilical and Temporal | 381 | ||
| Complications of Arterial Cannulation | 382 | ||
| Interpretation | 384 | ||
| Conclusion | 384 | ||
| Acknowledgment | 384 | ||
| References | 384.e1 | ||
| 21 Peripheral Intravenous Access | 385 | ||
| Introduction | 385 | ||
| Historical Perspective | 385 | ||
| Indications and Contraindications | 385 | ||
| Ultrasound Guidance and Transillumination | 386 | ||
| Anatomy | 386 | ||
| Preparation | 387 | ||
| Safety | 387 | ||
| Choosing the Catheter Gauge | 388 | ||
| Appropriate Site | 388 | ||
| Adjuncts for Finding a Vein | 388 | ||
| Anesthesia | 388 | ||
| IV Assembly | 388 | ||
| Inspection and Positioning | 388 | ||
| Cannulation | 389 | ||
| Anchoring the Device | 389 | ||
| Maintaining Patency | 389 | ||
| Dressing | 389 | ||
| Percutaneous Brachial Vein Cannulation | 389 | ||
| Complications | 392 | ||
| Extravasation of Medications and Vasopressors | 394 | ||
| References | 396.e1 | ||
| 22 Central Venous Catheterization and Central Venous Pressure Monitoring | 397 | ||
| Historical Perspective | 397 | ||
| Anatomy | 397 | ||
| SV System | 397 | ||
| IJ Vein | 397 | ||
| Femoral Vein | 399 | ||
| Indications | 399 | ||
| CVP Monitoring and Oximetry | 399 | ||
| Delivery of High-Flow Fluid Boluses and Blood Products | 400 | ||
| Emergency Venous Access and Inability to Achieve Peripheral Access | 400 | ||
| Routine Serial Blood Drawing | 400 | ||
| Infusion of Hyperalimentation and Other Concentrated Solutions | 400 | ||
| Other Indications | 401 | ||
| Contraindications | 401 | ||
| Subclavian Approach | 402 | ||
| IJ Approach | 402 | ||
| Femoral Approach | 402 | ||
| Procedure | 402 | ||
| Equipment | 403 | ||
| Ultrasound | 403 | ||
| Needle | 403 | ||
| Guidewire | 403 | ||
| Catheters | 404 | ||
| Technique | 405 | ||
| Preprocedure Preparation | 405 | ||
| Guidewire Placement with the Seldinger Technique | 405 | ||
| Sheath Unit and Catheter Placement | 409 | ||
| Replacement of Existing Catheters | 411 | ||
| Over-the-Needle Technique | 411 | ||
| Site Selection | 411 | ||
| Subclavian Approaches | 411 | ||
| IJ Approach | 411 | ||
| Femoral Approach | 412 | ||
| Specific Vessel Access Techniques | 412 | ||
| Infraclavicular Subclavian Approach | 412 | ||
| Positioning | 412 | ||
| Venipuncture Site | 412 | ||
| V Anesthetic and Analgesic Techniques | 519 | ||
| 29 Local and Topical Anesthesia | 519 | ||
| Background | 519 | ||
| Pharmacology and Physiology | 519 | ||
| Chemical Structure and Physiochemical Properties | 519 | ||
| Nerve Structure and Impulse Transmission | 520 | ||
| Functional and Structural Components of a Peripheral Nerve | 520 | ||
| The Nerve Impulse and Transmission | 520 | ||
| Mechanism of Action | 521 | ||
| The Active Form | 521 | ||
| The Physiologic and Cellular Basis for Neuronal Blockade | 521 | ||
| Activity Profile during Neuronal Blockade | 521 | ||
| Onset of Action | 521 | ||
| Potency | 522 | ||
| Duration | 522 | ||
| Topical Anesthesia | 523 | ||
| Mucous Membranes | 523 | ||
| Agents and Uses | 523 | ||
| Technique and Precautions | 525 | ||
| Intact Skin | 525 | ||
| Agents and Uses | 525 | ||
| Lidocaine Cream | 525 | ||
| EMLA Cream, ELA-Max, and Tetracaine Base Patch | 525 | ||
| Ethyl Chloride and Trichloromonofluoromethane and Dichlorodifluoromethane (Fluori-Methane) Sprays | 526 | ||
| Technique | 526 | ||
| Lidocaine Cream | 526 | ||
| Tetracaine Base Patch and EMLA Cream | 526 | ||
| Ethyl Chloride and Fluori-Methane Sprays | 526 | ||
| Iontophoresis | 526 | ||
| Microneedle Pretreatment | 526 | ||
| Jet Injection | 527 | ||
| Complications | 527 | ||
| Lacerations | 527 | ||
| Background | 527 | ||
| Indications and Contraindications | 527 | ||
| Agents and Effectiveness | 527 | ||
| TAC and Related Mixtures | 527 | ||
| LET and Related Solutions | 528 | ||
| Technique and Dosage | 528 | ||
| Complications | 529 | ||
| Infiltration Anesthesia | 529 | ||
| Background | 529 | ||
| Indications and Contraindications | 529 | ||
| Choice of Agent | 530 | ||
| Equipment | 531 | ||
| Technique | 531 | ||
| Buffering | 531 | ||
| Temperature Manipulation | 531 | ||
| Injection | 532 | ||
| Special Considerations | 532 | ||
| Hematoma Block | 532 | ||
| Intraarticular Anesthesia and Analgesia | 533 | ||
| Intrapleural Anesthesia | 533 | ||
| Indications | 533 | ||
| Technique | 533 | ||
| Complications | 534 | ||
| Local Anesthetic Effect on Wounds | 534 | ||
| Wound Healing | 534 | ||
| Wound Infection | 534 | ||
| Local Injuries | 534 | ||
| Use of Epinephrine with Local Anesthetics | 534 | ||
| Systemic Toxic Reactions | 535 | ||
| High Blood Levels | 535 | ||
| Site and Mode of Administration | 535 | ||
| Rate | 535 | ||
| Dose and Concentration | 535 | ||
| Addition of Epinephrine | 535 | ||
| Specific Drug. | 536 | ||
| Clearance | 536 | ||
| Maximum Safe Dosage | 536 | ||
| Inadvertent Intravascular Injection | 537 | ||
| Host Factors | 537 | ||
| Hypoxia | 537 | ||
| Acid-Base Status | 537 | ||
| Protein Binding | 537 | ||
| Concomitant Drugs. | 537 | ||
| Recognition of CNS Toxicity | 537 | ||
| Recognition of Cardiovascular Toxicity | 537 | ||
| Prevention of Toxicity | 537 | ||
| Treatment of Systemic Toxicity | 537 | ||
| Intravenous Lipid Emulsion | 538 | ||
| Allergic Reactions | 538 | ||
| Allergenic Agents | 538 | ||
| Diphenhydramine and Benzyl Alcohol | 539 | ||
| Skin Testing | 539 | ||
| Summary of Anesthetic “Allergy” Management | 539 | ||
| Catecholamine Reactions | 539 | ||
| Vasovagal Reactions | 539 | ||
| Summary | 540 | ||
| References | 540.e1 | ||
| 30 Regional Anesthesia of the Head and Neck | 541 | ||
| Anatomy of the Fifth Cranial (Trigeminal) Nerve | 541 | ||
| Ophthalmic Nerve | 541 | ||
| Maxillary Nerve | 542 | ||
| Mandibular Nerve | 543 | ||
| Equipment for Dental and Cranial Nerve Blocks | 543 | ||
| General Recommendations | 544 | ||
| Technique | 544 | ||
| Topical Anesthesia | 544 | ||
| Supraperiosteal Infiltration | 545 | ||
| Posterior or Superior Alveolar Nerve Block | 545 | ||
| Anatomy | 545 | ||
| VI Soft Tissue Procedures | 611 | ||
| 34 Principles of Wound Management | 611 | ||
| Background: Wound Healing | 611 | ||
| Initial Evaluation | 613 | ||
| History | 613 | ||
| Wound Age | 613 | ||
| Other Historical Factors | 613 | ||
| Physical Examination | 613 | ||
| Mechanism of Injury and Classification of Wounds | 613 | ||
| Contaminants (Bacteria and Foreign Material) | 614 | ||
| Devitalized Tissue | 614 | ||
| Wound Location | 614 | ||
| Underlying Structures | 614 | ||
| Cleaning | 614 | ||
| Patient Preparation | 615 | ||
| Mechanical Scrubbing | 615 | ||
| Antiseptics during Cleaning | 615 | ||
| Irrigation | 618 | ||
| Antibiotic Solutions for Irrigation | 618 | ||
| Recommendations for Cleaning the Wound | 618 | ||
| Preparation for Wound Closure | 619 | ||
| Débridement | 619 | ||
| Excision | 619 | ||
| Selective Débridement | 619 | ||
| Control of Hemorrhage | 622 | ||
| Tourniquets | 622 | ||
| Closure | 624 | ||
| Open versus Closed Wound Management | 624 | ||
| Delayed Primary or Secondary Closure | 626 | ||
| Protection | 627 | ||
| Dressings | 627 | ||
| Function of Dressings | 627 | ||
| Contact Layer: Dry, Semiocclusive, and Occlusive Dressings | 629 | ||
| Absorbent Layer | 631 | ||
| Outer Layer | 631 | ||
| Splinting and Elevation | 631 | ||
| Ointments | 632 | ||
| Wound Cultures | 633 | ||
| Systemic Antibiotics | 633 | ||
| Immunoprophylaxis | 633 | ||
| Patient Instructions | 634 | ||
| Secondary Wound Care | 635 | ||
| Reexamination | 635 | ||
| Suture Removal | 635 | ||
| Complications | 636 | ||
| Miscellaneous Aspects of Wound Care | 637 | ||
| The ED Approach to Puncture Wounds | 637 | ||
| Gunshot Wounds | 637 | ||
| Animal Bites | 637 | ||
| Human Bites | 639 | ||
| Serious Wound Infections | 642 | ||
| Digital Nerves | 642 | ||
| Accidental Soft Tissue Injection with an EpiPen | 642 | ||
| References | 643.e1 | ||
| 35 Methods of Wound Closure | 644 | ||
| Wound Tape | 644 | ||
| Background and Tape Comparisons | 644 | ||
| Indications | 644 | ||
| Contraindications | 644 | ||
| Equipment | 645 | ||
| VII Gastrointestinal Procedures | 789 | ||
| 39 Esophageal Foreign Bodies | 789 | ||
| General Features | 789 | ||
| Anatomy | 789 | ||
| Epidemiology | 789 | ||
| Complications | 789 | ||
| Clinical Findings | 790 | ||
| Evaluation | 790 | ||
| Radiology of Esophageal FBs | 791 | ||
| Background | 791 | ||
| Indications | 791 | ||
| Plain Radiographs | 791 | ||
| Contrast-Enhanced Esophagograms | 793 | ||
| Background | 793 | ||
| Procedure | 793 | ||
| CT | 794 | ||
| Conclusions | 794 | ||
| Visualization of Esophageal and Pharyngeal FBs | 794 | ||
| Esophagoscopy | 794 | ||
| Esophageal Pharmacologic Maneuvers | 795 | ||
| Background | 795 | ||
| Indications and Contraindications | 795 | ||
| Glucagon | 795 | ||
| Pharmacology | 795 | ||
| Indications and Contraindications | 796 | ||
| Administration of Glucagon | 796 | ||
| Complications | 796 | ||
| Further Evaluation and Therapy | 796 | ||
| Nitroglycerin and Nifedipine Pharmacology | 796 | ||
| VIII Musculoskeletal Procedures | 893 | ||
| 46 Prehospital Immobilization | 893 | ||
| Spine Immobilization | 893 | ||
| Background | 893 | ||
| Epidemiology | 894 | ||
| Pathophysiology | 894 | ||
| Indications | 895 | ||
| Contraindications | 895 | ||
| Equipment | 896 | ||
| Cervical Collars | 896 | ||
| Cervical Extrication Splints | 896 | ||
| Full-Body Spine Immobilizers | 897 | ||
| Full-Body Spine Boards (Backboards) | 897 | ||
| Scoop Stretchers | 898 | ||
| Full-Body Splints | 899 | ||
| Lateral Neck Stabilizers | 899 | ||
| Foam Padding | 899 | ||
| Procedure | 900 | ||
| Cervical Spine Immobilization | 900 | ||
| Thoracolumbar Spine Immobilization | 900 | ||
| Sitting Position | 900 | ||
| Recumbent Position | 902 | ||
| Scoop Stretcher. | 902 | ||
| Full-Body Spine Boards (Backboards). | 903 | ||
| Standing Position | 903 | ||
| Pediatric Patients | 903 | ||
| Complications | 905 | ||
| Cervical Immobilization | 905 | ||
| Thoracolumbar Immobilization | 906 | ||
| Conclusion | 906 | ||
| Extremity Immobilization | 906 | ||
| Upper Extremity | 906 | ||
| Background | 906 | ||
| Indications and Contraindications | 907 | ||
| Equipment | 907 | ||
| Rigid Splints | 907 | ||
| Soft Splints | 907 | ||
| Procedures | 907 | ||
| Rigid Splints | 909 | ||
| Soft Splints | 909 | ||
| Complications | 910 | ||
| Conclusion | 910 | ||
| Lower Extremity | 910 | ||
| Background | 910 | ||
| Indications | 911 | ||
| Contraindications | 911 | ||
| Equipment | 912 | ||
| Procedure | 912 | ||
| Special Considerations | 915 | ||
| IX Genitourinary, Obstetric, and Gynecologic Procedures | 1113 | ||
| 55 Urologic Procedures | 1113 | ||
| Introduction | 1113 | ||
| Testicular Torsion | 1113 | ||
| Background | 1113 | ||
| Anatomy and Physiology | 1113 | ||
| Pathophysiology | 1113 | ||
| Indications | 1116 | ||
| Contraindications | 1116 | ||
| Procedure | 1116 | ||
| Manual Detorsion and Spermatic Cord Anesthesia | 1116 | ||
| Spermatic Cord Anesthesia | 1116 | ||
| Manual Detorsion | 1116 | ||
| Aftercare | 1117 | ||
| Complications | 1117 | ||
| Conclusion | 1117 | ||
| Priapism | 1117 | ||
| Background | 1117 | ||
| Anatomy and Physiology | 1117 | ||
| Pathophysiology | 1117 | ||
| Indications | 1118 | ||
| Contraindications | 1119 | ||
| Procedure | 1119 | ||
| Minimally Invasive Technique—Simple Injection | 1119 | ||
| Aspiration/Irrigation Technique | 1121 | ||
| Aftercare | 1122 | ||
| Complications | 1122 | ||
| Conclusion | 1122 | ||
| Paraphimosis | 1122 | ||
| Background | 1123 | ||
| Anatomy and Physiology | 1123 | ||
| Pathophysiology | 1123 | ||
| Indications | 1125 | ||
| Contraindications | 1125 | ||
| Procedure | 1125 | ||
| Manual Reduction Technique | 1125 | ||
| Adjunctive Techniques to Assist in Manual Reduction | 1125 | ||
| Aftercare | 1125 | ||
| Complications | 1125 | ||
| Conclusion | 1125 | ||
| Phimosis | 1126 | ||
| Anatomy and Physiology | 1126 | ||
| Pathophysiology | 1127 | ||
| Indications | 1127 | ||
| Contraindications | 1127 | ||
| Procedure | 1127 | ||
| Aftercare | 1127 | ||
| Complications | 1129 | ||
| Conclusion | 1129 | ||
| Urethral Catheterization | 1129 | ||
| Background | 1130 | ||
| Anatomy and Physiology | 1130 | ||
| Female Catheterization | 1130 | ||
| Male Catheterization | 1132 | ||
| Indications | 1133 | ||
| Contraindications | 1133 | ||
| Procedure | 1133 | ||
| Equipment | 1133 | ||
| General Procedure (Figs. 55-21 and 55-22) | 1134 | ||
| Bladder Irrigation | 1137 | ||
| DUC | 1137 | ||
| Aftercare | 1138 | ||
| Complications | 1138 | ||
| Mechanical | 1138 | ||
| Bleeding | 1138 | ||
| Infection | 1138 | ||
| Long-Term Catheter Use | 1138 | ||
| Undesirable Catheter Retention | 1138 | ||
| Removal of a Nondeflating Catheter | 1138 | ||
| Traumatic Foley Catheter Removal | 1138 | ||
| Conclusion | 1142 | ||
| Suprapubic Aspiration | 1142 | ||
| Introduction | 1142 | ||
| Indications | 1142 | ||
| Contraindications | 1142 | ||
| Procedure | 1142 | ||
| Aftercare | 1142 | ||
| Complications | 1142 | ||
| Conclusion | 1143 | ||
| Suprapubic Cystostomy | 1144 | ||
| Introduction | 1144 | ||
| Indications | 1144 | ||
| Contraindications | 1144 | ||
| Procedure | 1144 | ||
| Aftercare | 1146 | ||
| Complications | 1146 | ||
| Conclusion | 1146 | ||
| Lower GU Tract Imaging | 1146 | ||
| Background | 1147 | ||
| Anatomy and Physiology | 1147 | ||
| Pathophysiology | 1147 | ||
| Indications | 1147 | ||
| Contraindications | 1148 | ||
| Procedure | 1148 | ||
| RUG | 1148 | ||
| Retrograde Cystography | 1150 | ||
| Aftercare | 1152 | ||
| Complications | 1152 | ||
| Conclusion | 1154 | ||
| Upper GU Tract Imaging | 1154 | ||
| Acknowledgment | 1154 | ||
| References | 1154.e1 | ||
| 56 Emergency Childbirth | 1155 | ||
| Background | 1155 | ||
| Anatomy and Physiology | 1155 | ||
| Identification of Labor | 1155 | ||
| Evaluation of Labor | 1156 | ||
| Labor Movements: Vertex | 1157 | ||
| Labor Movements: Breech | 1158 | ||
| Types | 1159 | ||
| Vaginal Examination | 1159 | ||
| Fetal Well-Being | 1160 | ||
| Auscultation | 1160 | ||
| Management of Fetal Distress | 1160 | ||
| Tocolytic Therapy | 1162 | ||
| β2-Receptor Agonists | 1162 | ||
| Magnesium Sulfate | 1163 | ||
| Calcium Channel Blockers | 1163 | ||
| Prostaglandin Inhibitors | 1163 | ||
| Steroids | 1163 | ||
| Vaginal Bleeding during the Third Trimester | 1163 | ||
| Procedure | 1163 | ||
| Technique for Uncomplicated Delivery | 1163 | ||
| Spontaneous Vertex Delivery | 1166 | ||
| Delivery of the Head | 1166 | ||
| Delivery of the Shoulders | 1166 | ||
| Clearing the Airway | 1166 | ||
| Clamping the Cord | 1166 | ||
| Delivery of the Placenta | 1166 | ||
| Complications | 1169 | ||
| Complex Deliveries | 1169 | ||
| Shoulder Dystocia | 1169 | ||
| Management | 1169 | ||
| Breech Delivery | 1169 | ||
| Technique | 1169 | ||
| Delivery of the Presenting Part and Body. | 1169 | ||
| Delivery of the Head. | 1172 | ||
| Episiotomy | 1172 | ||
| Technique | 1172 | ||
| Immediate Postpartum Hemorrhage | 1174 | ||
| Management | 1174 | ||
| Oxytocics | 1174 | ||
| PCS | 1175 | ||
| Indications | 1176 | ||
| Technique | 1176 | ||
| The Newborn | 1177 | ||
| Evaluation | 1178 | ||
| Respiration | 1178 | ||
| Heart Rate | 1178 | ||
| Color | 1178 | ||
| Stabilization Technique | 1178 | ||
| References | 1179.e1 | ||
| Selected Readings | 1179 | ||
| 57 Culdocentesis | 1180 | ||
| Anatomy | 1180 | ||
| Indications | 1180 | ||
| Ectopic Pregnancy | 1181 | ||
| Blunt Abdominal Trauma | 1183 | ||
| Contraindications | 1183 | ||
| Equipment | 1183 | ||
| Technique | 1184 | ||
| Preparation | 1184 | ||
| Exposure | 1184 | ||
| Aspiration | 1184 | ||
| Interpretation of Results | 1184 | ||
| Complications | 1187 | ||
| References | 1187.e1 | ||
| 58 Examination of the Sexual Assault Victim | 1188 | ||
| Definitions | 1188 | ||
| Evaluation and Treatment of Patients Suffering From Sexual Assault | 1188 | ||
| Preparation | 1188 | ||
| Consent | 1188 | ||
| History | 1189 | ||
| Physical Examination | 1190 | ||
| Collection of Clothing | 1190 | ||
| General Body Examination | 1190 | ||
| Imaging | 1190 | ||
| Oral Evaluation | 1190 | ||
| Genital Examination | 1191 | ||
| Pubic Hair Samples | 1191 | ||
| Colposcopy | 1192 | ||
| Forensic Evidence Collection | 1193 | ||
| Genital Testing for STDs | 1194 | ||
| Perineal Toluidine Blue Dye Staining | 1194 | ||
| Anal Evaluation | 1195 | ||
| Reference Samples | 1196 | ||
| Blood Tests | 1196 | ||
| Urine Tests | 1196 | ||
| Spermatozoa, Semen, and DNA Testing | 1196 | ||
| Chain of Custody | 1196 | ||
| Treatment | 1196 | ||
| STD Prophylaxis | 1196 | ||
| Prevention of Hepatitis B | 1197 | ||
| Prevention of HIV Infection | 1198 | ||
| Pregnancy Prophylaxis | 1198 | ||
| Psychological Support | 1198 | ||
| Postexamination Follow-Up | 1200 | ||
| Specific Populations | 1200 | ||
| Male Evidentiary Examinations | 1200 | ||
| Child Sexual Assault Examinations | 1200 | ||
| Suspect Examinations | 1202 | ||
| The Unconscious Victim and “Drug-Facilitated Sexual Assault” | 1202 | ||
| Legal Issues | 1203 | ||
| Sexual Assault Response Teams | 1203 | ||
| Acknowledgment | 1203 | ||
| References | 1203.e1 | ||
| X Neurologic Procedures | 1205 | ||
| 59 Management of Increased Intracranial Pressure and Intracranial Shunts | 1205 | ||
| Pathophysiology of ICP | 1205 | ||
| Brain | 1205 | ||
| CSF | 1206 | ||
| Blood | 1206 | ||
| Signs and Symptoms | 1206 | ||
| Medical Treatment of Increased ICP | 1207 | ||
| Oxygenation | 1207 | ||
| Sedation and Paralytics | 1207 | ||
| Oxygenation and Hyperventilation | 1208 | ||
| Head Position | 1208 | ||
| Fluid Management | 1208 | ||
| Diuresis | 1208 | ||
| Seizure Prophylaxis | 1208 | ||
| Steroids | 1209 | ||
| Glucose Control | 1209 | ||
| Hypothermia | 1209 | ||
| Skull Trephination | 1209 | ||
| Operative Management | 1212 | ||
| Intracranial Shunts | 1212 | ||
| Shunt Assessment | 1213 | ||
| Shunt Tapping | 1215 | ||
| Special Considerations—Postoperative Shunt Complications | 1217 | ||
| Hemorrhage | 1217 | ||
| Shunt Malfunction | 1217 | ||
| Seizures | 1217 | ||
| Shunt Infection—Treatment and Prevention | 1217 | ||
| Acknowledgment | 1217 | ||
| References | 1217.e1 | ||
| 60 Spinal Puncture and Cerebrospinal Fluid Examination | 1218 | ||
| Historical Perspective | 1218 | ||
| Anatomy and Physiology | 1218 | ||
| Indications for Spinal Puncture | 1219 | ||
| General Indications | 1219 | ||
| IIH (Pseudotumor Cerebri) | 1219 | ||
| Contraindications to Spinal Puncture | 1220 | ||
| Equipment | 1221 | ||
| Procedure | 1221 | ||
| Lateral Approach for Lumbar Puncture | 1226 | ||
| Lumbar Puncture in Infants | 1226 | ||
| The Difficult Lumbar Puncture | 1227 | ||
| Complications | 1228 | ||
| Headache after Lumbar Puncture | 1228 | ||
| Infection | 1230 | ||
| Herniation Syndromes after Lumbar Puncture | 1230 | ||
| Epidermoid Tumor | 1231 | ||
| Backache and Radicular Symptoms | 1231 | ||
| Spinal Epidural Hemorrhage | 1231 | ||
| Interpretation | 1232 | ||
| Pressure | 1232 | ||
| Appearance | 1232 | ||
| Cells | 1233 | ||
| Glucose | 1233 | ||
| Protein | 1233 | ||
| The Traumatic Tap | 1234 | ||
| Absolute Number of RBCs | 1234 | ||
| RBC Clearance from First to Last Tubes | 1234 | ||
| Xanthochromia | 1234 | ||
| CSF Analysis with Infections | 1234 | ||
| Bacterial Infections | 1234 | ||
| Microbial Antigens and PCR | 1235 | ||
| Empirical Antibiotic Use before Lumbar Puncture | 1236 | ||
| Dexamethasone Therapy for Bacterial Meningitis | 1237 | ||
| Neurosyphilis | 1238 | ||
| Viral Meningitis | 1238 | ||
| CSF Analysis in Immunocompromised Patients | 1239 | ||
| Neurosyphilis in Patients Infected with HIV | 1239 | ||
| Cryptococcal Meningitis | 1239 | ||
| Toxoplasmosis | 1239 | ||
| Mycobacterial Tuberculosis | 1242 | ||
| Primary CNS Lymphoma | 1242 | ||
| Progressive Multifocal Leukoencephalopathy | 1242 | ||
| Cytomegalovirus Infection | 1242 | ||
| Acknowledgment | 1242 | ||
| References | 1242.e1 | ||
| 61 Special Neurologic Tests and Procedures | 1243 | ||
| Caloric Testing | 1243 | ||
| Historical Perspective | 1243 | ||
| Physiology and Functional Anatomy | 1243 | ||
| Indications and Contraindications | 1244 | ||
| Equipment | 1245 | ||
| Procedure | 1245 | ||
| Complications | 1245 | ||
| Interpretation | 1245 | ||
| First Phase of Interpretation | 1245 | ||
| Second Phase of Interpretation | 1247 | ||
| Summary | 1248 | ||
| DIX-Hallpike Test For The Diagnosis of Positional Vertigo | 1248 | ||
| Background | 1248 | ||
| Indications and Contraindications | 1248 | ||
| Procedure | 1248 | ||
| Interpretation | 1248 | ||
| Complications | 1249 | ||
| Summary | 1249 | ||
| Canalith-Repositioning Maneuvers | 1249 | ||
| Background | 1249 | ||
| Indications and Contraindications | 1250 | ||
| Procedure | 1250 | ||
| Complications | 1251 | ||
| Summary | 1251 | ||
| Tests to Distinguish Central From Peripheral Lesions in Patients with AVS | 1251 | ||
| Background | 1251 | ||
| Indications and Contraindications | 1252 | ||
| Procedure | 1252 | ||
| Interpretation | 1253 | ||
| Complications | 1253 | ||
| Summary | 1253 | ||
| Brain Death Testing | 1253 | ||
| Background | 1253 | ||
| Indications and Contraindications | 1253 | ||
| Procedure | 1253 | ||
| Establishment of Coma and Cortical Assessment | 1253 | ||
| Brainstem Reflex Testing | 1254 | ||
| Pupillary Response | 1254 | ||
| Auditory Reflex | 1254 | ||
| Caloric Testing | 1254 | ||
| Corneal Reflex | 1254 | ||
| Cough Reflex | 1254 | ||
| Apneic Oxygenation Test | 1254 | ||
| Declaration of Death | 1254 | ||
| Complications | 1254 | ||
| Summary | 1254 | ||
| MG Testing | 1255 | ||
| XI Ophthalmologic, Otolaryngologic, and Dental Procedures | 1259 | ||
| 62 Ophthalmologic Procedures | 1259 | ||
| Assessment of Visual Acuity | 1259 | ||
| Indications | 1259 | ||
| Distant Visual Acuity Procedure | 1259 | ||
| Near Visual Acuity Procedure | 1260 | ||
| Dilating the Eye | 1261 | ||
| Indications and Contraindications | 1261 | ||
| Agents | 1262 | ||
| Procedure | 1263 | ||
| Complications | 1263 | ||
| The Fluorescein Examination | 1264 | ||
| Indications and Contraindications | 1265 | ||
| Procedure | 1265 | ||
| Interpretation | 1266 | ||
| Summary | 1267 | ||
| Eye Irrigation | 1267 | ||
| Indications and Contraindications | 1267 | ||
| Equipment | 1267 | ||
| Procedure | 1268 | ||
| Basic Technique | 1268 | ||
| Duration of Irrigation | 1269 | ||
| Prolonged Irrigation | 1270 | ||
| Complications | 1271 | ||
| Summary | 1271 | ||
| Ocular FB Removal | 1271 | ||
| Indications and Contraindications | 1271 | ||
| Globe Protection | 1271 | ||
| Equipment | 1271 | ||
| Consideration of an Intraocular FB | 1271 | ||
| Procedure | 1273 | ||
| FB Location | 1273 | ||
| FB Removal | 1273 | ||
| Rust Rings | 1276 | ||
| Multiple FBs | 1276 | ||
| Aftercare | 1276 | ||
| Use of Ophthalmic Anesthetic Agents | 1276 | ||
| Use of Ophthalmic NSAIDs | 1277 | ||
| Complications | 1277 | ||
| Summary | 1277 | ||
| Eye Patching | 1277 | ||
| Contact Lens Procedures | 1277 | ||
| Mechanism of Corneal Injury from Contact Lens Wear | 1277 | ||
| Hard Contact Lenses | 1277 | ||
| Soft Contact Lenses | 1278 | ||
| Indications for Removal | 1279 | ||
| Contraindication to Removal | 1279 | ||
| Procedure | 1279 | ||
| Hard Contact Lens Removal | 1279 | ||
| Soft Contact Lens Removal | 1279 | ||
| Lens Storage | 1281 | ||
| Evaluation of a “Lost” Contact Lens | 1281 | ||
| Complications of Lens Removal | 1281 | ||
| Summary | 1281 | ||
| Bandage Contect Lenses for Treatment of Corneal Abrasions | 1281 | ||
| Indications and Contraindications | 1281 | ||
| Equipment | 1281 | ||
| Procedure | 1282 | ||
| Complications | 1282 | ||
| Summary | 1282 | ||
| Infectious Keratitis | 1282 | ||
| Tonometry | 1282 | ||
| Tonometric Techniques | 1283 | ||
| Contraindications to Tonometry | 1284 | ||
| Procedure | 1284 | ||
| Palpation Technique | 1284 | ||
| Impression (Schiøtz) Technique | 1284 | ||
| Errors with Impression Tonometry | 1284 | ||
| Impression (Tono-Pen XL) Technique (Fig. 62-23) | 1286 | ||
| Complications | 1288 | ||
| Slit Lamp Examination | 1288 | ||
| Indications and Contraindications | 1288 | ||
| Equipment | 1288 | ||
| Procedure | 1289 | ||
| Unilateral Loss of Vision | 1291 | ||
| Central Renal Artery Occlusion | 1291 | ||
| Therapy | 1291 | ||
| Complications | 1292 | ||
| Orbital Compartment Syndrome | 1293 | ||
| Technique: Lateral Canthotomy and Cantholysis (Fig. 62-33) | 1293 | ||
| XII Special Procedures | 1363 | ||
| 65 Procedures Pertaining to Hypothermia and Hyperthermia | 1363 | ||
| Procedures Pertaining to Hypothermia | 1363 | ||
| Definitions | 1363 | ||
| Measurement of Core Temperature | 1364 | ||
| Pathophysiology | 1365 | ||
| Initial Evaluation and Stabilization of Hypothermic Patients | 1365 | ||
| Prehospital Care | 1365 | ||
| ED Management | 1367 | ||
| Management Guidelines | 1368 | ||
| Passive External Rewarming | 1369 | ||
| Active External Rewarming | 1369 | ||
| Indications | 1369 | ||
| Equipment | 1369 | ||
| Technique | 1369 | ||
| Arteriovenous Anastomoses Rewarming | 1370 | ||
| Complications | 1370 | ||
| Active Core Rewarming | 1370 | ||
| Emergency Warming of Saline in a Microwave | 1370 | ||
| Inhalation of Heated Humidified Oxygen or Air | 1370 | ||
| Indications and Contraindications. | 1370 | ||
| Appendix Commonly Used Formulas and Calculations | 1477 | ||
| Introduction | 1477 | ||
| English-to-Metric Conversions | 1477 | ||
| Calculation of MAP | 1477 | ||
| QT and QTc Intervals | 1477 | ||
| Predicted PEFR | 1477 | ||
| Endotracheal Intubation and Mechanical Ventilation | 1477 | ||
| Selecting the ETT | 1478 | ||
| Adults. | 1478 | ||
| Pediatrics. | 1478 | ||
| Determining Initial Ventilator Settings | 1478 | ||
| Renal Function | 1478 | ||
| Acid-Base, Fluid, and Electrolyte Balance | 1479 | ||
| Calculating the Osmolal Gap | 1479 | ||
| Hyponatremia | 1480 | ||
| Hypernatremia | 1480 | ||
| Potassium | 1480 | ||
| Calcium | 1480 | ||
| Maintenance IV Fluid Rate | 1481 | ||
| Fluid Resuscitation of Burned Patients | 1481 | ||
| Acid-Base Balance | 1481 | ||
| Winter’s Formula | 1483 | ||
| Glasgow Coma Scale | 1483 | ||
| NIH Stroke Score | 1484 | ||
| Diagnostic Probability | 1488 | ||
| Acknowledgment | 1488 | ||
| Index | 1489 | ||
| A | 1489 | ||
| B | 1492 | ||
| C | 1494 | ||
| D | 1499 | ||
| E | 1500 | ||
| F | 1502 | ||
| G | 1504 | ||
| H | 1505 | ||
| I | 1507 | ||
| J | 1508 | ||
| K | 1509 | ||
| L | 1509 | ||
| M | 1510 | ||
| N | 1511 | ||
| O | 1513 | ||
| P | 1514 | ||
| Q | 1517 | ||
| R | 1517 | ||
| S | 1519 | ||
| T | 1523 | ||
| U | 1525 | ||
| V | 1526 | ||
| W | 1527 | ||
| X | 1527 | ||
| Y | 1527 | ||
| Z | 1527 | ||
| Clinical Key | IBC1 | ||
| Appendix 2 | IBC2 |