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Book Details
Abstract
Emergency Medicine, 2nd Edition delivers all the relevant clinical core concepts you need for practice and certification, all in a comprehensive, easy-to-absorb, and highly visual format. This well-regarded emergency medicine reference offers fast-access diagnosis and treatment guidelines that quickly provide the pearls and secrets of your field, helping you optimize safety, efficiency, and quality in the ED as well as study for the boards.
- Consult this title on your favorite e-reader with intuitive search tools and adjustable font sizes. Elsevier eBooks provide instant portable access to your entire library, no matter what device you're using or where you're located.
- Get clear, concise descriptions and evidence-based treatment guidelines for a full range of clinical conditions, ranging from the common to the unusual.
- Find the information you need quickly with a highly visual format that features hundreds of full-color clinical photographs, illustrations, algorithms, tables, and graphs, plus key information highlighted for fast reference.
- Consult high-yield text boxes in every chapter for Priority Actions, Facts and Formulas, Documentation, Patient Teaching Tips, Red Flags, and Tips and Tricks.
- Make the most of your limited time with easy-to-digest blocks of information, consistently presented for clear readability and quick reference.
- Study efficiently and effectively for the boards, or rapidly consult this title in daily practice, thanks to well-organized chapters, a superb use of images and diagrams, and clinically relevant, easy-to-understand content.
- Benefit from the knowledge and expertise of renowned educators, dedicated to compiling today’s best knowledge in emergency medicine into one highly useful, readable text.
- Be prepared to manage increasingly prevalent problems seen in the ED, such as emergent complications of fertility treatment and management of patients who have had bariatric surgery.
- Deliver high-quality care to your younger patients with expanded pediatrics content.
- Stay up to date with new chapters on Clotting Disorders and Hemophilia, Patient-Centered Care, Health Disparities and Diversity in Emergency Medicine, Cost-Effectiveness Analysis, Antibiotic Recommendations for Empirical Treatment of Selected Infectious Diseases, and Cardiac Emergency Ultrasound: Evaluation for Pericardial Effusion & Cardiac Activity.
- Access the complete contents of Emergency Medicine online, fully searchable, at www.expertconsult.com, with downloadable images, tables and boxes, and expanded chapters, plus videos demonstrating ultrasound-guided vascular access, sonography for trauma, and more.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Emergency Medicine | i | ||
| Copyright page | iv | ||
| Dedication | v | ||
| Preface | vii | ||
| Contributors | ix | ||
| Table of Contents | xxi | ||
| Ultrasound Video Contents | xxviii | ||
| I Resuscitation Skills and Techniques | 1 | ||
| 1 Basic Airway Management | 1 | ||
| Key Points | 1 | ||
| Airway Assessment | 1 | ||
| Critical Airway Physiology | 2 | ||
| Oxygenation Techniques | 2 | ||
| Bag-Mask Technique | 3 | ||
| Emergency Airway Algorithm | 3 | ||
| Intubation | 4 | ||
| Medications, Pharmacology, and Physiologic Responses to Medication Classes | 5 | ||
| Sedative Agents | 5 | ||
| Neuromuscular Blocking Agents (Paralytics) | 5 | ||
| Pretreatment Agents | 5 | ||
| Putting It Together: Rapid-Sequence Intubation | 6 | ||
| Summary | 7 | ||
| Suggested Readings | 7 | ||
| References | 7 | ||
| References | 7.e1 | ||
| 2 Advanced Airway Techniques | 8 | ||
| Key Points | 8 | ||
| Perspective | 8 | ||
| Epidemiology | 8 | ||
| Anticipated Difficulty | 8 | ||
| Unanticipated Difficulty | 8 | ||
| Anticipated Difficult Airway | 8 | ||
| Rapid-Sequence Intubation for A Difficult Airway | 9 | ||
| Optimized Laryngoscopy | 9 | ||
| Head and Neck Positioning | 9 | ||
| External Laryngeal Manipulation | 9 | ||
| Facility with Various Blade Types | 9 | ||
| Augmented Laryngoscopy | 9 | ||
| Alternative Techniques for the Anticipated Difficult Airway | 10 | ||
| Fiberoptics | 10 | ||
| Flexible and Directable Fiberoptics | 10 | ||
| Flexible and Nondirectable Fiberoptics | 10 | ||
| Semirigid Fiberoptics | 10 | ||
| Rigid Fiberoptics | 11 | ||
| Optical Laryngoscopy | 11 | ||
| Video Laryngoscopy | 11 | ||
| Awake Techniques | 11 | ||
| Blind Nasotracheal Intubation | 12 | ||
| Light Wand | 12 | ||
| The Unanticipated Difficult Airway | 12 | ||
| Can’t Intubate, Can Ventilate | 12 | ||
| Tracheal Introducer | 12 | ||
| The Laryngeal Mask Airway | 12 | ||
| Can’t Intubate, Can’t Ventilate | 14 | ||
| Rescue Airway Devices | 14 | ||
| Invasive Intubation | 14 | ||
| Open Surgical Technique | 14 | ||
| Standard Technique | 14 | ||
| Rapid Four-Step Technique | 15 | ||
| Percutaneous Technique | 16 | ||
| Pediatric Considerations | 16 | ||
| Rescue Devices | 16 | ||
| Classic Laryngeal Mask Airway | 16 | ||
| King LT | 16 | ||
| GlideScope for Children | 18 | ||
| Fiberoptics | 18 | ||
| Invasive Considerations | 18 | ||
| References | 18 | ||
| References | 18.e1 | ||
| 3 Mechanical Ventilation | 19 | ||
| Key Points | 19 | ||
| Epidemiology | 19 | ||
| Pathophysiology | 19 | ||
| Presenting Signs and Symptoms | 19 | ||
| Differential Diagnosis and Medical Decision Making | 19 | ||
| Treatment | 20 | ||
| Prehospital Setting | 20 | ||
| Hospital Setting | 20 | ||
| Consultation | 20 | ||
| Techniques and Methods of Mechanical Ventilation | 20 | ||
| Modes of Invasive Mechanical Ventilation | 20 | ||
| Control Mode | 20 | ||
| Assist/Control Mode | 21 | ||
| Synchronized Intermittent Mandatory Ventilation and Pressure Support | 21 | ||
| Continuous Positive Airway Pressure | 22 | ||
| Other Modes | 22 | ||
| Monitoring Dynamic Pressure During Invasive Ventilation | 23 | ||
| Peak Inspiratory Airway Pressure | 23 | ||
| Plateau Pressure | 23 | ||
| Intrinsic Positive End-Expiratory Pressure | 23 | ||
| Modes of Noninvasive Mechanical Ventilation | 23 | ||
| Spontaneous and Spontaneous/Timed Modes | 23 | ||
| Initiation of Noninvasive Positive Pressure Ventilation | 24 | ||
| Specific Disease Processes | 24 | ||
| Controlling Airway Pressure—Lung-Protective Ventilator Strategies | 24 | ||
| Acute Respiratory Distress, Acute Lung Injury, and Pulmonary Edema | 24 | ||
| Obstructive Airways Disease | 25 | ||
| Follow-Up, Next Steps In Care, and Patient Education | 25 | ||
| Complications | 26 | ||
| Invasive Mechanical Ventilation | 26 | ||
| Intrinsic Positive End-Expiratory Pressure | 26 | ||
| Difficulty Triggering the Ventilator | 26 | ||
| Autocycling | 26 | ||
| Rapid Breathing | 26 | ||
| Outstripping the Ventilator and Double Cycling | 26 | ||
| Straining over the Ventilator | 27 | ||
| Coughing | 27 | ||
| Equipment Failure | 27 | ||
| Noninvasive Mechanical Ventilation | 27 | ||
| Prognosis | 27 | ||
| Suggested Readings | 27 | ||
| References | 27 | ||
| References | 27.e1 | ||
| 4 Shock | 28 | ||
| Key Points | 28 | ||
| Perspective | 28 | ||
| Anatomy | 28 | ||
| Pathophysiology of Circulatory Dysfunction | 28 | ||
| Presenting Signs and Symptoms | 29 | ||
| Initial Assessment | 29 | ||
| Vital Signs | 30 | ||
| Blood Pressure | 30 | ||
| Heart Rate | 30 | ||
| Orthostatic Blood Pressure | 31 | ||
| Pulse Pressure | 31 | ||
| History | 31 | ||
| Physical Examination | 31 | ||
| Emergency Ultrasonography | 33 | ||
| Step 1: Evaluate the Pump | 33 | ||
| Step 2: Evaluate the Tank | 34 | ||
| Step 3: Evaluate the Pipes | 34 | ||
| Additional Uses of Emergency Ultrasonography | 34 | ||
| Procedures and Circulatory Monitoring | 34 | ||
| Intravenous Access | 34 | ||
| Arterial Blood Pressure Monitoring | 35 | ||
| Central Venous Pressure | 36 | ||
| Pulmonary Artery Catheterization | 37 | ||
| Additional Circulatory Monitoring Modalities | 37 | ||
| Treatment of Circulatory Dysfunction | 38 | ||
| General Treatment Principles | 38 | ||
| Trendelenburg Position | 38 | ||
| Intravenous Fluid Administration | 38 | ||
| Preload Responsiveness | 38 | ||
| Static Versus Dynamic Measurements | 38 | ||
| Distensbility Index | 39 | ||
| Pulse Pressure Variation | 39 | ||
| Vasoactive Therapy | 40 | ||
| Mechanical Circulatory Support | 41 | ||
| Summary | 41 | ||
| References | 42 | ||
| References | 42.e1 | ||
| 5 Emergency Cardiac Ultrasound: | 43 | ||
| Key Points | 43 | ||
| Introduction | 43 | ||
| What We Are Looking For | 43 | ||
| Literature Review | 43 | ||
| Estimation of Global Cardiac Function and Ejection Fraction | 43 | ||
| Diagnosis of Pericardial Effusion | 43 | ||
| How to Scan/Scanning Protocols | 43 | ||
| Probe Selection | 43 | ||
| Acoustic Windows | 43 | ||
| Probe Orientation | 43 | ||
| Specific Views | 43 | ||
| Parasternal Long Axis | 43 | ||
| Parasternal Short Axis | 44 | ||
| Apical Four- and Two-Chamber Views | 45 | ||
| Subcostal Four-Chamber View | 45 | ||
| Normal and Abnormal Findings | 46 | ||
| Pericardial Effusion | 46 | ||
| Cardiac Arrest | 46 | ||
| Acute Heart Failure | 47 | ||
| Pitfalls | 48 | ||
| Pulmonary Embolism | 48 | ||
| Volume Status | 48 | ||
| Suggested Readings | 49 | ||
| References | 49 | ||
| References | 49.e1 | ||
| 6 Ultrasound-Guided Vascular Access | 50 | ||
| Key Points | 50 | ||
| Introduction | 50 | ||
| How to Scan and Scanning Protocols | 50 | ||
| Suggested Readings | 54 | ||
| References | 54 | ||
| References | 54.e1 | ||
| 7 Management of Cardiac Arrest and Post–Cardiac Arrest Syndrome | 55 | ||
| Key Points | 55 | ||
| Epidemiology | 55 | ||
| General Management Considerations | 55 | ||
| Cardiopulmonary Resuscitation | 56 | ||
| Electrical Therapy | 57 | ||
| Pharmacologic Therapy | 57 | ||
| The Airway | 58 | ||
| Management of Specific Dysrhythmias | 58 | ||
| Ventricular Fibrillation and Pulseless Ventricular Tachycardia | 58 | ||
| Pathophysiology | 59 | ||
| Clinical Presentation | 59 | ||
| Ventricular Fibrillation | 59 | ||
| Ventricular Tachycardia | 59 | ||
| Management of Pulseless Ventricular Tachycardia and Ventricular Fibrillation | 59 | ||
| Pulseless Electrical Activity | 64 | ||
| Definition | 64 | ||
| Pathophysiology | 64 | ||
| II Special Considerations in the Pediatric Patient | 97 | ||
| 12 Neonatal Cardiopulmonary Resuscitation | 97 | ||
| Key Points | 97 | ||
| Perspective | 97 | ||
| Survival with Comorbid Conditions | 97 | ||
| Anatomy | 97 | ||
| Presenting Signs and Symptoms | 97 | ||
| Interventions and Procedures: Resuscitation Steps | 97 | ||
| Airway | 98 | ||
| Breathing | 98 | ||
| Circulation | 100 | ||
| Maintenance of Temperature | 101 | ||
| Resuscitation Medications and Volume Replacement | 101 | ||
| References | 102 | ||
| References | 102.e1 | ||
| 13 Pediatric Resuscitation | 103 | ||
| Key Points | 103 | ||
| Epidemiology | 103 | ||
| Basic Principles of Cardiopulmonary Resuscitation | 103 | ||
| Airway Management | 104 | ||
| Anatomy | 105 | ||
| Rapid-Sequence Intubation in Children | 105 | ||
| Pharmacologic Agents for Rapid-Sequence Intubation in Children | 106 | ||
| Principles of Endotracheal Intubation | 106 | ||
| Breathing | 107 | ||
| Bag-Valve-Mask Ventilation | 107 | ||
| Initial Ventilator Settings | 107 | ||
| The Difficult Pediatric Airway | 107 | ||
| Failed Intubation | 107 | ||
| Needle Cricothyrotomy (Jet Ventilation) | 108 | ||
| Methods of Ventilation | 108 | ||
| Circulation | 108 | ||
| Peripheral Intravenous Lines | 108 | ||
| Intraosseous Access | 108 | ||
| Central Venous Access | 109 | ||
| Resuscitative Drugs | 109 | ||
| Epinephrine | 109 | ||
| Vasopressin | 109 | ||
| Atropine | 109 | ||
| Electrolytes | 109 | ||
| Adenosine | 110 | ||
| Lidocaine | 110 | ||
| Amiodarone | 110 | ||
| Procainamide | 110 | ||
| Interventions | 110 | ||
| References | 110 | ||
| References | 110.e1 | ||
| 14 General Approach to the Pediatric Patient | 113 | ||
| Key Points | 113 | ||
| General Approach | 113 | ||
| Growth and Development | 114 | ||
| The Family | 114 | ||
| Family Presence | 115 | ||
| Confidentiality and Consent | 116 | ||
| References | 116 | ||
| References | 116.e1 | ||
| 15 Emergencies in the First Weeks of Life | 117 | ||
| Key Points | 117 | ||
| The Normal Neonate | 117 | ||
| Weight | 117 | ||
| Feeding | 117 | ||
| Sleeping | 117 | ||
| Vital Signs | 117 | ||
| Apnea and Apparent Life-Threatening Events | 117 | ||
| Epidemiology | 117 | ||
| Pathophysiology | 117 | ||
| Presenting Signs and Symptoms | 119 | ||
| Differential Diagnosis and Medical Decision Making | 119 | ||
| Disposition | 120 | ||
| Excessive Crying and Irritability | 120 | ||
| Epidemiology | 120 | ||
| Pathophysiology | 120 | ||
| Presenting Signs and Symptoms | 120 | ||
| Differential Diagnosis and Medical Decision Making | 120 | ||
| Treatment | 121 | ||
| Disposition | 121 | ||
| Cyanosis | 121 | ||
| Pathophysiology | 121 | ||
| Presenting Signs and Symptoms | 122 | ||
| Differential Diagnosis and Medical Decision Making | 122 | ||
| Treatment | 122 | ||
| Disposition | 122 | ||
| Difficulty Breathing | 123 | ||
| Pathophysiology | 123 | ||
| Presenting Signs and Symptoms | 123 | ||
| Differential Diagnosis and Medical Decision Making | 123 | ||
| Treatment and Disposition | 124 | ||
| Fever | 124 | ||
| Scope | 124 | ||
| Pathophysiology | 125 | ||
| Presenting Signs and Symptoms | 125 | ||
| Differential Diagnosis and Medical Decision Making | 125 | ||
| Treatment | 125 | ||
| Vomiting | 125 | ||
| Scope | 125 | ||
| Pathophysiology | 126 | ||
| Signs and Symptoms | 126 | ||
| III Head & Neck Disorders | 209 | ||
| 26 Eye Emergencies | 209 | ||
| Key Points | 209 | ||
| IV Gastrointestinal Diseases | 269 | ||
| 31 Esophageal Disorders | 269 | ||
| Key Points | 269 | ||
| Reflux Esophagitis | 269 | ||
| Epidemiology | 269 | ||
| Pathophysiology | 269 | ||
| Presenting Signs and Symptoms | 269 | ||
| Differential Diagnosis and Medical Decision Making | 269 | ||
| Treatment | 270 | ||
| Next Steps in Care | 270 | ||
| Infectious Esophagitis | 271 | ||
| Epidemiology | 271 | ||
| Pathophysiology | 271 | ||
| Presenting Signs and Symptoms | 271 | ||
| Differential Diagnosis and Medical Decision Making | 271 | ||
| Treatment | 271 | ||
| Next Steps in Care | 271 | ||
| Pill Esophagitis And Caustic Esophageal Injury | 272 | ||
| V Thoracic and Respiratory Disorders | 397 | ||
| 48 Asthma | 397 | ||
| Key Points | 397 | ||
| Perspective | 397 | ||
| Epidemiology | 397 | ||
| Pathophysiology | 397 | ||
| Presenting Signs and Symptoms | 398 | ||
| Variations in Presenting Signs and Symptoms | 398 | ||
| Differential Diagnosis | 398 | ||
| Diagnostic Testing | 398 | ||
| Treatment | 399 | ||
| Pharmaceuticals | 399 | ||
| β2-Agonist Agents | 399 | ||
| Corticosteroids | 402 | ||
| Anticholinergics | 402 | ||
| Magnesium | 403 | ||
| Heliox, Ketamine, and Halothane | 403 | ||
| Mast Cell Modifiers | 403 | ||
| Leukotriene Modifiers | 403 | ||
| Theophylline | 403 | ||
| Mechanical Ventilation | 403 | ||
| Disposition | 403 | ||
| Suggested Readings | 404 | ||
| References | 404 | ||
| References | 404.e1 | ||
| 49 Chronic Obstructive Pulmonary Disease | 405 | ||
| Key Points | 405 | ||
| Perspective | 405 | ||
| Epidemiology | 405 | ||
| Pathophysiology | 405 | ||
| Chronically Compensated Chronic Obstructive Pulmonary Disease | 405 | ||
| Acute Exacerbations | 406 | ||
| Presenting Signs and Symptoms | 406 | ||
| Classic | 406 | ||
| Variations | 406 | ||
| Differential Diagnosis | 407 | ||
| Asthma | 407 | ||
| Congestive Heart Failure | 407 | ||
| Pulmonary Embolism | 407 | ||
| Acute Coronary Syndrome | 407 | ||
| Pneumothorax | 407 | ||
| Pneumonia | 408 | ||
| Diagnostic Testing | 408 | ||
| History | 408 | ||
| Physical Examination | 408 | ||
| Imaging and Laboratory Testing | 408 | ||
| Chest Radiographs | 408 | ||
| Pulse Oximetry | 408 | ||
| Arterial Blood Gas Analysis | 408 | ||
| Spirometry | 409 | ||
| Additional Laboratory Testing | 409 | ||
| Interventions, Procedures, and Treatment | 409 | ||
| Oxygen | 409 | ||
| Inhaled Medications | 409 | ||
| Corticosteroids | 410 | ||
| Antibiotics | 411 | ||
| Methylxanthines | 411 | ||
| Noninvasive Positive Pressure Ventilation | 411 | ||
| Endotracheal Intubation and Mechanical Ventilation | 412 | ||
| Disposition and Follow-Up | 412 | ||
| Suggested Readings | 413 | ||
| References | 413 | ||
| References | 413.e1 | ||
| 50 Lung Infections | 414 | ||
| Key Points | 414 | ||
| Epidemiology | 414 | ||
| Pathophysiology | 414 | ||
| Presenting Signs and Symptoms | 414 | ||
| Pathogens | 416 | ||
| Special Populations | 416 | ||
| Children | 416 | ||
| Patients Infected with Human Immunodeficiency Virus | 417 | ||
| Aspiration Pneumonia | 417 | ||
| Influenza | 417 | ||
| Community-Acquired Methicillin-Resistant Staphylococcus Aureus | 417 | ||
| Evaluation and Diagnostic Testing | 418 | ||
| Chest Radiographs | 418 | ||
| Sputum Studies | 418 | ||
| Blood Cultures | 419 | ||
| Other Studies | 419 | ||
| Treatment | 419 | ||
| Health Care–Associated Pneumonia | 420 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 420 | ||
| Suggested Readings | 422 | ||
| References | 422 | ||
| References | 422.e1 | ||
| 51 Pneumothorax | 423 | ||
| Key Points | 423 | ||
| Epidemiology | 423 | ||
| Pathophysiology | 423 | ||
| VI Cardiac Disorders | 445 | ||
| 54 Chest Pain | 445 | ||
| Key Points | 445 | ||
| Epidemiology | 445 | ||
| Pathophysiology | 445 | ||
| Presenting Signs and Symptoms | 445 | ||
| Acute Coronary Syndrome | 446 | ||
| Epidemiology | 446 | ||
| Presenting Signs and Symptoms | 447 | ||
| Diagnostic Testing | 447 | ||
| Observation Units and Protocols | 448 | ||
| Treatment | 449 | ||
| Disposition | 449 | ||
| Aortic Dissection | 449 | ||
| Presenting Signs and Symptoms | 449 | ||
| Diagnostic Testing | 450 | ||
| Treatment | 450 | ||
| Disposition | 450 | ||
| Cocaine-Associated Chest Pain | 450 | ||
| Pathophysiology | 451 | ||
| Presenting Signs and Symptoms | 451 | ||
| Medical Decision Making and Differential Diagnosis | 451 | ||
| Diagnostic Testing | 451 | ||
| Treatment and Disposition | 451 | ||
| References | 451 | ||
| References | 451.e1 | ||
| 55 Acute Coronary Syndrome | 452 | ||
| Key Points | 452 | ||
| Epidemiology | 452 | ||
| Definitions | 452 | ||
| Pathophysiology | 453 | ||
| Presenting Signs and Symptoms | 453 | ||
| History | 453 | ||
| Atypical Presentations | 454 | ||
| Physical Findings | 454 | ||
| Differential Diagnosis and Medical Decision Making | 454 | ||
| Diagnostic Testing | 454 | ||
| Electrocardiogram | 454 | ||
| Electrocardiographic Findings in ST-Segment Elevation Myocardial Infarction | 454 | ||
| Electrocardiographic Findings in Non–ST-Segment Elevation Acute Coronary Syndrome | 460 | ||
| Cardiac Biomarkers | 460 | ||
| Other Tests | 460 | ||
| Treatment | 462 | ||
| Prehospital Management | 462 | ||
| Hospital Management | 462 | ||
| Platelet Inhibitors | 462 | ||
| Beta-Blocking Agents | 465 | ||
| Nitrate Preparations | 465 | ||
| Oxygen | 465 | ||
| Anticoagulants | 465 | ||
| Morphine | 466 | ||
| Angiotensin-Converting Enzyme Inhibitors | 466 | ||
| Revascularization Therapy | 466 | ||
| Follow-Up and Next Steps in Care | 468 | ||
| Suggested Readings | 468 | ||
| References | 468 | ||
| References | 468.e1 | ||
| 56 Cardiac Imaging and Stress Testing | 469 | ||
| Key Points | 469 | ||
| Background and Scope | 469 | ||
| Electrocardiogram | 469 | ||
| Chest Roentgenogram | 470 | ||
| Exercise Treadmill Testing | 470 | ||
| Echocardiography | 470 | ||
| Rest Echocardiogram | 470 | ||
| Stress Echocardiogram | 472 | ||
| Myocardial Perfusion Imaging | 472 | ||
| Electron Beam Computed Tomography and Computed Tomographic Coronary Angiography | 472 | ||
| Magnetic Resonance Imaging | 473 | ||
| Example of a Chest Pain Unit Protocol That Uses Risk Stratification and Cardiac Imaging | 473 | ||
| Summary | 475 | ||
| References | 475 | ||
| References | 475.e1 | ||
| 57 Congestive Heart Failure | 476 | ||
| Key Points | 476 | ||
| Epidemiology | 476 | ||
| Pathophysiology | 477 | ||
| Presenting Signs and Symptoms | 477 | ||
| Differential Diagnosis and Medical Decision Making | 479 | ||
| Emergency Department Evaluation | 479 | ||
| Diagnostic Studies | 479 | ||
| Laboratory Tests | 479 | ||
| Markers of Cardiac Ischemia | 479 | ||
| B-Type Natriuretic Peptide and NT-Probnp | 479 | ||
| Electrocardiography | 480 | ||
| Chest Radiography | 480 | ||
| Cardiac Echocardiography | 480 | ||
| Pulmonary Artery (Swan-Ganz) Catheterization | 480 | ||
| Other Diagnostic Modalities | 481 | ||
| Treatment | 481 | ||
| Priorities of Treatment | 481 | ||
| Noninvasive Respiratory Support | 481 | ||
| Pharmacologic Therapy | 481 | ||
| Diuretics | 481 | ||
| Nitrates | 482 | ||
| Nesiritide | 483 | ||
| Angiotensin-Converting Enzyme Inhibitors | 483 | ||
| Inotropic Therapy | 483 | ||
| Morphine | 483 | ||
| Investigational Drugs | 483 | ||
| Beta-Blockers | 484 | ||
| Ultrafiltration | 484 | ||
| Special Circumstances | 484 | ||
| Cardiogenic Shock | 484 | ||
| Atrial Fibrillation | 484 | ||
| Renal Dysfunction | 484 | ||
| Follow-Up and Next Steps in Care | 484 | ||
| Observation Units | 486 | ||
| References | 486 | ||
| References | 486.e1 | ||
| 58 Bradyarrhythmias | 487 | ||
| Key Points | 487 | ||
| Epidemiology | 487 | ||
| Pathophysiology | 487 | ||
| Extrinsic Causes | 487 | ||
| Intrinsic Causes | 487 | ||
| Relative Bradycardia | 487 | ||
| Presenting Signs and Symptoms | 487 | ||
| Differential Diagnosis and Medical Decision Making | 488 | ||
| Sinus Bradycardia | 488 | ||
| Sick Sinus Syndrome | 488 | ||
| Second-Degree Heart Block | 491 | ||
| Type I Second-Degree Atrioventricular Block | 491 | ||
| Type II Second-Degree Atrioventricular Conduction Block | 491 | ||
| Third-Degree Atrioventricular Block | 491 | ||
| Bradycardia Associated With A Wide QRS Complex | 491 | ||
| Treatment | 493 | ||
| Prehospital Care | 493 | ||
| Hospital Care | 494 | ||
| Consultation | 495 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 495 | ||
| Admission | 495 | ||
| Prognosis | 495 | ||
| Pitfalls | 496 | ||
| References | 496 | ||
| References | 496.e1 | ||
| 59 Tachydysrhythmias | 497 | ||
| Key Points | 497 | ||
| Epidemiology | 497 | ||
| Pathophysiology and Mechanisms | 497 | ||
| Presenting Signs and Symptoms | 498 | ||
| Differential Diagnosis | 498 | ||
| Treatment | 498 | ||
| Specific Tachycardias | 499 | ||
| Supraventricular Tachycardias | 500 | ||
| Irregular Supraventricular Tachycardias | 500 | ||
| Atrial Fibrillation | 500 | ||
| Multifocal Atrial Tachycardia | 501 | ||
| Regular Supraventricular Tachycardias | 501 | ||
| Sinus Tachycardia | 501 | ||
| Atrial Flutter | 501 | ||
| Atrial Tachycardia | 502 | ||
| Reentrant Supraventricular Tachycardia | 503 | ||
| Preexcitation (Wolff-Parkinson-White) Syndrome | 504 | ||
| Junctional Tachycardia | 506 | ||
| Ventricular Tachycardias | 506 | ||
| Premature Ventricular Contractions and Nonsustained Ventricular Tachycardia | 506 | ||
| Monomorphic Ventricular Tachycardia | 507 | ||
| Wide QRS Complex Tachycardia: Differentiating Supraventricular From Ventricular Tachycardia | 508 | ||
| Polymorphic Ventricular Tachycardia | 510 | ||
| Summary | 513 | ||
| References | 513 | ||
| References | 513.e2 | ||
| 60 Pericarditis, Pericardial Tamponade, and Myocarditis | 514 | ||
| Key Points | 514 | ||
| Epidemiology | 514 | ||
| Pericarditis | 514 | ||
| Pathophysiology | 514 | ||
| Presenting Signs and Symptoms | 514 | ||
| Classic | 514 | ||
| Typical Variations | 515 | ||
| Differential Diagnosis and Medical Decision Making | 515 | ||
| Treatment | 517 | ||
| Follow-Up and Next Steps in Care | 517 | ||
| Pericardial Tamponade | 518 | ||
| Pathophysiology | 518 | ||
| Presenting Signs and Symptoms | 518 | ||
| Classic | 518 | ||
| Typical Variations | 518 | ||
| Differential Diagnosis and Medical Decision Making | 518 | ||
| Treatment | 519 | ||
| Follow-Up and Next Steps in Care | 520 | ||
| Myocarditis | 520 | ||
| Pathophysiology | 520 | ||
| Presenting Signs and Symptoms | 521 | ||
| Classic | 521 | ||
| Typical Variations | 521 | ||
| Differential Diagnosis and Medical Decision Making | 522 | ||
| Treatment | 523 | ||
| Follow-Up and Next Steps in Care | 523 | ||
| References | 523 | ||
| References | 523.e1 | ||
| 61 Cardiac Valvular Disorders | 524 | ||
| Key Points | 524 | ||
| Epidemiology | 524 | ||
| Pathophysiology and Presenting Signs and Symptoms | 524 | ||
| Differential Diagnosis and Medical Decision Making | 525 | ||
| Specific Valve Lesions | 525 | ||
| Aortic Stenosis | 525 | ||
| Aortic Regurgitation | 526 | ||
| Mitral Stenosis | 527 | ||
| Mitral Regurgitation | 527 | ||
| Mitral Valve Prolapse | 527 | ||
| Endocarditis and Rheumatic Fever Prophylaxis | 527 | ||
| Prosthetic Valve Disorders | 527 | ||
| Treatment | 528 | ||
| Disposition | 529 | ||
| References | 529 | ||
| References | 529.e1 | ||
| 62 Endocarditis | 530 | ||
| Key Points | 530 | ||
| Epidemiology | 530 | ||
| Pathophysiology | 531 | ||
| Microbiology of Infective Endocarditis | 532 | ||
| Bacteria | 532 | ||
| Viridans Group Streptococci | 532 | ||
| Staphylococcus aureus | 532 | ||
| Staphylococcus epidermidis | 532 | ||
| Streptococcus bovis | 532 | ||
| Streptococcus pneumoniae | 532 | ||
| Enterococci | 532 | ||
| Pseudomonas aeruginosa | 533 | ||
| Culture-Negative Bacteria | 533 | ||
| Fungi | 534 | ||
| Presenting Signs and Symptoms | 534 | ||
| Classic Triad | 534 | ||
| Organ-Specific Clinical Findings | 534 | ||
| Vascular Signs and Symptoms | 534 | ||
| Cardiac Signs and Symptoms | 534 | ||
| Pulmonary Signs and Symptoms | 535 | ||
| Neurologic and Psychiatric Signs and Symptoms | 535 | ||
| Ophthalmologic Signs and Symptoms | 535 | ||
| Hematopoietic Signs and Symptoms | 535 | ||
| Gastrointestinal Signs and Symptoms | 535 | ||
| Renal Signs and Symptoms | 535 | ||
| Dermatologic Signs and Symptoms | 535 | ||
| Differential Diagnosis and Medical Decision Making | 536 | ||
| Differential Diagnosis | 536 | ||
| Medical Decision Making | 537 | ||
| Diagnostic Testing | 539 | ||
| Laboratory Tests | 539 | ||
| Microbiology | 540 | ||
| Electrocardiography | 540 | ||
| Echocardiography | 540 | ||
| Transthoracic Echocardiography | 540 | ||
| Transesophageal Echocardiography | 540 | ||
| Radiography | 541 | ||
| Lumbar Puncture | 541 | ||
| Treatment | 541 | ||
| Resuscitation | 541 | ||
| Empiric Antibiotic Therapy | 542 | ||
| Cardiac Pacing | 544 | ||
| Anticoagulation | 544 | ||
| Surgical Therapy | 544 | ||
| Removal of Medical Hardware | 544 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 544 | ||
| Nonbacterial Thrombotic Endocarditis | 544 | ||
| Endocarditis Prophylaxis | 545 | ||
| Acknowledgment | 546 | ||
| Suggested Readings | 546 | ||
| References | 546 | ||
| References | 546.e1 | ||
| 63 Management of Emergencies Related to Implanted Cardiac Devices | 547 | ||
| Key Points | 547 | ||
| Introduction | 547 | ||
| Implantable Cardioverter-Defibrillators | 547 | ||
| General Concepts of Function | 547 | ||
| Indications for Placement of an Implantable Cardioverter-Defibrillator | 548 | ||
| Approach to Complications Related to the Implantation Procedure | 548 | ||
| Approach to Problems Related to Function and Dysfunction | 549 | ||
| Cardiac Arrest | 549 | ||
| Unstable with Ongoing Shocks | 550 | ||
| Electrical Storm | 550 | ||
| Stable with a Recent Isolated Shock | 550 | ||
| Stable with Other Cardiorespiratory Symptoms | 550 | ||
| Left Ventricular Assist Devices | 551 | ||
| General Concepts of Function | 551 | ||
| Indications for Placement of a Left Ventricular Assist Device | 551 | ||
| Approach to Problems Related to Function and Dysfunction | 552 | ||
| Thromboembolic and Bleeding Events | 552 | ||
| Infections | 552 | ||
| Minor Device Failure | 552 | ||
| Major Device Failure | 552 | ||
| Pacemakers | 553 | ||
| General Concepts of Function | 553 | ||
| Indications for Placement of a Pacemaker | 553 | ||
| Approach to Complications Related to the Implantation Procedure | 554 | ||
| Approach to Problems Related to Function and Dysfunction | 554 | ||
| Failure to Capture | 554 | ||
| Failure to Pace | 555 | ||
| Failure to Sense | 555 | ||
| Pacemaker-Induced Tachycardia | 555 | ||
| Suggested Readings | 556 | ||
| References | 556 | ||
| References | 556.e1 | ||
| 64 Syncope | 557 | ||
| Key Points | 557 | ||
| Epidemiology | 557 | ||
| Pathophysiology | 557 | ||
| Presenting Signs and Symptoms | 557 | ||
| Classification of Syncope | 557 | ||
| Neurally Mediated Syncope | 557 | ||
| Orthostatic Syncope | 558 | ||
| Neurologic Syncope | 558 | ||
| Cardiac-Related Syncope | 558 | ||
| Syncope of Unknown Cause | 558 | ||
| Recommended Diagnostic Tests | 558 | ||
| Prognosis | 558 | ||
| Acute Risk Stratification in the Emergency Department | 559 | ||
| Improved Diagnostic Strategies in the Emergency Department | 559 | ||
| Guidelines for Admission and Disposition | 560 | ||
| References | 560 | ||
| References | 560.e1 | ||
| VII Vascular Diseases | 561 | ||
| 65 Aortic Dissection | 561 | ||
| Key Points | 561 | ||
| Epidemiology | 561 | ||
| The Young Patient | 561 | ||
| Pathophysiology | 561 | ||
| Presenting Signs and Symptoms | 563 | ||
| Alternative Presentations | 564 | ||
| Abdominal Pain | 564 | ||
| Painless Dissection | 564 | ||
| Differential Diagnosis and Medical Decision Making | 564 | ||
| Patients with Undifferentiated Chest Pain | 565 | ||
| Chest Radiography | 565 | ||
| D-Dimer | 565 | ||
| Computed Tomography | 565 | ||
| Transesophageal Echocardiography | 566 | ||
| Magnetic Resonance Imaging | 567 | ||
| Angiography | 567 | ||
| Electrocardiography | 568 | ||
| Treatment | 569 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 570 | ||
| References | 570 | ||
| References | 570.e1 | ||
| 66 Abdominal Aortic Aneurysm | 571 | ||
| Key Points | 571 | ||
| Epidemiology | 571 | ||
| Pathophysiology | 571 | ||
| Presenting Signs and Symptoms | 572 | ||
| Differential Diagnosis and Medical Decision Making | 573 | ||
| Treatment | 576 | ||
| Future Therapy | 578 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 578 | ||
| Admission and Discharge | 578 | ||
| Complications | 578 | ||
| Patient Education | 578 | ||
| Suggested Reading | 579 | ||
| References | 579 | ||
| References | 579.e1 | ||
| 67 Aortic Ultrasound | 580 | ||
| Key Points | 580 | ||
| Introduction | 580 | ||
| What We are Looking for | 580 | ||
| Supporting Evidence | 580 | ||
| Scanning Protocols | 580 | ||
| Abnormal Findings | 582 | ||
| Pitfalls | 583 | ||
| Suggested Readings | 583 | ||
| References | 583 | ||
| References | 583.e1 | ||
| 68 Peripheral Arterial Disease | 584 | ||
| Key Points | 584 | ||
| Epidemiology | 584 | ||
| Pathophysiology | 584 | ||
| Thromboembolism | 585 | ||
| Atheroembolism | 585 | ||
| Inflammation | 585 | ||
| Trauma | 585 | ||
| Vasospasm | 586 | ||
| Arteriovenous Fistulas | 586 | ||
| Presenting Signs and Symptoms | 586 | ||
| Acute Arterial Occlusion | 586 | ||
| Intermittent Claudication | 587 | ||
| Rest Pain | 587 | ||
| Differential Diagnosis and Medical Decision Making | 587 | ||
| Acute Arterial Occlusion | 588 | ||
| Blue Toe Syndrome | 588 | ||
| Anke-Brachial Index | 588 | ||
| Imaging | 588 | ||
| Duplex Ultrasonography | 588 | ||
| Computed Tomographic Angiography | 588 | ||
| Magnetic Resonance Angiography | 588 | ||
| Diagnostic Angiography | 589 | ||
| Treatment | 589 | ||
| Patients with Viable Extremities | 589 | ||
| Patients with Threatened Extremities | 589 | ||
| Patients with Nonviable Extremities | 589 | ||
| Nonischemic Peripheral Arterial Disease | 590 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 590 | ||
| References | 591 | ||
| References | 591.e1 | ||
| 69 Hypertensive Crisis | 592 | ||
| Key Points | 592 | ||
| Epidemiology | 592 | ||
| Pathophysiology | 592 | ||
| Presenting Signs and Symptoms | 592 | ||
| Differential Diagnosis | 593 | ||
| Hypertensive Encephalopathy | 593 | ||
| Accelerated-Malignant Hypertension | 593 | ||
| Cerebrovascular Hypertensive Crisis | 594 | ||
| Cardiovascular Hypertensive Crisis | 594 | ||
| Renovascular Hypertensive Crisis | 594 | ||
| Catecholamine Excess | 594 | ||
| Hypertension in Pregnancy | 595 | ||
| Medical Decision Making | 595 | ||
| Diagnostic Testing | 595 | ||
| Treatment | 597 | ||
| Prehospital Management | 597 | ||
| Hospital Management | 597 | ||
| Hypertensive Emergency | 597 | ||
| Cerebrovascular Crisis | 597 | ||
| Cardiovascular Crisis | 597 | ||
| Renovascular Crisis | 599 | ||
| Catecholamine Excess | 599 | ||
| Hypertension in Pregnancy | 599 | ||
| Consultation | 599 | ||
| Next Steps in Care and Admission | 599 | ||
| Suggested Readings | 601 | ||
| References | 601 | ||
| References | 601.e1 | ||
| 70 Pulmonary Embolism | 602 | ||
| Key Points | 602 | ||
| Epidemiology | 602 | ||
| Pathophysiology | 602 | ||
| Presenting Signs and Symptoms | 603 | ||
| Differential Diagnosis and Medical Decision Making | 604 | ||
| Diagnostic Testing | 605 | ||
| Treatment | 608 | ||
| Risk Stratification | 608 | ||
| Treatment of Patients With Confirmed Pulmonary Embolism and Shock | 608 | ||
| Follow-Up, Next Steps In Care, and Patient Education | 609 | ||
| References | 610 | ||
| References | 610.e1 | ||
| 71 Venous Thrombosis | 611 | ||
| Key Points | 611 | ||
| Epidemiology | 611 | ||
| Pathophysiology | 611 | ||
| Presenting Signs and Symptoms | 612 | ||
| Differential Diagnosis and Medical Decision Making | 613 | ||
| Diagnostic Testing | 613 | ||
| Pretest Probability | 613 | ||
| Ultrasonography | 614 | ||
| Ultrasound Performed by Emergency Department Clinicians | 614 | ||
| Additional or Follow-up Ultrasonography | 614 | ||
| Venography | 614 | ||
| Runoff Venography After Chest Computed Tomography for Pulmonary Embolism | 614 | ||
| D-Dimer Test | 614 | ||
| Combining of Pretest Probability, D-Dimer Testing, and Duplex Ultrasonography | 615 | ||
| Treatment | 616 | ||
| Disposition | 616 | ||
| Special Cases Related to Treatment or Disposition Decisions | 616 | ||
| Superficial Thrombophlebitis | 616 | ||
| Isolated Calf Deep Vein Thrombosis | 617 | ||
| Phlegmasia Cerulea Dolens | 617 | ||
| Postphlebitic Syndrome | 617 | ||
| References | 617 | ||
| References | 617.e1 | ||
| 72 Lower Extremity Venous Ultrasonography | 618 | ||
| Key Points | 618 | ||
| Epidemiology | 618 | ||
| Perspective | 618 | ||
| Evidence-Based Review | 619 | ||
| Two-Point Compression Versus Whole-Leg Color Duplex Ultrasound | 619 | ||
| One Leg Versus Both Legs | 620 | ||
| How to Scan | 620 | ||
| How to Incorporate into Practice | 624 | ||
| Suggested Readings | 624 | ||
| References | 624 | ||
| References | 624.e1 | ||
| VIII Traumatic Brain Disorders | 625 | ||
| 73 Traumatic Brain Injury (Adult) | 625 | ||
| Key Points | 625 | ||
| Epidemiology | 625 | ||
| Pathophysiology | 625 | ||
| Presenting Signs and Symptoms | 625 | ||
| Glasgow Coma Scale Score | 625 | ||
| Clinical Findings | 625 | ||
| Differential Diagnosis and Medical Decision Making | 626 | ||
| Imaging | 626 | ||
| Treatment | 626 | ||
| General | 626 | ||
| Prehospital Management | 627 | ||
| Airway and Breathing | 628 | ||
| Circulation | 629 | ||
| Avoiding Cerebral Herniation | 629 | ||
| Seizure Prophylaxis | 629 | ||
| Steroids in Patients with Traumatic Brain Injury | 630 | ||
| Mild Traumatic Brain Injury | 630 | ||
| Overview | 630 | ||
| Imaging | 630 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 630 | ||
| Disposition | 630 | ||
| Patient Teaching | 630 | ||
| Concussion and Return to Play | 632 | ||
| Suggested Readings | 632 | ||
| References | 632 | ||
| References | 632.e1 | ||
| 74 Imaging of the Central Nervous System | 633 | ||
| Key Points | 633 | ||
| Perspective | 633 | ||
| Computed Tomography | 633 | ||
| Basic Principles | 633 | ||
| Attenuation Coefficient | 633 | ||
| Windowing | 633 | ||
| Artifact | 634 | ||
| Normal Neuroanatomy As Seen On Head Computed Tomography | 634 | ||
| Identifying Central Nervous System Pathology On Cranial Computed Tomography | 634 | ||
| Blood | 636 | ||
| Epidural Hematoma | 636 | ||
| Subdural Hematoma | 636 | ||
| Intraparenchymal Hemorrhage | 638 | ||
| Intraventricular Hemorrhage | 638 | ||
| Subarachnoid Hemorrhage | 638 | ||
| Extracranial Hemorrhage | 639 | ||
| Cisterns | 639 | ||
| Brain | 639 | ||
| Specific Brain Parencymal Lesions | 640 | ||
| Tumor | 640 | ||
| Abscess | 640 | ||
| Ischemic Infarction | 640 | ||
| Ventricles | 641 | ||
| Bone | 641 | ||
| Magnetic Resonance Imaging | 642 | ||
| Basic Principles | 642 | ||
| Magnetic Resonance Imaging Versus Computed Tomography | 644 | ||
| References | 644 | ||
| References | 644.e1 | ||
| 75 Spine Trauma and Spinal Cord Injury | 645 | ||
| Key Points | 645 | ||
| Epidemiology | 645 | ||
| Pathophysiology | 645 | ||
| Presenting Signs and Symptoms | 646 | ||
| Differential Diagnosis and Medical Decision Making | 648 | ||
| Indications for Cervical Spine Imaging | 648 | ||
| Choosing the Imaging Modality to Evaluate the Cervical Spine (Fig. 75.6) | 648 | ||
| Computed Tomography | 648 | ||
| Flexion-Extension Plain Film Radiography | 651 | ||
| Magnetic Resonance Imaging | 651 | ||
| Older and Osteopenic Patients | 651 | ||
| Clinical Clearance of the Cervical Spine | 651 | ||
| Classic Fracture Patterns (Tables 75.6 to 75.8; Figs. 75.7 to 75.9) | 652 | ||
| Cervical Spine Injuries | 652 | ||
| Thoracic and Lumbar Spine Injuries | 652 | ||
| Classification of Spinal Cord Injuries | 654 | ||
| Complete Injury | 654 | ||
| Incomplete Injury | 654 | ||
| Central Cord Syndrome | 657 | ||
| Anterior Cord Syndrome | 657 | ||
| Brown-Séquard Syndrome | 657 | ||
| Conus Medullaris Syndrome | 657 | ||
| Cauda Equina Syndrome | 657 | ||
| Treatment | 658 | ||
| In-Line Immobilization of the Cervical Spine | 658 | ||
| Neurogenic Shock | 658 | ||
| Corticosteroid Therapy for Spinal Cord Injury | 658 | ||
| Surgical Management of Spinal Cord Injury | 658 | ||
| Follow-up, Next Steps in Care, and Patient Education | 659 | ||
| Suggested Readings | 660 | ||
| References | 660 | ||
| References | 660.e1 | ||
| 76 Facial Trauma | 661 | ||
| Key Points | 661 | ||
| Perspective | 661 | ||
| General Anatomy | 661 | ||
| Approach to Multitrauma Patients with Facial Injuries | 661 | ||
| Frontal Skull Injuries | 663 | ||
| Pathophysiology | 663 | ||
| Anatomy | 663 | ||
| Treatment | 663 | ||
| Follow-up, Next Steps in Care, and Patient Education | 663 | ||
| Blunt Ophthalmic and Orbital Trauma | 664 | ||
| Pathophysiology | 664 | ||
| Anatomy | 665 | ||
| Presenting Signs and Symptoms | 665 | ||
| Diagnostic Criteria and Testing | 665 | ||
| Treatment | 665 | ||
| Follow-up, Next Steps in Care, and Patient Education | 666 | ||
| Zygoma Injury | 666 | ||
| Pathophysiology | 666 | ||
| Anatomy | 666 | ||
| Presenting Signs and Symptoms | 666 | ||
| Diagnostic Criteria and Testing | 667 | ||
| Treatment | 667 | ||
| Follow-up, Next Steps in Care, and Patient Education | 667 | ||
| Maxillary and Midface Injuries | 667 | ||
| Pathophysiology | 667 | ||
| Le Fort Classification | 667 | ||
| Le Fort I (Transverse) | 667 | ||
| Le Fort II (Pyramidal) | 667 | ||
| Le Fort III (Craniofacial Disjunction) | 667 | ||
| Anatomy | 667 | ||
| Presenting Signs and Symptoms | 668 | ||
| Diagnostic Criteria and Testing | 668 | ||
| Treatment | 668 | ||
| Follow-up, Next Steps in Care, and Patient Education | 668 | ||
| Nasal Injuries | 669 | ||
| Pathophysiology | 669 | ||
| Anatomy | 669 | ||
| Presenting Signs and Symptoms | 669 | ||
| Diagnostic Criteria and Testing | 669 | ||
| Treatment | 669 | ||
| Follow-up, Next Steps in Care, and Patient Education | 669 | ||
| Lower Face Injuries | 670 | ||
| Pathophysiology | 670 | ||
| Anatomy | 670 | ||
| Presenting Signs and Symptoms | 671 | ||
| Diagnostic Criteria and Testing | 671 | ||
| Treatment | 671 | ||
| Follow-up, next Steps in Care, and Patient Education | 671 | ||
| Suggested Readings | 672 | ||
| References | 672 | ||
| References | 672.e1 | ||
| 77 Penetrating Neck Trauma | 673 | ||
| Key Points | 673 | ||
| Epidemiology | 673 | ||
| Perspective | 673 | ||
| Pathophysiology | 673 | ||
| Anatomy | 673 | ||
| Presenting Signs and Symptoms | 673 | ||
| Airway Injury | 673 | ||
| Vascular Injury | 673 | ||
| Digestive Tract | 674 | ||
| Diagnostic Testing | 675 | ||
| Vascular Injury | 675 | ||
| Conventional Angiography | 675 | ||
| Duplex Ultrasonography | 675 | ||
| Multidetector Helical Computed Tomographic Angiography | 676 | ||
| Pharyngeal Injury | 677 | ||
| Esophageal Injury | 677 | ||
| Selective Evaluation | 678 | ||
| Neurologic Injury | 678 | ||
| Treatment | 678 | ||
| Prehospital Management | 678 | ||
| Airway Interventions | 678 | ||
| Wound Care and Evaluation | 679 | ||
| Vascular Injury | 679 | ||
| Esophageal Injury | 679 | ||
| Cervical Spine Injury | 679 | ||
| Admission and Discharge | 680 | ||
| References | 680 | ||
| References | 680.e1 | ||
| 78 Thoracic Trauma | 681 | ||
| Key Points | 681 | ||
| Epidemiology | 681 | ||
| Pathophysiology | 681 | ||
| Thoracic Cage Injuries: Rib, Sternum, and Scapula Fractures | 681 | ||
| Presenting Signs and Symptoms | 682 | ||
| Differential Diagnosis and Medical Decision Making | 682 | ||
| Treatment | 682 | ||
| Follow-up, Next Steps in Care, and Patient Education | 682 | ||
| Flail Chest | 683 | ||
| Presenting Signs and Symptoms | 683 | ||
| Differential Diagnosis and Medical Decision Making | 683 | ||
| Treatment | 683 | ||
| Follow-up, Next Steps in Care, and Patient Education | 683 | ||
| Pneumothorax and Hemothorax | 683 | ||
| Presenting Signs and Symptoms | 684 | ||
| Differential Diagnosis and Medical Decision Making | 684 | ||
| Treatment | 685 | ||
| Follow-up, Next Steps in Care, and Patient Education | 685 | ||
| Pulmonary Contusion | 685 | ||
| Presenting Signs and Symptoms | 685 | ||
| Differential Diagnosis and Medical Decision Making | 685 | ||
| Treatment | 686 | ||
| Follow-up, Next Steps in Care, and Patient Education | 686 | ||
| Tracheobronchial Injury | 686 | ||
| Presenting Signs and Symptoms | 686 | ||
| Differential Diagnosis and Medical Decision Making | 686 | ||
| Treatment | 687 | ||
| Follow-up, Next Steps in Care, and Patient Education | 687 | ||
| Blunt Cardiac Injury | 687 | ||
| Presenting Signs and Symptoms | 688 | ||
| Differential Diagnosis and Medical Decision Making | 688 | ||
| Treatment | 688 | ||
| Follow-up, Next Steps in Care, and Patient Education | 688 | ||
| Penetrating Cardiac Injury, Cardiac Tamponade, and Emergency Department Thoracotomy | 688 | ||
| Presenting Signs and Symptoms | 689 | ||
| Differential Diagnosis and Medical Decision Making | 689 | ||
| Treatment | 689 | ||
| Follow-up, Next Steps in Care, and Patient Education | 690 | ||
| Great Vessel Injury | 690 | ||
| Presenting Signs and Symptoms | 690 | ||
| Differential Diagnosis and Medical Decision Making | 690 | ||
| Treatment | 691 | ||
| Follow-up, Next Steps in Care, and Patient Education | 691 | ||
| Esophageal Injury | 692 | ||
| Presenting Signs and Symptoms | 692 | ||
| Differential Diagnosis and Medical Decision Making | 692 | ||
| Treatment | 692 | ||
| Follow-up, Next Steps in Care, and Patient Education | 692 | ||
| Diaphragmatic Injuries | 692 | ||
| Presenting Signs and Symptoms | 693 | ||
| Differential Diagnosis and Medical Decision Making | 693 | ||
| Treatment | 693 | ||
| Follow-up, Next Steps in Care, and Patient Education | 694 | ||
| Suggested Readings | 694 | ||
| References | 694 | ||
| References | 694.e1 | ||
| 79 Blunt Abdominal Trauma | 695 | ||
| Key Points | 695 | ||
| Epidemiology | 695 | ||
| Pathophysiology | 695 | ||
| Anatomy | 696 | ||
| Presenting Signs and Symptoms | 696 | ||
| Evaluation | 697 | ||
| Differential Diagnosis | 697 | ||
| Chance Fractures | 697 | ||
| Upper Abdominal Injuries | 697 | ||
| Lower Abdominal Injuries | 697 | ||
| Injuries with Delayed Presentation | 697 | ||
| Solid Organ Injuries | 698 | ||
| The Unstable Patient | 698 | ||
| Initial Management | 698 | ||
| Immediate Operative Intervention | 698 | ||
| Focused Abdominal Sonography for Trauma | 698 | ||
| Diagnostic Peritoneal Lavage | 698 | ||
| The Stable Patient | 698 | ||
| Laboratory Testing | 698 | ||
| Plain Radiographs | 699 | ||
| Ultrasonography | 699 | ||
| Diagnostic Peritoneal Lavage | 700 | ||
| Computed Tomography | 701 | ||
| Oral Contrast or No Oral Contrast? | 701 | ||
| Findings in Patients with Blunt Abdominal Trauma | 702 | ||
| Angiography | 702 | ||
| Treatment | 702 | ||
| Prioritizing Management of Injuries | 702 | ||
| Nonoperative Treatment | 703 | ||
| Interventional Radiology | 703 | ||
| Follow-Up, Next Steps in Care, and Patient Education (Admission and Discharge) | 703 | ||
| Suggested Readings | 703 | ||
| References | 703 | ||
| References | 703.e1 | ||
| 80 Penetrating Abdominal Trauma | 704 | ||
| Key Points | 704 | ||
| Epidemiology | 704 | ||
| Pathophysiology | 704 | ||
| Presenting Signs and Symptoms | 704 | ||
| Differential Diagnosis and Medical Decision Making | 705 | ||
| Diagnostic Modalities | 705 | ||
| Plain Radiography | 705 | ||
| Ultrasonography | 705 | ||
| Computed Tomography | 706 | ||
| Diagnostic Peritoneal Lavage | 706 | ||
| Laparoscopy | 706 | ||
| Diagnostic Testing for Specific Injuries | 706 | ||
| Anterior Stab Wounds | 706 | ||
| Flank Wounds | 707 | ||
| Gunshot Wounds | 707 | ||
| Other Injuries | 707 | ||
| Isolated Bowel Injuries | 707 | ||
| Diaphragmatic Injuries | 707 | ||
| Treatment | 707 | ||
| Fluid Resuscitation | 708 | ||
| Antibiotics | 708 | ||
| Tetanus Prophylaxis | 708 | ||
| Pain Control | 709 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 709 | ||
| Suggested Readings | 709 | ||
| References | 709 | ||
| References | 709.e1 | ||
| 81 Pelvic Fractures | 710 | ||
| Key Points | 710 | ||
| Epidemiology | 710 | ||
| Pathophysiology | 710 | ||
| Tile Classification of Pelvic Fractures | 711 | ||
| Presenting Signs and Symptoms | 711 | ||
| Differential Diagnosis and Medical Decision Making | 712 | ||
| Treatment | 713 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 714 | ||
| Suggested Readings | 715 | ||
| References | 715 | ||
| References | 715.e1 | ||
| 82 Genitourinary Trauma | 716 | ||
| Key Points | 716 | ||
| Epidemiology | 716 | ||
| Pathophysiology | 716 | ||
| External Genitalia | 716 | ||
| Urethra | 716 | ||
| Bladder | 717 | ||
| Ureters | 718 | ||
| Kidneys | 718 | ||
| Presenting Signs and Symptoms | 718 | ||
| External Genitalia Injuries | 718 | ||
| Urethral Injuries | 719 | ||
| Bladder Injuries | 719 | ||
| Ureteral Injuries | 719 | ||
| Kidney Injuries | 719 | ||
| Digital Rectal Examination | 719 | ||
| Vaginal Examination | 719 | ||
| Hematuria | 719 | ||
| Differential Diagnosis and Medical Decision Making | 720 | ||
| External Genitalia | 720 | ||
| Urethra | 720 | ||
| Retrograde Urethrography Procedure | 720 | ||
| Retrograde Cystography Procedure | 720 | ||
| Ureter | 722 | ||
| Kidney | 722 | ||
| Treatment | 722 | ||
| External Genitalia Injuries | 723 | ||
| Urethral Injuries | 723 | ||
| Bladder Injuries | 723 | ||
| Ureteral Injuries | 723 | ||
| Kidney Injuries | 723 | ||
| Pediatric Considerations | 724 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 724 | ||
| Suggested Readings | 725 | ||
| References | 725 | ||
| References | 725.e1 | ||
| 83 Hip and Femur Injuries | 726 | ||
| Key Points | 726 | ||
| Epidemiology | 726 | ||
| Pathophysiology | 726 | ||
| Anatomy | 726 | ||
| Presenting Signs and Symptoms | 727 | ||
| Differential Diagnosis and Medical Decision Making | 727 | ||
| Diagnostic Testing | 727 | ||
| Hip Fractures | 727 | ||
| Femoral Head Fractures | 728 | ||
| Femoral Neck Fractures | 728 | ||
| Intertrochanteric Fractures | 728 | ||
| Greater Trochanteric Fractures | 728 | ||
| Lesser Trochanteric Fractures | 728 | ||
| Subtrochanteric Fractures | 728 | ||
| Femoral Shaft Fractures | 728 | ||
| Distal Femoral Fractures | 728 | ||
| Stress Fractures | 729 | ||
| Hip Dislocations | 729 | ||
| Posterior Hip Dislocations | 729 | ||
| Anterior Hip Dislocations | 729 | ||
| Prosthetic Hip Dislocations | 729 | ||
| Ultrasound-Guided Femoral Nerve Block | 729 | ||
| Suggested Readings | 730 | ||
| References | 730 | ||
| References | 730.e1 | ||
| 84 Knee and Lower Leg Injuries | 731 | ||
| Key Points | 731 | ||
| Epidemiology | 731 | ||
| Pathophysiology | 731 | ||
| Knee | 731 | ||
| Anatomy | 731 | ||
| Evaluation | 731 | ||
| Diagnostic Testing | 732 | ||
| Lower Leg | 734 | ||
| Anatomy | 734 | ||
| Evaluation | 734 | ||
| Diagnostic Testing | 734 | ||
| Dislocations and Fractures | 735 | ||
| Dislocations | 735 | ||
| Knee Dislocations | 735 | ||
| Patellar Dislocation | 735 | ||
| Proximal Tibiofibular Joint Dislocations | 736 | ||
| Fractures | 737 | ||
| Patellar Fracture | 737 | ||
| Proximal Tibial Fractures | 737 | ||
| Tibial Plateau Fractures | 737 | ||
| Tibial Spine Fractures | 738 | ||
| Subcondylar Fractures | 738 | ||
| Tibial Shaft Fractures | 738 | ||
| Proximal Fibular Fractures | 738 | ||
| Tibial Tuberosity Fractures | 738 | ||
| Soft Tissue and Cartilaginous Injuries | 739 | ||
| Extensor Mechanism Injuries | 739 | ||
| Quadriceps and Patellar Tendon Injuries | 739 | ||
| Ligamentous and Meniscal Injuries | 740 | ||
| Muscle Strains | 741 | ||
| Gastrocnemius Muscle Strain | 741 | ||
| Strain or Rupture of the Plantaris Muscle | 742 | ||
| Shin Splints | 742 | ||
| Overuse Injuries | 742 | ||
| Osgood-Schlatter Disease | 742 | ||
| Stress Fractures | 743 | ||
| Other Disorders | 743 | ||
| Osteochondritis Dissecans | 743 | ||
| Osteonecrosis | 743 | ||
| Patellofemoral Pain Syndrome | 743 | ||
| Popliteal Cyst | 744 | ||
| Suggested Readings | 744 | ||
| References | 744 | ||
| References | 744.e1 | ||
| 85 Foot and Ankle Injuries | 745 | ||
| Key Points | 745 | ||
| Perspective | 745 | ||
| Epidemiology | 745 | ||
| Pathophysiology | 745 | ||
| Anatomy | 745 | ||
| Ligaments of the Ankle | 745 | ||
| Presenting Signs and Symptoms | 746 | ||
| History and Physical Examination | 746 | ||
| Other Maneuvers | 747 | ||
| Differential Diagnosis and Medical Decision Making | 747 | ||
| Classification of Ankle Sprains | 748 | ||
| Subluxation of the Peroneal Tendons | 748 | ||
| Achilles Tendon Injuries | 748 | ||
| Classification of Fractures | 748 | ||
| Danis-Weber Classification System | 748 | ||
| Supination Adduction (SA, Weber A) | 749 | ||
| Supination External Rotation (SE, Weber B) | 749 | ||
| Pronation Abduction (PA, Weber C1) | 749 | ||
| Pronation External Rotation (PE, Weber C2) | 749 | ||
| Maisonneuve Fracture (Weber C3) | 749 | ||
| Salter-Harris Classification System | 750 | ||
| Triplane Fractures | 750 | ||
| Dislocations | 750 | ||
| Foot Injuries | 751 | ||
| Talar Fractures | 751 | ||
| Osteochondritis Dissecans (Osteochondral Fracture) | 751 | ||
| Calcaneal Injuries | 752 | ||
| Other Tarsal Conditions | 752 | ||
| Lisfranc Injury | 752 | ||
| Metatarsal Injuries | 753 | ||
| Metatarsal Fractures | 753 | ||
| Freiberg Disease | 753 | ||
| Sesamoid Bone Fractures | 753 | ||
| Toe Fractures | 753 | ||
| Plantar Fasciitis | 753 | ||
| Tarsal Tunnel Syndrome | 753 | ||
| Diagnostic Testing | 754 | ||
| Imaging | 754 | ||
| Ottawa Ankle Rules | 754 | ||
| Treatment | 754 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 755 | ||
| Suggested Readings | 755 | ||
| References | 755 | ||
| References | 755.e1 | ||
| 86 Tendinitis and Bursitis | 756 | ||
| Key Points | 756 | ||
| Perspective | 756 | ||
| Epidemiology | 756 | ||
| Pathophysiology | 756 | ||
| Tendonitis | 756 | ||
| Bursitis | 756 | ||
| Presenting Signs and Symptoms | 757 | ||
| Shoulder | 757 | ||
| Supraspinatus Tendinitis/ Impingement Syndrome | 757 | ||
| Subacromial Bursitis | 757 | ||
| Elbow | 757 | ||
| Lateral and Medial Epicondylitis | 757 | ||
| Olecranon Bursitis | 758 | ||
| Wrist and Hand | 758 | ||
| Hip | 758 | ||
| Trochanteric Bursitis | 758 | ||
| Ischial Bursitis | 759 | ||
| Knee | 759 | ||
| Iliotibial Band Syndrome | 759 | ||
| Biceps Femoris and Popliteal Tendinopathy | 759 | ||
| Prepatellar Bursitis | 759 | ||
| Infrapatellar Bursitis | 760 | ||
| Anserine Bursitis | 760 | ||
| Ankle | 760 | ||
| Achilles Tendinitis | 760 | ||
| Calcaneal Bursitis | 760 | ||
| Differential Diagnosis | 760 | ||
| Diagnostic Testing | 761 | ||
| Imaging Studies | 761 | ||
| Treatment | 761 | ||
| Admission and Discharge | 762 | ||
| Suggested Readings | 762 | ||
| References | 762 | ||
| References | 762.e1 | ||
| 87 Injuries to the Shoulder Girdle and Humerus | 763 | ||
| Key Points | 763 | ||
| Epidemiology | 763 | ||
| Fractures | 763 | ||
| Dislocations | 763 | ||
| Soft Tissue Injuries | 763 | ||
| Pathophysiology | 763 | ||
| Presenting Signs and Symptoms | 763 | ||
| Sternoclavicular Joint Sprains and Dislocations | 763 | ||
| Acromioclavicular Joint Dislocation or Separation | 764 | ||
| Clavicle Fractures | 765 | ||
| Scapula Fractures | 765 | ||
| Glenohumeral Dislocations | 765 | ||
| Proximal Humerus Fractures | 766 | ||
| Humeral Shaft Fractures | 767 | ||
| Distal Humerus (Supracondylar) Fractures | 767 | ||
| Rotator Cuff Tendinitis/subacromial Bursitis, Rotator Cuff Tears, and Impingement Syndromes | 767 | ||
| Tenosynovitis and Rupture of the Long Head of the Biceps Tendon | 768 | ||
| Adhesive Capsulitis | 769 | ||
| Treatment | 769 | ||
| Sternoclavicular Dislocation | 769 | ||
| Acromioclavicular Dislocation or Separation | 770 | ||
| Clavicle Fractures | 770 | ||
| Scapula Fractures | 770 | ||
| Glenohumeral Dislocations | 770 | ||
| Anterior Dislocations | 770 | ||
| Scapular Manipulation | 770 | ||
| External Rotation | 771 | ||
| Modified Hippocratic (Traction-Countertraction) Method | 771 | ||
| Stimson Method | 771 | ||
| Posterior Dislocations | 772 | ||
| Luxatio Erecta (Inferior Dislocations) | 772 | ||
| Proximal Humerus Fractures | 772 | ||
| Humeral Shaft Fractures | 772 | ||
| Supracondylar Fractures | 773 | ||
| Rotator Cuff Tendinitis/subacromial Bursitis, Rotator Cuff Tears, and Impingement Syndromes | 773 | ||
| Tenosynovitis and Rupture of the Long Head of the Biceps Tendon | 773 | ||
| Adhesive Capsulitis | 773 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 774 | ||
| Sternoclavicular Strains, Subluxations, and Dislocations | 774 | ||
| Acromioclavicular Separation or Dislocation | 774 | ||
| Clavicle Fractures | 774 | ||
| Scapula Fractures | 774 | ||
| Glenohumeral Dislocations | 774 | ||
| Proximal Humeral Fractures | 774 | ||
| Humeral Shaft Fractures | 775 | ||
| Supracondylar Humeral Fractures | 775 | ||
| Rotator Cuff Tendinitis/subacromial Bursitis, Rotator Cuff Tears, and Impingement Syndromes | 775 | ||
| Suggested Readings | 775 | ||
| References | 775 | ||
| References | 775.e1 | ||
| 88 Forearm Fractures | 776 | ||
| Key Points | 776 | ||
| Epidemiology | 776 | ||
| Pathophysiology | 776 | ||
| Presenting Signs and Symptoms | 776 | ||
| Pediatric Fractures | 776 | ||
| Differential Diagnosis and Medical Decision Making | 777 | ||
| Treatment | 779 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 779 | ||
| Suggested Readings | 780 | ||
| References | 780 | ||
| References | 780.e1 | ||
| 89 Hand and Wrist Injuries | 781 | ||
| Key Points | 781 | ||
| Perspective | 781 | ||
| Epidemiology | 781 | ||
| Pathophysiology | 781 | ||
| Presenting Signs and Symptoms | 781 | ||
| Differential Diagnosis and Medical Decision Making | 782 | ||
| Fractures of the Hand | 782 | ||
| Metacarpal Bone Fractures | 782 | ||
| Bennett/Reverse Bennett and Rolando Fractures | 782 | ||
| Boxer’s Fracture | 783 | ||
| Proximal and Middle Phalanx Fractures | 783 | ||
| Distal Phalanx Fractures | 784 | ||
| Ligamentous Injuries of the Hand | 784 | ||
| de Quervain Tenosynovitis | 784 | ||
| Gamekeeper’s/Skier’s Thumb | 784 | ||
| Jersey Finger | 784 | ||
| Mallet Finger | 785 | ||
| Digital Dislocations | 785 | ||
| Extensor Tendon Injuries | 785 | ||
| Flexor Tendon Injuries | 786 | ||
| Fractures of the Wrist | 786 | ||
| Scaphoid Fractures | 786 | ||
| Triquetrum Fractures | 787 | ||
| Dislocations of the Wrist | 787 | ||
| Scapholunate Dislocation | 787 | ||
| Perilunate Dislocation | 787 | ||
| Triquetrum Dislocation | 788 | ||
| Lunate Dislocation | 788 | ||
| Bites to the Hand | 788 | ||
| High-Pressure Injection Injuries | 789 | ||
| Treatment | 789 | ||
| Anesthesia and Analgesia | 789 | ||
| Treatment of Open Wounds | 789 | ||
| Splinting | 789 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 790 | ||
| Suggested Readings | 790 | ||
| References | 790 | ||
| References | 790.e1 | ||
| 90 Arterial and Venous Trauma and Great Vessel Injuries | 791 | ||
| Key Points | 791 | ||
| Epidemiology | 791 | ||
| PathopHysiology | 792 | ||
| Arterial System | 792 | ||
| Venous System | 792 | ||
| Pulmonary Circulation | 792 | ||
| Presenting Signs and Symptoms (Box 90.1) | 792 | ||
| Differential Diagnosis and Medical Decision Making | 793 | ||
| Treatment | 795 | ||
| Initial Interventions and Procedures | 795 | ||
| Definitive Treatment | 796 | ||
| Suggested Readings | 796 | ||
| References | 796 | ||
| References | 796.e1 | ||
| 91 Acute Compartment Syndromes | 797 | ||
| Key Points | 797 | ||
| Epidemiology | 797 | ||
| Pathophysiology | 797 | ||
| Presenting Signs and Symptoms | 797 | ||
| Differential Diagnosis and Medical Decision Making | 798 | ||
| Treatment | 798 | ||
| Prehospital Management | 798 | ||
| Hospital Management | 798 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 798 | ||
| Special Circumstances | 799 | ||
| Acute Orbital Compartment Syndrome | 799 | ||
| Abdominal Compartment Syndrome | 800 | ||
| Chronic Compartment Syndrome | 800 | ||
| Suggested Readings | 800 | ||
| References | 800 | ||
| References | 800.e1 | ||
| 92 Low Back Pain | 801 | ||
| Key Points | 801 | ||
| Perspective | 801 | ||
| Epidemiology | 801 | ||
| Pathophysiology | 801 | ||
| Presenting Signs and Symptoms | 801 | ||
| Classic Symptoms | 801 | ||
| Typical Variations | 802 | ||
| Differential Diagnosis and Medical Decision Making | 802 | ||
| Diagnostic Testing | 805 | ||
| Treatment | 805 | ||
| Prehospital Management | 805 | ||
| Hospital Management | 805 | ||
| Admission and Discharge | 806 | ||
| References | 807 | ||
| References | 807.e1 | ||
| 93 Intimate Partner Violence | 808 | ||
| Key Points | 808 | ||
| Epidemiology | 808 | ||
| Pathophysiology | 808 | ||
| Presenting Signs and Symptoms | 808 | ||
| History | 808 | ||
| Physical Findings | 808 | ||
| Differential Diagnosis and Medical Decision Making | 809 | ||
| Treatment | 809 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 810 | ||
| Suggested Readings | 810 | ||
| References | 810 | ||
| References | 810.e1 | ||
| IX Nervous System Disorders | 811 | ||
| 94 Altered Mental Status and Coma | 811 | ||
| Key Points | 811 | ||
| Perspective | 811 | ||
| Epidemiology | 811 | ||
| Pathophysiology | 811 | ||
| Presenting Signs and Symptoms | 811 | ||
| Neurologic Evaluation | 814 | ||
| Differential Diagnosis and Medical Decision Making | 815 | ||
| Diagnostic Testing | 815 | ||
| Laboratory Evaluation | 815 | ||
| Imaging | 815 | ||
| Treatment | 816 | ||
| Admission and Discharge | 817 | ||
| Suggested Readings | 817 | ||
| References | 817 | ||
| References | 817.e1 | ||
| 95 Cranial Nerve Disorders | 818 | ||
| Key Points | 818 | ||
| Perspective | 818 | ||
| Epidemiology | 818 | ||
| Pathophysiology | 818 | ||
| Cranial Nerve I (Olfactory Nerve) | 818 | ||
| Anatomy | 818 | ||
| Presenting Signs and Symptoms | 818 | ||
| Treatment | 818 | ||
| Cranial Nerve II (Optic Nerve) | 819 | ||
| X Immune System Disorders | 917 | ||
| 106 Allergic Disorders | 917 | ||
| Key Points | 917 | ||
| Allergic Disease: Allergic Rhinits, Insect Stings, Drug Allergy | 917 | ||
| Epidemiology | 917 | ||
| Allergic Rhinitis | 917 | ||
| Insect Stings | 917 | ||
| Drug Allergy | 917 | ||
| Pathophysiology | 917 | ||
| Presenting Signs and Symptoms | 918 | ||
| XI Genitourinary and Renal Diseases | 969 | ||
| 111 Male Genitourinary Emergencies | 969 | ||
| Key Points | 969 | ||
| Anatomy and Pathophysiology | 969 | ||
| Presenting Signs and Symptoms | 970 | ||
| Acute Scrotal Pain | 970 | ||
| History | 970 | ||
| Onset of Symptoms | 970 | ||
| Character of Symptoms | 970 | ||
| Associated Symptoms | 970 | ||
| Physical Examination | 971 | ||
| Abdominal Examination | 971 | ||
| Genital Examination | 971 | ||
| Acute Penile Pain | 972 | ||
| Genitourinary Trauma | 972 | ||
| Sexually Transmitted Diseases | 972 | ||
| Special Signs and Techniques | 973 | ||
| Differential Diagnosis and Medical Decision Making | 973 | ||
| Laboratory Testing | 973 | ||
| Ultrasonography | 973 | ||
| Computed Tomography | 973 | ||
| Treatment | 974 | ||
| Analgesia | 974 | ||
| Manual Testicular Detorsion | 974 | ||
| Emergency Surgery for Testicular Torsion | 974 | ||
| Scrotal Elevation | 974 | ||
| Antibiotic Therapy | 974 | ||
| Sexually Transmitted Diseases | 974 | ||
| Priapism | 975 | ||
| Paraphimosis | 975 | ||
| Testicular Trauma | 975 | ||
| Suggested Readings | 975 | ||
| References | 975 | ||
| References | 975.e1 | ||
| 112 Nephrolithiasis | 976 | ||
| Key Points | 976 | ||
| Scope and Outline | 976 | ||
| Epidemiology | 976 | ||
| Pathophysiology | 976 | ||
| Anatomy | 976 | ||
| Clinical Presentation | 977 | ||
| History | 977 | ||
| Physical Examination | 977 | ||
| Differential Diagnosis | 977 | ||
| Diagnostic Testing | 978 | ||
| Laboratory Tests | 978 | ||
| Urinalysis | 978 | ||
| Urine Pregnancy Test | 978 | ||
| Blood Tests | 978 | ||
| Imaging | 979 | ||
| Helical Computed Tomography | 979 | ||
| Intravenous Pyelography | 979 | ||
| Sonography | 980 | ||
| Plain Radiography | 981 | ||
| Treatment | 981 | ||
| Pharmacologic Management | 981 | ||
| Nonsteroidal Antiinflammatory Drugs | 981 | ||
| Opiates | 981 | ||
| Management of Other Symptoms | 981 | ||
| Disposition | 982 | ||
| References | 983 | ||
| References | 983.e1 | ||
| 113 Hematuria | 984 | ||
| Key Points | 984 | ||
| Scope and Definitions | 984 | ||
| Pathophysiology | 984 | ||
| Clinical Presentation | 984 | ||
| Differential Diagnosis | 986 | ||
| Diagnostic Testing | 986 | ||
| Treatment and Disposition | 987 | ||
| Suggested Readings | 989 | ||
| References | 989 | ||
| References | 989.e1 | ||
| 114 Renal Failure | 990 | ||
| Key Points | 990 | ||
| Definitions | 990 | ||
| Epidemiology | 990 | ||
| Pathophysiology | 990 | ||
| Primary Disturbances | 992 | ||
| Secondary Disturbances | 992 | ||
| Presenting Signs and Symptoms | 992 | ||
| Differential Diagnosis and Medical Decision Making | 993 | ||
| Intrinsic Renal Failure: Vascular Causes | 993 | ||
| Intrinsic Renal Failure: Parenchymal Causes | 993 | ||
| Obstructive Renal Failure | 993 | ||
| Urine Formation Problems Resulting in Renal Failure | 993 | ||
| Treatment | 993 | ||
| Prehospital Management | 993 | ||
| Hospital Management | 994 | ||
| Treating Reversible Causes of Renal Failure | 994 | ||
| Other Treatment Considerations | 994 | ||
| Life-Threatening Complications of Renal Failure | 994 | ||
| Volume Overload | 994 | ||
| Hyperkalemia | 995 | ||
| Other Electrolyte and Acid-Base Disturbances | 995 | ||
| Chest Pain | 995 | ||
| Uremic Pericarditis | 996 | ||
| Pericardial Tamponade | 996 | ||
| Hemorrhage | 996 | ||
| Infection | 996 | ||
| Complications of Renal Replacement Therapy | 996 | ||
| Consultation | 996 | ||
| Next Steps in Care | 997 | ||
| Admission Versus Discharge | 997 | ||
| Pitfalls | 997 | ||
| Prognosis | 997 | ||
| Suggested Readings | 997 | ||
| References | 997 | ||
| References | 997.e1 | ||
| 115 Emergency Renal Ultrasonography | 998 | ||
| Key Points | 998 | ||
| Introduction | 998 | ||
| Evidence-Based Review | 998 | ||
| How to Scan | 999 | ||
| Images—Normal and Abnormal | 1000 | ||
| How to Incorporate into Practice | 1001 | ||
| References | 1002 | ||
| References | 1002.e1 | ||
| 116 Dialysis-Related Emergencies | 1003 | ||
| Key Points | 1003 | ||
| Scope | 1003 | ||
| Hemodialysis | 1003 | ||
| Structure and Function | 1003 | ||
| Complications | 1003 | ||
| Infection | 1003 | ||
| Thrombosis | 1005 | ||
| Bleeding | 1005 | ||
| Pseudoaneurysm | 1005 | ||
| Dialyzer Reactions | 1005 | ||
| Air Embolism | 1005 | ||
| Cardiac Tamponade | 1006 | ||
| Dialysis Disequilibrium Syndrome | 1006 | ||
| Dialysis Dementia | 1006 | ||
| Peritoneal Dialysis | 1006 | ||
| Structure and Function | 1006 | ||
| Complications | 1007 | ||
| XII Women's Health and Gynecologic Diseases | 1015 | ||
| 118 The Healthy Pregnancy | 1015 | ||
| Key Points | 1015 | ||
| Epidemiology | 1015 | ||
| Pathophysiology | 1015 | ||
| Presenting Signs and Symptoms | 1015 | ||
| Respiratory System | 1015 | ||
| Hematologic and Immunologic Systems | 1016 | ||
| Cardiovascular System | 1016 | ||
| Dermatologic System | 1017 | ||
| Genitourinary System | 1017 | ||
| Gastrointestinal System | 1017 | ||
| Musculoskeletal System | 1017 | ||
| Endocrine System | 1017 | ||
| Common Medical Diseases and Pregnancy | 1017 | ||
| Diabetes | 1017 | ||
| Urinary Tract Infections | 1017 | ||
| Asthma | 1018 | ||
| Seizure Disorders | 1018 | ||
| Migraine | 1018 | ||
| Thromboembolic Disease | 1018 | ||
| Hypertension | 1018 | ||
| Alcohol and Other Recreational Drugs | 1019 | ||
| Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome | 1019 | ||
| Medication Use During Pregnancy | 1019 | ||
| Analgesic Agents | 1020 | ||
| Anticoagulants | 1020 | ||
| Antiemetics | 1020 | ||
| Antimicrobial Agents | 1020 | ||
| Antiviral Agents | 1021 | ||
| Antiepileptic Drugs | 1021 | ||
| Antihypertensive Medications | 1022 | ||
| Antihyperglycemic Agents | 1022 | ||
| Immunizations | 1022 | ||
| Over-The-Counter Medications | 1022 | ||
| Acknowledgment | 1022 | ||
| Suggested Readings | 1022 | ||
| References | 1022 | ||
| References | 1022.e1 | ||
| 119 Disorders of Early Pregnancy | 1023 | ||
| Key Points | 1023 | ||
| Spontaneous Abortion | 1023 | ||
| Epidemiology | 1023 | ||
| Pathophysiology | 1023 | ||
| Presenting Signs and Symptoms | 1023 | ||
| Differential Diagnosis and Medical Decision Making | 1024 | ||
| Treatment | 1024 | ||
| Rh0 Immune Globulin | 1025 | ||
| Next Steps in Care and Follow-Up | 1026 | ||
| Ectopic Pregnancy | 1026 | ||
| Epidemiology | 1026 | ||
| Pathophysiology | 1026 | ||
| Presenting Signs and Symptoms | 1027 | ||
| Differential Diagnosis and Medical Decision Making | 1027 | ||
| Quantitative Human Chorionic Gonadotropin Testing | 1027 | ||
| Ultrasonography | 1028 | ||
| Ultrasonographic Findings Plus Human Chorionic Gonadotropin | 1028 | ||
| Treatment | 1028 | ||
| Methotrexate Therapy | 1028 | ||
| Surgical Treatment | 1029 | ||
| Next Steps in Care and Follow-Up | 1029 | ||
| Gestational Trophoblastic Disease | 1030 | ||
| Epidemiology | 1030 | ||
| Pathophysiology | 1030 | ||
| Presenting Signs and Symptoms | 1030 | ||
| Differential Diagnosis and Medical Decision Making | 1031 | ||
| Treatment | 1031 | ||
| Next Steps in Care and Follow-Up | 1031 | ||
| Hyperemesis Gravidarum | 1031 | ||
| Epidemiology | 1031 | ||
| Pathophysiology | 1031 | ||
| Presenting Signs and Symptoms | 1032 | ||
| Differential Diagnosis and Medical Decision Making | 1032 | ||
| Treatment | 1032 | ||
| Next Steps in Care and Follow-Up | 1033 | ||
| Suggested Readings | 1033 | ||
| References | 1033 | ||
| References | 1033.e1 | ||
| 120 First Trimester Ultrasonography | 1034 | ||
| Key Points | 1034 | ||
| Introduction | 1034 | ||
| Evidence-Based Review | 1034 | ||
| How to Scan | 1034 | ||
| Transabdominal Technique | 1035 | ||
| Endovaginal Technique | 1035 | ||
| Identification and Localization of the Pregnancy | 1036 | ||
| Intrauterine Pregnancy | 1036 | ||
| Live Intrauterine Pregnancy | 1038 | ||
| Abnormal Intrauterine Pregnancy | 1038 | ||
| Extrauterine Pregnancy | 1038 | ||
| No Definitive Pregnancy | 1040 | ||
| How to Incorporate Into Practice | 1040 | ||
| References | 1040 | ||
| References | 1040.e1 | ||
| 121 Third Trimester Pregnancy Emergencies | 1041 | ||
| Key Points | 1041 | ||
| Preeclampsia and Eclampsia | 1041 | ||
| Epidemiology | 1041 | ||
| Pathophysiology | 1041 | ||
| Presenting Signs and Symptoms | 1042 | ||
| Differential Diagnosis and Medical Decision Making | 1042 | ||
| Treatment | 1043 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1045 | ||
| Third Trimester Bleeding | 1046 | ||
| Epidemiology | 1046 | ||
| Pathophysiology | 1047 | ||
| Placental Abruption | 1047 | ||
| Placenta Previa | 1047 | ||
| Presenting Signs and Symptoms | 1048 | ||
| Differential Diagnosis and Medical Decision Making | 1048 | ||
| Diagnostic Testing | 1049 | ||
| Treatment | 1049 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1050 | ||
| Suggested Readings | 1050 | ||
| References | 1050 | ||
| References | 1050.e1 | ||
| 122 Emergency Delivery and Peripartum Emergencies | 1051 | ||
| Key Points | 1051 | ||
| Emergency Delivery | 1051 | ||
| Pathophysiology | 1051 | ||
| Presenting Signs and Symptoms | 1051 | ||
| Differential Diagnosis and Medical Decision Making | 1051 | ||
| Treatment | 1051 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1052 | ||
| Postpartum Hemorrhage | 1052 | ||
| Epidemiology | 1052 | ||
| Pathophysiology | 1052 | ||
| Presenting Signs and Symptoms | 1053 | ||
| Differential Diagnosis and Medical Decision Making | 1054 | ||
| Treatment | 1054 | ||
| Uterine Inversion | 1054 | ||
| Uterine Rupture | 1056 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1057 | ||
| Perimortem Cesarean Delivery | 1057 | ||
| Epidemiology | 1057 | ||
| Pathophysiology | 1058 | ||
| Differential Diagnosis and Medical Decision Making | 1058 | ||
| Treatment | 1059 | ||
| Amniotic Fluid Embolism | 1059 | ||
| Epidemiology | 1059 | ||
| Pathophysiology | 1059 | ||
| Presenting Signs and Symptoms | 1059 | ||
| Differential Diagnosis and Medical Decision Making | 1059 | ||
| Treatment | 1060 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1060 | ||
| Nonvertex Presentation in Delivery | 1060.e1 | ||
| Epidemiology | 1060.e1 | ||
| Pathophysiology | 1060.e1 | ||
| Differential Diagnosis and Medical Decision Making | 1060.e1 | ||
| Treatment | 1060.e1 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1060.e2 | ||
| Cord-Related Complications | 1060.e2 | ||
| Epidemiology | 1060.e2 | ||
| Pathophysiology | 1060.e2 | ||
| Differential Diagnosis and Medical Decision Making | 1060.e3 | ||
| Treatment | 1060.e4 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1060.e4 | ||
| Shoulder Dystocia | 1060.e4 | ||
| Epidemiology | 1060.e4 | ||
| Pathophysiology | 1060.e4 | ||
| Differential Diagnosis and Medical Decision Making | 1060.e5 | ||
| Treatment | 1060.e5 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1060.e7 | ||
| Premature Rupture of Membranes and Preterm Premature Rupture of Membranes | 1060.e7 | ||
| Epidemiology | 1060.e7 | ||
| Pathophysiology | 1060.e7 | ||
| Differential Diagnosis and Medical Decision Making | 1060.e8 | ||
| Management and Disposition | 1060.e8 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1060.e8 | ||
| Multiple Gestations | 1060.e8 | ||
| Epidemiology | 1060.e8 | ||
| Pathophysiology | 1060.e8 | ||
| Differential Diagnosis and Medical Decision Making | 1060.e9 | ||
| Treatment | 1060.e9 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1060.e9 | ||
| References | 1060 | ||
| References | 1060.e10 | ||
| 123 Postpartum Emergencies | 1061 | ||
| Key Points | 1061 | ||
| Epidemiology | 1061 | ||
| Pathophysiology: the Puerperium | 1061 | ||
| Presenting Signs and Symptoms | 1062 | ||
| Differential Diagnosis and Medical Decision Making | 1063 | ||
| Infections | 1063 | ||
| Genitourinary | 1063 | ||
| Metritis and Pelvic Infections | 1063 | ||
| Toxic Shock Syndrome | 1063 | ||
| Perineal Pain | 1063 | ||
| Urinary Tract Dysfunction | 1064 | ||
| Lactation and Breast Dysfunction | 1064 | ||
| Mastitis | 1064 | ||
| Gastrointestinal | 1064 | ||
| Appendicitis | 1064 | ||
| Hematologic | 1064 | ||
| Hemorrhage | 1064 | ||
| Thromboembolic Complications | 1065 | ||
| Cardiac | 1065 | ||
| Endocrine | 1065 | ||
| Sheehan Syndrome | 1065 | ||
| Thyroiditis | 1065 | ||
| Neurologic | 1065 | ||
| Psychiatric | 1066 | ||
| Treatment and Follow-Up | 1066 | ||
| Genitourinary | 1066 | ||
| Metritis and Pelvic Infections | 1066 | ||
| Toxic Shock Syndrome | 1066 | ||
| Perineal Pain | 1066 | ||
| Urinary Tract Dysfunction | 1067 | ||
| Lactation and Breast Dysfunction | 1067 | ||
| Breast Engorgement | 1067 | ||
| Galactocele | 1067 | ||
| Mastitis | 1067 | ||
| Hematologic | 1067 | ||
| Postpartum Bleeding | 1067 | ||
| Deep Vein Thrombosis | 1067 | ||
| Central Venous Thrombosis | 1067 | ||
| Cardiac | 1067 | ||
| Endocrine Disorders | 1067 | ||
| Thyroiditis | 1067 | ||
| Neurologic | 1067 | ||
| Psychiatric | 1068 | ||
| References | 1068 | ||
| References | 1068.e1 | ||
| 124 Gynecologic Pain and Vaginal Bleeding | 1069 | ||
| Key Points | 1069 | ||
| Vaginal Bleeding | 1069 | ||
| Epidemiology | 1069 | ||
| Dysfunctional Uterine Bleeding | 1069 | ||
| Uterine Leiomyomas (Fibroids) | 1069 | ||
| Vaginal Foreign Body | 1069 | ||
| Endometrial Cancer | 1069 | ||
| Cervical Cancer | 1069 | ||
| Pathophysiology | 1069 | ||
| Dysfunctional Uterine Bleeding | 1070 | ||
| Uterine Leiomyomas (Fibroids) | 1070 | ||
| Vaginal Foreign Body | 1070 | ||
| Endometrial Cancer | 1070 | ||
| XIII Environmental Disorders | 1135 | ||
| 130 Heat-Related Emergencies | 1135 | ||
| Key Points | 1135 | ||
| Perspective | 1135 | ||
| Epidemiology | 1135 | ||
| Pathophysiology of Heat Stroke | 1135 | ||
| Minor Heat-Related Syndromes | 1135 | ||
| Presenting Signs and Symptoms | 1135 | ||
| Heat Edema | 1135 | ||
| Prickly Heat | 1135 | ||
| Heat Syncope | 1135 | ||
| Heat Cramps | 1136 | ||
| Treatment | 1136 | ||
| Follow-up, Next Steps in Care, and Patient Education | 1136 | ||
| Severe Heat-Related Syndromes | 1138 | ||
| Presenting Signs and Symptoms | 1138 | ||
| Heat Exhaustion | 1138 | ||
| Heat Stroke | 1138 | ||
| Differential Diagnosis and Decision Making | 1138 | ||
| Diagnostic Testing | 1138 | ||
| Treatment | 1138 | ||
| Prehospital Management | 1138 | ||
| Hospital Management | 1139 | ||
| Shivering and Vasoconstriction | 1139 | ||
| Hypotension | 1139 | ||
| Additional Management | 1139 | ||
| Consultations and Expectations | 1140 | ||
| Follow-up, Next Steps in Care, and Patient Education | 1140 | ||
| Documentation | 1141 | ||
| Patient Teaching | 1141 | ||
| Prognosis | 1141 | ||
| Pitfalls | 1141 | ||
| Suggested Readings | 1141 | ||
| References | 1141 | ||
| References | 1141.e1 | ||
| 131 Hypothermia and Frostbite | 1142 | ||
| Key Points | 1142 | ||
| Perspective | 1142 | ||
| Epidemiology | 1142 | ||
| Hypothermia | 1142 | ||
| Pathophysiology | 1142 | ||
| Mechanisms of Heat Loss | 1142 | ||
| Presenting Signs and Symptoms | 1143 | ||
| Treatment | 1144 | ||
| Mild Hypothermia | 1144 | ||
| Moderate Hypothermia | 1144 | ||
| Severe Hypothermia | 1144 | ||
| Next Steps in Care | 1145 | ||
| Frostbite | 1145 | ||
| Pathophysiology | 1145 | ||
| Presenting Signs and Symptoms | 1145 | ||
| Treatment | 1145 | ||
| Prehospital Management | 1146 | ||
| Hospital Management | 1146 | ||
| Next Steps in Care | 1147 | ||
| Suggested Readings | 1147 | ||
| References | 1147 | ||
| References | 1147.e1 | ||
| 132 Lightning and Electrical Injuries | 1148 | ||
| Key Points | 1148 | ||
| Epidemiology | 1148 | ||
| Pathophysiology | 1148 | ||
| Anatomy | 1149 | ||
| Presenting Signs and Symptoms | 1150 | ||
| Differential Diagnosis and Medical Decision Making | 1150 | ||
| Diagnostic Testing | 1151 | ||
| Treatment | 1151 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1152 | ||
| Suggested Readings | 1152 | ||
| References | 1152 | ||
| References | 1152.e1 | ||
| 133 Dysbarisms, Dive Injuries, and Decompression Illness | 1153 | ||
| Key Points | 1153 | ||
| Epidemiology | 1153 | ||
| Pathophysiology | 1153 | ||
| Diving Physiology | 1153 | ||
| Bubble Physiology | 1154 | ||
| Principles of Gas Laws and Dysbarism | 1154 | ||
| Boyle’s Law | 1154 | ||
| Dalton’s Law | 1154 | ||
| Presenting Signs and Symptoms | 1155 | ||
| Barotrauma | 1155 | ||
| Differential Diagnosis and Medical Decision Making | 1156 | ||
| Ear Barotrauma | 1156 | ||
| External Ear Barotrauma (“Squeeze”) | 1156 | ||
| Middle Ear Barotrauma (“Squeeze”) | 1156 | ||
| Alternobaric Facial Palsy | 1157 | ||
| Reverse Middle Ear Barotrauma | 1157 | ||
| Inner Ear Barotrauma | 1157 | ||
| Alternobaric Vertigo | 1157 | ||
| Sinus Barotrauma | 1157 | ||
| Pulmonary Barotrauma and Pulmonary Overpressurization Syndromes | 1157 | ||
| Pneumomediastinum and Mediastinal Emphysema | 1157 | ||
| Subcutaneous Emphysema | 1157 | ||
| Pneumothorax | 1157 | ||
| Arterial Gas Embolism | 1157 | ||
| Gastrointestinal Barotrauma | 1158 | ||
| Tooth Barotrauma | 1158 | ||
| Decompression Sickness | 1158 | ||
| Type I (“Mild” Symptoms) | 1158 | ||
| Type II (“Severe” Symptoms) | 1158 | ||
| Type III Decompression Sickness | 1159 | ||
| Neurologic Examination | 1159 | ||
| Treatment | 1159 | ||
| Prehospital Management and Air Evacuation from the Site | 1159 | ||
| Emergency Department Evaluation and Treatment | 1159 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1160 | ||
| Flying after Diving | 1160 | ||
| Suggested Readings | 1161 | ||
| References | 1161 | ||
| References | 1161.e1 | ||
| 134 Submersion Injuries | 1162 | ||
| Key Points | 1162 | ||
| Epidemiology | 1162 | ||
| Pathophysiology | 1162 | ||
| Respiratory | 1162 | ||
| Central Nervous System | 1162 | ||
| Cardiovascular System | 1163 | ||
| Other Organs | 1163 | ||
| Presenting Signs and Symptoms | 1163 | ||
| Differential Diagnosis | 1164 | ||
| Diagnostic Investigations | 1164 | ||
| Prognostic Factors | 1164 | ||
| At the Scene | 1164 | ||
| In the Emergency Department | 1164 | ||
| Treatment | 1164 | ||
| Prehospital Management | 1164 | ||
| Emergency Department Management | 1164 | ||
| Airway | 1164 | ||
| Breathing | 1165 | ||
| Circulation | 1165 | ||
| Disability | 1165 | ||
| Exposure | 1165 | ||
| Management of Hypothermia | 1165 | ||
| Next Steps in Care and Patient Education | 1165 | ||
| Suggested Readings | 1166 | ||
| References | 1166 | ||
| References | 1166.e1 | ||
| 135 Acute Radiation Emergencies | 1167 | ||
| Key Points | 1167 | ||
| Epidemiology | 1167 | ||
| Pathophysiology | 1168 | ||
| Presenting Signs and Symptoms | 1169 | ||
| Differential Diagnosis and Medical Decision Making | 1169 | ||
| Treatment | 1172 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1176 | ||
| Suggested Readings | 1177 | ||
| References | 1177 | ||
| References | 1177.e1 | ||
| 136 Smoke Inhalation | 1178 | ||
| Key Points | 1178 | ||
| Epidemiology | 1178 | ||
| Pathophysiology | 1178 | ||
| Presenting Signs and Symptoms | 1179 | ||
| Differential Diagnosis and Medical Decision MakinG | 1179 | ||
| Treatment | 1180 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1181 | ||
| Suggested Readings | 1181 | ||
| References | 1181 | ||
| References | 1181.e1 | ||
| 137 Chemical and Nuclear Agents | 1182 | ||
| Key Points | 1182 | ||
| Epidemiology | 1182 | ||
| Perspective | 1182 | ||
| Basic Principles of Managing Contaminated Patients | 1182 | ||
| Communication and Mobilization | 1182 | ||
| Decontamination | 1183 | ||
| Security | 1183 | ||
| Chemical Agents | 1183 | ||
| Nerve Agents | 1183 | ||
| Pathophysiology | 1183 | ||
| Presenting Signs and Symptoms | 1183 | ||
| Treatment | 1183 | ||
| Vesicant Agents | 1184 | ||
| XIV Bites, Stings, and Injuries from Animals | 1187 | ||
| 138 Mammalian Bites | 1187 | ||
| Key Points | 1187 | ||
| Epidemiology | 1187 | ||
| Pathophysiology | 1187 | ||
| Presenting Signs and Symptoms | 1188 | ||
| Differential Diagnosis and Medical Decision Making | 1188 | ||
| Treatment | 1188 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1191 | ||
| Suggested Readings | 1191 | ||
| References | 1191 | ||
| References | 1191.e1 | ||
| 139 Venomous Snakebites in North America | 1192 | ||
| Key Points | 1192 | ||
| Perspective | 1192 | ||
| Epidemiology | 1192 | ||
| Pathophysiology | 1192 | ||
| Anatomy | 1192 | ||
| Presenting Signs and Symptoms | 1195 | ||
| Differential Diagnosis and Medical Decision Making | 1195 | ||
| Diagnostic Testing | 1195 | ||
| Treatment | 1195 | ||
| Prehospital Management | 1195 | ||
| Hospital Management | 1198 | ||
| Pit Viper Antivenom | 1198 | ||
| Coral Snake Antivenom | 1198 | ||
| Other Treatment Considerations | 1199 | ||
| Next Steps: Admission and Discharge | 1200 | ||
| Complications | 1200 | ||
| Adverse Reactions to Antivenom | 1200 | ||
| Compartment Syndrome | 1200 | ||
| Recurrent Coagulopathy | 1201 | ||
| Prognosis | 1201 | ||
| Suggested Readings | 1202 | ||
| References | 1202 | ||
| References | 1202.e1 | ||
| 140 Arthropod Bites and Stings | 1203 | ||
| Key Points | 1203 | ||
| Perspective | 1203 | ||
| Epidemiology | 1203 | ||
| Hymenoptera | 1203 | ||
| Pathophysiology | 1203 | ||
| Presenting Signs and Symptoms | 1204 | ||
| Diagnostic Testing | 1204 | ||
| Anaphylaxis and Allergic Reactions | 1204 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1205 | ||
| Arachnids—Spiders, Scorpions, and Ticks | 1205 | ||
| Spiders (Araneae) | 1205 | ||
| Pathophysiology | 1205 | ||
| Widow Spiders (Latrodectus Species) | 1205 | ||
| Presenting Signs and Symptoms | 1205 | ||
| Treatment | 1206 | ||
| Spiders Causing Dermonecrotic Arachnidism | 1206 | ||
| XV Toxicologic Emergencies | 1221 | ||
| 143 General Approach to the Poisoned Patient | 1221 | ||
| Key Points | 1221 | ||
| Epidemiology | 1221 | ||
| Presenting Signs and Symptoms | 1221 | ||
| Differential Diagnosis and Medical Decision Making | 1221 | ||
| Toxidromes | 1221 | ||
| Toxicology Screens | 1223 | ||
| Radiographic Evaluation | 1226 | ||
| Treatment | 1226 | ||
| “Coma cocktail” | 1228 | ||
| Decontamination | 1228 | ||
| Enhancement of Elimination | 1230 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1230 | ||
| References | 1230 | ||
| References | 1230.e1 | ||
| 144 Acetaminophen, Aspirin, and NSAIDs | 1231 | ||
| Acetaminophen | 1231 | ||
| Key Points | 1231 | ||
| Epidemiology | 1231 | ||
| Pathophysiology | 1231 | ||
| Presenting Signs and Symptoms | 1231 | ||
| Differential Diagnosis and Medical Decision Making | 1231 | ||
| Treatment | 1232 | ||
| Pediatric Considerations | 1233 | ||
| Pregnant Patient | 1234 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1235 | ||
| Aspirin (Salicylates) | 1235 | ||
| Key Points | 1235 | ||
| Epidemiology | 1235 | ||
| Pathophysiology | 1235 | ||
| Presenting Signs and Symptoms | 1235 | ||
| Differential Diagnosis and Medical Decision Making | 1236 | ||
| Treatment | 1236 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1237 | ||
| Nonsteroidal Antiinflammatory Drugs | 1237 | ||
| Key Points | 1237 | ||
| Epidemiology | 1237 | ||
| Pathophysiology | 1237 | ||
| Presenting Signs and Symptoms | 1238 | ||
| Differential Diagnosis and Medical Decision Making | 1238 | ||
| Treatment | 1238 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1238 | ||
| References | 1238 | ||
| References | 1238.e1 | ||
| 145 Anticholinergics | 1239 | ||
| Key Points | 1239 | ||
| Epidemiology | 1239 | ||
| Pathophysiology and Pharmacology | 1239 | ||
| Presenting Signs and Symptoms | 1241 | ||
| Differential Diagnosis and Medical Decision Making | 1241 | ||
| Diagnostic Features | 1241 | ||
| Diagnostic Testing | 1242 | ||
| Treatment | 1242 | ||
| Antidotal Therapy—Physostigmine | 1244 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1244 | ||
| Suggested Readings | 1245 | ||
| References | 1245 | ||
| References | 1245.e1 | ||
| 146 Insecticides, Herbicides, and Rodenticides | 1246 | ||
| Key Points | 1246 | ||
| insecticides | 1246 | ||
| Organophosphorus Compounds and Carbamates | 1246 | ||
| Epidemiology | 1246 | ||
| Pathophysiology | 1246 | ||
| Presenting Signs and Symptoms | 1246 | ||
| Differential Diagnosis and Medical Decision Making | 1247 | ||
| Treatment | 1248 | ||
| Organochlorines | 1248 | ||
| Epidemiology | 1248 | ||
| XVI Metabolic and Endocrine Disorders | 1351 | ||
| 159 Fluid Management | 1351 | ||
| Key Points | 1351 | ||
| Perspective | 1351 | ||
| Pathophysiology | 1351 | ||
| Oxygen Delivery and Tissue Perfusion | 1351 | ||
| Water | 1352 | ||
| Presenting Signs and Symptoms | 1352 | ||
| Treatment | 1353 | ||
| Fluid Resuscitation | 1353 | ||
| Resuscitation Targets (End Points) | 1353 | ||
| Empiric Fluid Challenge | 1353 | ||
| Predicting Volume Responsiveness | 1354 | ||
| Fluid Selection | 1354 | ||
| Crystalloids | 1354 | ||
| Colloids | 1354 | ||
| Hypertonic Solutions | 1355 | ||
| Hyperoncotic Albumin | 1355 | ||
| Hypertonic Saline | 1355 | ||
| Special Treatment Considerations | 1355 | ||
| Minimal-Volume Resuscitation of Hemorrhagic Shock | 1355 | ||
| Burn Resuscitation | 1356 | ||
| Oral Rehydration Therapy | 1356 | ||
| Maintenance Fluid Therapy | 1356 | ||
| References | 1356 | ||
| References | 1356.e1 | ||
| 160 Acid-Base Disorders | 1357 | ||
| Key Points | 1357 | ||
| Pathophysiology | 1357 | ||
| Regulation of Acid-Base Balance | 1357 | ||
| Chemical Buffering | 1357 | ||
| Alterations in Alveolar Ventilation | 1357 | ||
| Alterations in Renal Hydrogen Ion Excretion | 1357 | ||
| Nomenclature | 1357 | ||
| Diagnostic Interpretation | 1358 | ||
| Arterial and Venous Blood Gases | 1358 | ||
| Standard Base Excess | 1358 | ||
| Lactate | 1358 | ||
| Anion Gap | 1358 | ||
| Delta-Delta Calculation | 1359 | ||
| Serum Osmolar Gap | 1359 | ||
| Evaluation of Mixed Acid-Base Disorders | 1360 | ||
| Specific Acid-Base Disorders | 1360 | ||
| Respiratory Acidosis | 1360 | ||
| Respiratory Alkalosis | 1360 | ||
| Metabolic Acidosis | 1361 | ||
| Metabolic Alkalosis | 1362 | ||
| Treatment | 1363 | ||
| Metabolic Acidosis | 1363 | ||
| Metabolic Alkalosis | 1363 | ||
| References | 1364 | ||
| References | 1364.e1 | ||
| 161 Alcoholic Ketoacidosis | 1365 | ||
| Key Points | 1365 | ||
| Definition and Epidemiology | 1365 | ||
| Pathophysiology | 1365 | ||
| Presenting Signs and Symptoms | 1365 | ||
| Differential Diagnosis | 1367 | ||
| Diagnostic Testing | 1367 | ||
| Treatment | 1367 | ||
| Disposition | 1367 | ||
| References | 1368 | ||
| References | 1368.e1 | ||
| 162 Diabetes and Hyperglycemia | 1369 | ||
| Key Points | 1369 | ||
| Diabetes Mellitis | 1369 | ||
| Scope | 1369 | ||
| Epidemiology | 1369 | ||
| Structure and Function | 1369 | ||
| Clinical Presentation | 1370 | ||
| Diagnostic Testing | 1371 | ||
| XVII Infections | 1443 | ||
| 171 Meningitis, Encephalitis, and Brain Abscess | 1443 | ||
| Key Points | 1443 | ||
| Meningitis | 1443 | ||
| Epidemiology | 1443 | ||
| Etiology | 1443 | ||
| Pathophysiology | 1444 | ||
| Presenting Signs and Symptoms | 1444 | ||
| Differential Diagnosis | 1445 | ||
| Medical Decision Making | 1445 | ||
| Routine Laboratory Tests | 1445 | ||
| Neuroimaging Before Lumbar Puncture | 1445 | ||
| Lumbar Puncture and Cerebrospinal Fluid Analysis | 1446 | ||
| Treatment | 1446 | ||
| Follow-Up, Next Steps of Care, and Patient Education | 1448 | ||
| Acute Encephalitis | 1448 | ||
| Epidemiology | 1448 | ||
| Etiology | 1448 | ||
| Pathophysiology | 1449 | ||
| Presenting Signs and Symptoms | 1449 | ||
| Differential Diagnosis | 1449 | ||
| Medical Decision Making | 1449 | ||
| Treatment | 1450 | ||
| Follow-Up, Next Steps in Care, and Patient Care | 1450 | ||
| Intracranial Abscess | 1451 | ||
| Epidemiology | 1451 | ||
| Etiology | 1451 | ||
| Pathophysiology | 1451 | ||
| Presenting Signs and Symptoms | 1451 | ||
| Differential Diagnosis | 1452 | ||
| Medical Decision Making | 1452 | ||
| Treatment | 1452 | ||
| Follow-Up, Next Steps in Care, and Patient Care | 1452 | ||
| References | 1453 | ||
| References | 1453.e1 | ||
| 172 Sepsis | 1454 | ||
| Key Points | 1454 | ||
| Epidemiology | 1454 | ||
| Pathophysiology | 1454 | ||
| Presenting Signs and Symptoms | 1454 | ||
| Differential Diagnosis and Medical Decision Making | 1454 | ||
| Treatment | 1455 | ||
| Sepsis Bundles | 1456 | ||
| Antimicrobial Therapy | 1456 | ||
| Early Goal-Directed Therapy | 1456 | ||
| Vasopressors | 1456 | ||
| Low-Dose Corticosteroids and Activated Protein C | 1457 | ||
| Follow-Up, Next Steps of Care, and Patient Education | 1457 | ||
| Suggested Readings | 1457 | ||
| References | 1457 | ||
| References | 1457.e1 | ||
| 173 Infections in the Immunocompromised Host | 1458 | ||
| Key Points | 1458 | ||
| Perspective | 1458 | ||
| Malignancy, Neutropenia, and Fever | 1458 | ||
| Epidemiology | 1458 | ||
| Pathophysiology | 1458 | ||
| Presenting Signs and Symptoms | 1459 | ||
| Medical Decision Making | 1459 | ||
| Treatment | 1459 | ||
| Admission | 1460 | ||
| Immunosuppressive and Corticosteroid Therapy | 1460 | ||
| Solid Organ Transplantation | 1460 | ||
| Bone Marrow Transplantation | 1462 | ||
| Diabetes Mellitus | 1462 | ||
| Malignant Otitis Externa | 1462 | ||
| Mucormycosis | 1462 | ||
| Emphysematous Pyelonephritis | 1463 | ||
| Emphysematous Cholecystitis | 1463 | ||
| Skin and Soft Tissue Infections | 1463 | ||
| Suggested Readings | 1464 | ||
| References | 1464 | ||
| References | 1464.e1 | ||
| 174 Viral Infections | 1465 | ||
| Key Points | 1465 | ||
| Pathophysiology | 1465 | ||
| Herpes | 1465 | ||
| Herpes Simplex Virus | 1465 | ||
| Epidemiology | 1465 | ||
| Presenting Signs and Symptoms | 1466 | ||
| Diagnostic Testing | 1466 | ||
| Treatment and Disposition | 1467 | ||
| Varicella-Zoster Virus | 1467 | ||
| Epidemiology | 1467 | ||
| Presenting Signs and Symptoms | 1468 | ||
| Chickenpox | 1468 | ||
| Shingles | 1469 | ||
| Influenza | 1470 | ||
| Epidemiology | 1470 | ||
| Signs and Symptoms | 1470 | ||
| Testing, Treatment, and Disposition | 1470 | ||
| Pandemic Influenza | 1470 | ||
| Mononucleosis | 1471 | ||
| Epidemiology | 1471 | ||
| Presenting Signs and Symptoms | 1471 | ||
| Classic Presentation | 1471 | ||
| Typical Variations | 1471 | ||
| Hepatitis | 1471 | ||
| Rash | 1471 | ||
| Splenic Rupture | 1471 | ||
| Fulminant Infection | 1471 | ||
| Diagnostic Testing | 1471 | ||
| Treatment and Disposition | 1472 | ||
| Severe Acute Respiratory Syndrome | 1472 | ||
| Epidemiology | 1472 | ||
| West Nile Virus | 1474 | ||
| Epidemiology | 1474 | ||
| Presenting Signs and Symptoms | 1474 | ||
| Diagnostic Testing | 1474 | ||
| Treatment and Disposition | 1474 | ||
| References | 1474 | ||
| References | 1474.e1 | ||
| 175 Human Immunodeficiency Virus Infection | 1475 | ||
| Key Points | 1475 | ||
| Testing | 1475 | ||
| Rapid Assays | 1476 | ||
| Opt-Out Testing | 1476 | ||
| Monitoring Infection and Treatment | 1476 | ||
| Acute Infection | 1477 | ||
| Opportunistic Infections | 1477 | ||
| Central Nervous System Infections | 1477 | ||
| Toxoplasmosis | 1477 | ||
| Pulmonary Infections | 1477 | ||
| Pneumocystis pneumonia | 1477 | ||
| Gastrointestinal Infections | 1478 | ||
| Mucocutaneous Candidiasis | 1478 | ||
| Disseminated Infection | 1478 | ||
| Mycobacterium Avium Complex | 1478 | ||
| Ophthalmologic Infections | 1478 | ||
| Cytomegalovirus Retinitis | 1478 | ||
| Immune Reconstitution inflammatory Syndrome | 1478 | ||
| Antiretroviral Therapy | 1478 | ||
| Adverse Effects | 1479 | ||
| Prophylaxis Against Common Opportunistic Infection | 1479 | ||
| Postexposure Prophylaxis | 1479 | ||
| Occupational Exposure | 1479 | ||
| Nonoccupational Exposure | 1481 | ||
| Prevention of HIV Infection | 1482 | ||
| References | 1482 | ||
| References | 1482.e1 | ||
| 176 Fungal Infections | 1483 | ||
| Key Points | 1483 | ||
| General Epidemiology | 1483 | ||
| Risk Factors | 1483 | ||
| Anatomy | 1483 | ||
| Presenting Signs and Symptoms | 1483 | ||
| Organ-Specific Clinical Findings | 1484 | ||
| Pulmonary Disorders | 1484 | ||
| Central Nervous System Disorders | 1484 | ||
| Sepsis | 1484 | ||
| Ear, Nose, and Throat Disorders | 1484 | ||
| Rheumatic Disorders | 1484 | ||
| Cutaneous Disorders | 1484 | ||
| Vulvovaginal Disorders | 1485 | ||
| Diagnostic Testing | 1485 | ||
| Specific Fungal Infections | 1485 | ||
| Blastomycosis | 1485 | ||
| Histoplasmosis | 1486 | ||
| Coccidioidomycosis | 1486 | ||
| Aspergillosis | 1487 | ||
| Cryptococcosis | 1487 | ||
| Candidiasis | 1488 | ||
| Sporotrichosis | 1489 | ||
| Zygomycosis | 1489 | ||
| Medication | 1490 | ||
| References | 1490 | ||
| References | 1490.e1 | ||
| 177 Helminths, Bedbugs, Scabies, and Lice Infections | 1491 | ||
| Key Points | 1491 | ||
| Helminths | 1491 | ||
| XVIII Cutaneous Disorders | 1559 | ||
| 186 Wound Repair | 1559 | ||
| Key Points | 1559 | ||
| Epidemiology | 1559 | ||
| Pathophysiology | 1559 | ||
| Presenting Signs and Symptoms | 1560 | ||
| Differential Diagnosis and Medical Decision Making | 1560 | ||
| Patient Evaluation | 1560 | ||
| Injury to Underlying Structures | 1560 | ||
| Foreign Bodies | 1561 | ||
| Treatment | 1561 | ||
| Wound Preparation | 1561 | ||
| Sterile Technique | 1561 | ||
| Anesthesia | 1562 | ||
| Wound Cleansing and Irrigation | 1562 | ||
| Wound Edge Preparation | 1562 | ||
| Planning the Repair | 1562 | ||
| Wound Closure Techniques | 1562 | ||
| Suture Repair | 1562 | ||
| Simple Interrupted Suture | 1563 | ||
| Running Suture | 1563 | ||
| Running Subcuticular Sutures | 1563 | ||
| Deep Sutures | 1563 | ||
| Corner Stitch | 1563 | ||
| Mattress Sutures | 1563 | ||
| Staples | 1563 | ||
| Tissue Adhesives | 1564 | ||
| Wound Tape and Strips | 1565 | ||
| Puncture Wounds | 1566 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1566 | ||
| Patient Teaching | 1567 | ||
| Suggested Readings | 1567 | ||
| References | 1567 | ||
| References | 1567.e1 | ||
| 187 Soft Tissue Injury | 1568 | ||
| Key Points | 1568 | ||
| Retained Foreign Bodies | 1568 | ||
| Epidemiology | 1568 | ||
| Pathophysiology | 1568 | ||
| Presenting Signs and Symptoms | 1568 | ||
| Differential Diagnosis and Medical Decision Making | 1569 | ||
| Treatment (see the “Tips and Tricks” box) | 1571 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1572 | ||
| Tendon and Nerve Lacerations | 1572 | ||
| Epidemiology | 1572 | ||
| Pathophysiology | 1574 | ||
| Presenting Signs and Symptoms | 1575 | ||
| Differential Diagnosis and Medical Decision Making | 1575 | ||
| Treatment | 1576 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1576 | ||
| Suggested Readings | 1577 | ||
| References | 1577 | ||
| References | 1577.e1 | ||
| 188 Local and Regional Anesthesia | 1578 | ||
| Key Points | 1578 | ||
| Perspective | 1578 | ||
| Selection of Anesthetic Agents | 1578 | ||
| Mechanism of Action | 1578 | ||
| Toxicity | 1578 | ||
| Systemic Agents | 1579 | ||
| Lidocaine | 1579 | ||
| Mepivacaine | 1579 | ||
| Tetracaine | 1579 | ||
| Ropivacaine | 1579 | ||
| Bupivacaine | 1579 | ||
| Allergic Reactions | 1579 | ||
| Topical Agents | 1580 | ||
| Lidocaine, Epinephrine, and Tetracaine | 1580 | ||
| EMLA | 1580 | ||
| Liposomal Lidocaine | 1580 | ||
| Regional Nerve Blocks | 1580 | ||
| Indications | 1580 | ||
| General Technique | 1580 | ||
| Upper Extremity Blocks | 1580 | ||
| Median Nerve | 1580 | ||
| Ulnar Nerve | 1581 | ||
| Radial Nerve | 1581 | ||
| Digital Nerves | 1581 | ||
| Interscalene Nerve | 1581 | ||
| Bier Block | 1582 | ||
| Lower Extremity Blocks | 1582 | ||
| Femoral Nerve and Three-in-One Block | 1582 | ||
| Sural Nerve | 1582 | ||
| Peroneal Nerves (Superficial and Deep) | 1582 | ||
| Saphenous Nerve | 1582 | ||
| Posterior Tibial Nerve | 1582 | ||
| Facial and Oral Blocks | 1584 | ||
| Supraorbital Nerve | 1584 | ||
| Infraorbital Nerve | 1584 | ||
| Anterior Superior Alveolar Nerve | 1584 | ||
| Posterior Superior Alveolar Nerve | 1585 | ||
| Middle Superior Alveolar Nerve | 1585 | ||
| Inferior Alveolar Nerve | 1585 | ||
| Mental Nerve | 1585 | ||
| Nerve Block of an Individual Tooth (Supraperiosteal Block) | 1586 | ||
| Ear Block | 1586 | ||
| Miscellaneous Nerve Blocks | 1586 | ||
| Intercostal Nerve Block | 1586 | ||
| Hematoma Block | 1586 | ||
| Suggested Readings | 1586 | ||
| References | 1586 | ||
| References | 1586.e1 | ||
| 189 Thermal Burns | 1587 | ||
| Key Points | 1587 | ||
| Epidemiology | 1587 | ||
| Pathophysiology | 1587 | ||
| Presenting Signs and Symptoms | 1587 | ||
| Differential Diagnosis and Medical Decision Making | 1588 | ||
| Treatment | 1589 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1593 | ||
| References | 1593 | ||
| References | 1593.e1 | ||
| 190 Chemical Burns | 1594 | ||
| Key Points | 1594 | ||
| Epidemiology | 1594 | ||
| Pathophysiology | 1594 | ||
| Presenting Signs and Symptoms | 1594 | ||
| Differential Diagnosis and Medical Decision Making | 1594 | ||
| Hazardous Materials | 1595 | ||
| Treatment | 1595 | ||
| Elemental Metals: Do Not Irrigate | 1595 | ||
| Ocular Exposure | 1595 | ||
| Ingestions | 1595 | ||
| Inhalational Injury | 1596 | ||
| Directed Therapies | 1596 | ||
| Hydrofluoric Acid | 1596 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1597 | ||
| References | 1597 | ||
| References | 1597.e1 | ||
| 191 Approach to the Adult Rash | 1598 | ||
| Key Points | 1598 | ||
| Epidemiology | 1598 | ||
| Pathophysiology | 1598 | ||
| Presenting Signs and Symptoms | 1598 | ||
| Physical Examination Tips | 1598 | ||
| Specific Signs | 1599 | ||
| Differential Diagnoses and Medical Decision Making | 1599 | ||
| Travel History | 1599 | ||
| Medical, Occupational, and Recreational History | 1600 | ||
| Medicinal History | 1600 | ||
| The Algorithmic Approach | 1600 | ||
| Erythematous Rashes | 1600 | ||
| Maculopapular Rashes | 1600 | ||
| Petechial/Purpuric Rashes | 1600 | ||
| Vesiculobullous Rashes | 1601 | ||
| Treatment | 1604 | ||
| Erythematous Rashes | 1604 | ||
| Febrile Patients with a Positive Nikolsky Sign | 1604 | ||
| Febrile Patients Without a Positive Nikolsky Sign | 1605 | ||
| Afebrile Patients Without a Nikolsky Sign | 1605 | ||
| Maculopapular Rashes | 1606 | ||
| Central Maculopapular Rashes in Febrile or Ill-Appearing Patients | 1606 | ||
| Central Maculopapular Rashes in Well-Appearing Patients | 1606 | ||
| Peripheral Maculopapular Rashes in Febrile or Ill-Appearing Patients with Target Lesions | 1606 | ||
| Peripheral Maculopapular Rashes in Febrile or Ill-Appearing Patients Without Target Lesions | 1606 | ||
| Peripheral, Flexural, Maculopapular Rashes in Well-Appearing Patients | 1606 | ||
| Peripheral, Extensural, Maculopapular Rashes in Well-Appearing Patients | 1606 | ||
| Petechial/Purpuric Rashes | 1606 | ||
| Palpable Petechial/Purpuric Rashes in Febrile Patients | 1606 | ||
| Nonpalpable Petechial/Purpuric Rashes in Febrile Patients | 1606 | ||
| Petechial/Purpuric Rashes in Afebrile Patients | 1607 | ||
| Vesiculobullous Rashes | 1607 | ||
| Febrile Patients with a Diffuse Rash | 1607 | ||
| Febrile Patients with a Localized Rash | 1607 | ||
| Afebrile Patients with a Diffuse Rash | 1607 | ||
| Afebrile Patients with a Localized Rash | 1607 | ||
| Follow-Up and Patient Education | 1607 | ||
| Patients with Erythematous Rashes | 1607 | ||
| Patients with Maculopapular Rashes | 1607 | ||
| Patients with Petechial/Purpuric Rashes | 1607 | ||
| Patients with Vesiculobullous Rashes | 1608 | ||
| Suggested Readings | 1608 | ||
| References | 1608 | ||
| References | 1608.e1 | ||
| 192 Rash in the Severely Ill Patient | 1609 | ||
| Key Points | 1609 | ||
| Introduction | 1609 | ||
| Pathophysiology | 1609 | ||
| Presenting Signs and Symptoms | 1609 | ||
| History Taking | 1609 | ||
| Physical Examination | 1609 | ||
| Physical Signs | 1609 | ||
| Differential Diagnois and Medical Decision Making | 1610 | ||
| Algorithmic Approach to Classification | 1610 | ||
| Erythematous Rashes | 1610 | ||
| Toxic Epidermal Necrolysis | 1612 | ||
| Staphylococcal Scalded Skin Syndrome | 1612 | ||
| Toxic Shock Syndrome | 1612 | ||
| Kawasaki Disease | 1612 | ||
| Erythroderma | 1612 | ||
| Maculopapular Rashes | 1612 | ||
| Stevens-Johnson Syndrome | 1613 | ||
| Lyme Disease | 1613 | ||
| Rocky Mountain Spotted Fever | 1614 | ||
| Secondary Syphilis | 1614 | ||
| Meningococcemia | 1614 | ||
| Vesiculobullous Rashes | 1615 | ||
| Necrotizing Fasciitis | 1615 | ||
| Varicella | 1615 | ||
| Smallpox | 1615 | ||
| Purpura Fulminans/Disseminated Intravascular Coagulopathy | 1615 | ||
| Petechial/Purpuric Rashes | 1616 | ||
| Bacteremic Endocarditis | 1616 | ||
| Thrombotic Thrombocytopenic Purpura | 1616 | ||
| Treatment | 1616 | ||
| Erythematous Rashes | 1616 | ||
| Maculopapular Rashes | 1616 | ||
| XIX Emergency Psychiatric Disorders | 1619 | ||
| 193 The Emergency Psychiatric Assessment | 1619 | ||
| Key Points | 1619 | ||
| Perspective | 1619 | ||
| Epidemiology | 1619 | ||
| Pathophysiology | 1619 | ||
| Definitions | 1619 | ||
| Delirium | 1619 | ||
| Dementia | 1620 | ||
| Presenting Signs and Symptoms | 1621 | ||
| History | 1621 | ||
| Physical Examination | 1621 | ||
| Differential Diagnosis and Medical Decision Making | 1621 | ||
| Diagnostic Testing | 1622 | ||
| Treatment | 1625 | ||
| Follow-Up and Next Steps in Care | 1625 | ||
| Suggested Readings | 1626 | ||
| References | 1626 | ||
| References | 1626.e1 | ||
| 194 Psychosis and Psychotropic Medication | 1627 | ||
| Key Points | 1627 | ||
| Definitions and Epidemiology | 1627 | ||
| Pathophysiology | 1627 | ||
| Presenting Signs and Symptoms | 1627 | ||
| Differential Diagnosis | 1628 | ||
| Diagnostic Testing | 1628 | ||
| Psychotropic Medications | 1628 | ||
| Typical (First-Generation) Antipsychotic Agents | 1628 | ||
| Atypical (Second-Generation) Antipsychotic Agents | 1628 | ||
| Partial Receptor Agonists | 1629 | ||
| Benzodiazepines | 1629 | ||
| Treatment | 1629 | ||
| Disposition | 1629 | ||
| References | 1629 | ||
| References | 1629.e1 | ||
| 195 The Violent Patient | 1630 | ||
| Key Points | 1630 | ||
| Epidemiology | 1630 | ||
| How to Predict Violence | 1630 | ||
| Interventions | 1631 | ||
| Deescalation Techniques | 1631 | ||
| Medical Clearance | 1632 | ||
| Treatment | 1632 | ||
| Physical Restraint | 1632 | ||
| Rationale | 1632 | ||
| Documentation | 1632 | ||
| Technique | 1632 | ||
| Types of Physical Restraint | 1633 | ||
| Positioning | 1633 | ||
| Complications | 1634 | ||
| Chemical Restraint, Anxiolysis, and Sedation | 1634 | ||
| Rationale | 1634 | ||
| Butyrophenones | 1634 | ||
| Haloperidol (Haldol) | 1634 | ||
| Droperidol (Inapsine) | 1635 | ||
| Benzodiazepines | 1636 | ||
| Lorazepam (Ativan) | 1636 | ||
| Midazolam (Versed) | 1636 | ||
| Combination Therapy | 1636 | ||
| Atypical Antipsychotic Medications | 1636 | ||
| Ziprasidone (Geodon) | 1636 | ||
| Olanzapine (Zyprexa) | 1637 | ||
| Risperidone (Risperdal) | 1637 | ||
| Aripiprazole (Abilify) | 1637 | ||
| Next Steps | 1637 | ||
| Suggested Readings | 1638 | ||
| References | 1638 | ||
| References | 1638.e1 | ||
| 196 Self-Harm and Danger to Others | 1639 | ||
| Key Points | 1639 | ||
| Epidemiology | 1639 | ||
| Pathophysiology | 1639 | ||
| Presenting Signs and Symptoms | 1640 | ||
| Differential Diagnosis and Medical Decision Making | 1641 | ||
| Most Common and Most Threatening Presentations | 1641 | ||
| Diagnostic Testing | 1641 | ||
| Treatment | 1641 | ||
| Disposition | 1641 | ||
| Suggested Readings | 1643 | ||
| References | 1643 | ||
| References | 1643.e1 | ||
| 197 Anxiety and Panic Disorders | 1644 | ||
| Key Points | 1644 | ||
| Definition and Epidemiology | 1644 | ||
| Pathophysiology | 1644 | ||
| Clinical Presentation | 1645 | ||
| Differential Diagnosis, Diagnostic Criteria, and Testing | 1645 | ||
| Treatment | 1645 | ||
| Disposition | 1647 | ||
| References | 1647 | ||
| References | 1647.e1 | ||
| 198 Conversion Disorder, Psychosomatic Illness, and Malingering | 1648 | ||
| Key Points | 1648 | ||
| Epidemiology | 1648 | ||
| Definitions | 1648 | ||
| Pathophysiology | 1649 | ||
| Presenting Signs and Symptoms | 1649 | ||
| Classic Features | 1649 | ||
| Victims of Intimate Partner Violence | 1650 | ||
| Differential Diagnosis and Testing | 1650 | ||
| Treatment | 1651 | ||
| Follow-Up and Next Steps in Care | 1652 | ||
| Suggested Readings | 1652 | ||
| References | 1652 | ||
| References | 1652.e1 | ||
| 199 Addiction | 1653 | ||
| Key Points | 1653 | ||
| Scope, Epidemiology, and Definitions | 1653 | ||
| Pathophysiology and Anatomy | 1654 | ||
| Presenting Signs and Symptoms | 1655 | ||
| Differential Diagnosis | 1657 | ||
| Diagnostic Testing | 1657 | ||
| Treatment and Disposition | 1657 | ||
| Prevention of Relapse | 1658 | ||
| Disposition | 1658 | ||
| Treatment Efficacy | 1659 | ||
| Alcohol | 1659 | ||
| Opiates | 1659 | ||
| References | 1659 | ||
| References | 1659.e1 | ||
| 200 Anorexia Nervosa and Bulimia Nervosa | 1660 | ||
| Key Points | 1660 | ||
| Definitions and Epidemiology | 1660 | ||
| Presenting Signs and Symptoms | 1660 | ||
| Classic Presentation | 1660 | ||
| Atypical Presentation | 1661 | ||
| Complications | 1661 | ||
| Associated Comorbid Conditions | 1661 | ||
| Differential Diagnosis | 1661 | ||
| Diagnostic Testing | 1661 | ||
| Treatment | 1662 | ||
| Disposition | 1662 | ||
| Suggested Readings | 1663 | ||
| References | 1663 | ||
| References | 1663.e1 | ||
| XX Hematology and Oncology Management | 1665 | ||
| 201 Introduction to Oncologic Emergencies | 1665 | ||
| Key Points | 1665 | ||
| Epidemiology | 1665 | ||
| Triage | 1665 | ||
| Isolation and Infectious Control Issues | 1665 | ||
| Oncologic History | 1666 | ||
| Fever | 1666 | ||
| Epidemiology | 1666 | ||
| Pathophysiology | 1666 | ||
| Differential Diagnosis and Medical Decision Making | 1666 | ||
| Diagnostic Testing | 1666 | ||
| Treatment | 1666 | ||
| Follow-Up and Next Steps | 1667 | ||
| Infectious Causes of Fever Unique to the Patient with Cancer | 1668 | ||
| Neutropenic Enterocolitis (Typhlitis) | 1668 | ||
| Fungal Infections | 1668 | ||
| Invasive Fungal Sinusitis | 1668 | ||
| Electrolyte Disturbances in the Oncology Patient | 1668 | ||
| Tumor Lysis Syndrome | 1668 | ||
| Perspective | 1668 | ||
| Pathophysiology | 1669 | ||
| Presenting Signs and Symptoms | 1669 | ||
| Diagnostic Testing | 1669 | ||
| Treatment | 1669 | ||
| Hypercalcemia | 1670 | ||
| Epidemiology | 1670 | ||
| Pathophysiology | 1670 | ||
| Presenting Signs and Symptoms | 1670 | ||
| Diagnostic Testing | 1670 | ||
| Treatment | 1670 | ||
| Follow-up, Next Steps, and Admission and Discharge | 1671 | ||
| Hypotension | 1671 | ||
| Differential Diagnosis and Medical Decision Making | 1671 | ||
| Adrenal Insufficiency | 1671 | ||
| Pathophysiology | 1671 | ||
| Presenting Signs and Symptoms | 1671 | ||
| Diagnostic Testing | 1671 | ||
| XXI Leadership, Communication, and Administration | 1727 | ||
| 207 Leadership and Emergency Medicine | 1727 | ||
| Key Points | 1727 | ||
| Perspective | 1727 | ||
| Scope | 1727 | ||
| Leadership Qualities | 1727 | ||
| Group Size and Leadership | 1727 | ||
| Manager Versus Leader | 1727 | ||
| Character | 1728 | ||
| Strategic Positioning: Out in Front | 1728 | ||
| Communication | 1728 | ||
| Fairness and Justice | 1729 | ||
| Managing Leadership | 1729 | ||
| Learning and Knowledge | 1729 | ||
| Effective Leadership | 1729 | ||
| Leadership in Emergency Medicine | 1730 | ||
| Suggested Readings | 1730 | ||
| 208 Quality and Patient Safety in Emergency Medicine | 1731 | ||
| Key Points | 1731 | ||
| History of Health Care Quality | 1731 | ||
| Costs in Health Care | 1733 | ||
| Variability in Health Care | 1733 | ||
| Institute of Medicine Aim: Patient Safety | 1733 | ||
| Active and Latent Failure Types | 1733 | ||
| Reason’s “Swiss Cheese” Model | 1734 | ||
| Cognitive Errors | 1735 | ||
| Heuristics | 1735 | ||
| Error-Producing Conditions in the Emergency Department | 1736 | ||
| High-Reliability Organizations | 1736 | ||
| Institute of Medicine Aim: Timeliness | 1736 | ||
| Institute of Medicine Aim: Patient-Centered Care | 1737 | ||
| Institute of Medicine Aims: Effective, Efficient, and Equitable Care | 1737 | ||
| Special Focus: Care Coordination | 1738 | ||
| Special Focus: From “Never Events” to “Serious Reportable Events” | 1738 | ||
| Financial Strategies to Improve Health Care Quality and Value | 1738 | ||
| Center for Medicare and Medicaid Services | 1738 | ||
| Future Reimbursement Models | 1739 | ||
| Measure Development | 1739 | ||
| Health Care Quality Lapses and Individual Providers | 1740 | ||
| Remaining Challenges | 1741 | ||
| Suggested Readings | 1742 | ||
| References | 1742 | ||
| References | 1742.e1 | ||
| 209 Conflict Resolution in Emergency Medicine | 1743 | ||
| Key Points | 1743 | ||
| Examples of Conflict | 1744 | ||
| Importance of Communication | 1745 | ||
| Costs of Conflict | 1745 | ||
| Conflict Resolution in Emergency Medicine | 1745 | ||
| Challenges to Conflict Resolution | 1746 | ||
| Strategies for Successful Conflict Resolution | 1746 | ||
| Relationships in the Emergency Department | 1746 | ||
| Benefits of Conflict Resolution | 1747 | ||
| Summary | 1748 | ||
| References | 1748 | ||
| References | 1748.e1 | ||
| 210 Informed Consent and Assessing Decision-Making Capacity in the Emergency Department | 1749 | ||
| Key Points | 1749 | ||
| Informed Consent | 1749 | ||
| Background | 1749 | ||
| Elements | 1749 | ||
| Decision-Making Capacity | 1750 | ||
| When to Exercise Additional Care in Assessing Capacity | 1750 | ||
| Suggested Questions to Aid in the Determination of Capacity | 1751 | ||
| Conclusion | 1752 | ||
| References | 1752 | ||
| References | 1752.e1 | ||
| 211 Regulatory and Legal Issues in the Emergency Department | 1753 | ||
| Key Points | 1753 | ||
| Background | 1753 | ||
| Public Health Authority | 1753 | ||
| The Joint Commission | 1754 | ||
| Emergency Medical Treatment and Active Labor Act | 1755 | ||
| Health Insurance Portability and Accountability Act | 1756 | ||
| Special Circumstances | 1757 | ||
| Mandatory Reporting | 1757 | ||
| Sexual Assault | 1757 | ||
| Restraints | 1758 | ||
| References | 1758 | ||
| References | 1758.e1 | ||
| 212 Medical-Legal Issues in Emergency Medicine | 1759 | ||
| Key Points | 1759 | ||
| Establishing a Trusting and Positive physician-Patient Relationship | 1759 | ||
| Be Service Oriented | 1759 | ||
| Charting and the Medical Record | 1759 | ||
| Discharge Instructions | 1759 | ||
| Understanding the Medical-Legal System | 1759 | ||
| Concerns Specific to the Current-Day Emergency Department | 1759 | ||
| Ownership of Patients | 1760 | ||
| Combative Patients | 1760 | ||
| Civil Commitment | 1760 | ||
| Transfers | 1760 | ||
| Reportable Illnesses | 1760 | ||
| Legal Blood Draw for Alcohol Testing | 1761 | ||
| Incident Reports | 1761 | ||
| Response to in-House Emergencies | 1761 | ||
| Writing Orders for Admitted Patients | 1761 | ||
| Prescriptions from the Emergency Department | 1761 | ||
| Midlevel Providers, Residents, and Emergency Physician Supervision | 1761 | ||
| Patients Who Leave before Examination or Against Medical Advice or Who Elope | 1761 | ||
| Return Visits | 1762 | ||
| Change of Shift | 1762 | ||
| Laboratory Studies, Radiographs, and Electrocardiograms | 1762 | ||
| Health Insurance Portability and Accountability Act | 1762 | ||
| Duty to a Third Party | 1762 | ||
| Minors | 1762 | ||
| Telephone Orders and Telephone Advice | 1762 | ||
| Specific High-Risk Medical Complaints | 1762 | ||
| Orthopedics | 1762 | ||
| Eye, Ear, Nose, and Throat or Airway | 1762 | ||
| Wounds | 1762 | ||
| Poisoning | 1762 | ||
| Psychiatry | 1762 | ||
| Chest Pain | 1763 | ||
| Abdominal Pain | 1763 | ||
| Back Pain | 1763 | ||
| Urologic Issues | 1763 | ||
| Elevated Blood Pressure | 1764 | ||
| Headache Emergencies | 1764 | ||
| Spinal Cord Injury | 1764 | ||
| Seizures and Syncope | 1764 | ||
| Transient Ischemic Attacks and Stroke | 1764 | ||
| Trauma | 1764 | ||
| Obstetric and Gynecologic Issues | 1764 | ||
| Pediatrics | 1764 | ||
| Suggested Readings | 1765 | ||
| 213 Documentation | 1766 | ||
| Key Points | 1766 | ||
| Introduction | 1766 | ||
| Current Procedural Terminology Codes | 1766 | ||
| Evaluation and Management | 1766 | ||
| Critical Care | 1767 | ||
| Billing Compliance | 1768 | ||
| Procedural Billing | 1769 | ||
| Observation Care | 1769 | ||
| Hospital Billing and Capturable Revenue | 1769 | ||
| Suggested Reading | 1769 | ||
| References | 1769 | ||
| Procedural Billing | 1769.e1 | ||
| Observation Care | 1769.e1 | ||
| Hospital Billing and Capturable Revenue | 1769.e1 | ||
| References | 1769.e2 | ||
| 214 Ethics of Resuscitation | 1770 | ||
| Key Points | 1770 | ||
| Perspective | 1770 | ||
| Epidemiology | 1771 | ||
| Pathophysiology | 1771 | ||
| Presenting Signs and Symptoms | 1771 | ||
| Differential Diagnosis and Medical Decision Making | 1771 | ||
| Treatment | 1772 | ||
| Follow-Up, Next Steps in Care, and Patient Education | 1772 | ||
| Suggested Readings | 1773 | ||
| References | 1773 | ||
| References | 1773.e1 | ||
| 215 Emergency Medical Services and Disaster Medicine | 1774 | ||
| Key Points | 1774 | ||
| Introduction and History | 1774 | ||
| EMS System Design | 1774 | ||
| Public and Private Agencies | 1775 | ||
| Rural and Urban EMS Systems | 1775 | ||
| Single-Tiered and Multitiered Systems | 1775 | ||
| EMS System Organization, Training, and Transport Types | 1775 | ||
| Dispatch and Medical Control | 1775 | ||
| EMS Responder Personnel | 1776 | ||
| EMS Vehicles, Equipment, and Types of Transport | 1776 | ||
| Air Medicine Transport | 1777 | ||
| Current Controversies in EMS | 1778 | ||
| Cardiovascular Emergencies | 1778 | ||
| Prehospital Resuscitative Interventions | 1778 | ||
| Trauma | 1778 | ||
| Response Time | 1778 | ||
| Disaster Medicine | 1778 | ||
| Introduction and History | 1778 | ||
| Definitions and Classifications | 1779 | ||
| Disaster Planning | 1779 | ||
| Disaster Response | 1779 | ||
| Prehospital Disaster Response and Triage | 1779 | ||
| Hospital and Agency Disaster Response | 1781 | ||
| Weapons of Mass Destruction and Hazardous Materials | 1783 | ||
| The Role of Emergency Physicians in Disaster Medicine | 1783 | ||
| References | 1783 | ||
| References | 1783.e1 | ||
| 216 Patient-Centered Care | 1784 | ||
| Key Points | 1784 | ||
| Introduction | 1784 | ||
| Goals | 1784 | ||
| Background | 1784 | ||
| Personal Issues | 1784 | ||
| Communication | 1785 | ||
| Operational Considerations | 1785 | ||
| Intake | 1785 | ||
| Assessment | 1785 | ||
| Waiting and Delays | 1785 | ||
| Disposition | 1785 | ||
| Humanistic Considerations | 1785 | ||
| Time: Making the Most of What We Have | 1786 | ||
| Provider Emotions: Leaving Our Personal Reactions and Feelings at the Door | 1786 | ||
| Systems Issues | 1786 | ||
| Patient Satisfaction | 1786 | ||
| Operational Efficiency | 1786 | ||
| Medical-Legal Factors | 1787 | ||
| Compliance | 1788 | ||
| Critical Issues | 1788 | ||
| Advanced Directives | 1788 | ||
| Family-Witnessed Resuscitation | 1788 | ||
| Informed Refusal | 1789 | ||
| Conclusion | 1789 | ||
| References | 1789 | ||
| References | 1789.e1 | ||
| 217 Health Care Disparities and Diversity in Emergency Medicine | 1790 | ||
| Key Points | 1790 | ||
| Introduction | 1790 | ||
| Identifying Issues of Disparity | 1790 | ||
| Understanding Cultural Competency | 1790 | ||
| Exploring Solutions | 1792 | ||
| Moving Toward Parity in Health Care | 1792 | ||
| Moving Toward Justice in Research | 1792 | ||
| Moving Toward Diversity in Medical Education and Practice of Emergency Medicine | 1793 | ||
| Leadership Strategies in Emergency Medicine | 1793 | ||
| Organizational Leadership | 1793 | ||
| Barriers and Challenges | 1793 | ||
| Future Directions | 1794 | ||
| References | 1794 | ||
| References | 1794.e1 | ||
| 218 Introduction to Cost-Effectiveness Analysis | 1795 | ||
| Key Points | 1795 | ||
| What Is Cost-Effectiveness Analysis? | 1795 | ||
| How Does Cost-Effectiveness Analysis Affect the Emergency Physician? | 1795 | ||
| Methodology in Cost-Effectiveness Analysis | 1795 | ||
| Components of A Cost-Effectiveness Analysis | 1795 | ||
| Inputs | 1796 | ||
| Perspective | 1796 | ||
| Costs | 1796 | ||
| Effectiveness | 1796 | ||
| Clinical Probabilities | 1797 | ||
| Discounting | 1797 | ||
| The Model | 1797 | ||
| Primary Outcomes | 1797 | ||
| Sensitivity Analyses | 1798 | ||
| Evaluating a Cost-Effectiveness Analysis | 1799 | ||
| Suggested Readings | 1801 | ||
| References | 1801 | ||
| References | 1801.e1 | ||
| Index | 1803 | ||
| A | 1803 | ||
| B | 1809 | ||
| C | 1811 | ||
| D | 1818 | ||
| E | 1821 | ||
| F | 1823 | ||
| G | 1825 | ||
| H | 1827 | ||
| I | 1832 | ||
| J | 1834 | ||
| K | 1834 | ||
| L | 1835 | ||
| M | 1836 | ||
| N | 1839 | ||
| O | 1840 | ||
| P | 1841 | ||
| Q | 1846 | ||
| R | 1846 | ||
| S | 1849 | ||
| T | 1853 | ||
| U | 1856 | ||
| V | 1857 | ||
| W | 1858 | ||
| X | 1859 | ||
| Y | 1859 | ||
| Z | 1859 | ||
| Evidence-Based Medicine | e1 | ||
| Clinical Scenarios | e1 | ||
| Acute Headache in the Emergency Department | e1 | ||
| Ask | e1 | ||
| Acquire | e2 | ||
| Appraise | e2 | ||
| Apply | e3 | ||
| Chest Pain in the Emergency Department | e5 | ||
| Background | e5 | ||
| Ask | e5 | ||
| Acquire and Appraise | e5 | ||
| Apply | e7 | ||
| Conclusion | e8 | ||
| References | e8 | ||
| Basic Emergency Ultrasound | e9 | ||
| Key Points | e9 | ||
| Introduction | e9 | ||
| What We Are Looking For | e9 | ||
| Physics of Ultrasound | e9 | ||
| Selecting a Transducer | e10 | ||
| Image Orientation | e10 | ||
| Image Manipulation and Artifacts | e11 | ||
| Other Ultrasound Modes | e14 | ||
| References | e15 | ||
| Conflict Resolution in Emergency Medicine | e16 | ||
| Key Points | e16 | ||
| Examples of Conflict | e17 | ||
| The Importance of Communication | e18 | ||
| Costs of Conflict | e20 | ||
| Conflict Resolution in Emergency Medicine | e20 | ||
| Challenges to Conflict Resolution | e22 | ||
| Strategies for Successful Conflict Resolution | e22 | ||
| Relationships in the Emergency Department | e22 | ||
| Benefits of Conflict Resolution | e24 | ||
| Failure of Conflict Resolution | e24 | ||
| Red Flags Associated with Conflict and Inadequate Conflict Management | e25 | ||
| Summary | e25 | ||
| Acknowledgment | e26 | ||
| References | e26 | ||
| Medical-Legal Issues in Emergency Medicine | e28 | ||
| Key Points | e28 | ||
| Scope | e28 | ||
| Be Service Oriented | e28 | ||
| Small Things Count | e29 | ||
| Barriers to Proper Care | e29 | ||
| Establishing the Relationship | e29 | ||
| Medical-Legal System Organization and Problems | e30 | ||
| Structure of A Lawsuit | e30 | ||
| Engaging A Defense: First Steps | e31 | ||
| Charting and the Medical Record | e31 | ||
| Legibility and Decipherability | e32 | ||
| Timeliness of Making A Record | e32 | ||
| Charting Useless Information | e32 | ||
| Altering the Medical Record | e32 | ||
| Electronic Medical Records | e32 | ||
| Discrepancies Among Professionals | e32 | ||
| Comments on the Chart | e32 | ||
| Discharge Instructions | e32 | ||
| Specific Medical-Legal Situations: Pearls | e32 | ||
| Specific Medical Problems | e36 | ||
| Suggested Readings | e40 | ||
| Health Care Disparities and Diversity in Emergency Medicine | e41 | ||
| Key Points | e41 | ||
| Introduction | e41 | ||
| History of Health Care Disparities in the United States | e41 | ||
| History of Disparity in Research | e43 | ||
| History of Disparity in Medical Education | e43 | ||
| Diversity and Cultural Competency | e44 | ||
| Introduction | e44 | ||
| Definitions | e44 | ||
| Tools for Cultural Competency | e44 | ||
| Institute of Medicine Committee and Sullivan Commission National Reports | e44 | ||
| Association of American Medical Colleges | e45 | ||
| Moving Toward Parity in Health Care | e45 | ||
| Moving Toward Justice in Research | e45 | ||
| Moving Toward Diversity in Medical Education and Practice of Emergency Medicine | e46 | ||
| Current Scope of the Problem in Emergency Medicine | e47 | ||
| Leadership Strategies | e47 | ||
| Organizational Leadership | e47 | ||
| society for Academic Emergency Medicine Disparities Consensus Conference (2003) | e47 | ||
| The Promoting Diversity in Emergency Medicine: Council of Emergency Medicine Residency Directors Academic Assembly Diversity Workgroup (2009) | e48 | ||
| Future Directions | e48 | ||
| Suggested Readings | e48 | ||
| Suggested Organizational Links | e49 | ||
| References | e49 |