BOOK
SPEC - Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care 12-Month Access, eBook
(2017)
Additional Information
Book Details
Abstract
Comprehensive, detailed, and up to date, Roberts and & Hedges’ Clinical Procedures in Emergency Medicine and Acute Care, 7th Edition, provides highly visual coverage of both common and uncommon procedures encountered in emergency medicine and acute care practice. It clearly describes the ins and outs of every procedure you're likely to consider, such as how, why, when to, and when not to perform them, in addition toand recommends other emergency or acute care procedures that may be an option. Thoroughly revised and updated throughout, the 7th Edition remains the most well-known and trusted procedures manual in its field
- Covers the latest equipment, devices, drug therapies, and techniques you need to know for the effective practice of emergency medicine and acute care.
- Features new and updated information on ultrasound throughout the text, including Ultrasound Boxes which that are expertly written and richly illustrated with photographs and clinical correlative images.
- Includes more Procedure Boxes that allow you to see entire procedures at a glance, functioning as a mini-atlas that allows you to quickly grasp how to perform a procedure.
- Contains hundreds more than 100 of new figures— – of more than 3,500 images total— – plus including new color photographs, a new Ultrasound Boxes, and new algorithms,
- new authors, new concepts and approaches.
- Features a new chapter on Procedures in the Setting of Anticoagulation.
- Covers hot topics such as novel loop abscess drainage technique, ENT techniques, and ophthalmology techniques, as well as procedures performed by acute care practitioners such as sedation of the agitated patient, alternate methods of drug delivery, and common errors and complications in the acute care setting.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Half title page | i | ||
| ASSOCIATE EDITORS | ii | ||
| Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care | iii | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| How this Medical Textbook Should be Viewed by the Practicing Clinician and the Judicial System | vii | ||
| Contributors | viii | ||
| Preface | xv | ||
| Foreword | xvii | ||
| Acknowledgments | xviii | ||
| Table Of Contents | xix | ||
| Video Contents | xxiii | ||
| Supplementary Videos | xxx | ||
| I Vital Signs and Patient Monitoring Techniques | 1 | ||
| 1 Vital Signs Measurement | 1 | ||
| Background | 1.e1 | ||
| Normal Values | 1 | ||
| Respiration | 2 | ||
| Indications and Contraindications | 3 | ||
| Procedure | 3 | ||
| Interpretation | 3 | ||
| Respiratory Rate | 3 | ||
| Respiratory Pattern and Amplitude | 3 | ||
| Pulse | 5 | ||
| Physiology | 5 | ||
| Indications and Contraindications | 5 | ||
| Procedure | 5 | ||
| Interpretation | 5 | ||
| Pulse Rate | 5 | ||
| Heart Rhythm | 5 | ||
| Pulse Amplitude and Contour | 6 | ||
| Pulses During Cardiopulmonary Resuscitation | 6 | ||
| Arterial Blood Pressure | 6 | ||
| Physiology | 6 | ||
| Indications and Contraindications | 6 | ||
| Equipment | 6 | ||
| Cuff Type | 7 | ||
| Procedure | 7 | ||
| Complications | 8 | ||
| Interpretation | 8 | ||
| Hypertension | 9 | ||
| Measurement Errors | 9 | ||
| Pulse Pressure | 9 | ||
| Differential Brachial Artery Pressure | 10 | ||
| Pulse-Pressure Variation | 10 | ||
| Pulsus Paradoxus | 10 | ||
| Shock Index | 11 | ||
| Doppler Ultrasound for Evaluation of Pulse and Blood Pressure | 11 | ||
| Principles of Doppler Ultrasound | 11 | ||
| Indications and Contraindications | 11 | ||
| Equipment | 11 | ||
| Procedure | 11 | ||
| Interpretation | 12 | ||
| Vital Sign Determination of Volume Status | 12 | ||
| Orthostatic Vital Signs Measurement | 13 | ||
| Physiologic Response to Hypovolemia | 13 | ||
| Physiologic Response to Changes in Posture | 14 | ||
| Variables Affecting Orthostatic Vital Signs | 15 | ||
| Indications and Contraindications | 16 | ||
| Technique | 16 | ||
| Interpretation | 16 | ||
| Capillary Refill | 16 | ||
| Indications and Contraindications | 17 | ||
| Procedure | 17 | ||
| Interpretation | 17 | ||
| Temperature | 17 | ||
| Physiology | 17 | ||
| Indications and Contraindications | 18 | ||
| Measurement Sites | 18 | ||
| Core Body Temperature | 18 | ||
| Peripheral Body Sites Approximating Core Temperature | 18 | ||
| Procedure | 19 | ||
| Interpretation | 19 | ||
| Pain as a Vital Sign | 21 | ||
| Background | 21 | ||
| Procedure/Interpretation | 21 | ||
| Overall Goal of Pain Relief | 22 | ||
| References | 22.e1 | ||
| 2 Devices for Assessing Oxygenation and Ventilation | 23 | ||
| Spirometry | 23 | ||
| Indications | 23 | ||
| Evaluation of Acute Asthma Attacks | 23 | ||
| Evaluation of Exacerbations of COPD | 23 | ||
| Differentiating Causes of Dyspnea | 23 | ||
| Evaluation of Neuromuscular and Chest Wall Disease | 23 | ||
| Contraindications | 23 | ||
| Need for Immediate Intervention | 23 | ||
| Conditions That May Be Worsened by Increased Intrathoracic Pressure | 23 | ||
| Equipment | 23 | ||
| Procedure | 24 | ||
| Interpretation | 24 | ||
| Noninvasive Oxygenation Monitoring: Pulse Oximetry | 25 | ||
| Technology | 25 | ||
| Physiology | 25 | ||
| Clinical Utility | 26 | ||
| Indications | 26 | ||
| Procedure | 26 | ||
| Interpretation | 26 | ||
| Sources of Interference | 28 | ||
| Effects of Dyshemoglobinemias | 28 | ||
| Fetal Hemoglobin | 28 | ||
| Low Perfusion | 28 | ||
| Intravenous Dyes | 28 | ||
| Bilirubin | 29 | ||
| Skin Pigmentation | 29 | ||
| Nail Polish | 29 | ||
| High Saturation | 29 | ||
| Venous Pulsations | 29 | ||
| Anemia | 29 | ||
| Ambient Light | 29 | ||
| Motion | 29 | ||
| Probe Site | 29 | ||
| Electrocautery | 29 | ||
| Conclusions | 29 | ||
| Future Directions | 29 | ||
| CO2 Monitoring | 29 | ||
| Terminology | 30 | ||
| Technology | 30 | ||
| Physiology | 31 | ||
| Indications for Intubated Patients | 31 | ||
| Verification of ET Tube Placement | 31 | ||
| Monitoring Tube Position During Transport | 32 | ||
| Gauging the Effectiveness of CPR | 32 | ||
| Indicator of ROSC | 32 | ||
| Assessing Prognosis After Initiation of Cardiac Arrest Resuscitation | 32 | ||
| Identifying the Cause of Cardiac Arrest | 32 | ||
| Titrating ETCO2 in Patients With Suspected Increased Intracranial Pressure | 32 | ||
| Indications for Capnography in Spontaneously Breathing Patients | 33 | ||
| Assessment of Critically Ill, Injured, or Seizing Patients | 33 | ||
| Assessment and Triage of Victims of Chemical Terrorism and Mass Casualty | 33 | ||
| Gauging Severity and Response to Treatment of Patients in Acute Respiratory Distress | 33 | ||
| Procedural Sedation and Analgesia | 33 | ||
| Determining the Adequacy of Ventilation in Patients With Altered Mental Status | 34 | ||
| Detection of Metabolic Acidosis | 34 | ||
| Limitations | 37 | ||
| Conclusion | 37 | ||
| References | 38.e1 | ||
| II Respiratory Procedures | 39 | ||
| 3 Basic Airway Management and Decision Making | 39 | ||
| The Challenge of Emergency Airway Management | 39 | ||
| Basic Airway Management Techniques | 39 | ||
| Opening the Airway | 39 | ||
| Manual Airway Maneuvers | 39 | ||
| The Jaw-Thrust Maneuver | 40 | ||
| The Head-Tilt/Chin-Lift Maneuver | 40 | ||
| The Triple Airway Maneuver | 40 | ||
| Patient Positioning | 40 | ||
| Foreign Body Airway Obstruction | 41 | ||
| Abdominal Thrusts (Heimlich Maneuver), Chest Thrusts, and Back Blows (Slaps) | 41 | ||
| Suctioning | 42 | ||
| Oropharyngeal and Nasopharyngeal Artificial Airways | 43 | ||
| Indications and Contraindications | 43 | ||
| Artificial Airway Placement | 43 | ||
| Complications | 45 | ||
| Oxygen Therapy | 45 | ||
| Indications and Contraindications | 45 | ||
| Oxygen Administration During Cardiac Arrest and Neonatal Resuscitation | 45 | ||
| Oxygen Delivery Devices | 45 | ||
| Procedure | 48 | ||
| Preoxygenation Prior to Endotracheal Intubation | 48 | ||
| Complications of Oxygen Therapy | 48 | ||
| Bag-Mask Ventilation | 49 | ||
| Indications and Contraindications | 49 | ||
| BMV Technique | 49 | ||
| Complications | 50 | ||
| Cricoid Pressure (Sellick Maneuver) | 51 | ||
| Extraglottic Airway Devices | 52 | ||
| Laryngeal Mask Airways | 52 | ||
| Indications | 52 | ||
| Contraindications | 54 | ||
| Types of LMAs | 54 | ||
| Procedure | 54 | ||
| Intubating LMAs | 54 | ||
| Nonintubating LMAs | 57 | ||
| Aftercare | 57 | ||
| Complications | 57 | ||
| Retroglottic Airway Devices | 58 | ||
| King LT | 58 | ||
| Indications and Contraindications | 59 | ||
| Placement of the King LT | 59 | ||
| Complications | 60 | ||
| Combitube and EasyTube | 60 | ||
| Placement of the Combitube | 60 | ||
| Complications | 61 | ||
| Conclusion | 61 | ||
| References | 61.e1 | ||
| 4 Tracheal Intubation | 62 | ||
| General Approach to Emergency Intubation | 62 | ||
| Airway Anatomy | 62 | ||
| Preparation | 62 | ||
| Preoxygenation | 64 | ||
| Apneic Oxygenation During Intubation | 65 | ||
| Assessing for a Difficult Airway | 65 | ||
| Emergency Airway Decision Making | 67 | ||
| Decision to Perform Rapid-Sequence Intubation (RSI) | 68 | ||
| Ideal Versus Emergency Technique | 68 | ||
| Failed Airways | 68 | ||
| Emergency Airway Algorithm | 68 | ||
| Direct Laryngoscopy (DL) | 69 | ||
| Indications and Contraindications | 69 | ||
| Equipment | 69 | ||
| Laryngoscope | 69 | ||
| Tracheal Tubes | 70 | ||
| Optimal Patient Positioning for DL | 71 | ||
| Procedure and Technique of DL | 72 | ||
| Learning DL | 72 | ||
| Adults | 72 | ||
| Infants and Children | 72 | ||
| Cricoid Pressure, ELM, Bimanual Laryngoscopy, and BURP | 75 | ||
| Cricoid Pressure | 75 | ||
| ELM, Bimanual Laryngoscopy, and BURP | 75 | ||
| Passing the Tube | 77 | ||
| Tracheal Tube Introducer (Bougie) | 78 | ||
| Laryngospasm | 80 | ||
| Positioning and Securing the Tube | 80 | ||
| Confirmation of Tracheal Tube Placement | 80 | ||
| Clinical Assessment | 80 | ||
| Esophageal Detector Device | 81 | ||
| End-Tidal CO2 | 83 | ||
| Ultrasound Detection of Tracheal Tube Location | 84 | ||
| Comparison of Detector Devices | 84 | ||
| Complications of Intubation | 84 | ||
| Conclusion | 85 | ||
| Video and Optical Laryngoscopes | 85 | ||
| Video Laryngoscopes With Standard Macintosh Blades | 85 | ||
| Background | 85 | ||
| Indications | 86 | ||
| Contraindications | 87 | ||
| Procedure | 87 | ||
| Complications | 87 | ||
| Video Laryngoscopes With Angulated Blades | 87 | ||
| Background | 87 | ||
| Indications | 87 | ||
| Contraindications | 88 | ||
| Procedure and Technique | 88 | ||
| Complications | 88 | ||
| Summary | 90 | ||
| Video and Optical Laryngoscopes With a Tube Channel | 90 | ||
| Indications | 90 | ||
| Contraindications | 91 | ||
| Procedure | 91 | ||
| Aftercare | 91 | ||
| Complications | 91 | ||
| Intubating Laryngeal Mask Airways | 91 | ||
| Types of ILMAs | 92 | ||
| Indications | 92 | ||
| Contraindications | 93 | ||
| Intubation through the LMA Fastrach | 93 | ||
| Procedure and Technique for Blind Intubation | 93 | ||
| Using a Standard ET Tube | 93 | ||
| Flexible Endoscopic Intubation through ILMAs | 93 | ||
| ILMA Removal After Intubation | 95 | ||
| Intubation through the LMA Classic | 95 | ||
| Complications When Intubating through LMAs | 95 | ||
| Summary | 95 | ||
| Flexible Endoscopic Intubation | 95 | ||
| Indications and Contraindications | 96 | ||
| Procedure and Technique | 96 | ||
| Preparation | 96 | ||
| Nasal Approach | 98 | ||
| Oral Approach | 98 | ||
| Endoscope Technique | 100 | ||
| Complications | 100 | ||
| Summary | 100 | ||
| Optical and Video Intubating Stylets | 101 | ||
| Indications and Contraindications | 101 | ||
| Procedure and Technique | 101 | ||
| Summary | 101 | ||
| Orotracheal Intubation With a King Laryngeal Tube (LT) or Combitube in Place | 101 | ||
| Blind Nasotracheal (NT) Intubation | 102 | ||
| Indications and Contraindications | 102 | ||
| Procedure and Technique | 103 | ||
| Technical Difficulties | 103 | ||
| Anterior to the Epiglottis | 103 | ||
| Arytenoid Cartilage and Vocal Cord | 103 | ||
| Piriform Sinus | 104 | ||
| Esophageal Placement | 104 | ||
| Laryngospasm | 104 | ||
| Complications | 104 | ||
| Summary | 105 | ||
| Digital Intubation | 105 | ||
| Indications and Contraindications | 105 | ||
| Procedure and Technique | 105 | ||
| Complications | 106 | ||
| Summary | 106 | ||
| Retrograde Intubation | 106 | ||
| Indications and Contraindications | 106 | ||
| Equipment | 106 | ||
| Procedure and Technique | 106 | ||
| Complications | 108 | ||
| Summary | 108 | ||
| Changing Tracheal Tubes | 109 | ||
| Procedure and Technique | 110 | ||
| Preventing Unplanned Extubation | 110 | ||
| Conclusion | 110 | ||
| References | 110.e1 | ||
| 5 Pharmacologic Adjuncts to Intubation | 111 | ||
| Overview of RSI | 111 | ||
| Pretreatment: Preventing the Complications of Intubation | 113 | ||
| The Pressor Response | 113 | ||
| Hypotension | 114 | ||
| Intracranial Hypertension | 114 | ||
| Atropine for Prevention of Bradycardia | 115 | ||
| Bronchospasm | 115 | ||
| Induction Agents | 116 | ||
| Etomidate | 116 | ||
| Ketamine | 117 | ||
| Propofol | 119 | ||
| Benzodiazepines (Midazolam) | 119 | ||
| Opioids (Fentanyl) | 120 | ||
| Neuromuscular Blocking Agents | 120 | ||
| Succinylcholine | 121 | ||
| Nondepolarizing Agents | 122 | ||
| Long-Acting Agents: Pancuronium | 123 | ||
| Intermediate-Acting Agents: Vecuronium, Atracurium, Mivacurium, and Rocuronium | 123 | ||
| The “Sedated Look” Evaluation of the Airway Before RSI | 124 | ||
| Awake Intubation | 124 | ||
| Direct Application of Topical Anesthetics | 124 | ||
| Cricothyroid Membrane Puncture | 125 | ||
| Nebulized Anesthesia | 125 | ||
| Sedation for Awake Intubation | 125 | ||
| Delayed-Sequence Intubation | 125 | ||
| Conclusion | 125 | ||
| Acknowledgment | 126 | ||
| References | 126.e1 | ||
| 6 Cricothyrotomy and Percutaneous Translaryngeal Ventilation | 127 | ||
| Anatomy | 127 | ||
| Surgical Cricothyrotomy | 127 | ||
| Indications and Contraindications | 127 | ||
| Equipment | 130 | ||
| Procedure | 130 | ||
| Traditional Technique | 130 | ||
| Rapid Four-Step Technique (Brofeldt) | 133 | ||
| Melker Percutaneous Cricothyrotomy Technique | 134 | ||
| Complications | 134 | ||
| Success Rates | 136 | ||
| Percutaneous Translaryngeal Ventilation | 136 | ||
| Indications and Contraindications | 136 | ||
| Equipment | 137 | ||
| Procedure | 138 | ||
| Complications | 139 | ||
| Conclusion | 140 | ||
| References | 141 | ||
| References | 141.e1 | ||
| 7 Tracheostomy Care | 142 | ||
| Introduction | 142 | ||
| Background | 142 | ||
| Tracheal Anatomy and Physiology | 142 | ||
| Evaluation of Tracheostomy Patients | 142 | ||
| General Equipment for Tracheostomy Patients | 143 | ||
| Routine Tracheostomy Maintenance | 143 | ||
| Ventilating Tracheostomy Patients | 144 | ||
| Tracheal Suctioning | 144 | ||
| Indications | 145 | ||
| Equipment | 145 | ||
| Procedure and Technique | 146 | ||
| Complications of Suctioning | 147 | ||
| Minitracheostomy Suctioning Procedure | 147 | ||
| Changing a Tracheostomy Tube | 147 | ||
| Indications | 147 | ||
| Equipment | 148 | ||
| Sizing | 148 | ||
| Components | 149 | ||
| Procedure | 149 | ||
| Complications of Tracheostomy | 151 | ||
| Obstruction and Complications From Tube Changes | 151 | ||
| Preparation | 151 | ||
| Interventions | 151 | ||
| Dislodgement | 152 | ||
| Preparation | 152 | ||
| Interventions | 152 | ||
| False Passage | 153 | ||
| Equipment Failure | 153 | ||
| Fracture | 153 | ||
| Tracheal Cuff Complications | 153 | ||
| Infection | 153 | ||
| Tracheal Stenosis and Tracheomalacia | 153 | ||
| III Cardiac Procedures | 221 | ||
| 11 Techniques for Supraventricular Tachycardias | 221 | ||
| Introduction | 221 | ||
| Overview/Significance: Anatomy and Physiology of Supraventricular Tachycardia | 221 | ||
| Indications for Vagal Maneuvers | 225 | ||
| Equipment and Setup | 226 | ||
| CSM | 227 | ||
| Contraindications | 228 | ||
| Technique | 229 | ||
| Complications | 229 | ||
| Valsalva Maneuver | 230 | ||
| Contraindications | 230 | ||
| Technique | 230 | ||
| Apneic Facial Exposure to Cold (Diving Reflex, or Diving Bradycardia) | 231 | ||
| Technique | 231 | ||
| Selected Pharmacologic Agents (Fig. 11.10 and Box 11.4) | 231 | ||
| Adenosine | 232 | ||
| Indications and Contraindications | 232 | ||
| Dosage | 232 | ||
| Procainamide | 233 | ||
| IV Vascular Techniques and Volume Support | 353 | ||
| 19 Pediatric Vascular Access and Blood Sampling Techniques | 353 | ||
| Patient Preparation and Restraint | 353 | ||
| Anesthesia | 353 | ||
| Blood Sampling Techniques | 353 | ||
| Capillary Blood Sampling | 353 | ||
| Indications and Contraindications | 353 | ||
| V Anesthetic and Analgesic Techniques | 523 | ||
| 29 Local and Topical Anesthesia | 523 | ||
| Background | 523 | ||
| Pharmacology and Physiology | 523 | ||
| Chemical Structure and Physiochemical Properties | 523 | ||
| Nerve Structure and Impulse Transmission | 524 | ||
| Functional and Structural Components of a Peripheral Nerve | 524 | ||
| The Nerve Impulse and Transmission | 524 | ||
| Mechanism of Action | 525 | ||
| The Active Form | 525 | ||
| The Physiologic and Cellular Basis for Neuronal Blockade | 525 | ||
| Activity Profile During Neuronal Blockade | 525 | ||
| Onset of Action | 525 | ||
| Potency | 526 | ||
| Duration | 526 | ||
| Topical Anesthesia | 526 | ||
| Mucous Membranes | 526 | ||
| Agents and Uses | 526 | ||
| Technique and Precautions | 528 | ||
| Intact Skin | 529 | ||
| Agents and Uses | 529 | ||
| Lidocaine Cream and Patch | 529 | ||
| EMLA Cream, ELA-Max, and Tetracaine Base Patch | 529 | ||
| Ethyl Chloride and Trichloromonofluoromethane and Dichlorodifluoromethane (Fluori-Methane) Sprays | 530 | ||
| Technique | 530 | ||
| Lidocaine Cream | 530 | ||
| Tetracaine Base Patch and EMLA Cream | 530 | ||
| Ethyl Chloride and Fluori-Methane Sprays | 530 | ||
| Iontophoresis | 530 | ||
| Microneedle Pretreatment | 530 | ||
| Jet Injection | 530 | ||
| Complications | 530 | ||
| Lacerations | 531 | ||
| Background | 531 | ||
| Indications and Contraindications | 531 | ||
| Agents and Effectiveness | 532 | ||
| TAC and Related Mixtures | 532 | ||
| LET and Related Solutions | 532 | ||
| Technique and Dosage | 532 | ||
| Complications | 533 | ||
| Infiltration Anesthesia | 533 | ||
| Background | 533 | ||
| Indications and Contraindications | 533 | ||
| Choice of Agent | 534 | ||
| Equipment | 534 | ||
| Technique | 535 | ||
| Buffering | 535 | ||
| Temperature Manipulation | 535 | ||
| Injection | 535 | ||
| Special Considerations | 536 | ||
| Hematoma Block | 536 | ||
| Intraarticular Anesthesia and Analgesia | 537 | ||
| Intrapleural Anesthesia | 537 | ||
| Indications | 537 | ||
| Technique | 537 | ||
| Complications | 537 | ||
| Local Anesthetic Effect on Wounds | 537 | ||
| Wound Healing | 537 | ||
| Wound Infection | 538 | ||
| Local Injuries | 538 | ||
| Use of Epinephrine With Local Anesthetics | 538 | ||
| Systemic Toxic Reactions | 538 | ||
| High Blood Levels | 539 | ||
| Site and Mode of Administration | 539 | ||
| Rate of Administration | 539 | ||
| Dose and Concentration | 539 | ||
| Addition of Epinephrine | 539 | ||
| Specific Drugs | 539 | ||
| Clearance | 540 | ||
| Maximum Safe Dosage | 540 | ||
| Inadvertent Intravascular Injection | 540 | ||
| Host Factors | 541 | ||
| Hypoxia | 541 | ||
| Acid-Base Status | 541 | ||
| Protein Binding | 541 | ||
| Concomitant Drugs. | 541 | ||
| Recognition of CNS Toxicity | 541 | ||
| Recognition of Cardiovascular Toxicity | 541 | ||
| Prevention of Toxicity | 541 | ||
| Treatment of Systemic Toxicity | 541 | ||
| Intravenous Lipid Emulsion | 542 | ||
| Allergic Reactions | 542 | ||
| Allergenic Agents | 542 | ||
| Diphenhydramine and Benzyl Alcohol | 543 | ||
| Skin Testing | 543 | ||
| Summary of Anesthetic “Allergy” Management | 543 | ||
| Catecholamine Reactions | 543 | ||
| Vasovagal Reactions | 543 | ||
| Summary | 544 | ||
| References | 544.e1 | ||
| 30 Regional Anesthesia of the Head and Neck | 545 | ||
| Anatomy of the Trigeminal Nerve (Cranial Nerve V) | 545 | ||
| Equipment for Facial Nerve Blocks | 545 | ||
| General Recommendations | 546 | ||
| Supraperiosteal Injection | 546 | ||
| VI Soft Tissue Procedures | 621 | ||
| 34 Principles of Wound Management | 621 | ||
| Background: Wound Healing | 621 | ||
| Initial Evaluation | 623 | ||
| History | 623 | ||
| Wound Age | 623 | ||
| Other Historical Factors | 623 | ||
| Physical Examination | 623 | ||
| Mechanism of Injury and Classification of Wounds | 624 | ||
| Contaminants (Bacteria and Foreign Material) | 624 | ||
| Devitalized Tissue | 624 | ||
| Wound Location | 624 | ||
| Underlying Structures | 624 | ||
| Cleaning | 625 | ||
| Patient Preparation | 625 | ||
| Mechanical Scrubbing | 625 | ||
| Antiseptics During Cleaning | 627 | ||
| Irrigation | 628 | ||
| Antibiotic Solutions for Irrigation | 628 | ||
| Recommendations for Cleaning the Wound | 628 | ||
| Preparation for Wound Closure | 628 | ||
| Débridement | 630 | ||
| Excision | 630 | ||
| Selective Débridement | 630 | ||
| Control of Hemorrhage | 631 | ||
| Tourniquets | 632 | ||
| Closure | 634 | ||
| Open Versus Closed Wound Management | 634 | ||
| Delayed Primary or Secondary Closure | 636 | ||
| Protection | 637 | ||
| Dressings | 637 | ||
| Function of Dressings | 637 | ||
| Contact Layer: Dry, Semiocclusive, and Occlusive Dressings | 639 | ||
| Absorbent Layer | 642 | ||
| Outer Layer | 642 | ||
| Splinting and Elevation | 642 | ||
| Ointments | 643 | ||
| Wound Cultures | 643 | ||
| Systemic Antibiotics | 644 | ||
| Tetanus Immunoprophylaxis | 644 | ||
| Patient Instructions | 645 | ||
| Secondary Wound Care | 646 | ||
| Reexamination | 646 | ||
| Suture Removal | 646 | ||
| Complications | 648 | ||
| Miscellaneous Aspects of Wound Care | 648 | ||
| The ED Approach to Puncture Wounds | 648 | ||
| Gunshot Wounds | 648 | ||
| Animal Bites | 648 | ||
| Human Bites | 650 | ||
| Serious Wound Infections | 653 | ||
| Digital Nerves | 653 | ||
| Accidental Soft Tissue Injection With an EpiPen | 653 | ||
| References | 654.e1 | ||
| 35 Methods of Wound Closure | 655 | ||
| Wound Tape | 655 | ||
| Background and Tape Comparisons | 655 | ||
| Indications | 655 | ||
| Contraindications | 655 | ||
| Equipment | 656 | ||
| Procedure | 657 | ||
| Complications | 657 | ||
| Summary | 657 | ||
| Tissue Adhesive (Tissue Glue) | 657 | ||
| Procedure | 659 | ||
| Complications | 660 | ||
| Wound Staples | 661 | ||
| Background | 661 | ||
| Indications and Contraindications | 661 | ||
| Equipment | 661 | ||
| Procedure | 661 | ||
| Complications | 663 | ||
| Sutures | 664 | ||
| Equipment | 664 | ||
| Instruments | 664 | ||
| Suture Material | 664 | ||
| Composition | 664 | ||
| Handling and Performance | 664 | ||
| Absorption and Reactivity | 666 | ||
| Size and Strength | 666 | ||
| Needles | 667 | ||
| Suturing Techniques (Figs. 35.17 and 35.18) | 667 | ||
| Skin Preparation | 667 | ||
| Closure Principles | 667 | ||
| Minimizing Tissue Trauma | 670 | ||
| Relieving Tension | 670 | ||
| Undermining. | 670 | ||
| Layered Closure. | 670 | ||
| Suture Placement | 671 | ||
| SQ Layer Closure | 671 | ||
| Surface Closure | 673 | ||
| Complications | 673 | ||
| Eversion Techniques | 675 | ||
| Interrupted Stitch | 675 | ||
| Continuous Stitch | 675 | ||
| Continuous Subcuticular Stitch | 676 | ||
| Mattress Stitch | 679 | ||
| Figure-of-Eight Stitch | 683 | ||
| Correction of Dog-Ears | 683 | ||
| Stellate Lacerations | 683 | ||
| Repair of Special Structures | 685 | ||
| Facial Wounds (General Features) | 685 | ||
| Forehead | 686 | ||
| Eyebrow and Eyelid Lacerations | 689 | ||
| Ear Lacerations | 689 | ||
| Nose Lacerations | 689 | ||
| Lip and Intraoral Lacerations | 690 | ||
| Tongue Lacerations | 693 | ||
| Scalp Lacerations | 694 | ||
| Nail Bed Lacerations | 697 | ||
| Subungual Hematomas | 697 | ||
| Partial Nail Avulsions | 697 | ||
| Nail Bed Repair | 698 | ||
| Complete Nail Avulsions | 700 | ||
| Complicated Nail Bed Injuries | 701 | ||
| Removal of a Nail | 702 | ||
| Tuft Fractures | 702 | ||
| Drains in Sutured Wounds | 702 | ||
| Lacerations Over Joints | 702 | ||
| Fingertip Amputations | 702 | ||
| Distally and Proximally Based Flap Lacerations | 706 | ||
| References | 707.e1 | ||
| 36 Foreign Body Removal | 708 | ||
| Evaluation and Diagnosis | 708 | ||
| Augmenting the Physical Examination: Imaging Techniques | 708 | ||
| Plain Radiography | 708 | ||
| US | 709 | ||
| CT | 711 | ||
| MRI | 712 | ||
| Fluoroscopy | 714 | ||
| FB Removal | 715 | ||
| Removal Decisions | 715 | ||
| Equipment and Preparation | 716 | ||
| Operative Technique | 716 | ||
| Special Scenarios and Techniques | 717 | ||
| Puncture Wounds in the Sole of the Foot | 717 | ||
| Subungual FBs | 718 | ||
| Metallic Fragments and Bullets | 719 | ||
| FBs in Fatty Tissue | 719 | ||
| Pencil Lead/Graphite | 720 | ||
| Fishhooks | 720 | ||
| Advance and Cut Technique | 720 | ||
| String-Yank Technique | 720 | ||
| Needle Cover Technique | 720 | ||
| Retrograde Technique | 721 | ||
| Wooden Splinters | 721 | ||
| Traumatic Tattooing | 722 | ||
| Marine FBs | 723 | ||
| Coelenterates | 724 | ||
| Coral | 724 | ||
| Sponges | 724 | ||
| Sea Urchins and Starfish | 725 | ||
| Catfish | 725 | ||
| Stingrays | 726 | ||
| Tetanus and Antibiotic Therapy | 726 | ||
| Cactus Spines | 726 | ||
| Ring Removal | 727 | ||
| String-Wrap Method | 727 | ||
| Ring Cutter | 727 | ||
| Body Piercing and Removal | 728 | ||
| Postoperative Suture Removal | 730 | ||
| Tick Removal | 730 | ||
| Zipper Entrapment | 731 | ||
| Infiltration of Radiographic Contrast Material | 732 | ||
| TASER Darts | 732 | ||
| Human and Animal Bite FBs | 733 | ||
| Pyogenic Granuloma (Lobar Capillary Hemangioma) | 733 | ||
| Hair-Thread Tourniquet | 734 | ||
| Disposition Management | 734 | ||
| Tetanus | 734 | ||
| Antibiotics | 734 | ||
| FB Reactions | 735 | ||
| Discharge Instructions | 737 | ||
| Acknowledgment | 737 | ||
| References | 737.e1 | ||
| 37 Incision and Drainage | 738 | ||
| Abscess Etiology and Pathogenesis | 738 | ||
| Bacteriology of Cutaneous Abscesses | 738 | ||
| Special Considerations | 739 | ||
| MRSA | 740 | ||
| Manifestations of Cutaneous Abscesses | 742 | ||
| Imaging | 743 | ||
| Ultrasound-Guided Needle Aspiration | 743 | ||
| Laboratory Findings | 743 | ||
| Indications for and Contraindications to I&D | 745 | ||
| Prophylactic and Therapeutic Antibiotic Therapy | 745 | ||
| Therapeutic Antibiotics | 746 | ||
| Prophylactic Antibiotics | 746 | ||
| Prophylaxis for Endocarditis | 746 | ||
| Prophylaxis for Bacteremia in Other Conditions | 747 | ||
| Recurrent Infections | 747 | ||
| I&D Procedure | 748 | ||
| Procedure Setting | 748 | ||
| Equipment and Anesthesia | 748 | ||
| Incision | 749 | ||
| Wound Dissection | 751 | ||
| Wound Irrigation | 751 | ||
| Packing and Dressing | 751 | ||
| Follow-Up Examination | 753 | ||
| Specific Abscess Therapy | 754 | ||
| Folliculitis, Furuncles, and Carbuncles | 754 | ||
| Hidradenitis Suppurativa | 756 | ||
| Breast Abscess | 758 | ||
| Pilonidal Abscess | 758 | ||
| Perirectal Abscesses | 760 | ||
| Pathophysiology | 760 | ||
| Physical and Laboratory Findings | 761 | ||
| Treatment | 762 | ||
| Infected Sebaceous Cyst | 762 | ||
| Paronychia | 763 | ||
| Herpetic Whitlow | 767 | ||
| Felon | 767 | ||
| Subungual Hematoma | 770 | ||
| Methods of Trephination | 770 | ||
| Outcome | 772 | ||
| Conditions With a Similar Appearance | 772 | ||
| Acknowledgments | 773 | ||
| References | 773.e1 | ||
| 38 Burn Care Procedures | 774 | ||
| Wound Evaluation | 774 | ||
| Estimating Burn Depth | 774 | ||
| Estimating Burn Size | 777 | ||
| Histopathology of Burns | 778 | ||
| Outpatient Versus Inpatient Care | 779 | ||
| Procedure | 780 | ||
| Emergency Treatment | 780 | ||
| Initial Care of Major Burns | 781 | ||
| Initial Care of Minor Burns | 782 | ||
| Outpatient Care of Minor Burns | 783 | ||
| Open Burn Care | 783 | ||
| Burn Dressings | 783 | ||
| Biologic Dressings | 783 | ||
| Synthetic Dressings | 783 | ||
| Specific Clinical Issues in Minor Burn Care | 784 | ||
| Analgesia | 784 | ||
| Pruritus | 785 | ||
| Edema | 786 | ||
| Use of Topical Preparations and Antimicrobials | 786 | ||
| Specific Topical Agents | 786 | ||
| Silver Sulfadiazine (Silvadene, Pfizer). | 786 | ||
| Other Topical Preparations. | 787 | ||
| broad-spectrum antibiotic ointments. | 787 | ||
| aloe vera cream. | 787 | ||
| honey. | 787 | ||
| corticosteroids. | 787 | ||
| Follow-Up Care of Minor Burns | 787 | ||
| Outpatient Physical Therapy for Burn Care | 788 | ||
| Burn Wound Healing | 788 | ||
| Special Minor Burn Care Circumstances | 789 | ||
| Blisters | 789 | ||
| Minor Burn Infections | 789 | ||
| Foot Burns | 790 | ||
| Hand Burns | 790 | ||
| Facial Burns | 791 | ||
| Abuse of Children and Elderly Individuals | 792 | ||
| Burns in Pregnancy | 794 | ||
| Specific Burning Agents | 794 | ||
| Hot Tar Burns | 794 | ||
| Chemical Burns | 795 | ||
| Acid and Alkali Burns | 795 | ||
| Contact Burns From Wet Cement | 796 | ||
| Air Bag Keratitis and Thermal Burns | 796 | ||
| Hydrocarbon Burns | 797 | ||
| Phenol Injury | 797 | ||
| Hydrofluoric Acid Injury | 797 | ||
| Chromic Acid Injury | 800 | ||
| Phosphorus Burns | 800 | ||
| Elemental Alkali Metal Burns | 800 | ||
| Electrical Burns | 800 | ||
| TEN and SJS | 800 | ||
| Clinical Features | 801 | ||
| Management | 802 | ||
| Frostbite | 803 | ||
| Radiation Burns | 803 | ||
| Emergency Escharotomy | 803 | ||
| Indications | 804 | ||
| Technique of Escharotomy | 804 | ||
| Limbs | 804 | ||
| Chest | 805 | ||
| Neck | 805 | ||
| Penis | 805 | ||
| Complications | 805 | ||
| Conclusion | 805 | ||
| Acknowledgments | 805 | ||
| References | 805.e1 | ||
| VII Gastrointestinal Procedures | 807 | ||
| 39 Esophageal Foreign Bodies | 807 | ||
| General Features | 807 | ||
| Anatomy | 807 | ||
| Epidemiology | 807 | ||
| Complications | 807 | ||
| Clinical Findings | 808 | ||
| Evaluation | 808 | ||
| Radiology of Esophageal Foreign Bodies | 809 | ||
| Background | 809 | ||
| Indications | 809 | ||
| Plain Radiographs | 809 | ||
| Computed Tomography | 810 | ||
| Contrast-Enhanced Esophagograms | 810 | ||
| Background | 810 | ||
| Procedure | 811 | ||
| Follow-up Radiographs | 812 | ||
| Conclusions | 812 | ||
| Visualization of Esophageal and Pharyngeal Fbs | 813 | ||
| Esophagoscopy | 813 | ||
| Esophageal Pharmacologic Maneuvers | 813 | ||
| Background | 813 | ||
| Indications and Contraindications | 813 | ||
| Glucagon | 814 | ||
| Pharmacology | 814 | ||
| Indications and Contraindications | 814 | ||
| Administration of Glucagon | 814 | ||
| Complications | 814 | ||
| VIII Musculoskeletal Procedures | 917 | ||
| 46 Prehospital Immobilization | 917 | ||
| Spinal Motion Restriction | 917 | ||
| Background | 917 | ||
| Epidemiology | 917 | ||
| Pathophysiology | 918 | ||
| Indications | 919 | ||
| Contraindications | 920 | ||
| Equipment | 921 | ||
| C-Collars | 921 | ||
| Cervical Extrication Splints | 921 | ||
| Full-Body Spinal Restriction | 922 | ||
| Long Spine Boards (Backboards) | 922 | ||
| Scoop Stretchers | 922 | ||
| Full-Body Splints | 923 | ||
| Lateral Neck Stabilizers | 924 | ||
| Foam Padding | 924 | ||
| Procedure | 924 | ||
| Cervical Spinal Motion Restriction | 924 | ||
| Thoracolumbar Spinal Motion Restriction | 926 | ||
| Sitting Position | 926 | ||
| Recumbent Position | 926 | ||
| Scoop Stretcher. | 926 | ||
| Full-Body Spine Boards (Backboards). | 927 | ||
| Standing Position | 929 | ||
| Pediatric Patients | 929 | ||
| Complication | 930 | ||
| Cervical Immobilization | 930 | ||
| Thoracolumbar Immobilization | 930 | ||
| Conclusion | 930 | ||
| Extremity Immobilization | 930 | ||
| Upper Extremity | 930 | ||
| Background | 930 | ||
| Indications and Contraindications | 931 | ||
| Equipment | 931 | ||
| Rigid Splints | 931 | ||
| Soft Splints | 931 | ||
| Procedures | 933 | ||
| Rigid Splints | 933 | ||
| Soft Splints | 933 | ||
| Complications | 934 | ||
| Conclusion | 934 | ||
| Lower Extremity | 934 | ||
| Background | 934 | ||
| Indications | 936 | ||
| Contraindications | 936 | ||
| Equipment | 936 | ||
| Procedure | 936 | ||
| Special Considerations | 939 | ||
| Complications | 939 | ||
| Conclusion | 939 | ||
| Pelvic Immobilization | 939 | ||
| Background | 939 | ||
| Indications and Contraindications | 939 | ||
| Procedure | 939 | ||
| Complications | 940 | ||
| Conclusion | 940 | ||
| Removal of Helmets and Protective Equipment | 940 | ||
| Background | 940 | ||
| Indications | 942 | ||
| Contraindications | 943 | ||
| Procedure | 943 | ||
| Sport Helmet Removal | 943 | ||
| Motorcycle Helmet Removal | 946 | ||
| Complications | 946 | ||
| Conclusion | 946 | ||
| References | 946.e1 | ||
| 47 Management of Amputations | 947 | ||
| Background | 947 | ||
| Indications | 948 | ||
| Contraindications | 948 | ||
| General Considerations | 948 | ||
| Mechanism of Injury | 948 | ||
| Ischemia Time | 949 | ||
| Patient Assessment and Management | 949 | ||
| Care of the Stump and Amputated Part | 949 | ||
| Stump | 949 | ||
| Amputated Part | 951 | ||
| Special Considerations | 951 | ||
| Lower Extremity Amputations | 951 | ||
| Hand Function | 951 | ||
| Fingertip Amputations and Dermal Slice Wounds | 953 | ||
| Partial Fingertip Amputations | 954 | ||
| Penis, Ear, and Nose Amputations | 954 | ||
| Complications | 955 | ||
| Field Amputations | 955 | ||
| Acknowledgment | 955 | ||
| References | 955.e1 | ||
| 48 Extensor and Flexor Tendon Injuries in the Hand, Wrist, and Foot | 956 | ||
| Extensor Tendons | 956 | ||
| Functional Anatomy | 956 | ||
| General Approach to Extensor Tendon Injuries | 958 | ||
| Use of Antibiotics | 962 | ||
| Preparation for Repair | 962 | ||
| Patterns of Injury and Management | 962 | ||
| Zone 7 and 8 Injuries | 963 | ||
| Zone 6 Injuries | 963 | ||
| Zone 5 Injuries | 965 | ||
| Zone 4 Injuries | 966 | ||
| Zone 3 Injuries | 967 | ||
| Zone 1 and 2 Injuries | 968 | ||
| Complications | 970 | ||
| Postrepair Care and Rehabilitation | 971 | ||
| Extensor Tendon Injuries of the Foot | 972 | ||
| Flexor Tendon Injuries | 973 | ||
| Achilles Tendon Rupture | 975 | ||
| Knee Extensor Tendon Rupture | 978 | ||
| References | 979.e1 | ||
| 49 Management of Common Dislocations | 980 | ||
| Preparation of the Patient | 980 | ||
| General Principles | 980 | ||
| Timing of Reduction | 982 | ||
| Shoulder Dislocations | 983 | ||
| Anterior Shoulder Dislocations | 983 | ||
| Clinical Assessment | 983 | ||
| Radiologic Examination | 984 | ||
| Reduction Techniques | 986 | ||
| Stimson Maneuver (Fig. 49.12A) | 988 | ||
| Scapular Manipulation Technique (See Fig. 49.12B) | 989 | ||
| Best of Both (BOB) Technique (See Fig. 49.12C) | 990 | ||
| External Rotation Method (See Fig. 49.12D) | 990 | ||
| Milch Technique (See Fig. 49.12E) | 990 | ||
| Traction-Countertraction (See Fig. 49.12F) | 990 | ||
| Spaso Technique (See Fig. 49.12G) | 993 | ||
| Other Methods | 993 | ||
| Post-reduction Care | 993 | ||
| Posterior Shoulder Dislocations | 994 | ||
| Clinical Assessment | 994 | ||
| Radiologic Examination | 994 | ||
| Reduction Technique (Fig. 49.18A) | 996 | ||
| Post-reduction Care | 997 | ||
| Unusual Shoulder Dislocations | 997 | ||
| Luxatio Erecta | 997 | ||
| AC Joint Subluxation and Dislocation | 997 | ||
| First Degree (Type I) | 997 | ||
| Second Degree (Type II) | 998 | ||
| Third Degree (Type III) | 998 | ||
| Fourth, Fifth, and Sixth Degrees (Types IV to VI) | 998 | ||
| Radiographic Examination | 998 | ||
| Sternoclavicular Dislocations | 999 | ||
| Elbow Dislocations | 999 | ||
| Posterior Dislocations | 1000 | ||
| Radiologic Examination | 1000 | ||
| Reduction Techniques and Post-Reduction Care | 1000 | ||
| Recommended Initial Approach | 1000 | ||
| Traditional Traction Method | 1001 | ||
| Alternatives | 1001 | ||
| Post-Reduction Care | 1002 | ||
| Anterior Dislocations | 1002 | ||
| Radial Head Subluxation (Nursemaid’s Elbow) | 1002 | ||
| Clinical Assessment | 1002 | ||
| Radiographic Examination | 1003 | ||
| Reduction Techniques | 1004 | ||
| Supination Method | 1004 | ||
| Pronation Method | 1004 | ||
| After Attempted Reduction | 1004 | ||
| Hand Injuries | 1005 | ||
| Thumb Dislocations | 1006 | ||
| Interphalangeal Joint Dislocation of the Thumb | 1006 | ||
| Metacarpophalangeal Joint Injury of the Thumb | 1006 | ||
| Dorsal Dislocation | 1006 | ||
| Volar Dislocation | 1007 | ||
| Ulnar Collateral Ligament Rupture | 1007 | ||
| Carpometacarpal (CMC) Dislocations of the Thumb | 1008 | ||
| Finger Dislocations | 1008 | ||
| Proximal Interphalangeal (PIP) Joint Dislocations | 1009 | ||
| Dorsal PIP Dislocations | 1009 | ||
| Volar PIP Dislocations | 1010 | ||
| Lateral PIP Dislocations | 1010 | ||
| Distal Interphalangeal (DIP) Dislocations | 1010 | ||
| MCP Dislocations | 1010 | ||
| CMC Dislocations | 1011 | ||
| Carpal Dislocation/Dissociation | 1011 | ||
| Hip Dislocations | 1012 | ||
| Radiographic Examination | 1013 | ||
| Analgesia and Anesthesia | 1013 | ||
| Posterior Hip Dislocation | 1014 | ||
| Reduction Techniques | 1014 | ||
| Stimson Technique (Fig. 49.51A) | 1014 | ||
| Allis Technique (See Fig. 49.51B) | 1014 | ||
| Whistler Technique (See Fig. 49.51C) | 1014 | ||
| Captain Morgan Technique (See Fig. 49.51D) | 1014 | ||
| Dislocations of Hip Prostheses | 1014 | ||
| Anterior Hip Dislocation | 1015 | ||
| Reduction Techniques (Fig. 49.55) | 1016 | ||
| Knee (Femur, Tibia) Dislocations | 1016 | ||
| Clinical Assessment | 1018 | ||
| Vascular Injury | 1018 | ||
| Reduction Technique (Fig. 49.60) | 1019 | ||
| Post-reduction Care | 1020 | ||
| Dislocations of the Fibular Head | 1020 | ||
| Reduction Technique | 1020 | ||
| Patellar Dislocation | 1020 | ||
| Clinical Assessment | 1021 | ||
| Radiographs | 1021 | ||
| Reduction Technique and Post-Reduction Care | 1021 | ||
| Ankle Dislocations | 1021 | ||
| Radiographic Examination | 1022 | ||
| Reduction Techniques (Fig. 49.67) | 1023 | ||
| Post-reduction Care | 1023 | ||
| Dislocations of the Foot | 1023 | ||
| Hindfoot Injuries | 1023 | ||
| Subtalar Dislocation | 1023 | ||
| Dislocation of the Talus | 1024 | ||
| Forefoot Dislocations | 1024 | ||
| Metatarsophalangeal (MTP) Dislocations | 1024 | ||
| Interphalangeal Dislocations | 1025 | ||
| Conclusion | 1026 | ||
| References | 1026.e1 | ||
| 50 Splinting Techniques | 1027 | ||
| Indications and Contraindications | 1028 | ||
| Equipment (See Review Box 50.1) | 1029 | ||
| Support Materials | 1029 | ||
| Plaster of Paris | 1029 | ||
| Prefabricated Splint Rolls | 1029 | ||
| Woodcast Composite Splinting Material | 1029 | ||
| Protective and Miscellaneous Equipment | 1029 | ||
| Stockinette | 1029 | ||
| Padding | 1029 | ||
| Elastic Bandages | 1030 | ||
| Adhesive Tape | 1030 | ||
| Utility Knife, Scalpel, and Plaster or Trauma Scissors | 1030 | ||
| Bucket | 1030 | ||
| Protective Gear | 1030 | ||
| General Procedure of Custom Splint Application | 1030 | ||
| Patient Preparation | 1034 | ||
| Padding | 1034 | ||
| Plaster Preparation | 1035 | ||
| Splint Application (see Fig. 50.5) | 1035 | ||
| Patient Instructions | 1036 | ||
| Upper Extremity Splints | 1036 | ||
| Long Arm Splints | 1036 | ||
| Long Arm Posterior Splint | 1036 | ||
| Indications. | 1036 | ||
| Construction. | 1037 | ||
| Application. | 1037 | ||
| Long Arm Anterior Splint | 1037 | ||
| Indications. | 1037 | ||
| IX Genitourinary, Obstetric, and Gynecologic Procedures | 1141 | ||
| 55 Urologic Procedures | 1141 | ||
| X Neurologic Procedures | 1243 | ||
| 59 Management of Increased Intracranial Pressure and Intracranial Shunts | 1243 | ||
| Pathophysiology of ICP | 1243 | ||
| Brain | 1243 | ||
| CSF | 1244 | ||
| Blood | 1245 | ||
| Signs and Symptoms | 1245 | ||
| Medical Treatment of Increased ICP | 1246 | ||
| Oxygenation | 1246 | ||
| Sedation and Paralytics | 1246 | ||
| Oxygenation and Hyperventilation | 1247 | ||
| Head Position | 1247 | ||
| Fluid Management | 1247 | ||
| Hyperosmolar Therapy | 1247 | ||
| Seizure Prophylaxis | 1247 | ||
| Steroids | 1248 | ||
| Glucose Control | 1248 | ||
| Hypothermia | 1248 | ||
| Skull Trephination | 1248 | ||
| Operative Management | 1251 | ||
| Intracranial Shunts | 1251 | ||
| Shunt Failure | 1253 | ||
| Mechanical Obstruction | 1253 | ||
| Excessive CSF Drainage | 1253 | ||
| Shunt Infection: Treatment and Prevention | 1253 | ||
| Clinical Presentation | 1253 | ||
| Shunt Assessment | 1253 | ||
| Shunt Tapping | 1255 | ||
| Future Directions | 1257 | ||
| Acknowledgments | 1257 | ||
| References | 1257.e1 | ||
| 60 Spinal Puncture and Cerebrospinal Fluid Examination | 1258 | ||
| Historical Perspective | 1258 | ||
| Anatomy and Physiology | 1258 | ||
| Indications for Spinal Puncture | 1259 | ||
| General Indications | 1259 | ||
| Idiopathic Intracranial Hypertension (Pseudotumor Cerebri) | 1259 | ||
| Contraindications to Spinal Puncture | 1260 | ||
| Equipment | 1261 | ||
| Procedure | 1261 | ||
| Lateral Approach for Lumbar Puncture | 1266 | ||
| Lumbar Puncture in Infants | 1266 | ||
| The Difficult Lumbar Puncture | 1267 | ||
| Complications | 1268 | ||
| Headache After Lumbar Puncture | 1268 | ||
| Infection | 1270 | ||
| Herniation Syndromes After Lumbar Puncture | 1270 | ||
| Epidermoid Tumor | 1271 | ||
| Backache and Radicular Symptoms | 1271 | ||
| Spinal Epidural Hemorrhage | 1272 | ||
| Interpretation | 1272 | ||
| Pressure | 1272 | ||
| Appearance | 1272 | ||
| Cells | 1273 | ||
| Glucose | 1273 | ||
| Protein | 1274 | ||
| The Traumatic Tap | 1274 | ||
| Absolute Number of RBCs | 1274 | ||
| RBC Clearance From First to Last Tubes | 1274 | ||
| Xanthochromia | 1274 | ||
| CSF Analysis With Infections | 1275 | ||
| Bacterial Infections | 1275 | ||
| Microbial Antigens and PCR | 1275 | ||
| Empirical Antibiotic Use Before Lumbar Puncture | 1276 | ||
| Dexamethasone Therapy for Bacterial Meningitis | 1276 | ||
| Neurosyphilis | 1278 | ||
| Viral Meningitis | 1278 | ||
| CSF Analysis in Immunocompromised Patients | 1279 | ||
| Neurosyphilis in Patients Infected With HIV | 1279 | ||
| Cryptococcal Meningitis | 1279 | ||
| Toxoplasmosis | 1279 | ||
| Mycobacterial Tuberculosis | 1280 | ||
| Primary CNS Lymphoma | 1280 | ||
| Progressive Multifocal Leukoencephalopathy | 1280 | ||
| Cytomegalovirus Infection | 1280 | ||
| Acknowledgments | 1280 | ||
| References | 1280.e1 | ||
| 61 Special Neurologic Tests and Procedures | 1281 | ||
| Evaluation of the Comatose Patient | 1281 | ||
| Caloric Testing | 1281 | ||
| Background | 1281 | ||
| Physiology and Functional Anatomy | 1281 | ||
| Indications and Contraindications | 1281 | ||
| Equipment | 1281 | ||
| Procedure | 1281 | ||
| Complications | 1281 | ||
| Interpretation | 1282 | ||
| Summary | 1284 | ||
| Brain Death Testing | 1284 | ||
| Background | 1284 | ||
| Indications and Contraindications | 1284 | ||
| Procedure | 1284 | ||
| Coma Assessment | 1284 | ||
| Brain Stem Reflex Testing | 1284 | ||
| Pupillary Response. | 1284 | ||
| Auditory Reflex. | 1284 | ||
| Oculocephalic Reflex. | 1285 | ||
| Caloric Testing. | 1285 | ||
| Corneal Reflex. | 1285 | ||
| Cough Reflex. | 1285 | ||
| Apneic Oxygenation Test. | 1285 | ||
| Declaration of Death | 1285 | ||
| Complications | 1285 | ||
| Summary | 1285 | ||
| Procedures to Evaluate and Treat Vertigo | 1285 | ||
| Dix-Hallpike Test | 1285 | ||
| Background | 1285 | ||
| Indications and Contraindications | 1285 | ||
| Procedure | 1286 | ||
| Interpretation | 1286 | ||
| Complications | 1286 | ||
| Summary | 1286 | ||
| Canalith-Repositioning Maneuvers | 1286 | ||
| Background | 1286 | ||
| Indications and Contraindications | 1286 | ||
| Procedure | 1287 | ||
| Epley Maneuver | 1287 | ||
| Semont Maneuver | 1287 | ||
| Complications | 1288 | ||
| Summary | 1288 | ||
| HINTS Examination | 1288 | ||
| Background | 1288 | ||
| Indications and Contraindications | 1288 | ||
| Procedure | 1288 | ||
| Horizontal Head Impulse Test (Video 61.3) | 1288 | ||
| Test of Nystagmus | 1289 | ||
| Test of Skew | 1289 | ||
| Interpretation | 1289 | ||
| Horizontal Head Impulse Test | 1289 | ||
| Test of Nystagmus | 1290 | ||
| Test of Skew | 1290 | ||
| HINTS Exam | 1290 | ||
| Complications | 1290 | ||
| Summary | 1290 | ||
| Evaluation of Weakness | 1290 | ||
| Background | 1290 | ||
| Edrophonium (Tensilon) Test | 1291 | ||
| Background | 1291 | ||
| Indications and Contraindications | 1291 | ||
| Equipment | 1291 | ||
| Procedure (Video 61.4) | 1291 | ||
| Complications | 1292 | ||
| Interpretation | 1292 | ||
| Ice-Pack Test | 1292 | ||
| Background | 1292 | ||
| Indications | 1292 | ||
| Procedure | 1292 | ||
| Complications | 1293 | ||
| Interpretation | 1293 | ||
| Summary | 1293 | ||
| Acknowledgments | 1293 | ||
| References | 1293.e1 | ||
| XI Ophthalmologic, Otolaryngologic, and Dental Procedures | 1295 | ||
| 62 Ophthalmologic Procedures | 1295 | ||
| Assessment of Visual Acuity | 1295 | ||
| Indications | 1295 | ||
| Distant Visual Acuity Procedure | 1295 | ||
| Near Visual Acuity Procedure | 1295 | ||
| Use of Ophthalmic Anesthetic and Analgesic Agents | 1296 | ||
| Indications and Contraindications | 1296 | ||
| Procedure | 1296 | ||
| Complications | 1298 | ||
| Dilating the Eye | 1298 | ||
| Indications and Contraindications | 1299 | ||
| Agents | 1299 | ||
| Procedure | 1301 | ||
| Complications | 1301 | ||
| The Fluorescein Examination | 1302 | ||
| Indications and Contraindications | 1303 | ||
| Procedure | 1303 | ||
| Interpretation | 1303 | ||
| Summary | 1304 | ||
| Eye Irrigation | 1305 | ||
| Indications and Contraindications | 1305 | ||
| Equipment | 1305 | ||
| Procedure | 1305 | ||
| Basic Technique | 1305 | ||
| Duration of Irrigation | 1306 | ||
| Prolonged Irrigation | 1307 | ||
| Complications | 1308 | ||
| Summary | 1308 | ||
| Globe Protection and Evaluation | 1309 | ||
| Bedside ED Ocular Ultrasound | 1310 | ||
| Indications and Contraindications | 1310 | ||
| Equipment | 1310 | ||
| Procedure | 1310 | ||
| Complications | 1311 | ||
| Findings | 1311 | ||
| Summary | 1312 | ||
| Ocular FB Removal | 1312 | ||
| Indications and Contraindications | 1312 | ||
| Equipment | 1312 | ||
| Consideration of an Intraocular FB | 1312 | ||
| Procedure | 1313 | ||
| FB Location | 1313 | ||
| FB Removal | 1313 | ||
| Rust Rings | 1316 | ||
| Multiple FBs | 1316 | ||
| Aftercare | 1316 | ||
| Complications | 1316 | ||
| Summary | 1316 | ||
| Eye Patching | 1316 | ||
| Contact Lens Procedures | 1317 | ||
| Corneal Injury From Contact Lens Wear | 1317 | ||
| Hard Contact Lenses | 1317 | ||
| Soft Contact Lenses | 1317 | ||
| Indications for Removal | 1318 | ||
| Contraindication to Removal | 1318 | ||
| Procedure | 1318 | ||
| Hard Contact Lens Removal | 1318 | ||
| Soft Contact Lens Removal | 1319 | ||
| Lens Storage | 1319 | ||
| Evaluation of a “Lost” Contact Lens | 1319 | ||
| Complications of Lens Removal | 1319 | ||
| Summary | 1319 | ||
| Bandage Contact Lenses for Treatment of Corneal Abrasions | 1319 | ||
| Indications and Contraindications | 1321 | ||
| Equipment | 1321 | ||
| Procedure | 1321 | ||
| Complications | 1321 | ||
| Summary | 1321 | ||
| Infectious Keratitis | 1321 | ||
| Tonometry | 1322 | ||
| Tonometric Techniques | 1322 | ||
| Contraindications to Tonometry | 1323 | ||
| Procedure | 1323 | ||
| Palpation Technique | 1323 | ||
| Impression (Schiøtz) Technique | 1323 | ||
| Errors With Impression Tonometry | 1325 | ||
| Impression (Tono-Pen XL, Tono-Pen AVIA) Technique (Fig. 62.29) | 1325 | ||
| Calibration | 1325 | ||
| Measurement | 1325 | ||
| Impression/Rebound (Icare) Technique | 1326 | ||
| Complications | 1328 | ||
| Slit Lamp Examination | 1328 | ||
| Indications and Contraindications | 1328 | ||
| Equipment | 1329 | ||
| Procedure | 1329 | ||
| Unilateral Loss of Vision | 1331 | ||
| Central Renal Artery Occlusion | 1331 | ||
| Therapy | 1331 | ||
| Complications | 1333 | ||
| Orbital Compartment Syndrome | 1333 | ||
| Technique: Lateral Canthotomy and Cantholysis (Fig. 62.44 and Video 62.6) | 1334 | ||
| Complications | 1334 | ||
| Reduction of Globe Luxation | 1334 | ||
| Indications and Contraindications | 1334 | ||
| Technique | 1334 | ||
| Complications | 1336 | ||
| Aftercare | 1336 | ||
| Stye | 1336 | ||
| APD or Marcus Gunn Pupil | 1336 | ||
| Subconjunctival Hemorrhage | 1337 | ||
| Acknowledgment | 1337 | ||
| References | 1337.e1 | ||
| 63 Otolaryngologic Procedures | 1338 | ||
| Pharynx and Larynx | 1338 | ||
| Examination of the Larynx | 1338 | ||
| Anatomy | 1338 | ||
| Laryngoscopy Indications and Contraindications | 1338 | ||
| Equipment | 1338 | ||
| Procedure | 1338 | ||
| Flexible Laryngoscopy | 1338 | ||
| Mirror Laryngoscopy | 1339 | ||
| Complications | 1342 | ||
| Tonsil: Peritonsillar Abscess | 1343 | ||
| Anatomy | 1343 | ||
| Pathophysiology and Clinical Findings | 1344 | ||
| Indications and Contraindications | 1344 | ||
| Equipment | 1345 | ||
| Procedure | 1345 | ||
| Needle Aspiration | 1346 | ||
| Incision and Drainage | 1346 | ||
| Complications of Surgical Drainage | 1348 | ||
| Antibiotic Therapy | 1348 | ||
| Glucocorticoid Therapy | 1348 | ||
| Ear | 1348 | ||
| Anatomy | 1348 | ||
| Anesthesia of the External Ear | 1349 | ||
| Auricle | 1349 | ||
| Procedure | 1350 | ||
| EAC and TM | 1351 | ||
| Procedure | 1351 | ||
| Examination | 1351 | ||
| Removal of Impacted Cerumen | 1351 | ||
| Indications and Contraindications | 1352 | ||
| Procedure | 1352 | ||
| Ceruminolytics | 1353 | ||
| Irrigation (Ear Syringing) | 1353 | ||
| Manual Instrumentation | 1353 | ||
| Complications | 1353 | ||
| Ear Canal Débridement and Wick Placement | 1355 | ||
| Indications and Contraindications | 1355 | ||
| Procedure | 1355 | ||
| Complications | 1355 | ||
| FBs in the Ear Canal | 1355 | ||
| Indications and Contraindications | 1356 | ||
| Procedures | 1356 | ||
| Suction-Tipped Catheters | 1356 | ||
| Manual Instrumentation | 1357 | ||
| Fogarty Catheters | 1357 | ||
| Cyanoacrylate (Superglue) | 1357 | ||
| Removal of Insects | 1357 | ||
| Complications | 1357 | ||
| Drainage of Auricular Hematomas | 1358 | ||
| Indications and Contraindications | 1358 | ||
| Procedure | 1360 | ||
| Needle Aspiration | 1360 | ||
| Incision (see Fig. 63.23) | 1360 | ||
| Complications | 1360 | ||
| Nose | 1361 | ||
| Anatomy | 1361 | ||
| Anesthesia of the Nose | 1361 | ||
| Examination | 1362 | ||
| Management of Epistaxis | 1363 | ||
| Anticoagulated Patients With Epistaxis | 1363 | ||
| Additional Testing for Epistaxis | 1363 | ||
| Indications and Contraindications to Treatment of Epistaxis | 1364 | ||
| Equipment | 1364 | ||
| Procedure | 1364 | ||
| Cautery | 1365 | ||
| Anterior Nasal Packing | 1366 | ||
| Complications | 1368 | ||
| Posterior Nasal Packing | 1368 | ||
| Posterior Gauze Pack | 1368 | ||
| Inflatable Balloon Packs | 1369 | ||
| Other Techniques | 1372 | ||
| Complications | 1372 | ||
| Antibiotics Following Nasal Packing | 1372 | ||
| Patient Disposition Following Nasal Packing | 1372 | ||
| Tranexamic Acid | 1372 | ||
| Septal Hematoma | 1373 | ||
| Indications and Contraindications | 1373 | ||
| Equipment | 1373 | ||
| Procedure | 1374 | ||
| Complications | 1374 | ||
| Reduction of Nasal Fractures | 1374 | ||
| Indications and Contraindications | 1374 | ||
| Equipment | 1375 | ||
| Procedure | 1375 | ||
| Complications | 1376 | ||
| Nasal FB Removal | 1376 | ||
| Indications and Contraindications | 1376 | ||
| Equipment | 1376 | ||
| Procedure | 1377 | ||
| Manual Instrumentation | 1377 | ||
| Balloon Catheter | 1377 | ||
| Positive Pressure | 1378 | ||
| Complications | 1379 | ||
| Dislocation of the Mandible | 1379 | ||
| Indications and Contraindications | 1379 | ||
| Equipment | 1379 | ||
| Procedure | 1379 | ||
| Classic Technique (see Fig. 63.46B) | 1381 | ||
| Recumbent Approach (see Fig. 63.46C) | 1381 | ||
| Posterior Approach | 1381 | ||
| Ipsilateral Approach (see Fig. 63.46C) | 1381 | ||
| Alternative Manual Method | 1381 | ||
| Wrist Pivot Method (see Fig. 63.46C) | 1381 | ||
| Gag Reflex Method | 1381 | ||
| Syringe Technique (Fig. 63.47) | 1381 | ||
| Complications | 1381 | ||
| Uvulitis/Angioedema of the Uvula | 1382 | ||
| Posttonsillectomy Bleeding | 1383 | ||
| References | 1383.e1 | ||
| 64 Emergency Dental Procedures | 1384 | ||
| Teeth | 1384 | ||
| The Periodontium | 1384 | ||
| Acute Toothache in the ED | 1385 | ||
| Dentoalveolar Trauma | 1387 | ||
| Dental Fractures | 1387 | ||
| Ellis Class I Fractures | 1387 | ||
| Ellis Class II Fractures | 1387 | ||
| Ellis Class III Fractures | 1389 | ||
| Luxation, Subluxation, Intrusion, and Avulsion | 1390 | ||
| Luxation and Subluxation | 1390 | ||
| Intrusion and Avulsion | 1391 | ||
| Prognosis | 1393 | ||
| Alveolar Bone Fractures | 1394 | ||
| Lacerations and Dentoalveolar Soft Tissue Trauma | 1394 | ||
| Buccal Mucosa | 1394 | ||
| Gingiva | 1395 | ||
| Frenulum | 1395 | ||
| The Tongue | 1395 | ||
| Oral Hemorrhage | 1396 | ||
| Direct Pressure | 1397 | ||
| Alveolar Osteitis (Dry Socket) | 1397 | ||
| Dentoalveolar Infections | 1398 | ||
| Disease of the Pulp | 1398 | ||
| Disease of the Periodontium | 1399 | ||
| Drainage of Dentoalveolar Infections | 1399 | ||
| Intraoral Technique | 1399 | ||
| Extraoral Technique | 1399 | ||
| Deep Space Infections of the Head and Neck | 1400 | ||
| Dental Material | 1403 | ||
| Intraoral Piercing | 1403 | ||
| Acknowledgments | 1404 | ||
| References | 1404.e1 | ||
| XII Special Procedures | 1405 | ||
| 65 Procedures Pertaining to Hypothermia and Hyperthermia | 1405 | ||
| Procedures Pertaining to Hypothermia | 1405 | ||
| Definitions | 1405 | ||
| Measurement of Core Temperature | 1406 | ||
| Pathophysiology | 1407 | ||
| Initial Evaluation and Stabilization of Hypothermic Patients | 1409 | ||
| Prehospital Care | 1409 | ||
| ED Management | 1410 | ||
| Management Guidelines | 1411 | ||
| Passive External Rewarming | 1411 | ||
| Active External Rewarming | 1411 | ||
| Indications | 1411 | ||
| Equipment | 1412 | ||
| Technique | 1412 | ||
| Arteriovenous Anastomoses Rewarming | 1412 | ||
| Complications | 1412 | ||
| Active Core Rewarming | 1413 | ||
| Emergency Warming of Saline in a Microwave | 1413 | ||
| Inhalation of Heated Humidified Oxygen or Air | 1413 | ||
| Indications and Contraindications. | 1413 | ||
| Technique. | 1413 | ||
| Summary. | 1413 | ||
| Peritoneal Dialysis (Lavage) | 1414 | ||
| Appendix Commonly Used Formulas and Calculations | 1529 | ||
| Introduction | 1529 | ||
| English-to-Metric Conversions | 1529 | ||
| Mean Arterial Pressure | 1529 | ||
| QT and QTC Intervals | 1529 | ||
| Predicted Peak Expiratory Flow Rate | 1529 | ||
| Endotracheal Tube Size | 1529 | ||
| Adults | 1529 | ||
| Pediatrics | 1530 | ||
| Ventilator Settings | 1530 | ||
| Ideal Body Weight | 1530 | ||
| Absolute Neutrophil Count | 1531 | ||
| White Blood Cell Correction in Cerebrospinal Fluid | 1531 | ||
| Renal Function | 1531 | ||
| Fractional Excretion of Sodium | 1531 | ||
| Sodium Deficit | 1532 | ||
| Sodium Correction | 1532 | ||
| Hypernatremia | 1532 | ||
| Potassium | 1532 | ||
| Calcium | 1532 | ||
| Maintenance IV Fluid Rate | 1532 | ||
| Fluid Resuscitation of Burned Patients | 1533 | ||
| Anion Gap | 1533 | ||
| Osmolal Gap | 1533 | ||
| Acid-Base Balance | 1534 | ||
| Winter’s Formula | 1536 | ||
| Glasgow Coma Scale | 1536 | ||
| National Institutes of Health Stroke Score | 1536 | ||
| Diagnostic Probability | 1541 | ||
| Acknowledgment | 1541 | ||
| Index | 1543 | ||
| A | 1543 | ||
| B | 1546 | ||
| C | 1548 | ||
| D | 1553 | ||
| E | 1554 | ||
| F | 1556 | ||
| G | 1559 | ||
| H | 1559 | ||
| I | 1561 | ||
| J | 1563 | ||
| K | 1563 | ||
| L | 1563 | ||
| M | 1565 | ||
| N | 1566 | ||
| O | 1567 | ||
| P | 1568 | ||
| Q | 1571 | ||
| R | 1571 | ||
| S | 1574 | ||
| T | 1577 | ||
| U | 1579 | ||
| V | 1580 | ||
| W | 1581 | ||
| X | 1581 | ||
| Y | 1581 | ||
| Z | 1581 | ||
| Inside Back Cover | ibc1 |