Current emergency diagnosis & treatment

DIAGNOSIS & TREATMENT - 5th Ed. (2004) FRONT MATTER Title Page Copyright Page Contents Authors Preface SECTION I - SPECIAL ASPECTS OF EMERGENCY MEDICINE SECTION II - MANAGEMENT OF COMMON EMERGENCY PROBLEMS SECTION III - TRAUMA EMERGENCIES SECTION IV - NONTRAUMA EMERGENCIES SECTION I - SPECIAL ASPECTS OF EMERGENCY MEDICINE 1. Approach to the Emergency Department Patient - Mary Nan S. Mallory, MD, RDMS & Robert Perry Pringle, Jr., MD WHAT IS EMERGENCY MEDICINE? BIRTH & GROWTH OF EMERGENCY MEDICINE SCOPE OF PRACTICE PRINCIPLES OF EMERGENCY MEDICINE CONCLUSION TABLES 2. Prehospital Emergency Medical Services1 - Eric M. Sergienko, MD, & Thomas N. Bottoni, MD INTRODUCTION COMPONENTS OF THE EMERGENCY MEDICAL SERVICES SYSTEM PREHOSPITAL SKILLS & TECHNIQUES TABLES FIGURES 3. Nuclear, Biologic, & Chemical Agents; Weapons of Mass Destruction - Michael W. Stava, MD, & Joachim Franklin, MD INTRODUCTION NUCLEAR WEAPONS BIOLOGIC WEAPONS CHEMICAL WEAPONS (See Table 3-5.) TABLES 4. Multicasualty Incidents & Disasters1 - Louis James Kroot, MD, & Robert B. Gray, MD INTRODUCTION EPIDEMIOLOGY OF DISASTERS PREHOSPITAL MANAGEMENT OF MULTICASUALTY INCIDENTS & DISASTERS EMERGENCY DEPARTMENT DISASTER MANAGEMENT STRESS MANAGEMENT & PSYCHOLOGICAL SUPPORT TABLES FIGURES 5. Legal Aspects of Emergency Care - Charles A. Eckerline, Jr, MD, FACEP, & Steven D. Rothert, MD, JD INTRODUCTION GENERAL LEGAL PRINCIPLES COMMON LEGAL PROBLEMS IN THE EMERGENCY DEPARTMENT 6. Emergency Procedures1 - William Randall Partin, MD GENERAL INSTRUCTIONS FOR SKIN PREPARATION & STERILE TECHNIQUE UPPER EXTREMITY VENIPUNCTURE EMERGENCY ANTECUBITAL FOSSA VENOUS CUTDOWN PERIPHERAL VENOUS CATHETERIZATION WITH A CATHETER-CLAD NEEDLE PERIPHERAL VENOUS CATHETERIZATION WITH A SCALP VEIN (BUTTERFLY) NEEDLE EXTERNAL JUGULAR VEIN CATHETERIZATION INTERNAL JUGULAR VEIN CATHETERIZATION SUBCLAVIAN VEIN CATHETERIZATION FEMORAL VEIN PHLEBOTOMY OR CATHETERIZATION SAPHENOUS VEIN CUTDOWN INTRAOSSEOUS INFUSION RADIAL ARTERY PUNCTURE (For Blood Gas & pH Analysis) DIRECT LARYNGOSCOPY, OROTRACHEAL INTUBATION, & NASOTRACHEAL INTUBATION NASOGASTRIC INTUBATION (For Gastric Evacuation or Lavage) INSERTION OF SENGSTAKEN-BLAKEMORE OR MINNESOTA TUBE CRICOTHYROTOMY TRANSTRACHEAL JET VENTILATION THORACENTESIS TUBE THORACOSTOMY (Insertion of a Chest Tube) PERICARDIOCENTESIS FOCUSED ASSESSMENT WITH SONOGRAPHY FOR TRAUMA ABDOMINAL PARACENTESIS PERITONEAL CATHETER INSERTION & PERITONEAL LAVAGE INSERTION OF INDWELLING (FOLEY) URINARY CATHETER PERCUTANEOUS SUPRAPUBIC CYSTOTOMY LUMBAR PUNCTURE ANTERIOR & POSTERIOR NASAL PACKING FOR CONTROL OF EPISTAXIS ARTHROCENTESIS (Knee, Shoulder, Elbow, Ankle, Wrist, Hand, & Foot Joints) INCISION & DRAINAGE OF SUPERFICIAL ABSCESS TRANSCUTANEOUS CARDIAC PACING TABLES FIGURES SECTION II - MANAGEMENT OF COMMON EMERGENCY PROBLEMS 7. Basic & Advanced Cardiac Life Support - Eric M. Sergienko, MD, & Thomas N. Bottoni, MD OVERVIEW OF CARDIAC ARREST ADULT BASIC LIFE SUPPORT (See Figure 7-1.) ADULT ADVANCED LIFE SUPPORT CARDIOPULMONARY RESUSCITATION IN INFANTS & CHILDREN NOVEL APPROACHES IN CARDIAC ARREST MANAGEMENT TABLES FIGURES 8. Compromised Airway1 - Harriet L. Boozer, MD, & Melissa M. Cheeseman, MD IMMEDIATE MANAGEMENT OF THE COMPROMISED AIRWAY (See Figure 8-1.) PRINCIPLES OF INTUBATION NONSURGICAL ALTERNATIVES FOR MANAGING THE DIFFICULT AIRWAY NEEDLE CRICOTHYROIDOTOMY SURGICAL AIRWAYS USE OF DRUGS TO ASSIST IN INTUBATION SPECIAL CASES CARE OF THE INTUBATED PATIENT TABLES FIGURES 9. Shock1 - Peter W. Greenwald, MD IMMEDIATE MANAGEMENT OF SHOCK (See Figure 9-1.) DETERMINATION OF THE CAUSE OF SHOCK EMERGENCY TREATMENT OF SPECIFIC CAUSES OF SHOCK TABLES FIGURES 10. The Multiply Injured Patient - Julia Martin, MD, & Michael McClurg, MD IMMEDIATE MANAGEMENT OF LIFE-THREATENING PROBLEMS (See Figure 10-1.) EMERGENCY TREATMENT OF SPECIFIC DISORDERS TABLES FIGURES 11. Dyspnea, Respiratory Distress, & Respiratory Failure1 - Sabina A. Braithwaite, MD, & Debra G. Perina, MD IMMEDIATE MANAGEMENT OF LIFE-THREATENING PROBLEMS (See Figure 11-1.) FURTHER DIAGNOSTIC EVALUATION EMERGENCY TREATMENT OF SPECIFIC DISORDERS TABLES FIGURES 12. Chest Pain1 - Sean P. Barbabella, DO & William R. Dennis, Jr., MD2,3 IMMEDIATE MANAGEMENT OF LIFE-THREATENING PROBLEMS (See Figure 12-1.) FURTHER EVALUATION OF THE PATIENT WITH CHEST PAIN MANAGEMENT OF SPECIFIC DISORDERS CAUSING CHEST PAIN TABLES FIGURES 13. Abdominal Pain1 - Roger Humphries, MD, & Jon Andrew Russell, MD IMMEDIATE MANAGEMENT OF LIFE-THREATENING PROBLEMS (See Figure 13-1.) FURTHER EVALUATION OF THE PATIENT WITH ABDOMINAL PAIN ADDITIONAL MEASURES FOR THE MANAGEMENT OF ACUTE ABDOMEN MANAGEMENT OF SPECIFIC DISORDERS CAUSING ABDOMINAL PAIN CONDITIONS CAUSING ACUTE ABDOMINAL PAIN THAT ARE NOT AMENABLE TO SURGERY TABLES FIGURES 14. Gastrointestinal Bleeding1 - Charles W. Erdman, MD, & James J. Mensching, DO, FACEP INTRODUCTION IMMEDIATE MANAGEMENT OF LIFE-THREATENING BLEEDING (See Figure 14-1.) FURTHER EVALUATION OF GASTROINTESTINAL BLEEDING EMERGENCY TREATMENT OF SPECIFIC DISORDERS CAUSING UPPER GASTROINTESTINAL BLEEDING EMERGENCY TREATMENT OF SPECIFIC DISORDERS CAUSING LOWER GASTROINTESTINAL BLEEDING TABLES FIGURES 15. Diarrhea & Vomiting - Phillip A. Clement, MD, & Jason A. Gardiner, MD INTRODUCTION IMMEDIATE MANAGEMENT OF LIFE-THREATENING PROBLEMS FURTHER EVALUATION OF THE PATIENT WITH DIARRHEA & VOMITING EMERGENCY EVALUATION & MANAGEMENT OF INFECTIOUS CAUSES OF DIARRHEA & VOMITING TABLES FIGURES 16. Coma1 - Steven D. Kelley, MD, & Adam Saperston, MD, MS IMMEDIATE MANAGEMENT OF LIFE-THREATENING PROBLEMS (See Figure 16-1 AND TABLE 16-1.) FURTHER EVALUATION OF THE COMATOSE PATIENT EMERGENCY TREATMENT OF SPECIFIC DISORDERS CRITERIA FOR BRAIN DEATH TABLES FIGURES 17. Syncope, Seizures, & Other Causes of Episodic Loss of Consciousness1 - Adam Saperston, MD, MS I. IMMEDIATE MANAGEMENT OF LIFE-THREATENING PROBLEMS (See Figure 17-1.) II. EVALUATION OF THE CONSCIOUS PATIENT WITH A HISTORY OF SYNCOPE III. EMERGENCY TREATMENT OF SPECIFIC DISORDERS CAUSING EPISODIC LOSS OF CONSCIOUSNESS TABLES FIGURES 18. Weakness & Stroke1 - Heidi P. Cordi, MD, MS INTRODUCTION I. IMMEDIATE MANAGEMENT OF LIFE-THREATENING PROBLEMS ASSOCIATED WITH WEAKNESS (See Figure 18-1.) II. FURTHER EVALUATION OF THE PATIENT WITH WEAKNESS III. EMERGENCY MANAGEMENT OF SPECIFIC WEAKNESS DISORDERS IV. IMMEDIATE MANAGEMENT OF LIFE-THREATENING PROBLEMS ASSOCIATED WITH STROKE V. FURTHER EVALUATION OF THE PATIENT WITH STROKE VI. MANAGEMENT OF SPECIFIC STROKE SYNDROMES TABLES FIGURES 19. Headache1 - C. Keith Stone, MD, & Nancy J. Antonacci, MD IMMEDIATE EVALUATION & MANAGEMENT OF HEADACHE CAUSED BY LIFE-THREATENING CONDITIONS (See Figure 19-1.) APPROACH TO THE DIAGNOSIS OF HEADACHE MANAGEMENT OF SPECIFIC DISORDERS CAUSING ACUTE HEADACHE MANAGEMENT OF SPECIFIC DISORDERS CAUSING SUBACUTE HEADACHE MANAGEMENT OF SPECIFIC DISORDERS CAUSING CHRONIC HEADACHE FIGURES 20. Delirium & Acute Confusional States - Eric W. Flach, MD, Timothy A. Coakley, MD, & James J. Mensching, MD, DO, FACEP1,2 IMMEDIATE MANAGEMENT OF LIFE-THREATENING PROBLEMS (See Figure 20-1.) EMERGENCY MANAGEMENT OF SPECIFIC DISORDERS TABLES FIGURES 21. Arthritis & Back Pain1 - Roger L. Humphries, MD, & David O'Keefe, MD I. EVALUATION OF THE PATIENT WITH ACUTE ARTHRITIS (See Figure 21-1.) II. EMERGENCY TREATMENT OF SPECIFIC CONDITIONS CAUSING ACUTE ARTHRITIS III. EVALUATION OF THE PATIENT WITH ACUTE BACK PAIN (See Figure 21-2.) IV. EMERGENCY TREATMENT OF SPECIFIC CONDITIONS CAUSING BACK PAIN TABLES FIGURES SECTION III - TRAUMA EMERGENCIES 22. Head Injuries - Stephen C. Ausband, MD, FACEP, & Ritu Sahni, MD, MPH IMMEDIATE MANAGEMENT OF LIFE-THREATENING PROBLEMS MANAGEMENT OF OTHER SYMPTOMS EMERGENCY TREATMENT OF SPECIFIC HEAD INJURIES MINOR HEAD INJURIES SPECIAL CONSIDERATIONS FOR PEDIATRICS INDICATIONS FOR HOSPITALIZATION DISCHARGE INSTRUCTIONS INTOXICATED PATIENTS TABLES FIGURES 23. Maxillofacial & Neck Trauma1 - Fermin S. Godinez, DO, & Susan J. Letterle, MD I. IMMEDIATE MANAGEMENT OF LIFE-THREATENING PROBLEMS II. FURTHER DIAGNOSIS & EVALUATION III. EMERGENCY MANAGEMENT OF SPECIFIC INJURIES FIGURES 24. Chest Trauma - James Svenson, MD, MS, & Desiree LaCharite, MD INTRODUCTION IMMEDIATE MANAGEMENT OF LIFE-THREATENING PROBLEMS IMMEDIATELY LIFE-THREATENING THORACIC INJURIES IDENTIFIED ON PRIMARY SURVEY POTENTIALLY LIFE-THREATENING INJURIES IDENTIFIED ON SECONDARY SURVEY OTHER INJURIES PENETRATING TRAUMA FIGURES 25. Abdominal Trauma - Luis E. Rodriguez, MD, & John E. Gough, MD, FACEP IMMEDIATE MANAGEMENT OF LIFE-THREATENING INJURIES EMERGENCY TREATMENT OF SPECIFIC INJURIES FIGURES 26. Genitourinary Trauma - Geoffrey A. Wiss, MD, Claudia Whitaker, MD, & Robert K. Dunne, MD, FACEP IMMEDIATE MANAGEMENT OF LIFE-THREATENING INJURIES EMERGENCY TREATMENT OF SPECIFIC INJURIES FIGURES 27. Vertebral Column & Spinal Cord Trauma1 - Robert Casey Wilson, MD, & Louis J. Kroot, MD IMMEDIATE MANAGEMENT OF THE PATIENT WITH SUSPECTED SPINAL INJURY FURTHER EVALUATION OF THE PATIENT WITH SPINAL INJURY EMERGENCY TREATMENT OF SPECIFIC SPINAL INJURIES TABLES FIGURES 28. Orthopedic Emergencies - Luis E. Rodriguez, MD, & John E. Gough, MD, FACEP I. IMMEDIATE MANAGEMENT OF LIFE-THREATENING INJURIES II. IMMEDIATE MANAGEMENT OF LIMB-THREATENING INJURIES III. GENERAL ORTHOPEDIC PRINCIPLES IV. MANAGEMENT OF SPECIFIC ORTHOPEDIC INJURIES V. COMMON PITFALLS TABLES FIGURES 29. Hand Trauma1 - Adam Saperston, MD, MS EMERGENCY EVALUATION & TREATMENT EXAMINATION OF THE HAND & ASSESSMENT OF FUNCTION (See Figures 29-3 & 29-4. ) EQUIPMENT & MATERIALS FOR TREATMENT MANAGEMENT OF SPECIFIC TYPES OF HAND INJURIES SPECIAL EMERGENCY DEPARTMENT PROBLEMS FIGURES 30. Wound Care1 - Louis J. Kroot, MD, & David Hurst, MD EMERGENCY MANAGEMENT OF LIFE-THREATENING PROBLEMS WOUND ASSESSMENT EMERGENCY TREATMENT OF SPECIFIC TYPES OF WOUNDS TABLES FIGURES SECTION IV - NONTRAUMA EMERGENCIES 31. Eye Emergencies1 - William R. Dennis, Jr, MD, & Alia M. Dennis, MD I. EMERGENCY EVALUATION OF IMPORTANT OCULAR SYMPTOMS II. OCULAR CONDITIONS REQUIRING IMMEDIATE TREATMENT III. NONTRAUMATIC OCULAR EMERGENCIES IV. OCULAR BURNS & TRAUMA V. EQUIPMENT & SUPPLIES VI. COMMON TECHNIQUES FOR TREATMENT OF OCULAR DISORDERS VII. COMMON PITFALLS TO BE AVOIDED IN THE MANAGEMENT OF OCULAR DISORDERS TABLES FIGURES 32. ENT Emergencies: Disorders of the Ear, Nose, Sinuses, Oropharynx, & Mouth - David C. Van, MD, MS I. IMMEDIATE MANAGEMENT OF POTENTIALLY HARMFUL DISORDERS II. MANAGEMENT OF SPECIFIC DISORDERS TABLES FIGURES 33. Pulmonary Emergencies1 - Christopher R. Pund, MD, & C. Keith Stone, MD IMMEDIATE MANAGEMENT OF LIFE-THREATENING PROBLEMS (See also Chapter 11.) EMERGENCY MANAGEMENT OF SPECIFIC CONDITIONS TABLES 34. Cardiac Emergencies21 - Roger L. Humphries, MD, & C. Keith Stone, MD Immediate Management ACUTE CORONARY SYNDROME HEART FAILURE HYPERTENSION & HYPERTENSIVE CRISIS PERICARDITIS, PERICARDIAL EFFUSION, & CARDIAC TAMPONADE MYOCARDITIS & CARDIOMYOPATHY AORTIC ANEURYSMS & DISSECTIONS CONGENITAL HEART DISEASE TABLES 35. Cardiac Arrhythmias - David A. Wald, DO INTRODUCTION TACHYARRHYTHMIAS BRADYARRHYTHMIAS, CONDUCTION DISTURBANCES, & ESCAPE RHYTHMS IDIOVENTRICULAR RHYTHM ATRIOVENTRICULAR JUNCTIONAL RHYTHM PERMANENT CARDIAC PACEMAKERS (See Appendix, Figures 35-32, 35-33, 35-34, 35-35, 35-36 and 35-37.) IMPLANTABLE CARDIOVERTER DEFIBRILLATORS APPENDIX: COMMONLY ENCOUNTERED CARDIAC ARRHYTHMIAS TABLES FIGURES 36. Obstetric & Gynecologic Emergencies & Rape1 - Melissa Platt, MD, & Mary Nan Mallory, MD, RDMS IMMEDIATE MANAGEMENT OF LIFE-THREATENING PROBLEMS EMERGENCY MANAGEMENT OF GYNECOLOGIC DISORDERS EMERGENCY MANAGEMENT OF OBSTETRIC DISORDERS TABLES FIGURES 37. Genitourinary Emergencies1 - Susan J. Letterle, MD IMMEDIATE MANAGEMENT OF SERIOUS & LIFE-THREATENING CONDITIONS EMERGENCY TREATMENT OF SPECIFIC DISORDERS TABLES FIGURES 38. Vascular Emergencies1 - Scott W. Hines, MD, & James J. Mensching, MD, DO, FACEP INTRODUCTION I. VASCULAR EMERGENCIES DUE TO TRAUMA II. VASCULAR EMERGENCIES NOT DUE TO TRAUMA TABLES FIGURES 39. Hematologic Emergencies - J. Stephan Stapczynski, MD, & Geoffrey A. Martin, MD I. HEMOSTATIC DISORDERS: GENERAL CONSIDERATIONS II. HEMOSTATIC DISORDERS: PLATELET DISORDERS III. HEMOSTATIC DISORDERS: COAGULATION FACTOR DISORDERS IV. ANEMIA V. POLYCYTHEMIA VI. WHITE CELL DISORDERS VII. TRANSFUSION THERAPY TABLES FIGURES 40. Infectious Disease Emergencies - Brian Hawkins, MD, & Daniel F. Danzl, MD I. IMMEDIATE MANAGEMENT OF LIFE-THREATENING PROBLEMS II. EMERGENCY MANAGEMENT OF SPECIFIC DISORDERS III. MANAGEMENT OF INFECTIONS CAUSED BY SPECIFIC ORGANISMS IV. AIDS & HIV INFECTION (See Table 40-14. ) TABLES 41. Metabolic & Endocrine Emergencies - Micheal D. Rush, MD, & Wason W. S. Louie, MD EMERGENCY MANAGEMENT OF DISORDERS OF CARBOHYDRATE METABOLISM EMERGENCY MANAGEMENT OF OTHER METABOLIC & ENDOCRINE ABNORMALITIES TABLES 42. Fluid, Electrolyte, & Acid-Base Emergencies - Michael E. Chansky, MD, FACEP, Andrew Nyce, MD, & Jason Friedman, MD1 I. DIAGNOSIS OF FLUID & ELECTROLYTE DISORDERS II. MANAGEMENT OF SPECIFIC DISORDERS APPENDIX: USEFUL EQUATIONS & FORMULAS TABLES FIGURES 43. Burns & Smoke Inhalation1 - Melissa M. Cheeseman, MD, & Harriet L. Boozer, MD IMMEDIATE MANAGEMENT OF LIFE-THREATENING PROBLEMS (See Figure 43-1.) FURTHER EVALUATION OF THE PATIENT WITH BURNS OR INHALATION INJURY EMERGENCY TREATMENT OF SPECIFIC TYPES OF BURNS TABLES FIGURES 44. Disorders Due to Physical & Environmental Agents1 - D. Shannon Waters, MD, & Rebecca C. Bowers, MD EMERGENCY TREATMENT OF DISORDERS DUE TO COLD EMERGENCY TREATMENT OF DISORDERS DUE TO HEAT EMERGENCY TREATMENT OF ELECTRICAL INJURIES EMERGENCY TREATMENT OF RADIATION INJURIES EMERGENCY TREATMENT OF NEAR-DROWNING EMERGENCY TREATMENT OF DISORDERS DUE TO ATMOSPHERIC PRESSURE CHANGES EMERGENCY TREATMENT OF DISORDERS DUE TO VENOMOUS ANIMALS TABLES FIGURES 45. Poisoning1 - D. Shannon Waters, MD, Darren Waters, MD, & Travis Sewalls, MD IMMEDIATE MANAGEMENT OF LIFE-THREATENING CONDITIONS FURTHER MANAGEMENT OF VICTIMS OF POISONING MANAGEMENT OF CONDITIONS ASSOCIATED WITH POISONING EMERGENCY TREATMENT OF SPECIFIC POISONINGS TABLES FIGURES 46. Dermatologic Emergencies - Joseph A. Salomone III, MD, FAAEM, & Martha Ann Pratt, MD IMMEDIATE RECOGNITION & MANAGEMENT OF LIFE-THREATENING PROBLEMS RECOGNITION & MANAGEMENT OF POTENTIALLY LIFE-THREATENING PROBLEMS RECOGNITION & MANAGEMENT OF NON-LIFE-THREATENING PROBLEMS 47. Psychiatric Emergencies - Gregory Hall, MD, & Denis J. Fitzgerald, MD I. INTRODUCTION II. THE S.A.F.E.S.T. APPROACH TO VIOLENT OR AGITATED PATIENTS III. EMERGENCY DEPARTMENT SCREENING ASSESSMENT IV. ORGANIC CAUSES FOR PSYCHIATRIC EMERGENCIES V. FUNCTIONAL CAUSES FOR PSYCHIATRIC EMERGENCIES VI. PSYCHOPHARMACO- THERAPY VII. DISPOSITION FIGURES 48. Pediatric Emergencies - Roger L. Humphries, MD, Keith D. Bricking, MD, & Thomas M. Huhn, MD1 General Considerations CARDIOVASCULAR EMERGENCIES RESPIRATORY DISTRESS NEUROLOGIC EMERGENCIES INFECTIOUS DISEASES GASTROINTESTINAL DISORDERS HEMATOLOGIC DISEASES NEWBORN EMERGENCIES CHILD ABUSE TABLES FIGURES