An Introduction to Clinical Emergency Medicine : Guide for Practitioners in the Emergency Department

Now with updated ACLS algorithms An Introduction to Clinical Emergency Medicine is a much-needed resource for individuals practicing in this challenging field. It takes a novel approach, describing in detail the best and most current methods including initial patient evaluation, generation of differential diagnoses, problem-solving and management of challenging conditions based on presenting symptoms. Unlike other textbooks, in which the diagnosis is known, this textbook approaches clinical problems as clinicians approach patients - without full knowledge of the final diagnosis. It provides an understanding of how to approach patients with undifferentiated conditions, ask the right questions, gather historical data, utilize physical examination skills and order and interpret laboratory and radiographic tests. It provides current management and disposition strategies with controversies presented, including pearls and summary points for each topic covered. The book is multi-author, each contributor chosen because of a track record in teaching as well as being internationally recognised experts in the specialty. Half-title......Page 2 Title......Page 4 Copyright......Page 5 Contents......Page 6 List of contributors......Page 12 Foreword......Page 16 Acknowledgments......Page 18 Dedication......Page 20 Section 1 Principles of Emergency Medicine......Page 21 1 Approach to the emergency patient......Page 23 Scope of the problem......Page 24 Social concerns......Page 25 History......Page 26 General appearance......Page 28 Pearls specific to the physical......Page 29 Diagnostic testing......Page 30 Radiologic studies......Page 31 General treatment principles......Page 32 Elderly......Page 33 Difficult patients......Page 34 Consultation......Page 35 Admission/discharge......Page 36 Pearls, pitfalls, and myths......Page 37 References......Page 38 Anatomic essentials......Page 39 Initial airway assessment......Page 41 Opening the airway......Page 42 Ventilation......Page 43 Inability to maintain or protect the airway......Page 44 Rapid sequence intubation......Page 45 Awake oral intubation......Page 54 Blind nasotracheal intubation......Page 55 The failed airway......Page 56 Retrograde intubation......Page 57 Transtracheal jet ventilation (TTJV)......Page 58 Pediatric......Page 59 Status asthmaticus......Page 61 Suspected cervical spine injury......Page 63 References......Page 64 The primary survey......Page 67 Breathing......Page 69 Defibrillation......Page 70 Circulation......Page 71 Physical examination......Page 75 Diagnostic studies......Page 76 Termination of efforts......Page 77 Special patients......Page 78 References......Page 82 The sinoatrial node......Page 83 The His–Purkinje system......Page 84 History......Page 85 Cardiovascular......Page 87 Laboratory studies......Page 88 Management of specific bradydysrhythmias......Page 89 Management of specific tachydysrhythmias......Page 93 References......Page 103 History......Page 105 Physical examination......Page 106 Cardiogenic shock......Page 107 Oxygenation......Page 108 Cardiac intervention......Page 109 Vasoactive agent intervention......Page 110 References......Page 112 Airway with cervical spine control......Page 113 Breathing......Page 115 Circulation......Page 118 Disability......Page 121 Exposure and environmental control......Page 122 Secondary survey......Page 123 History......Page 125 Laboratory studies......Page 128 Radiologic studies......Page 130 Pediatric......Page 133 Pregnant......Page 134 Pearls, pitfalls, and myths......Page 135 References......Page 136 EMS personnel and qualifications......Page 137 EMS response......Page 138 Clinical capabilities of EMS......Page 139 Medical direction......Page 143 Patient transport......Page 145 Special considerations in air transport......Page 146 References......Page 149 Oligoanalgesia......Page 151 Self-report assessment......Page 152 Nonself-report assessment......Page 153 Nonpharmacologic modalities......Page 154 Non-opioid agents......Page 155 Opioid analgesic agents......Page 157 Choice of route of administration......Page 158 Migraine headaches......Page 159 References......Page 160 Section 2 Primary Complaints......Page 163 History......Page 165 Associated symptoms......Page 167 Vital signs......Page 168 Abdomen......Page 169 Pelvic......Page 170 Differential diagnosis......Page 171 Radiologic studies......Page 174 Volume repletion......Page 176 Immune compromised......Page 177 Discharge......Page 178 References......Page 179 History......Page 181 Associated symptoms......Page 182 Genitourinary......Page 183 Differential diagnosis......Page 184 Diagnostic testing......Page 185 Determine the need for emergency pyschiatric admission......Page 186 Implement physical or chemical restraint when necessary......Page 187 Immune compromised......Page 188 Pearls, pitfalls, and myths......Page 189 References......Page 190 History......Page 191 Past medical......Page 192 Abdomen......Page 193 Airway control......Page 194 Disposition......Page 196 Pitfalls......Page 197 References......Page 198 Anatomic essentials......Page 199 Vital signs......Page 200 Head, ears, eyes, nose and throat......Page 201 Neurologic......Page 204 Differential diagnosis......Page 206 Diagnostic testing......Page 207 Flumazenil......Page 208 Pediatric......Page 209 Pearls, pitfalls, and myths......Page 210 References......Page 211 History......Page 213 Severity......Page 214 Pulmonary......Page 215 Jugular venous pressure (JVP)......Page 216 Differential diagnosis......Page 217 Laboratory studies......Page 219 Electrocardiogram......Page 221 Radiologic studies......Page 222 General treatment principles......Page 225 Admission vs. discharge......Page 228 References......Page 229 Other symptoms......Page 231 General appearance and vital signs......Page 232 Laboratory studies......Page 233 Specific therapy......Page 234 Pearls, pitfalls, and myths......Page 235 References......Page 236 History......Page 237 Abdomen......Page 238 Head and neck......Page 239 Miscellaneous......Page 240 Radiologic studies......Page 241 Laboratory studies......Page 242 Pearls, pitfalls, and myths......Page 243 References......Page 244 History......Page 245 General treatment principles......Page 246 Special patients......Page 247 Physical examination......Page 248 Hypoglycemia......Page 249 General treatment principles......Page 250 References......Page 251 History......Page 253 General appearance......Page 254 Differential diagnosis......Page 255 Radiologic studies......Page 256 Antimotility agents......Page 257 Disposition......Page 258 References......Page 259 Near-syncope......Page 261 History......Page 262 Head, eyes, ears, nose, and throat......Page 264 Neurologic......Page 265 Clinical tests......Page 266 Differential diagnosis......Page 267 Radiologic studies......Page 268 Peripheral vertigo......Page 269 Elderly......Page 271 References......Page 272 Anatomic essentials......Page 273 Associated symptoms......Page 275 Head, eyes, ears, nose and throat......Page 276 Cranial nerves......Page 279 Differential diagnosis......Page 280 Otitis media......Page 281 Otitis media with tympanic membrane perforation......Page 282 Discharge......Page 283 References......Page 284 Anatomic essentials......Page 285 Past medical......Page 286 Head, eyes, ears, nose and throat......Page 287 Differential diagnosis......Page 288 Direct pressure......Page 289 Packing......Page 290 Ear, nose and throat consultation......Page 291 References......Page 292 Anatomic essentials......Page 293 Associated symptoms......Page 294 Oropharynx......Page 295 Differential diagnosis......Page 297 Radiologic studies......Page 301 Laryngoscopy......Page 302 Antibiotics......Page 303 Immune compromised......Page 304 Pearls, pitfalls, and myths......Page 305 References......Page 306 Anatomic essentials......Page 307 History......Page 314 Associated symptoms......Page 315 Nerves and vessels......Page 316 Regional......Page 317 Radiographs......Page 326 Description of fractures......Page 328 General treatment principles......Page 329 Pediatric......Page 330 Disposition......Page 331 References......Page 332 Anatomic essentials......Page 333 History......Page 335 Vital signs......Page 336 Ocular motility......Page 337 Pupillary......Page 338 Anterior segment......Page 339 Intraocular pressure......Page 342 Differential diagnosis......Page 343 Laboratory studies......Page 346 The red eye......Page 347 Pediatric......Page 349 Disposition......Page 350 References......Page 351 Systemic fever response......Page 353 Hyperpyrexia......Page 354 History......Page 355 Past medical......Page 356 Central nervous system......Page 357 Gastrointestinal......Page 358 Differential diagnosis......Page 359 Noninfectious causes of fever......Page 363 Laboratory tests......Page 364 General treatment principles......Page 367 Antimicrobial therapy......Page 368 Organ transplant......Page 369 Post-surgical/postpartum......Page 370 Pearls, pitfalls, and myths......Page 371 References......Page 372 History......Page 373 Vital signs......Page 375 Neck......Page 376 Skin......Page 377 Differential diagnosis......Page 378 Laboratory studies......Page 380 Management algorithms......Page 381 Empiric antibiotic therapy......Page 382 Pearls, pitfalls, and myths......Page 383 References......Page 384 History......Page 385 Vital signs......Page 386 Differential diagnosis......Page 387 Laboratory studies......Page 389 General treatment principles......Page 390 Upper gastrointestinal bleeding......Page 391 Lower gastrointestinal bleeding......Page 392 Immune compromised......Page 393 References......Page 394 History......Page 395 Head......Page 397 Meningeal signs......Page 398 Differential diagnosis......Page 399 Radiologic studies......Page 404 General treatment principles......Page 405 Migraines......Page 406 Tumor headache......Page 408 Pediatric......Page 409 Pearls, pitfalls, and myths......Page 410 References......Page 411 Pathophysiology......Page 413 Past medical......Page 414 Cardiovascular......Page 415 Diagnostic testing......Page 416 General treatment principles......Page 417 Disposition......Page 419 References......Page 420 Anatomic essentials......Page 421 Associated symptoms......Page 422 Musculoskeletal......Page 423 Differential diagnosis......Page 425 Synovial fluid analysis......Page 428 Radiologic studies......Page 429 Drainage......Page 430 Pearls, pitfalls, and myths......Page 431 References......Page 432 Anatomic essentials......Page 433 History......Page 434 Past medical......Page 435 Neurologic......Page 436 Clinical tests for radiculopathy......Page 437 Differential diagnosis......Page 439 Radiologic studies......Page 441 General treatment principles......Page 442 Prevention......Page 443 Disposition......Page 444 References......Page 445 History......Page 447 Abdomen......Page 449 Pelvic......Page 450 Gastrointestinal etiologies......Page 451 Laboratory studies......Page 454 Radiologic studies......Page 455 Antibiotics......Page 456 Geriatric......Page 458 Discharge......Page 459 References......Page 460 History......Page 463 Associated symptoms......Page 464 General appearance......Page 465 Skin......Page 466 Diagnostic testing......Page 477 Antivirals and antibiotics......Page 478 Discharge......Page 479 References......Page 480 Anatomic essentials......Page 481 History......Page 482 Associated symptoms......Page 483 Genital......Page 484 Special signs/techniques......Page 486 Diagnostic testing......Page 488 General treatment principles......Page 489 Pediatric......Page 490 References......Page 491 Pathophysiology......Page 493 History......Page 494 Cardiovascular......Page 495 Differential diagnosis......Page 496 Laboratory studies......Page 497 Summary of diagnostic considerations for certain types of seizures......Page 499 Pharmacologic abortive seizure therapy......Page 500 Pediatric......Page 501 Pregnant......Page 502 Disposition......Page 503 References......Page 504 History......Page 505 Social......Page 507 Head, eyes, ears, nose, and throat......Page 508 Differential diagnosis......Page 509 Laboratory studies......Page 513 Additional specialized studies......Page 516 Acute asthma excacerbation......Page 517 Congestive heart failure......Page 518 Pediatric......Page 520 Pearls and pitfalls......Page 521 References......Page 522 History......Page 523 Family......Page 524 Vital signs......Page 525 Head, eyes, ears, nose, and throat......Page 526 Neurologic......Page 527 Differential diagnosis......Page 528 Laboratory studies......Page 531 General treatment......Page 532 Specific treatment......Page 533 Consultation......Page 534 Pearls......Page 535 References......Page 536 History......Page 537 General appearance......Page 539 Pelvic......Page 540 Differential diagnosis......Page 541 Electrocardiogram......Page 544 Radiologic studies......Page 547 Elderly......Page 548 Discharge......Page 549 References......Page 550 For the patient......Page 551 For the family, friends, emergency medical services, and law enforcement......Page 552 Pulmonary......Page 553 Differential diagnosis......Page 554 Radiologic studies......Page 555 Laboratory tests......Page 556 Supportive care......Page 557 Gastric and other decontamination......Page 558 Enhanced elimination......Page 559 Disposition......Page 560 References......Page 561 Anatomic essentials......Page 563 History......Page 564 Perineum......Page 566 Laboratory studies......Page 567 Radiologic studies......Page 569 Infection treatment......Page 570 Obstruction relief......Page 571 Pregnant......Page 572 Pearls and pitfalls......Page 573 References......Page 574 Physiology of menstruation......Page 575 Fertilization, implantation, and embryology......Page 576 History......Page 577 Past medical......Page 578 Pelvic......Page 579 Auscultation for fetal heart tones......Page 580 Laboratory studies......Page 582 Radiologic studies......Page 583 Ectopic pregnancy......Page 585 First-trimester vaginal bleeding......Page 586 References......Page 587 History......Page 589 Physical examination......Page 590 Neurologic......Page 591 Differential diagnosis......Page 592 Volume repletion......Page 596 Antiemetics......Page 597 Consultation......Page 598 References......Page 599 Central nervous system......Page 601 History......Page 603 Associated symptoms......Page 604 General appearance......Page 605 Neurologic......Page 606 Differential diagnosis......Page 609 Electrocardiogram......Page 615 Other studies......Page 616 Acute ischemic stroke......Page 617 Myasthenia gravis......Page 620 Tick paralysis......Page 621 Pearls and pitfalls......Page 622 References......Page 623 Section 3 Unique Issues in Emergency Medicine......Page 625 Identification......Page 627 Child abuse......Page 628 Physical examination......Page 629 Diagnostic tests......Page 631 Elder abuse......Page 632 Documentation......Page 634 Physical evidence......Page 635 Reporting......Page 636 References......Page 638 Pathophysiology......Page 639 Increased internal heat production......Page 640 General appearance......Page 641 Differential diagnosis......Page 642 Laboratory studies......Page 643 Elderly......Page 644 References......Page 645 History......Page 646 Differential diagnosis......Page 647 Laboratory studies......Page 648 Rewarming......Page 649 Further management......Page 650 Myths......Page 651 References......Page 652 Pathophysiology......Page 653 Vital signs......Page 654 Differential diagnosis......Page 655 Neurologic treatment......Page 656 Myths......Page 657 References......Page 658 History......Page 659 Differential diagnosis......Page 660 Airway, Breathing, Circulation......Page 661 Myths......Page 662 References......Page 663 Scope of the problem......Page 664 Anatomic essentials......Page 665 History......Page 666 Abdomen......Page 667 Radiologic studies......Page 668 General treatment principles......Page 669 Additional treatment......Page 670 Pearls, pitfalls, and myths......Page 671 References......Page 672 Making ethical decisions......Page 673 Choosing an ethical framework......Page 674 Resuscitation preferences......Page 675 Death notification......Page 676 Informed consent......Page 677 Pearls of wisdom: issues of professional ethics for physicians-in-training......Page 678 References......Page 679 Treatment of minors......Page 681 Involuntary detainment......Page 682 The criminal justice system......Page 683 EMTALA/COBRA......Page 684 Medical malpractice......Page 685 Conclusion......Page 686 Referenes......Page 687 History......Page 689 Selected agents......Page 690 Hand hygiene......Page 691 Splash protection......Page 692 Human immunodeficiency virus......Page 693 Hepatitis B......Page 695 Tuberculosis......Page 696 Pitfalls......Page 697 References......Page 698 Appendices......Page 699 Peripheral venous cannulation......Page 701 Central venous cannulation......Page 703 Intraosseous infusion......Page 707 Arterial puncture......Page 708 Nasogastric intubation......Page 709 Bladder catheterization......Page 711 Lumbar puncture......Page 713 References......Page 715 Shoulder......Page 716 Radial head subluxation......Page 717 Phalangeal......Page 718 Patella......Page 719 Tube thoracostomy......Page 720 References......Page 723 Abscess incision and drainage......Page 724 Reference......Page 725 Anesthesia......Page 727 Local infiltration......Page 728 Wound cleaning......Page 729 Local wound preparation......Page 730 Pitfalls in wound care......Page 731 References......Page 732 History......Page 733 Past medical......Page 734 Description of the wound......Page 735 Foreign bodies and wound contamination......Page 736 Methods of wound closure......Page 737 Pearls, pitfalls, and myths......Page 742 References......Page 743 Patient assessment and selection......Page 745 Drug selection......Page 746 Recovery and discharge......Page 750 References......Page 751 Clinical indications for the FAST exam......Page 753 Limitations and pitfalls......Page 756 References......Page 757 Complete blood count with differential......Page 759 Serum chemistries......Page 760 Calcium......Page 762 Liver function tests......Page 763 Cardiac markers......Page 764 B-type natriuretic peptide......Page 765 D-dimer (ELISA)......Page 766 Alveolar–arterial oxygen gradient......Page 767 Urinalysis......Page 768 Pregnancy tests......Page 769 Erythrocyte sedimentation rate......Page 770 References......Page 771 Index......Page 773 Describes In Detail The Best And Most Current Methods Including Initial Patient Evaluation, Generation Of Differential Diagnoses, Problem-solving And Management Of Challenging Conditions Based On Presenting Symptoms. Unlike Other Textbooks, In Which The Diagnosis Is Known, This Textbook Approaches Clinical Problems As Clinicians Approach Patients - Without Full Knowledge Of The Final Diagnosis. It Provides An Understanding Of How To Approach Patients With Undifferentiated Conditions, Ask The Right Questions, Gather Historical Data, Utilize Physical Examination Skills And Order And Interpret Laboratory And Radiographic Tests. It Provides Current Management And Disposition Strategies With Controversies Presented, Including Pearls And Summary Points For Each Topic Covered. Principles Of Emergency Medicine. Approach To The Emergency Patient / Gus M. Garmel -- Airway Management / S.v. Mahadevan And Shannon Sovndal -- Cardiopulmonary And Cerebral Resuscitation / Robert R. Leschke -- Cardiac Dysrhythmias / S.v. Gurudevan -- Shock / Robert J. Sigillito And Peter M.c. Deblieux -- Traumatic Injuries / David E. Manthey -- Prehospital Care And Emergency Medical Services / Paul D. Biddinger And Stephen H. Thomas -- Pain Management / Eustacia (jo) Su -- Primary Complaints. Abdominal Pain / S.v. Mahadevan -- Abnormal Behavior / Tim Meyers And Gus M. Garmel. Allergic Reactions And Anaphylactic Syndromes / Steven Go -- Altered Mental Status / Barry Simon And Flavia Nobay -- Chest Pain / Jeffrey A. Tabas And Susan B. Promes -- Constipation / Victoria Brazil -- Crying And Irritability / Lee W. Shockley -- Diabetes-related Emergencies / Christopher R.h. Newton -- Diarrhea / Rawle A. Seupaul -- Dizziness And Vertigo / Andrew K. Chang -- Ear Pain, Nosebleed, And Throat Pain (ent) -- Extremity Trauma / Dan Garza And Gregory W. Hendy -- Eye Pain, Redness And Visual Loss / Janet G. Alteveer -- Fever In Adults / Tamas R. Peredy And Gus M. Garmel. Fever In Children / Lynne Mccullough And Eric Savitsky -- Gastrointestinal Bleeding / J. Scott Taylor -- Headache / Gino A. Farina And Kumar Alagappan -- Hypertensive Urgencies And Emergencies / Loretta Jackson-williams And Robert Galli -- Joint Pain / Douglas W. Lowery And Melissa J. Lamberson -- Low Back Pain / Mel Herbert And Mary Lanctot-herbert -- Pelvic Pain / Peter G. Kumasaka -- Rash / Jamie Collings And Brigham Temple -- Scrotal Pain / Jonathan E. Davis. Seizures / Stephen R. Hayden -- Shortness Of Breath In Adults / Sharon E. Mace -- Shortness Of Breath In Children / Lance Brown And Steven M. Green. Syncope / Amal Mattu -- Toxicologic Emergencies / Steven A. Mclaughlin -- Urinary-related Complaints / Fred A. Severyn -- Vaginal Bleeding / Pamela L. Dyne And Rita Oregon -- Vomiting / Jennifer A. Oman -- Weakness / R. Jason Thurman And Kristy Self Reynolds -- Unique Issues In Emergency Medicine. Child Abuse, Elder Abuse, Intimate Partner Violence / Carolyn J. Sachs -- Environmental Emergencies -- Ethics And End-of-life Issues / Michael A. Gisondi -- Legal Aspects Of Emergency Care / Gregory Guldner And Amy Leinen -- Occupational Exposures In The Emergency Department / Stephen J. Playe And Cemel M. Erdem. Appenices. Common Emergency Procedures / George Sternbach -- Wound Preparation / Michelle Lin -- Laceration Repair / F.c. Von Trampe And Wendy C. Coates -- Procedural Sedation And Analgesia / Eustacia (jo) Su And Robert L. Cloutier -- Focused Assessment With Sonography In Trauma / Rita A. Sweeney And Diku Mandavia -- Interpretation Of Emergency Laboratories / J. Michael Ballester. [edited By] Swaminatha V. Mahadevan, Gus M. Garmel. Includes Bibliographical References And Index. Principles of emergency medicine. Approach to the emergency patient / Gus M. Garmel. Airway management / S.V. Mahadevan and Shannon Sovndal. Cardiopulmonary and cerebral resuscitation / Robert R. Leschke. Cardiac dysrhythmias / S.V. Gurudevan. Shock / Robert J. Sigillito and Peter M.C. DeBlieux. Traumatic injuries / David E. Manthey. Prehospital care and emergency medical services / Paul D. Biddinger and Stephen H. Thomas. Pain management / Eustacia (Jo) Su Primary complaints. Abdominal pain / S.V. Mahadevan. Abnormal behavior / Tim Meyers and Gus M. Garmel. Allergic reactions and anaphylactic syndromes / Steven Go. Altered mental status / Barry Simon and Flavia Nobay. Chest pain / Jeffrey A. Tabas and Susan B. Promes. Constipation / Victoria Brazil. Crying and irritability / Lee W. Shockley. Diabetes-related emergencies / Christopher R.H. Newton. Diarrhea / Rawle A. Seupaul. Dizziness and vertigo / Andrew K. Chang. Ear pain, nosebleed, and throat pain. Extremity trauma / Dan Garza and Gregory W. Hendy. Eye pain, redness and visual loss / Janet G. Alteveer. Fever in adults / Tamas R. Peredy and Gus M. Garmel. Fever in children / Lynne McCullough and Eric Savitsky. Gastrointestinal bleeding / J. Scott Taylor. Headache / Gino A. Farina and Kumar Alagappan. Hypertensive urgencies and emergencies / Loretta Jackson-Williams and Robert Galli. Joint pain / Douglas W. Lowery and Melissa J. Lamberson. Low back pain / Mel Herbert and Mary Lanctot-Herbert. Pelvic pain / Peter G. Kumasaka. Rash / Jamie Collings and Brigham Temple. Scrotal pain / Jonathan E. Davis. Seizures / Stephen R. Hayden. Shortness of breath in adults / Sharon E. Mace. Shortness of breath in children / Lance Brown and Steven M. Green. Syncope / Amal Mattu. Toxicologic emergencies / Steven A. McLaughlin. Urinary-related complaints / Fred A. Severyn. Vaginal bleeding / Pamela L. Dyne and Rita Oregon. Vomiting / Jennifer A. Oman. Weakness / R. Jason Thurman and Kristy Self Reynolds Unique issues in emergency medicine. Child abuse, elder abuse, intimate partner violence / Carolyn J. Sachs. Environmental emergencies. Ethics and end-of-life issues / Michael A. Gisondi. Legal aspects of emergency care / Gregory Guldner and Amy Leinen. Occupational exposures in the emergency department / Stephen J. Playe and Cemel M. Erdem Appendices. Common emergency procedures / George Sternbach. Wound preparation / Michelle Lin. Laceration repair / F.C. von Trampe and Wendy C. Coates. Procedural sedation and analgesia / Eustacia (Jo) Su and Robert L. Cloutier. Focused assessment with sonography in trauma / Rita A. Sweeney and Diku Mandavia. Interpretation of emergency laboratories / J. Michael Ballester. An Introduction to Clinical Emergency Medicine is a newly-conceived textbook, focusing on the skills necessary to provide emergency care, aimed primarily at medical students. Emergency health care professionals, such as technicians, prehospital care providers, physician assistants, nurses and nurse practitioners will find this book stimulating and tremendously valuable as well