Rosen's Emergency Medicine: Concepts and Clinical Practice: Volume - 1&2, 9e

Front Matter Copyright Page Acknowledgments Contributors Preface to the Ninth Edition How This Medical Textbook Should Be Viewed by the Practicing Clinician and Judicial System Part I: Fundamental Clinical Concepts Section One: Critical Management Principles Chapter 1: Airway Principles Background Anatomy, Physiology, and Pathophysiology Failure to Maintain or Protect the Airway Failure of Ventilation or Oxygenation Anticipated Clinical Course Identification of the Difficult Airway Difficult Direct Laryngoscopy: LEMON L—Look Externally. E—Evaluate 3-3-2. M—Mallampati Scale. O—Obstruction or Obesity. N—Neck Mobility. Difficult Bag-Mask Ventilation: MOANS Difficult Extraglottic Device Placement: RODS Difficult Cricothyrotomy: SMART Measurement and Incidence of Intubation Difficulty Confirmation of Endotracheal Tube Placement Management Decision Making Difficult Airway Failed Airway Methods of Intubation Rapid Sequence Intubation Preparation. Preoxygenation. Pretreatment. Paralysis With Induction. Positioning. Placement of Tube. Postintubation Management. Delayed Sequence Intubation Blind Nasotracheal Intubation Awake Oral Intubation Oral Intubation Without Pharmacologic Agents Pharmacologic Agents Neuromuscular Blocking Agents Succinylcholine. Uses and Dosing. Cardiovascular Effects. Fasciculations. Hyperkalemia. Masseter Spasm. Malignant Hyperthermia. Competitive Agents. Rocuronium. Paralysis After Intubation. Induction Agents Etomidate. Ketamine. Propofol. Other Induction Agents. Special Clinical Circumstances Status Asthmaticus Hemodynamic Consequences of Intubation Elevated Intracranial Pressure Hypotension and Shock Potential Cervical Spine Injury Airway Devices and Techniques Direct Versus Video Laryngoscopy Videolaryngoscopes Fiberoptic and Video Intubating Stylets Flexible Intubating Scopes Extraglottic Devices Laryngeal Mask Airways. Other Extraglottic Devices. Surgical Airway Management Needle Cricothyrotomy With Transtracheal Jet Ventilation Cricothyrotomy Outcomes References Chapter 1: Questions & Answers Chapter 2: Mechanical Ventilation and Noninvasive Ventilatory Support Perspective Principles of Mechanical Ventilation Physiology of Positive-Pressure Breathing Invasive Mechanical Ventilation: Control Variable and Ventilator Mode Positive End-Expiratory Pressure Noninvasive Techniques Management Decision Making: Noninvasive Versus Invasive Ventilation Approach to Initial Ventilator Settings Noninvasive Ventilation Mechanical Ventilation of the Intubated Patient Ongoing Management Sedation and Analgesia of the Ventilated Patient Complications Troubleshooting the Ventilator Special Clinical Circumstances Acute Exacerbation of Chronic Obstructive Pulmonary Disease Status Asthmaticus Acute Respiratory Distress Syndrome Outcomes References Chapter 2: Questions & Answers Chapter 3: Pain Management Principles Background and Importance Anatomy, Physiology, and Pathophysiology Pain Conduction Pathways Pain Detection Information Transmission Peripheral Nerve Fibers. Pain Transmission Dorsal Horn. Visceral Pain. Ascending Tracts Associated With Pain. Pain Modulation Central Sensitization Pain Expression Reflex Responses to Pain Endorphin System Acute Versus Chronic Pain Management Decision Making Pain Assessment Oligoanalgesia Pain Measurement Treatment Groups Chronic Pain. Recurrent Pain. Chronic Pain of Malignancy. Neuropathic Pain. Acute Pain. Pharmacologic Therapy Opioid Analgesic Agents Mechanism of Action and Toxic Effects. Drug-Seeking Behavior. Administration of Pain Control. Specific Agents Morphine. Meperidine. Hydromorphone. Fentanyl. Oxycodone. Hydrocodone. Codeine. Methadone. Naloxone. Tramadol. Tapentadol. Opioid Agonist-Antagonist Analgesic Agents. Opioid Use for Acute Abdominal Pain. Nonopioid Analgesic Agents Acetaminophen. Nonsteroidal Antiinflammatory Drugs Drug Interactions With Nonsteroidal Antiinflammatory Drugs Aspirin. Oral Anticoagulants. Angiotensin-Converting Enzyme Inhibitors. Diuretics. Glucocorticoids. Lithium. Nonselective Cyclooxygenase Inhibitor Selection. Ketorolac Tromethamine. Ibuprofen. Skeletal Muscle Relaxants. Nitrous Oxide–Oxygen Mixtures. Ketamine. Local Anesthesia Mechanism of Action. Classes of Local Anesthetic Agents. Allergic Reactions. Local and Systemic Toxicity Local Toxicity. Systemic Toxicity. Reducing the Pain of Local Anesthetic Injection. Topical Anesthesia Topical Anesthetics Applied to Intact Skin Eutectic Mixture of Local Anesthetics. Ethyl Chloride and Fluoromethane Sprays. Agents Applied to Mucosal Surfaces Cocaine. Lidocaine. Tetracaine. Benzocaine. Agents Applied to Open Skin: Lidocaine, Epinephrine and Tetracaine. Nonpharmacologic Interventions Transcutaneous Electrical Nerve Stimulation Hypnosis Out-of-Hospital Analgesia Outcomes: Treatment Endpoints References Chapter 3: Questions & Answers Chapter 4: Procedural Sedation and Analgesia Principles Background Terminology Management Decision Making Patient Assessment. Preprocedural Fasting. Personnel. Supplies and Equipment. Monitoring Devices and Techniques. Recovery. Postprocedure Recovery and Discharge. Pharmacologic Therapy Routes of Administration. Opioids. Fentanyl. Morphine. Benzodiazepines. Midazolam. Barbiturates. Ketamine. Sedative-Hypnotics Etomidate. Propofol. Ketamine Plus Propofol. Ultra—Fast-Acting Agents. Reversal and Rescue Agents. Naloxone. Flumazenil. Drug Selection and Administration References Chapter 4: Questions & Answers Chapter 5: Monitoring the Emergency Patient Blood Pressure Measurement Principles Decision Making Devices and Techniques Pulse Oximetry Principles Decision Making Devices and Techniques End-Tidal Carbon Dioxide Monitoring Principles Anatomy and Pathophysiology Management Capnography in Spontaneously Breathing Patients Rapid Assessment of Critically Ill Patients. Assessment and Measurement of Response to Treatment in Patients With Acute Respiratory Distress. During Procedural Sedation and Analgesia. Rapid Assessment of Obtunded or Unconscious Patients. Rapid Assessment of Patients With Severe Illness. Cerebral Function Monitoring Principles Fetal Monitoring Principles Monitor Alarms and Limits References Chapter 5: Questions & Answers Chapter 6: Shock Principles Background and Importance Anatomy, Physiology, and Pathophysiology Specific Causes Hemorrhagic Shock Septic Shock Cardiogenic Shock Neurogenic Shock Management Decision Making Monitoring Perfusion Status Quantitative Resuscitation Pharmacology Volume Replacement Crystalloids. Colloids and Hypertonic Saline. Blood Products. Vasopressors Inotropes Antimicrobial Therapy Corticosteroids Special Cases Devices and Procedures Ventilation Source Control Intraaortic Balloon Pumps and Percutaneous Coronary Intervention Pericardiocentesis and Thrombectomy Outcomes References Chapter 6: Questions & Answers Chapter 7: Brain Resuscitation Principles Background Anatomy, Physiology, and Pathophysiology Elevated Intracranial Pressure Management Decision Making Pharmacology, Devices, and Techniques Cardiopulmonary Resuscitation Reperfusion Optimizing Perfusion and Oxygenation. Elevated Intracranial Pressure Medical Treatment. Surgical Treatment. Maintenance of Body Temperature Resuscitative Mild Hypothermia Avoidance of Hyperglycemia Seizure Management Outcomes Summary References Chapter 7: Questions and Answers Chapter 8: Adult Resuscitation Principles Background Anatomy, Physiology, and Pathophysiology Management Decision Making History and Physical Examination Monitoring Arterial Blood Pressure and Coronary Perfusion Pressure End-Tidal Carbon Dioxide Central Venous Oxygen Saturation Pharmacologic Therapy Devices and Techniques Echocardiography Laboratory Testing Resuscitation Defibrillation Pulseless Electrical Activity Asystole Extracorporeal Cardiopulmonary Resuscitation Outcomes Post–Cardiac Arrest Care Hypothermic Targeted Temperature Management Coronary Angiography and Primary Percutaneous Coronary Intervention References Chapter 8: Questions & Answers Section Two: Signs, Symptoms, and Presentations Chapter 9: Fever in the Adult Patient Perspective Epidemiology Pathophysiology Diagnostic Approach and Algorithm Diagnostic Approach Differential Considerations Pivotal Findings Symptoms Signs Ancillary Testing Diagnostic Algorithm Empirical Management Disposition References Chapter 9: Questions and Answers Chapter 10: Weakness Perspective Epidemiology Pathophysiology Diagnostic Approach and Algorithm Differential Considerations Diagnostic Algorithm Critical Diagnoses Unilateral Weakness Combination of Arm, Hand, or Leg With Ipsilateral Facial Involvement. Combination of Arm, Hand, or Leg With Contralateral Facial Involvement. Combination of Arm, Hand, or Leg Without Facial Involvement. One Limb Only (Monomelic Weakness, Monoparesis, or Monoplegia). Bilateral Weakness Lower Extremities Only (Paraparesis or Paraplegia). Upper Extremities Only. All Four Extremities Without Facial Involvement (Quadriparesis or Quadriplegia). Proximal Portions of Extremities Only. Distal Portions of Extremities Only. Facial Weakness Without Extremity Involvement Unilateral Facial Droop. Facial Weakness Not Limited to Cranial Nerve VII and Muscle of Expression. Pivotal Findings Management Disposition Reference Chapter 10: Questions and Answers Chapter 11: Cyanosis Perspective Epidemiology Pathophysiology Diagnostic Approach Pivotal Findings Symptoms Signs Laboratory and Ancillary Testing Other Diagnostic Modalities Imaging Electrocardiography and Echocardiography Differential Algorithms Critical Diagnoses Emergent Diagnoses Empirical Management Specific Strategies Methemoglobinemia and Sulfhemoglobinemia Other Causes of Cyanosis Patient Disposition Admission Discharge References Chapter 11: Questions and Answers Chapter 12: Syncope Perspective Epidemiology Pathophysiology Diagnostic Approach Differential Considerations Pivotal Findings Symptoms Signs Ancillary Studies Diagnostic Algorithm Empirical Management References Chapter 12: Questions and Answers Chapter 13: Depressed Consciousness and Coma Perspective Epidemiology Pathophysiology Diagnostic Approach Differential Considerations Pivotal Findings Symptoms Signs Ancillary Testing Diagnostic Algorithm Empirical Management References Chapter 13: Questions & Answers Chapter 14: Confusion Perspective Epidemiology Pathophysiology Diagnostic Approach Differential Considerations Pivotal Findings Symptoms Signs Ancillary Testing Diagnostic Algorithm Empirical Management References Chapter 14: Questions & Answers Chapter 15: Seizures Perspective Epidemiology Pathophysiology Diagnostic Approach Differential Considerations Pivotal Findings Symptoms Signs Ancillary Testing Laboratory Testing Imaging Studies Electroencephalography Diagnostic Algorithm Empirical Management Prehospital Management Emergency Department Management Disposition References Chapter 15: Questions & Answers Chapter 16: Dizziness and Vertigo Perspective Pathophysiology Diagnostic Approach Differential Considerations Pivotal Findings Symptoms Physical Examination Vital Signs. Head and Neck. Neurologic Examination. Positional Testing. HINTS. Ancillary Testing Radiologic Imaging. Diagnostic Algorithm Empirical Management Disposition References Chapter 16: Questions & Answers Chapter 17: Headache Perspective Pathophysiology Diagnostic Approach Differential Diagnosis Considerations Pivotal Findings Signs Ancillary Testing Diagnostic Algorithm Empirical Management Disposition References Chapter 17: Questions & Answers Chapter 18: Diplopia Perspective Epidemiology Pathophysiology Diagnostic Approach Differential Considerations Pivotal Findings Symptoms Monocular Cause. Mechanical Orbitopathy. Isolated Oculomotor Nerve Palsy. Neuroaxial Process Involving the Brainstem and Related Cranial Nerves. Neuromuscular Disorder. Signs Monocular Cause. Mechanical Orbitopathy. Isolated Oculomotor Nerve Palsy. Neuroaxial Process Involving the Brainstem and Related Cranial Nerves. Neuromuscular Disorder. Ancillary Testing Diagnostic Algorithm Empirical Management Management Algorithm References Chapter 18: Questions & Answers Chapter 19: Red and Painful Eye Perspective Epidemiology and Pathophysiology Diagnostic Approach Differential Diagnosis Considerations Pivotal Findings Symptoms Signs Visual Acuity Visual Field Testing External Examination Extraocular Muscle Function Pupillary Evaluation Ancillary Testing Swinging Flashlight Test Pressure Determination Slit-Lamp Examination Direct Funduscopic Examination Topical Anesthetics Imaging Laboratory Testing Diagnostic Algorithm Critical Diagnoses Emergent Diagnoses Urgent Diagnoses Empirical Management References Chapter 19: Questions & Answers Chapter 20: Sore Throat Perspective Epidemiology Pathophysiology Diagnostic Approach Differential Considerations Pivotal Findings Symptoms and Signs Ancillary Testing Imaging Diagnostic Algorithm Critical and Emergent Diagnoses Empirical Management References Chapter 20: Questions & Answers Chapter 21: Hemoptysis Perspective Epidemiology Pathophysiology Diagnostic Approach Differential Diagnosis Considerations Pivotal Findings Symptoms Signs Ancillary Testing Diagnostic Algorithm Critical Diagnoses Bronchoscopy Empirical Management References Chapter 21: Questions & Answers Chapter 22: Dyspnea Perspective Epidemiology Pathophysiology Diagnostic Approach Differential Diagnosis Considerations Pivotal Findings Symptoms Duration of Dyspnea. Onset of Dyspnea. Positional Changes. Signs Ancillary Testing Diagnostic Algorithm Critical Diagnoses Emergent Diagnoses Empirical Management References Chapter 22: Questions & Answers Chapter 23: Chest Pain Perspective Epidemiology Pathophysiology Diagnostic Approach Differential Considerations Rapid Stabilization and Assessment Pivotal Findings History Physical Examination Ancillary Studies Diagnostic Table Empirical Management References Chapter 23: Questions & Answers Chapter 24: Abdominal Pain Perspective Epidemiology Pathophysiology Diagnostic Approach Differential Diagnosis Considerations Rapid Assessment and Stabilization Pivotal Findings Symptoms Signs Ancillary Testing Diagnostic Algorithm Critical Diagnoses Emergent Diagnoses Empirical Management Disposition Bibliography Chapter 24: Questions & Answers Chapter 25: Jaundice Perspective Epidemiology Pathophysiology Normal Bilirubin Metabolism Abnormalities in Bilirubin Metabolism Diagnostic Approach Differential Diagnosis Considerations Pivotal Findings Symptoms Signs Laboratory Tests Imaging Diagnostic Algorithm Empirical Management References Chapter 25: Questions & Answers Chapter 26: Nausea and Vomiting Perspective Epidemiology Pathophysiology Diagnostic Approach Differential Diagnosis Considerations Pivotal Findings Symptoms Signs Ancillary Studies Diagnostic Algorithm Empirical Management Special Situations Opioid-Induced Vomiting Headache Pregnancy Chemotherapy Cyclical Vomiting Vertigo Disposition References Chapter 26: Questions & Answers Chapter 27: Gastrointestinal Bleeding Perspective Diagnostic Approach Differential Considerations Pivotal Findings Symptoms Relevant Medical History Signs Ancillary Testing Occult Blood and Guaiac Bedside Testing Laboratory Studies Electrocardiography Imaging Diagnostic Algorithm Management Empirical Treatment Resuscitation Blood Product Transfusion Nasogastric Aspiration and Lavage Sengstaken-Blakemore Tube Pharmacologic Agents Definitive Management Consultation Endoscopy Colonoscopy Disposition References Chapter 27: Questions & Answers Chapter 28: Diarrhea Perspective Epidemiology Pathophysiology Diagnostic Approach Differential Diagnosis Considerations Pivotal Findings Signs and Symptoms Ancillary Testing Blood Tests. Lactate. Hemoccult and Fecal Cell Count. Assays for Fecal Calprotectin and Fecal Lactoferrin. Clostridium difficile Toxin Assay. Escherichia coli O157:H7 Toxin Assay. Stool Culture for Bacteria. Stool Examination for Ova and Parasites. Giardia Antigen Assay and Serologic Testing for Amebiasis. Radiographic Studies. Gastrointestinal Referral. Diagnostic Algorithm Critical Diagnoses Emergent Diagnoses Empirical Management References Chapter 28: Questions & Answers Chapter 29: Constipation Principles Epidemiology Pathophysiology Diagnostic Approach Differential Diagnosis Considerations Pivotal Findings Symptoms Signs Ancillary Testing Diagnostic Algorithm Empirical Management References Chapter 29: Questions & Answers Chapter 30: Acute Pelvic Pain Perspective Epidemiology Pathophysiology Diagnostic Approach Differential Considerations Pivotal Findings Symptoms Signs Ancillary Testing Diagnostic Algorithm Empirical Management References Chapter 30: Questions & Answers Chapter 31: Vaginal Bleeding Perspective Epidemiology Pathophysiology Nonpregnant Patients Pregnant Patients Diagnostic Approach Differential Considerations Pivotal Findings Symptoms Signs Ancillary Testing Diagnostic Algorithm Empirical Management Disposition References Chapter 31: Questions & Answers Chapter 32: Back Pain Perspective Epidemiology Pathophysiology II. Diagnostic Approach Differential Considerations Pivotal Findings Symptoms Signs Ancillary Testing Laboratory Tests Imaging Diagnostic Algorithm Critical Diagnoses Empirical Management Acknowledgments References Chapter 32: Questions & Answers Part II: Trauma Section One: General Concepts and System Injuries Chapter 33: Multiple Trauma Principles Epidemiology Anatomy and Physiology Pathophysiology Clinical Features Primary Survey Secondary Survey Differential Diagnoses Diagnostic Testing Laboratory Evaluation Radiographic Evaluation Management Out-of-Hospital Management Emergency Department Disposition References Chapter 33: Questions & Answers Chapter 34: Head Trauma Principles of Disease Background and Importance Anatomy and Pathophysiology Scalp and Cranium Brain and Cerebrospinal Fluid Cerebral Hemodynamics and Increased Intracranial Pressure Increased Intracranial Pressure Cushing’s Reflex Definitions and Patterns of Injury Traumatic Brain Injuries: Severe, Moderate, and Mild Direct and Indirect Injuries Direct Injury. Indirect Injury. Neurochemical Cascade Penetrating Head Trauma Scalp Wounds Skull Fractures Linear Fractures Depressed Fractures Basilar Fractures Extra-Axial and Intra-Axial Intracranial Injuries Extra-Axial Injury Epidural Hematoma. Subdural Hematoma. Traumatic Subarachnoid Hemorrhage. Subdural Hygroma. Intra-Axial Injury Diffuse Axonal Injury and Traumatic Axonal Injury. Cerebral Contusions. Intracerebral Hematoma. Intracerebellar Hematoma. Primary and Secondary Brain Injuries Primary Brain Injury Secondary Systemic Insults Hypotension. Hypoxia. Hypocarbia and Hypercarbia. Anemia. Hyperpyrexia. Altered Levels of Consciousness Cerebral Herniation Syndromes Uncal Herniation Central Transtentorial Herniation Cerebellotonsillar Herniation Upward Transtentorial Herniation Moderate and Severe Traumatic Brain Injury Clinical Features and History Common Presentations of Specific Lesions Epidural Hematoma Subdural Hematoma Traumatic Subarachnoid Hemorrhage Subdural Hygroma Traumatic Axonal Injury Cerebral Contusion Intracerebral Hematoma Traumatic Intracerebellar Hematoma Physical Examination Acute Neurologic Examination General. Glasgow Coma Scale. Pupillary Examination. Motor Examination. Brainstem Function. Differential Diagnosis Diagnostic Testing Laboratory Tests Neuroimaging Skull Radiography. Computed Tomography. Pneumocephalus. Epidural Hematoma. Subdural Hematoma. Traumatic Subarachnoid Hemorrhage. Subdural Hygroma. Diffuse Axonal Injury/ Traumatic Axonal Injury. Cerebral Contusions. Intracerebral Hematoma. Traumatic Intracerebellar Hematoma. Cerebral Edema. Rotterdam Computed Tomography Score. Management Out-of-Hospital Care Airway. Hypotension. Agitation. Emergency Department Management General. Airway. Hypotension. Brain-Directed Hyperosmolar Therapy. Hyperventilation. Cranial Decompression. Hemostatic Agents. Induced Hypothermia. Seizure Prophylaxis. Antibiotic Prophylaxis. Other Therapies Corticosteroids. Barbiturates. Monitoring of Intracranial Pressure and Cerebral Spinal Fluid Drainage. Glucose Control and Nutrition. Erythropoietin. Progesterone. Hyperbaric Oxygen Therapy. Management of Specific Injuries Scalp Wounds. Skull Fractures. Linear Fractures. Depressed Fractures. Basilar Skull Fractures. Extra-Axial Lesions Epidural Hematoma. Subdural Hematoma. Traumatic Subarachnoid Hemorrhage. Subdural Hygroma. Intra-Axial Lesions Cerebral Contusion. Intracerebral Hematoma. Intracerebellar Hematoma. Complications and Outcome Seizures Central Nervous System Infections Meningitis After Basilar Fractures. Brain Abscess. Cranial Osteomyelitis. Medical Complications Disseminated Intravascular Coagulation. Neurogenic Pulmonary Edema. Cardiac Dysfunction. Disposition Mild Traumatic Brain Injury Clinical Features and History Physical Examination Differential Diagnosis Diagnostic Testing Neuroimaging in the Emergency Department With Computed Tomography Other Neuroimaging Modalities Structural MRI. Susceptibility-Weighted Imaging. Diffusion Tensor Imaging. Computed Tomography Angiography and Magnetic Resonance Angiography. Ancillary Studies Laboratory Testing. Neuropsychological Testing. Disposition Complications Postconcussive Syndrome Seizures Posttraumatic Transient Cortical Blindness Special Populations With Mild Traumatic Brain Injury Mild Traumatic Brain Injury and Concussion in Sports Military Personnel and Blast Injury Anticoagulated Patients Patients on Anticoagulant Medications. Patients With Inherent Bleeding Disorders. Head Trauma in Older Adults References Chapter 34: Questions & Answers Chapter 35: Facial Trauma Principles Background and Importance Anatomy of the Face Bones Nerve Supply Ears Eyes Nose Mouth Temporomandibular Joint Soft Tissue, Vasculature, and Specialized Glands Pathophysiology Clinical Features History Physical Examination Eyes and Orbits. Oropharynx. Ears. Nose. Neurologic Examination Differential Diagnosis Based on Anatomic Site Soft Tissue Injuries and Lacerations Mouth Perioral Burns Cheeks Nose Ears Eyes Fractures and Dislocations Forehead Orbit Midface Zygoma Mandible Dental and Alveolar Trauma Temporomandibular Joint Diagnostic Testing Imaging Management Out-of-Hospital Care Emergency Department Treatment General Measures Disposition References Chapter 35: Questions & Answers Chapter 36: Spinal Injuries Principles Background and Importance Anatomy and Physiology Pathophysiology Classification of Spinal Column Injuries Flexion. Shear Injury. Flexion-Rotation. Extension. Vertical Compression. Classification of Spinal Cord Injuries Primary Spinal Cord Injury. Secondary Spinal Cord Injury. Classification of Cervical Soft Tissue Injuries Clinical Features Neurologic Evaluation Spinal Cord Lesions Complete Spinal Cord Lesions Incomplete Spinal Cord Lesions Differential Diagnosis Diagnostic Testing Radiographic Evaluation Indications Cervical Plain Radiographs Cross-Table Lateral View. Odontoid View. Anteroposterior View. Flexion and Extension Views. Advanced Imaging: Computed Tomography and Magnetic Resonance Management Spinal Column Stabilization Out-of-Hospital Care Emergency Department Airway Management Spinal Shock Pharmacologic Treatment for Incomplete Cord Injury Associated Injuries Cardiopulmonary Gastrointestinal and Genitourinary Skin Definitive Treatment and Prognosis Disposition Cervical Soft Tissue Injuries Minor Fractures References Chapter 36: Questions & Answers Chapter 37: Neck Principles Background Anatomy Pathophysiology Clinical Features Differential Diagnosis Diagnostic Testing Management Airway Breathing Circulation Cervical Spine Thoracotomy Venous/Arterial Air Embolism Nasogastric Tubes Pharyngoesophageal Trauma Principles Epidemiology Pathophysiology Clinical Features Diagnostic Testing Management Laryngotracheal Trauma Principles Clinical Features Diagnostic Testing Management Vascular Trauma Principles Penetrating Injury Blunt Injury Clinical Features Penetrating Injury Blunt Trauma Diagnostic Testing Penetrating Trauma Blunt Trauma Other Radiographic Options Management Penetrating Injury Blunt Injury Nervous System, Glandular, and Retropharyngeal Injuries Near Hanging and Strangulation Principles Clinical Features Diagnostic Testing Management Disposition References Chapter 37: Questions & Answers Chapter 38: Thoracic Trauma Chest Wall Injury Rib Fracture Principles Background and Importance Anatomy and Physiology Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Sternal Fracture Principles Background and Importance Pathophysiology Clinical Features Diagnostic Testing Management Nonpenetrating Ballistic Injury Principles Background and Importance Pathophysiology Clinical Features Diagnostic Testing Management Disposition Pulmonary Injuries Pulmonary Contusion and Laceration Principles Background and Importance Pathophysiology Clinical Features Diagnostic Testing Laboratory Radiology Management Pneumothorax Principles Background and Importance Pathophysiology Simple Pneumothorax. Communicating Pneumothorax. Tension Pneumothorax. Clinical Features Diagnostic Testing Occult Pneumothorax Management Simple Pneumothorax Communicating Pneumothorax Tension Pneumothorax Hemothorax Principles Background and Importance Pathophysiology Clinical Features Diagnostic Testing Management Tracheobronchial Injury Principles Background and Importance Pathophysiology Clinical Features Diagnostic Testing Management Diaphragmatic Injury Principles Background and Importance Pathophysiology Diagnostic Testing Management Cardiovascular Trauma Blunt Cardiac Trauma Myocardial Concussion Principles Background and Importance Pathophysiology Clinical Features Diagnostic Testing Laboratory Tests and Electrocardiogram Management Disposition Myocardial Contusion Principles Background and Importance Pathophysiology Clinical Features Diagnostic Testing Laboratory Tests and Electrocardiogram Electrocardiogram. Cardiac Biomarkers. Imaging Management Disposition Myocardial Rupture Principles Background and Importance Anatomy and Physiology Pathophysiology Clinical Features Diagnostic Testing Management Penetrating Cardiac Trauma Acute Pericardial Tamponade Principles Background and Importance Pathophysiology Clinical Features Diagnostic Testing Radiology Ultrasound. Radiography. Electrocardiography Management Emergency Department Thoracotomy Indications for Emergency Department Thoracotomy. Blunt Aortic Injury Principles Background and Importance Pathophysiology Clinical Features Diagnostic Testing Chest Radiography Chest Computed Tomography Scan Management Stabilization and Empirical Therapy Definitive Management Endovascular Repair. Esophageal Perforation Principles Background and Importance Pathophysiology Clinical Features Iatrogenic Foreign Bodies Caustic Burns Penetrating and Blunt Trauma Spontaneous Rupture Diagnostic Testing Radiology Endoscopy Management References Chapter 38: Questions & Answers Chapter 39: Abdominal Trauma Principles Background Penetrating Abdominal Trauma Blunt Abdominal Trauma Anatomy and Physiology Pathophysiology Penetrating Abdominal Trauma Stab Wounds. Gunshot Wounds: Ballistics. High-Velocity Missiles. Shotgun Wounds. Blunt Abdominal Trauma Seatbelt Injuries. Iatrogenic Injuries. Clinical Features Penetrating Abdominal Trauma Stab Wounds. Gunshot Wounds. Blunt Abdominal Trauma Physical Examination Penetrating Abdominal Trauma Stab Wounds. Gunshot Wounds. Blunt Abdominal Trauma Differential Diagnoses Trauma Versus Medical Condition Single Versus Multisystem Trauma Single Versus Multiple Intraperitoneal Organ Injury Intraperitoneal Injury Versus Necessary Laparotomy Diagnostic Testing Ultrasonography Laboratory Hematocrit White Blood Cell Count Chemistry Radiology Plain Radiographs Computed Tomography Magnetic Resonance Imaging Management Penetrating Abdominal Trauma: Stab Wounds Anterior Abdomen Step I: Clinical Indications for Emergent Laparotomy. Step II: Peritoneal Violation. Step III: Injury Requiring Laparotomy. Thoracoabdominal Penetration Flank and Back Penetrating Abdominal Trauma: Gunshot Wounds Step I: Clinical Indications for Laparotomy Step II: Peritoneal Violation Thoracoabdominal Flank and Back Shotgun Wounds Blunt Abdominal Trauma Operative Versus Nonoperative Management Pelvic Fracture Multiple System Injury Bedside Procedures Diagnostic Peritoneal Lavage Local Wound Exploration Therapeutic Angioembolization Disposition Consultation Transfer References Chapter 39: Questions & Answers Chapter 40: Genitourinary System Principles Background and Importance Anatomy and Physiology Pathophysiology Renal Trauma Clinical Features Differential Diagnosis Diagnostic Testing Management Ureteral Trauma Clinical Features Differential Diagnosis Diagnostic Testing Management Bladder Trauma Clinical Features Differential Diagnosis Diagnostic Testing Management Urethral Trauma Clinical Features Differential Diagnosis Diagnostic Testing Management Genital Trauma Clinical Features Differential Diagnoses Diagnostic Testing Imaging Management References Chapter 40: Questions & Answers Chapter 41: Peripheral Vascular Injury Principles Background and Importance Anatomy and Physiology Upper Extremity Lower Extremity Pathophysiology Penetrating Trauma Blunt Trauma Complete Occlusive Injury Transection. Thrombosis. Reversible Arterial Spasm. Nonocclusive Injuries Intimal Flap. Pseudoaneurysm. Arteriovenous Fistula. Compartment Syndrome. Clinical Features Hard Findings of Vascular Injury Soft Findings of Vascular Injury Asymptomatic High-Risk Wounds History Physical Examination Differential Diagnoses Diagnostic Testing Plain Radiography Pulse Oximetry and Near-Infrared Spectroscopy Handheld Doppler Arterial Pressure Index and Ankle-Brachial Index Ultrasound Computed Tomography and Magnetic Resonance Imaging Arteriography Diagnosis of Specific Vascular Injuries Management Major Vascular I