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Tintinalli's Emergency Medicine Manual 7/E (Emergency Medicine PDF

988 Pages·2012·17.98 MB·English
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Tintinalli’s Emergency Medicine Manual Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confi rm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. Tintinalli’s Emergency Medicine Manual David M. Cline, MD Professor and Director of Departmental Research Department of Emergency Medicine Wake Forest University School of Medicine Winston-Salem, North Carolina O. John Ma, MD Professor and Chair Department of Emergency Medicine Oregon Health & Science University Portland, Oregon Rita K. Cydulka, MD, MS Professor and Vice Chair Department of Emergency Medicine MetroHealth Medical Center Case Western Reserve University Cleveland, Ohio Garth D. Meckler, MD, MSHS Associate Professor Assistant Section Chief and Fellowship Director Department of Emergency Medicine and Pediatrics Oregon Health & Science University Portland, Oregon Stephen H. Thomas, MD, MPH George Kaiser Family Foundation Professor & Chair Department of Emergency Medicine University of Oklahoma School of Community Medicine Tulsa, Oklahoma Daniel A. Handel, MD, MPH Associate Professor Department of Emergency Medicine Oregon Health & Science University Portland, Oregon New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2012, 2004, 2000, 1996, by The McGraw-Hill Companies, Inc. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. ISBN: 978-0-07-178520-4 MHID: 0-07-178520-5 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-178184-8, MHID: 0-07-178184-6. All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefi t of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this book, they have been printed with initial caps. McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs. To contact a representative please e-mail us at [email protected]. TERMS OF USE This is a copyrighted work and The McGraw-Hill Companies, Inc. (“McGraw-Hill”) and its licensors reserve all rights in and to the work. Use of this work is subject to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill’s prior consent. You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may be terminated if you fail to comply with these terms. THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free. Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill has no responsibility for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. Contents Contributors xi Preface xvii Section 1 Resuscitative Problems and Techniques 1 1 Advanced Airway Support Robert J. Vissers 1 2 Arrhythmia Management James K. Takayesu 8 3 Resuscitation of Children and Neonates Marc F. Collin 26 4 Fluids, Electrolytes, and Acid-Base Disorders Mary A. Wittler 33 5 Therapeutic Approach to the Hypotensive Patient John E. Gough 47 6 Anaphylaxis, Acute Allergic Reactions, and Angioedema Alix L. Mitchell 52 Section 2 Analgesia, Anesthesia, and Sedation 55 7 Acute Pain Management and Procedural Sedation Boris Garber 55 8 Management of Patients With Chronic Pain David M. Cline 64 Section 3 Emergency Wound Management 69 9 Evaluating and Preparing Wounds Timothy Reeder 69 10 Methods for Wound Closure David M. Cline 73 11 Lacerations to the Face and Scalp J. Hayes Calvert 80 12 Injuries of the Arm, Hand, Fingertip, and Nail David M. Cline 86 13 Lacerations to the Leg and Foot Henderson D. McGinnis 93 14 Soft Tissue Foreign Bodies Rodney L. McCaskill 97 15 Puncture Wounds and Mammalian Bites David M. Cline 100 16 Post Repair Wound Care Eugenia B. Quackenbush 107 Section 4 Cardiovascular Diseases 111 17 Chest Pain: Cardiac or Not Thomas Rebbecchi 111 18 Acute Coronary Syndromes: Management of Myocardial Infarction and Unstable Angina Jim Edward Weber 117 19 Cardiogenic Shock Brian Hiestand 124 20 Low Probability Acute Coronary Syndromes Chadwick D. Miller 127 21 Syncope Michael G. Mikhail 131 22 Congestive Heart Failure and Acute Pulmonary Edema Lori Whelan 135 23 Valvular Emergencies Boyd Burns 138 24 The Cardiomyopathies, Myocarditis, and Pericardial Disease N. Stuart Harris 144 25 Thromboembolism Christopher Kabrhel 150 26 Systemic and Pulmonary Hypertension David M. Cline 156 27 Aortic Dissection and Aneurysms David E. Manthey 160 28 Occlusive Arterial Disease Carolyn K. Synovitz 165 Section 5 Pulmonary Emergencies 167 29 Respiratory Distress Joshua T. Hargraves 167 30 Bronchitis, Pneumonia, and SARS Jeffrey M. Goodloe 172 31 Tuberculosis Amy J. Behrman 177 32 Spontaneous and Iatrogenic Pneumothorax Rodney L. McCaskill 181 33 Hemoptysis Jeffrey Dixon 183 34 Asthma and Chronic Obstructive Pulmonary Disease Joshua Gentges 185 v vi Contents Section 6 Gastrointestinal Emergencies 189 35 Acute Abdominal Pain David M. Cline 189 36 Nausea and Vomiting Jonathan A. Maisel 193 37 Disorders Presenting Primarily With Diarrhea Jonathan A. Maisel 196 38 Acute and Chronic Constipation Jonathan A. Maisel 204 39 Gastrointestinal Bleeding Mitchell C. Sokolosky 207 40 Esophageal Emergencies Mitchell C. Sokolosky 209 41 Peptic Ulcer Disease and Gastritis Matthew C. Gratton 215 42 Pancreatitis and Cholecystitis Casey Glass 218 43 Acute Appendicitis Charles E. Stewart 223 44 Diverticulitis James O’Neill 226 45 Intestinal Obstruction and Volvulus Mark Hess 228 46 Hernia in Adults and Children Dave W. Lu 230 47 Anorectal Disorders Chad E. Branecki 233 48 Jaundice, Hepatic Disorders, and Hepatic Failure Joshua Gentges 239 49 Complications of General Surgical Procedures Daniel J. Egan 247 Section 7 Renal and Genitourinary Disorders 251 50 Acute Renal Failure Marc D. Squillante 251 51 Rhabdomyolysis Michael D. Levine 256 52 Emergencies in Renal Failure and Dialysis Patients Jonathan A. Maisel 258 53 Urinary Tract Infections and Hematuria Ann T. McIntosh 261 54 Acute Urinary Retention Casey Glass 265 55 Male Genital Problems Eric J. Brown 268 56 Urologic Stone Disease Geetika Gupta 273 57 Complications of Urologic Devices William K. Gray 276 Section 8 Gynecology and Obstetrics 279 58 Vaginal Bleeding and Pelvic Pain in the Nonpregnant Patient Thomas W. Lukens 279 59 Ectopic Pregnancy and Emergencies in the First 20 Weeks of Pregnancy Robert Jones 284 60 Comorbid Diseases in Pregnancy Abigail D. Hankin 289 61 Emergencies After 20 Weeks of Pregnancy and the Postpartum Period Howard Roemer 295 62 Emergency Delivery Stacie Zelman 299 63 Vulvovaginitis Stacie Zelman 304 64 Pelvic Infl ammatory Disease and Tubo-Ovarian Abscess Paul W. Beck 307 65 Complications of Gynecologic Procedures Anitha Mathew 310 Section 9 Pediatrics 313 66 Fever and Serious Bacterial Illness in Children Milan D. Nadkarni 313 67 Common Neonatal Problems Lance Brown 319 68 Common Infections of the Ears, Nose, Neck, and Throat David M. Spiro 325 69 Upper Respiratory Emergencies—Stridor and Drooling Kathleen M. Adelgais 332 70 Wheezing in Infants and Children Donald H. Arnold 339 71 Pneumonia in Infants and Children Lance Brown 344 72 Pediatric Heart Disease Garth D. Meckler 347 73 Vomiting and Diarrhea in Infants and Children Stephen B. Freedman 353 74 Pediatric Abdominal Emergencies Mark R. Zonfrillo 357 75 Pediatric Urinary Tract Infections Lance Brown 363 76 Seizures and Status Epilepticus in Children Maya Myslenski 365 77 Headache and Altered Mental Status in Children Kathleen M. Adelgais 369 78 Syncope and Sudden Death in Children and Adolescents Derya Caglar 373 Contents vii 79 Hypoglycemia and Metabolic Emergencies in Infants and Children Matthew Hansen 376 80 The Diabetic Child Adam Vella 380 81 Fluid and Electrolyte Therapy Lance Brown 382 82 Musculoskeletal Disorders in Children Mark X. Cicero 386 83 Rashes in Infants and Children Lance Brown 394 84 Sickle Cell Anemia in Children Ilene Claudius 404 85 Hematologic-Oncologic Emergencies in Children Ilene Claudius 409 86 Renal Emergencies in Infants and Children Deborah R. Liu 415 Section 10 Infectious and Immunologic Diseases 419 87 Sexually Transmitted Diseases David M. Cline 419 88 Toxic Shock Vicky Weidner 427 89 Septic Shock John E. Gough 431 90 Soft Tissue Infections Chris Melton 436 91 Disseminated Viral Infections Matthew J. Scholer 442 92 HIV Infections and AIDS Scott Felten 447 93 Infective Endocarditis John C. Nalagan 453 94 Tetanus and Rabies Vincent Nacouzi 456 95 Malaria David M. Cline 460 96 Foodborne and Waterborne Diseases David M. Cline 464 97 Zoonotic Infections Christopher R. Tainter 466 98 World Travelers David M. Cline 473 99 The Transplant Patient David M. Cline 480 Section 11 Toxicology and Pharmacology 489 100 General Management of the Poisoned Patient L. Keith French 489 101 Anticholinergic Toxicity O. John Ma 497 102 Psychopharmacologic Agents C. Crawford Mechem 499 103 Sedatives and Hypnotics L. Keith French 507 104 Alcohols Michael P. Kefer 512 105 Drugs of Abuse Jeanmarie Perrone 516 106 Analgesics Joshua N. Nogar 521 107 Xanthines and Nicotine Jean C.Y. Lo 529 108 Cardiac Medications D. Adam Algren 533 109 Anticonvulsants Alicia Minns 545 110 Iron O. John Ma 549 111 Hydrocarbons and Volatile Substances Allyson A. Kreshak 553 112 Caustics Christian A. Tomaszewski 556 113 Pesticides Christian A. Tomaszewski 558 114 Metals and Metalloids D. Adam Algren 562 115 Industrial Toxins and Cyanide Christian A. Tomaszewski 568 116 Herbals and Vitamins Stephen L. Thornton 572 117 Dyshemoglobinemias B. Zane Horowitz 574 Section 12 Environmental Injuries 577 118 Frostbite and Hypothermia Michael C. Wadman 577 119 Heat Emergencies T. Paul Tran 581 120 Bites and Stings Burton Bentley II 585 121 Trauma and Envenomation from Marine Fauna Christian A. Tomaszewski 593 122 High-Altitude Medical Problems Shaun D. Carstairs 597 123 Dysbarism and Complications of Diving Christian A. Tomaszewski 600 124 Near Drowning Richard A. Walker 602 125 Thermal and Chemical Burns Sandra L. Werner 604 viii Contents 126 Electrical and Lightning Injuries Sachita Shah 611 127 Carbon Monoxide Christian A. Tomaszewski 617 128 Mushroom and Plant Poisoning B. Zane Horowitz 620 Section 13 Endocrine Emergencies 627 129 Diabetic Emergencies Michael P. Kefer 627 130 Alcoholic Ketoacidosis Michael P. Kefer 635 131 Thyroid Disease Emergencies Katrina A. Leone 637 132 Adrenal Insuffi ciency and Adrenal Crisis Michael P. Kefer 641 Section 14 Hematologic and Oncologic Emergencies 645 133 Evaluation of Anemia and the Bleeding Patient Daniel A. Handel 645 134 Acquired Bleeding Disorders Aaron Barksdale 651 135 Hemophilias and von Willebrand Disease Daniel A. Handel 656 136 Sickle Cell Disease and Other Hereditary Hemolytic Anemias Jason B. Hack 662 137 Transfusion Therapy T. Paul Tran 667 138 Anticoagulants, Antiplatelet Agents, and Fibrinolytics Jessica L. Smith 673 139 Emergency Complications of Malignancy Ross J. Fleischman 678 Section 15 Neurology 685 140 Headache and Facial Pain Steven Go 685 141 Stroke, Transient Ischemic Attack, and Subarachnoid Hemorrhage Steven Go 691 142 Altered Mental Status and Coma C. Crawford Mechem 706 143 Ataxia and Gait Disturbances Ross J. Fleischman 712 144 Vertigo and Dizziness Steven Go 715 145 Seizures and Status Epilepticus in Adults C. Crawford Mechem 721 146 Acute Peripheral Neurological Lesions Jeffrey L. Hackman 726 147 Chronic Neurologic Disorders Sarah Andrus Gaines 729 148 Central Nervous System and Spinal Infections O. John Ma 734 Section 16 Eye, Ear, Nose, Throat, and Oral Emergencies 739 149 Ocular Emergencies Steven Go 739 150 Face and Jaw Emergencies Jeffrey G. Norvell 752 151 Ear, Nose, and Sinus Emergencies Medley D. Gatewood 756 152 Oral and Dental Emergencies Steven Go 762 153 Neck and Upper Airway Disorders Aaron Barksdale 769 Section 17 Disorders of the Skin 773 154 Dermatologic Emergencies Daniel A. Handel 773 155 Other Dermatologic Disorders Daniel A. Handel 780 Section 18 Trauma 787 156 Trauma in Adults Jonathan S. Ilgen 787 157 Trauma in Children Matthew Hansen 791 158 Trauma in the Elderly O. John Ma 795 159 Trauma in Pregnancy Nicole M. DeIorio 798 160 Head Trauma in Adults and Children O. John Ma 801 161 Spine and Spinal Cord Injuries in Adults and Children Todd W. Ellingson 807 162 Facial Injuries Jonathan S. Ilgen 813 163 Trauma to the Neck Katrina A. Leone 818 164 Cardiothoracic Trauma Ross J. Fleischman 822 165 Abdominal Injuries O. John Ma 828 166 Penetrating Trauma to the Flank and Buttocks Christine Sullivan 833 Contents ix 167 Genitourinary Injuries Matthew C. Gratton 835 168 Penetrating Trauma to the Extremities Amy M. Stubbs 839 Section 19 Injuries to the Bones, Joints, and Soft Tissue 843 169 Initial Evaluation and Management of Orthopedic Injuries Michael P. Kefer 843 170 Hand and Wrist Injuries Michael P. Kefer 847 171 Forearm and Elbow Injuries Sandra L. Najarian 852 172 Shoulder and Humerus Injuries Sandra L. Najarian 856 173 Pelvis, Hip, and Femur Injuries Jeffrey G. Norvell 861 174 Knee and Leg Injuries Sandra L. Najarian 867 175 Ankle and Foot Injuries Sarah Andrus Gaines 871 176 Compartment Syndromes Sandra L. Najarian 875 Section 20 Nontraumatic Musculoskeletal Disorders 877 177 Neck and Thoracolumbar Pain Amy M. Stubbs 877 178 Shoulder Pain Andrew D.Perron 882 179 Hip and Knee Pain Jeffrey L. Hackman 885 180 Acute Disorders of the Joints and Bursae Andrew D. Perron 889 181 Emergencies in Systemic Rheumatic Diseases Michael P. Kefer 894 182 Infectious and Noninfectious Disorders of the Hand Michael P. Kefer 899 183 Soft Tissue Problems of the Foot Robert L. Cloutier 902 Section 21 Psychosocial Disorders 907 184 Clinical Features of Behavioral Disorders Lance H. Hoffman 907 185 Emergency Assessment and Stabilization of Behavioral Disorders Lance H. Hoffman 910 186 Panic and Conversion Disorders Lance H. Hoffman 914 Section 22 Abuse and Assault 919 187 Child and Elderly Abuse Jonathan Glauser 919 188 Sexual Assault and Intimate Partner Violence and Abuse Sara Laskey 922 Index 927

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The full spectrum of emergency medicine at your fingertips -- and small enough to fit in a pocket NOW IN FULL COLOR Written by clinicians engaged in the day-to-day practice of emergency medicine, this handy manual is derived from Tintinalli’s Emergency Medicine, 7e, the field’s most trusted text
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