Table Of Content

An Introduction to Clinical Emergency Medicine An Introduction to Clinical Emergency Medicineis a order and interpret appropriate laboratory and much-needed resource for individuals practicing radiographic tests. This textbook also provides this challenging field. This textbook is novel in current management and disposition strategies its approach to emergency medicine topics. It with controversies presented, including pearls, describes in detail the best and most current meth- pitfalls, and myths for topics covered. Chapters odsto care for patients in the emergency depart- are written by nationally- and internationally- ment, including initial evaluation, generation of respected clinicians, educators, and researchers differential diagnoses, problem solving, and in the field of emergency medicine. An Introduction management of challenging conditions based on to Clinical Emergency Medicineoffers just the right presenting symptoms. Unlike other textbooks, in combination of text, clinical images, and practi- which the diagnosis is known, this textbook cal information for students, residents, physician approaches clinical problems as clinicians manage assistants, nurse practitioners, and experienced patients – without full knowledge of the final physicians in all medical disciplines. The over- diagnosis. It provides an understanding for how riding goal of this textbook is to improve the to approach patients with undifferentiated con- practitioner’s understanding of emergency med- ditions, ask the right questions, gather historical icine principles and practice, directly benefiting data, utilize physical examination skills, and patient care in a variety of emergency settings. An Introduction to Clinical Emergency Medicine Swaminatha V. Mahadevan, MD, FACEP, FAAEM Associate Chief, Division of Emergency Medicine Assistant Professor of Surgery (Emergency Medicine) Stanford University School of Medicine Emergency Department Medical Director Medical Student Clerkship Director Stanford University Medical Center, Stanford, CA Gus M. Garmel, MD, FACEP, FAAEM Co-Program Director, Stanford/Kaiser Emergency Medicine Residency Clinical Associate Professor of Surgery (Emergency Medicine) Stanford University School of Medicine Senior Staff Emergency Physician, The Permanente Medical Group Clerkship Director for Medical Students and Rotating Interns Kaiser Permanente Medical Center, Santa Clara, CA    Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo Cambridge University Press The Edinburgh Building, Cambridge  , UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridg e.org /9780521542593 © Cambridge University Press 2005 This publication is in copyright. Subject to statutory exception and to the provision of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published in print format 2005 - ---- eBook (NetLibrary) - --- eBook (NetLibrary) - ---- paperback - --- paperback Cambridge University Press has no responsibility for the persistence or accuracy of s for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Every effort has been made in preparing this book to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use. Contents C o n t e n t s List of contributors xi Foreword xv Acknowledgments xvii Dedication xix Section 1 Principles of Emergency Medicine 1 Approach to the emergency patient 3 Gus M. Garmel 2 Airway management 19 S.V. Mahadevan and Shannon Sovndal 3 Cardiopulmonary and cerebral resuscitation 47 Robert R. Leschke 4 Cardiac dysrhythmias 63 S.V. Gurudevan 5 Shock 85 Robert J. Sigillito and Peter M.C. DeBlieux 6 Traumatic injuries 93 David E. Manthey 7 Prehospital care and emergency medical services 117 Paul D. Biddinger and Stephen H. Thomas 8 Pain management 131 Eustacia (Jo) Su Section 2 Primary Complaints 9 Abdominal pain 145 S.V. Mahadevan Contents v 10 Abnormal behavior 161 C o n t Tim Meyers and Gus M. Garmel e n t s 11 Allergic reactions and anaphylactic syndromes 171 Steven Go 12 Altered mental status 179 Barry Simon and Flavia Nobay 13 Chest pain 193 Jeffrey A. Tabas and Susan B. Promes 14 Constipation 211 Victoria Brazil 15 Crying and irritability 217 Lee W. Shockley 16 Diabetes-related emergencies 225 Christopher R.H. Newton 17 Diarrhea 233 Rawle A. Seupaul 18 Dizziness and vertigo 241 Andrew K. Chang 19 Ear pain, nosebleed and throat pain (ENT) 253 Ear pain 253 Gregory H. Gilbert and S.V. Mahadevan Nosebleed 265 Gregory H. Gilbert Throat pain 273 Michelle Huston 20 Extremity trauma 287 Dan Garza and Gregory W. Hendey vi Contents 21 Eye pain, redness and visual loss 313 C o n Janet G. Alteveer t e n t s 22 Fever in adults 333 Tamas R. Peredy and Gus M. Garmel 23 Fever in children 353 Lynne McCullough and Eric Savitsky 24 Gastrointestinal bleeding 365 J. Scott Taylor 25 Headache 375 Gino A. Farina and Kumar Alagappan 26 Hypertensive urgencies and emergencies 393 Loretta Jackson-Williams and Robert Galli 27 Joint pain 401 Douglas W. Lowery and Melissa J. Lamberson 28 Low back pain 413 Mel Herbert and Mary Lanctot-Herbert 29 Pelvic pain 427 Peter G. Kumasaka 30 Rash 443 Jamie Collings and Brigham Temple 31 Scrotal pain 461 Jonathan E. Davis 32 Seizures 473 Stephen R. Hayden 33 Shortness of breath in adults 485 Sharon E. Mace Contents vii 34 Shortness of breath in children 503 C o n t Lance Brown and Steven M. Green e n t s 35 Syncope 517 Amal Mattu 36 Toxicologic emergencies 531 Steven A. McLaughlin 37 Urinary-related complaints 543 Fred A. Severyn 38 Vaginal bleeding 555 Pamela L. Dyne and Rita Oregon 39 Vomiting 569 Jennifer A. Oman 40 Weakness 581 R. Jason Thurman and Kristy Self Reynolds Section 3 Unique Issues in Emergency Medicine 41 Child abuse, elder abuse, intimate partner violence 607 Carolyn J. Sachs 42 Environmental emergencies 619 Heat illness 619 Ken Zafren Hypothermia 626 Ken Zafren Lightning injuries 633 Ken Zafren Near-drowning 639 Ken Zafren Terrestrial venomous bites and stings 644 Robert L. Norris viii Contents 43 Ethics and end-of-life issues 653 C o n Michael A. Gisondi t e n t s 44 Legal aspects of emergency care 661 Gregory Guldner and Amy Leinen 45 Occupational exposures in the emergency department 669 Stephen J. Playe and Cemil M. Erdem Section 4 Appendices Appendix A Common emergency procedures 681 George Sternbach Peripheral venous cannulation 681 Central venous cannulation 683 Intraosseous infusion 687 Arterial puncture 688 Nasogastric intubation 689 Bladder catheterization 691 Lumbar puncture 693 Slit lamp examination 695 Reduction of dislocations 696 Tube thoracostomy 700 Cervical spine clearance 703 Abscess incision and drainage 704 Appendix B Wound preparation 707 Michelle Lin Appendix C Laceration repair 713 F.C. von Trampe and Wendy C. Coates Appendix D Procedural sedation and analgesia 725 Eustacia (Jo) Su and Robert L. Cloutier Appendix E Focused assessment with sonography in trauma 733 Rita A. Sweeney and Diku Mandavia Contents ix