Acquisitions Editor: Jamie M. Elfrank Product Development Editor: Ashley Fischer Editorial Assistant: Brian Convery Marketing Manager: Stephanie Kindlick Production Project Manager: David Orzechowski Design Coordinator: Stephen Druding Manufacturing Coordinator: Beth Welsh Prepress Vendor: Absolute Service, Inc. Copyright © 2016 Wolters Kluwer All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at [email protected], or via our website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Printed in China Library of Congress Cataloging-in-Publication Data Atlas of clinical emergency medicine / [lead editor] Scott C. Sherman ; editors, Stephen John Cico, Erik Nordquist, Christopher Ross, Ernest Wang. — 1st edition. p. ; cm. ISBN 978-1-4511-8882-0 I. Sherman, Scott C., editor. II. Cico, Stephen John, editor. III. Nordquist, Erik, editor. IV. Ross, Christopher (Professor of emergency medicine), editor. V. Wang, Ernest, editor. [DNLM: 1. Emergencies—Atlases. 2. Emergency Treatment—Atlases. 3. Wounds and Injuries—diagnosis —Atlases. WB 17] RC86.7 616.02′50222—dc23 2015021071 This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work. This work is no substitute for individual patient assessment based on healthcare professionals’ examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data, and other factors unique to the patient. The publisher does not provide medical advice or guidance, and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments. Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings, and side effects and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used, or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law, or otherwise, or from any reference to or use by any person of this work. LWW.com To my father, for being an example of courage, compassion, and perseverance. —SCOTT C. SHERMAN, MD I would like to thank my spouse, Dr. Lane Coffee, for unwavering enthusiasm for and confidence in me during this project and my academic career. I need to thank my parents, Carol (Provci) and Stephen Cico, for their support and encouragement throughout my life and education. I wish to thank my grandparents, Libby (Havlicek) and John Provci, and Margaret (Golobich) and Steve Cico, and especially my great-grandmother “Baba” Anna Nosek Havlicek, who imparted this wisdom on four generations of our family—“People can take everything away from you, but they can never take away your education!” —STEPHENJOHN CICO, MD, MEd, FAAEM, FAAP To my wife, Jazmir, and children, Rocio, Ambrose, and Cleo, for their enduring love and forbearance of too many fatherless nights and weekends. To my parents for a lifetime of support. —ERIK NORDQUIST, MD Most importantly, I would like to thank the patients who have allowed photographs of themselves to educate physicians. I also wanted to thank the department for your interest in providing me great photography opportunities. And my family that has stood by me all these years and shown me what is really important in life. —CHRISTOPHER ROSS, MD, FRCPC, FACEP, FAAEM I would like to gratefully thank my wife Daria, my children—Natalia, Sophia, Julia, and Amelia, and my colleagues for their support in allowing me the time to bring this atlas to life. I also want to thank the medical students and residents that I have had the privilege to teach over the years. You have all made me a better person and physician with your inspiration and collaboration. —ERNEST WANG, MD, FACEP FOREWORD One of the greatest pleasures in medicine is the art of diagnosing patients’ conditions and translating that into an appropriate therapeutic plan. Over the years, the evolution of medicine has increased pressure on practitioners to see more patients in shorter time frames to keep up with the economic demands of modern medicine. This evolution has threatened to turn the art of medicine into the factory of medicine. The Atlas of Clinical Emergency Medicine is a tool that practitioners can use to “turn back the clock” during patient encounters. The Atlas enhances our ability to instantly recognize patients’ conditions through the wide array of images. In addition, the Atlas provides us with specific and concise diagnostic and treatment plans. The editorial team consists of outstanding practitioners and educators who care for thousands of patients each year. They have assembled an impressive array of images that enriches our practice of medicine so that we can regain the art of medicine that we yearn for on a daily basis. Jeffrey J. Schaider, MD Professor, Department of Emergency Medicine Rush Medical College Chairman, Department of Emergency Medicine Cook County Health & Hospitals System Chicago, Illinois PREFACE It was 2001 when I began taking photographs in the medical setting. I was in my emergency medicine residency, rotating at a community hospital on the northwest side of Chicago. I bought a disposable “cardboard box” camera on the way into my shift one day. I had no formal training, just an interest in documenting for the purpose of education. I still remember some of the cases from that month—nail gun injury, scapholunate dissociation. I enjoyed it and started giving lectures the following year to my fellow residents with the pictures. It seemed to make it more real to the audience. I graduated to a Canon Elph because it easily fit in the pocket and I dutifully carried it with me on every shift for years to come building a library of images that mostly sat unused on the hard drive of my office computer. I have always subscribed to the statement that “a picture is worth a thousand words.” It is the way I have best learned throughout my schooling. Seeing a physical finding, radiographic image, or a disease process made it stick in my mind much better than reading pages of voluminous text. And today, in the clinical setting, I prefer to hear a student presentation at the bedside. Not just because it involves the patient and allows for bedside teaching but because I have a visual of the patient and the words take on more meaning. I may not be alone in this belief. Research suggests that approximately 70% of the population uses visual/spatial thinking either predominantly or in combination with words. In the Atlas of Clinical Emergency Medicine, you will find 342 topics laid out in the same, straightforward, organizational format. Immediately under the topic title, the reader will find a relevant