Table Of Content

aL ANGmEe dical book Clinical Emergency Medicine ScotCt.S hermaMnD, MediSctauldC elsnehtrD ikeipcr tor PAR eisdyeD nricector AssoeRc seiiadteDrnieccyt or DeparotfEm megenertn Mceyd icine CooCkon ut(ySo tgreHro)s pital RusMhe diCcolalelg e Cihc,aI lglionois josepMh.W eberM,D EMMSe diDrcieaclt or DeparotfEm meenrtyg M eendcicine CooCkon ut(ySo tgreHro)s pital AssstniatP rofoefEs msgeoerrn Mceyd icine RusMhe diCcolalelg e Cihc,aI lglionois MichaAe.lS chindl,bM eDc k AssnitPs rtoafessor DeparotfEm megenertn Mceyd icine RusMhe diCcolalelg e AssstniatRs edinecDyri ector CooCkon ut(ySo tgreHro)is ltp a Cihc,aI lglionois RahuGl. P atwaMrDi , MeidclSa tudCelsnehtrD ikeipcr tor AssnitPsr toafessor AttenPdhsiyincgi an DeparotfEm meenrtyg M eendcicine RusMhe diCcolalelg e Chaig,cIo llinois M ide I NeYwro kC hicSaagFnorn aicos cAtehnsL nodoMna drMiedx Ciictoy MilNawen D ehliS inogera SpyndeyT rooon t Copyri©g h2t01b4y M cGraw-HEidlulc atiAolnlr. i ghrtess ervEexdc.e patsp ermitutnedde trh eU niteSdt atCeosp yriAgchtto f1 97n6o, parotft hipsu blicamtaiyob ne r eproduocred di stribiunat neydf ormo rb ya nym eanso,rs torienda d atabaosrre e trieval wsiytshtoeumt, thepr iowrr ittpeenr missoifto hnep ublisher. ISBN9: 78-0-07-179461-9 MHID:0 -07-179461-1 Them ateriinat lh iesB ooakl saop peairnts hep rivnetr siooftn h itsi tIlSeB:N 9: 78-0-07-179460-2, MHID:0 -07-179460-3. eBoocko nversbiyoc no deMantra Versio1n. 0 Allt rademaarrkets r ademaorfkt sh eirre specotwinveer Rsa.t hetrh apnu ta trademasrymkb oalft eerv eroyc curreonfca e t rademarked namew,e usen amesi na ne ditorfiaaslh ioonnl ya,n dt ot heb enefiotft het rademaorwkn erw,i tnho i ntentoifoi nn fringemoefnt th e trademaWrhke.r seu cdhe signataipopnesai rnt hibso okt,h ehya vbee epnr intweidti hn itial caps. McGraw-Hill Educatiaoranev eaBioloaakbtssl p ee ciqaula ntity ditsouc soeau snp trse miuamnsd s alperso motioornf sou rs ei nc orporate trainpirnogg raTmosc .o ntaacr te presentpalteiavvseie,s t ihteC ontaUcstp agaet w ww.mbprofessional.com. Notice Mediciinsea ne ver-chansgciinegn Acsen .e wr esearacnhdc liniecxaple riebnrcoea doeunr k nowledcghea,n gienst reatmaenndtd rug theraapryer equirTehde.a uthoarnsd t hep ublisohfet rh iwso rkh avec heckewdit sho urcbeesl ievteobd e r eliaibnlt eh eierff 01ttso proviidnef ormatthiaoitnsc ompleatnedg enerailnal cyc orwdi tthh set andards aacttc hetepi tmeoedf p ublicaHtoiwoenv.e irn,v ieowf t he possiboiflh iutmya ne rroorrc hangiensm edicsacli ences, tnheaeiu tthheonrro srt hpeu blisnhoerar n yo thepra rtwyh ob asb eeinn volviend thper eparaotrip ounb licaotfti hoinws o rkw arrantthsat th ien formactoinotna ihneerde iisni ne verrye speacctc uroartc eo mpleatned,t hey disclaalirlme sponsifboiarln iyet ryr oorros m issioornf so trh ree suolbttsa infreodmu seo ft hien formactoinotna iinnet dh iwso rkR.e aders areen couratgoec do nfirtmh ei nformactoinotna ihneerde wiint oht hesro urcFeosr.e xamplaen di np articruelaadre,ar rsae d visteocd h eck thep roduicntf ormasthieoenit n cludientd h ep ackaogfee acdhr utgh epyl atno a dministtobe erc e1tatihnat th ei nformactoinotna iinne d thiwso rki sa ccuraantdet hat changenso tb heaevnme a dei nt her ecommenddeods oe ri nt hec ontraindifcoaartd imoinnsi strTahtiiso n. recommendaitsoi fop na rticiumlpa0r1 tainncc oen nectwiiotnnh e wo ri nfrequeunsteddlr yu gs. TERMS OFUSE Thiiss a c opyrigwhotrekda ndM cGraw-Hill Edauncdai ttlisi ocne nsroersse ravlerl i ghitnas n dt ot hew orkU.s eo ft hiwso rki ss ubject tot hestee rmEsx.c epatsp ermitutnedde trh eC opyriAgchtto f1 97a6n dt her ighttos toraen dr etrioenveec opyo ft hew orky,o um ay notd ecompidlies,a ssemrbelvee,re sneg inereerp,r odumcoed,ify ,c readteer ivawtoirvekb sa seudp on, tradnissmtirti,bd uitses,e minate, selplu,b liosrsh u blicetnhsewe o rko ra nyp arotf i tw ithoMuctG raw-HEidlulc atiporni'ocsro nseYnotu.m ayu set hew orkf oyro uorw n noncommeracnidap le rsonuaslea ;n yo theurs eo ft hew orki ss tricptrloyh ibiYtoeudrr. i gthotu set hew orkm ayb et erminaitfye oduf ail toc omplwyi tthh estee rms. THE WORK ISP ROVIDED" AS IS.M"c GRAW-HILLE DUCATIONA ND ITSL ICENSORSM AKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY,A DEQUACY OR COMPLETENESSO F OR RESULTS TO BE OBTAINEDF ROM USING THE WORK, INCLUDING ANY INFORMATIONT HAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISEA,N D EXPRESSLY DISCLAIMA NY WARRANTY, EXPRESSO R IMPLIEDI,N CLUDINGB UT NOT IMlTEDT O IMPLIEWARDRANT IESO F MERCHANTABILITOYR FITNESSF ORA PARTICULARP URPOSEM.c Graw-Hill Educatiaonndi tlsi censdoorn so tw arraonrtg uaranttheaett h efu nctiocnosn taiinnet dh ew ork wmielelty ourre quiremoernt thsai tt s operatwiiolnbl e u ninterrourpe trerdof rr eNee.i thMecrG raw-HEidlulc atnioorni tlsi censsohrasbl ell iabtloye o uo ra nyoneel sfeo arn y inaccurearcryoo,rr o missiroeng,a rdloefc sasu sien,t hew orko rf ora nyd amagerse sulttihnegr efroMmc.G raw-HEidlulc atiboansn o responsifboitrlh iceto yn teonfat n yi nformaatcicoens stehdr outghhwe o rkU.n denro c ircumstasnhcaMelcslG raw-HEidlulc atainodn/ iotrs licensboelr isa bfloear n yi ndirienccti,d enstpaelc,ip auln,i ticvoen,s equeonrts iiamli ldaarm agetsh arte suflrto mt heu seo fo ri nabitloi ty uset hew orke,v einf a nyo ft hemb asb eeand visoefdt hep ossibiolfsi utcydh a mageTsh.i lsi mitaotfil oina bislhiatalypl p ltyoa nyc laim orc ausweh atsoewvheert hseurc chl aiomrc ausaer isiencs o ntratc0t1o,iro therwise. Tom yp arenftostr,e achinmge them eaningo fh arwdo rka ndr emindimneg w hent o slodwo wnT.o M asona ndC oliyno,u b rinmge altlh jeo ya ndh appintehsasat f ather coulidm aginTeoM. i chelfloeyr,o ucro nstlaonvtae n ds upport. ScoCt.St h ermMaDn , Tom y parenftosar l ifetoifem enc ouragemteonB tr;i dgEelts,ia en,dJ anewh,o g ive meaningto m y lifaen;dt oo urp atiewnhtosg ,i vues t heo pportutniolt eya rn somethinnegwe versyh ift. JoseMp.Wh eb eMrD, Tom y beautiwfuilf leo,v ipnagr enatnsdg, r acisoiusst ers, wwhiotshceoo mupta ssion ands uppomryt c areweoru lndo tb ep ossibAlnedt. o t eacheevresr ywhheerlep,i ng then exgte nerataicohni etvhee dirre ams. MikSec hindlMbDe ck, Tom y studenwthsoc, o ntinusahlolwmy e h owm uch moreIh avteo l earn. RahulP atwMaDr i, Thpiasgi en tenlteibftol naanlkl y Contents Contributors viii Preface XVI Acknowledgments xvii IC.om mono cPueredrs I.VP ulmyoE nmeagrrensc ie 1.In cisainodnD rainage 1 20D.y spnea 84 2.Ar terBilaolo Gda s 4 21A.s thma 89 3.Ce ntrVaeln ouAsc cess 8 22C.h ronOibcs trucPtuilvmeo nary Disease 95 4.Pr oceduSreadla tion 13 23P.n eumonia 100 5.Lu mbaPru ncture 16 24P.n eumothorax 105 6.La ceratRieopna ir 20 25P.u lmonaErmyb olism 108 7.Ne edlaen dT ubTeh oracostomy2 4 V.A bdomiEnmaeglre ncies 8.In troducttoEi moenr gency Ultrasonography 27 26A.c utAeb dominal Pain 112 I.IR esucsaittoin 27A.p pendicitis 118 9.Em ergenMceyd icSaelr vices 30 28A.c utCeh olecystitis 121 1o .C ardiopulmonary Arrest3 3 29A.b dominAaolr tAince urysm 125 11A.i rwaMya nagement 37 30G.a strointeBslteiendailn g 128 12S.h ock 42 31I.n testOibnsatlr uction 131 IlClad.r ivaoslcauErm egrencies 32M.e senteIrsicch emia 135 13C.h esPta in 46 VII.fn etcioDusise aEsmeegr encies 14A.c utCeo ronaSryyn dromes 50 33F.e ver 138 15C.o ngestHievaerF ta ilure 57 34S.e psis 142 16D.y srhythmias 63 35M.e ningiatnidEs n cephalitis1 47 17A.o rtDiics section 70 36S.o fTti ssIunef ections 151 18H.y pertensive Emergenci7e5s 37H.u manI mmunodeficViiernucsy 156 19S.y ncope 80 38B.l ooadn dB odyF luiEdx posure 162 v CONTESN T VII.G enitoyEu mregirennacries XIE.n ovnimrentEamleg rensc ie 39N.e phrolithiasis 166 61H.y pothermia 259 40U.r inaTrrya cItn fections 170 62C.o ld-IndTuicsesdIu nej uries 263 41T.e sticTuolrasri on 174 63H.e at-RelIaltlende ss 267 42P.e niDlies orders 177 64D.r owniInngc idents 270 VII.IO btsect/srGiyencloogEimecgr encies6 5E.n venomation 274 43V.a ginBalle eding 181 XIIM.e tbao/lEincdoEcmregirennesc ie 44V.a ginDails charge 185 66D.i abeEtmiecr gencies 280 45P.r eeclamapnsdiE ac lampsia 189 67P.o tassiDuims orders 284 46E.m ergenDceyl ivery 192 68T.h yroEimde rgencies 288 IXP.e idatErmeigrce ncies 69A.d renEamle rgencies 292 47T.h eP ediatPraitci ent 196 XII.IH ematoil/coOgnocloEgmeigrce cnies 48P.e diatFreivce r 201 70O.n coloEgmiecr gencies 295 49R.e spiraDtiosrtyr ess 206 71S.i ckCleelE lm ergencies 299 50A.b dominPaali n 212 72T.r ansfuRseiaocnt ions 304 51D.e hydration 217 73A.n ticoaguTlhaenrta apnyd I ts Complications 308 52O.t itMiesd ia 221 XI.VH EEENmeTgr encies 53P.h aryngitis 225 74 .Sl iLta mpE xamination 312 X.T xoicology 75R.e dE ye 315 54T.h e Poisoned Patient2 30 76A.c utVei suLaols s 319 55T.o xiAcl cohols 235 77E.p istaxis 324 56A.c etaminopThoexni city 239 78D.e ntaElm ergencies 327 57S.a licyTloaxtiec ity 244 XVN. eoulroEgmeigrce ncies 58C.a rboMno noxiPdoei soning 247 79A.l terMeedn taSlt atus 332 59D.i goxin 251 80H.e adache 336 60C.y clAinct idepressants 255 81D.i zziness 341 CONTESN T vii 82C.e rebrovasAccucliadre nt 347 92L.o wB acPka in 403 83S.e izuarnedsS tatEupsi lepticu3s5 3 93C.o mpartmSeynntd romes 407 XVITa.ru ma 94S.e ptAirct hritis 410 84T.r aumPar inciples 358 95S.p linting 414 85H.e adI njuries 363 XVI.IID ermoaltoEgmeigrce nsc ie 86C.e rviScpailn Ien juries 368 96L.i fe-ThreaDteernmiantgo ses 418 87T.h oraTcriacu ma 374 97A.l lerRgeiacc tions 423 88A.b dominTarla uma 381 XIXP.sc yhtiraEimceg rencies 89B.u rns 387 98A.p proatcoht heP sychiaPtartiice n4t2 6 XVII.Ot rhopEemdegirecn sc ie Index 429 90U.p peErx tremIintjyu ries 391 91L.o weErx tremIintjyu ries 397 Contributors NegeAfifian, DO JonathBaann koMff,D ,F ACEP DepartomfEe mnetr geMnecdyi cine MediDciarle ctor CooCko un(ttSyr ogHeors)p ital EmergeDnecpya rtment ChicaIglloi,n ois MiddlHeossepxi tal MiddletCoownnn,e cticut StevEe.nAk s,D O DirecTthoeTro x,i kCoonn sortiwn EriHc. B eckD,O ,NR EM T-P DivisoifoT no xcioglyo,D epartmoefnE tm egrencyA ssisPtraonfte ssor Medicine SectoifEo mne rgeMnecdyi cine CooCko un(ttSyr ogHeors)p ital TheU niveorfsCi htiyc ago AssocPiraeotsfes or EMSM ediDciarle ctor DepartomfEe mnetr geMnecdyi cine ChicEaMgSo RusMhe diCcoalll ege IlliEnMoSRi esg i1o,1Mn e diDciarle cCtoonrsso rtium ChicaIglol,i nois ChicaIglol,i nois Amer ZAilad eeMnD, LaureEnmil yB encMeD, AssisPtraonfte ssor DepartomfEe mnetr geMnecdyi cine DepartomfEe mnetr gency Medicine UniveorfsC ihtiyc ago Hospital NorthweUsntievrenr sity FeoifMn ebdeircgi nSec hCohoilc aIgloli,n ois AttenPdhiynsgi cian DepartomfEe mnetr geMnecdyi cine StevHe.nB owmanM,D ,F ACEP AssisPtraonfte ssor NorthweMsetmeorrnHi oaslp ital DepartomfEe mnetr gency Medicine ChicaIgilonl,o is RusMhe diCcoalll ege KimL .A skewM,D ProgrDaimr ector Assistant Professor DepartomfEe mnetr geMnecdyi cine DepartomfEe mnetr geMnecdyi cine CooCko un(ttSyr ogHeors)p ital WakFe oreUnsitv eSrcsihtooyofM l e dicine ChicaIglol,i nois Winsnt-olSeamN,o rtCha rolina SeaMn. B rayntM,D JohnB ailiMtDz,, RDMS AssocPiraotfee ssor EmergeUnlctyr asDoiurnedc tor EmergeMnecdyi cine DepartomfEe mnetr geMnecdyi cine AssisFtealnlto wDsihriepc tor CooCko un(ttSyr ogHeors)p ital ToxikoCno nsortium AssisPtraonfteo sfEs moerr geMnecdyi cine CooCko un(ttSyr ogHeors)p ital DepartomfEe mnetr geMnecdyi cine AssioacMteed iDciarle ctor RusMhe diCcoalll ege IlliPnooiisCsoe nn ter ChicaIglol,i nois ChicaIglol,i nois JefferAy.B akeMrD, AnnB uchanaMnD, AttenPdhiynsgi cian AssisDtiarnetc torM/eTdriaDcuiamrlae ctor DepartomfEe mnetr geMnecdyi cine DepartomfEe mnetr geMnecdyi cine StD.a viMde'dsi Cceanlt er OchsnHeera lStyhs tem AustTienx,a s ClinIincsatlr uctor UniveorfsQ iuteye nsOlcahnsdnC,el irn Sicchaolo l PauEl. C aseMyD, NewO rleLaonusi,s iana InstriunCc ltionrMi ecdailc ine DepartomfEe mnetr geMnecdyi cine RusUhn iveMresdiitCcyea nlt er Chicago, illinois viii CONRTITBOURS EsthHe.rC henM,D E.P auDle KoningM,D ,M S AssioacPtreo fessor AssisPtraonfte ssor EmergeMnecdyi cine EmergeMnecdyi cine UniveorfsCi atloyir fnSiaaFn,r ancGiesnceoHr oaslp ital Dartmouth-HMietdcihCcceaonlct ke r SaFnr ancCiaslciof,o rnia MediSctauld Eednutc aDtiiroenc tor EmergeMnecdyi cine GeorgCeh iampaDsO, DartmoMuetdhi Sccahlo ol AssisPtraonfteD sespoarr,t omfEe mnetr geMnecdyi cine LeboannN,e wH ampshire NorthweUsntievrenFr esiintbyS ecrhgoo ofMl e dicine TeamP hysiNcoiratnh,w eUsntievrenr sity BradlLe.Dy e meteMrD, Medical DBiarnoekfAc mteorri,Cc hai cMaagroa thon EMSP hysician ChicaIgloli,n ois EmergeMnecdyi cine UniveorfsCi htiyc ago KristCiinees lMaDk , ChicaIgloli,n ois AssisPtraonfte ssor DepartomfPe endti atrics VinodinLe.eD issanayMaDk e, NorthweUsntievrenr sity FeoifMn ebdeircgi nSec hGololo bTaoxilc olFoegly lEomwe rgeMnecdyi cine ChicaIgilonl,o is Univeorfsi tIyla ltCi hniociaasng dCo o oCko un(tSyt roger) DirecPteodri,a tric MEemdeircgiennec y Hospital DepartomfPe endti aEtmreircg eMnecdyi cine ClinIincsatlr uctor ChildMreemno'rsai tCa eln tDruaPla Hgoes pital UniveorfsI iiltnlyoa itCs h icago WinfieIlldl,si noi ChicaIgloli,n ois MarcD oucetMtDe , MichaTe.lC udnikM,D ,M PH AssocPiraotfee ssor AssisPtraonfte ssor EmergeMnecdyi cine DepartomfEe mnetr geMnecdyi cine UniveorfsC iotlyo rSacdhooo ofMl e dicine TheO hiSot aUtnei veMresdiitCcyea nlt er AttenPdhiynsgi cian ColubmusO,h io EmergeMnecdyi cine JoannWai eczorDeakv idsMoDn , StA.n thoHnoys piStyaslt em DepartomfEe mnetr geMnecdyi cine DenvCeorl,o rado CooCko un(ttSyr ogHeors)p ital MattheTw.E mery, MD ChicaIgloli,n ois AssisPtraonfte ssor EmergeMnecdyi cine John Davis, MD, PhD MichiSgtaaUntn ei versitoyfH uCmoallMnee gdei cine AssisPtraonfte ssor DepartomfMe endti cine AttenPdhiynsgi cian TheO hiSot aUtnei versity DepartomfEe mnetr geMnecdyi cine AttenPdhiynsgi cian Spectrum HealBtuht tHeorCswapomirpttuahsl - DepartomfMe endti cine GranRda piMdisc,h igan WexnerM ediCceanlt aetTr h eO hiSot aUtnei versity RakesSh.E ngineMeDr , ColuumsbO,h io AssisPtraonfte ssor EmergeMnecdyi cine Alexd el aF uentMeD, CasSec hooofMl e dicine PrivPartaec tice AttenPdhiynsgi cian EverWeatsth,i ngton Emergency ISsniettruvtiec es NicoMl.eD eiorMiDo , CleveCllainndi c AssocPiraotfee ssor CleveOlhainod , DepartomfEe mnetr geMnecdyi cine JorgFee rnandMeDz , DirecMteodri,Sc tauld Eednutc ation Assistanto fCP lrionfEiemcseasrlog reM necdyi cine OregHoena latnhSd c ieUnnciev ersity DepartomfEe mnetr geMnecdyi cine PortlOarnedg,o n UniveorfsSi otuyt hCearlni fornia DirecotfMo erd iSctauld Eednutc ation DepartomfEe mnetr geMnecdyi cine LAC oun+tU yS CM ediCceanlt er LoAsn gelCaelsi,f ornia