Clinical Procedures in Emergency Medicine

1405 Pages·2010·368.777 MB·English

by  James R. Roberts, Jerris R. Hedges (eds.)

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clinical procedures in mergency edicine
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A S S O C I A T E E D I T O R S
Catherine B. Custalow, MD, PhD
Associate Professor, Retired
Department of Emergency Medicine
University of Virginia School of Medicine
Charlottesville, Virginia
Arjun S. Chanmugam, MD, MBA
Associate Professor and Director of Education
Department of Emergency Medicine
The Johns Hopkins School of Medicine
Baltimore, Maryland
Carl R. Chudnofsky, MD
Chairman
Department of Emergency Medicine
Albert Einstein Medical Center
Associate Professor
Jefferson Medical College
Philadelphia, Pennsylvania
LTC John McManus, MD, FACEP
Adjunct Assistant Professor
Department of Emergency Medicine
Oregon Health and Science University
Portland, Oregon
Clinical Research Physician
Army Institute of Surgical Research
Brooke Army Medical Center
Fort Sam Houston, Texas
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clinical procedures in
E M
mergency edicine
F I F T H E D I T I O N
E D I T O R S
James R. Roberts, MD, FACEP, FAAEM, FACMT
Professor of Emergency Medicine
Vice Chair, Department of Emergency Medicine
Senior Consultant, Division of Toxicology
Drexel University College of Medicine
Hahnemann University Medical Center
Chairman
Department of Emergency Medicine
Director, Division of Toxicology
Mercy Catholic Medical Center
Philadelphia, Pennsylvania
Jerris R. Hedges, MD, MS
Professor and Dean
John A. Burns School of Medicine
University of Hawaii—Manoa
Honolulu, Hawaii
Professor and Vice-Dean, Emeritus
Department of Emergency Medicine
Oregon Health and Science University
School of Medicine
Portland, Oregon
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1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
CLINICAL PROCEDURES IN EMERGENCY MEDICINE ISBN: 978-1-4160-3623-4
Copyright © 2010 by Saunders, an imprint of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by
any means, electronic or mechanical, including photocopying, recording, or any information storage and
retrieval system, without permission in writing from the publisher. Permissions may be sought directly
from Elsevier’s Rights Department: phone: [phone] (US) or ([phone] (UK); fax:
([phone]; e-mail: [email protected]. You may also complete your request on-line
via the Elsevier website at http://www.elsevier.com/permissions.
Notice
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or
appropriate. Readers are advised to check the most current information provided (i) on procedures
featured or (ii) by the manufacturer of each product to be administered, to verify the recommended
dose or formula, the method and duration of administration, and contraindications. It is the
responsibility of the practitioner, relying on their own experience and knowledge of the patient, to
make diagnoses, to determine dosages and the best treatment for each individual patient, and to take
all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the
Editors assumes any liability for any injury and/or damage to persons or property arising out of or
related to any use of the material contained in this book.
The Publisher
Previous editions copyrighted 2004, 1998, 1991, 1985.
Library of Congress Cataloging-in-Publication Data
Clinical procedures in emergency medicine / editors, James R. Roberts, Jerris R. Hedges ; associate
editors, Catherine B. Custalow … [et al.].—5th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4160-3623-4
1. Emergency medicine. I. Roberts, James R., 1946- II. Hedges, Jerris R. III. Title: Emergency
medicine.
[DNLM: 1. Emergency Treatment. 2. Emergencies. WB 105 C641 2010]
RC86.7.C55 2010
616.02′5—dc22 2008041760
Acquisitions Editor: Stefanie Jewell-Thomas
Developmental Editor: Dee Simpson
Design Direction: Steven Stave
Illustrations Manager: Kari Wszolek
Marketing Manager: Courtney Ingram
Working together to grow
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Printed in United States of America www.elsevier.com | www.bookaid.org | www.sabre.org
C Last digit is the print number: 9 8 7 6 5 4 3 2
To Lydia, my eternally supportive wife; to Martha, a newly minted RN with unbridled enthusiasm and passion for
emergency medicine; and to Matt, always an inspiration for everything. You all make my life worthwhile.
To Cathy Custalow, MD who picked up the slack everywhere.
To Gary Setnik, MD and Todd Thomsen, MD for their illustrative input.
To Rose Bacher who kept us on target and productive.
To the folks at Elsevier who made this edition a reality: Dee Simpson for gargantuan help with all aspects of this project;
to Judy Fletcher, supportive yet again; Berta Steiner who made it all come together.
J.R.R.
As the Fifth edition comes together, I wish to acknowledge the support that Catherine Custalow has brought to this
edition by enhancing the overall text and stepping up as I ventured into new areas of responsibility. Without her efforts,
this edition would not be possible.
As always, I am appreciative of my family and the years of sacrifice they have made such that this knowledge could be
made available to aid future generations of emergency physicians and other practitioners—who themselves seek to
alleviate suffering and extend lives.
J.R.H.
To my son, Nick and to the memory of my daughter, Lauren. To James and Doris Bomberger who first were parents
and now are friends. To Dr. Harold F. Young for reasons that are obvious to anyone who knows him.
C.B.C.
To my wonderful wife Karen, thank you for your inspiration, support and remarkable partnership; to Sydney, William
and Nathan who will always be reminders of what is truly important; to my father who helped to foster the passion of
medical education as a public service. Finally to those who practice and teach emergency medicine, may this book serve
you well.
A.S.C.
The Fifth edition of the book is dedicated to my past, current, and future residents at Albert Einstein Medical Center…
your passion for learning, your devotion to healing, and your zeal for life are truly inspirational.
C.R.C.
My dedication is first in memory of my Grandfather William “Big Daddy” McDonald for his love, wisdom, and
guidance. Also, for my family Laura and our two children for their current and future love and support. Finally, for
our military personnel who continually sacrifice for our freedom.
J.G.M.
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C O N T R I B U T O R S
Benjamin S. Abella, MD, MPhil Steven J. Bauer, MD
Assistant Professor, Department of Emergency Medicine Clinical Assistant Professor of Emergency Medicine,
and Associate Director, Center for Resuscitation West Virginia University Hospitals-East; Jefferson
Science, University of Pennsylvania, Philadelphia, Memorial Hospital, Ranson, West Virginia
Pennsylvania Alternative Methods of Drug Administration
Artificial Perfusion during Cardiac Arrest
Lance B. Becker, MD, FAHA
Bruce D. Adams, MD, FACEP Professor, Department of Emergency Medicine, and
Clinical Professor of Emergency Medicine, Medical Director, Center for Resuscitation Science,
College of Georgia, Augusta, Georgia; Chief, University of Pennsylvania, Philadelphia,
Department of Clinical Investigation, and Chief, Pennsylvania
Department of Emergency Medicine, William Artificial Perfusion during Cardiac Arrest
Beaumont Army Medical Center, Fort Bliss, Texas;
Colonel, Medical Corps, United States Army Kip Benko, MD, MS
Central Venous Catheterization and Central Venous Pressure Assistant Clinical Professor of Emergency Medicine,
Monitoring University of Pittsburgh School of Medicine; Faculty
Staff, Presbyterian University Hospital, Pittsburgh,
James T. Amsterdam, DMD, MD, MMM, Pennsylvania
FACEP, FACPE Emergency Dental Procedures
Professor of Clinical Emergency Medicine, Penn State
University College of Medicine, Hershey; Adjunct Edward S. Bessman, MD
Professor of Emergency Medicine, Drexel University Assistant Professor, Department of Emergency
College of Medicine, Philadelphia; Chair/Service Line Medicine, The Johns Hopkins University;
Director, Department of Emergency Medicine, York Chairman, Department of Emergency Medicine,
Hospital, York, Pennsylvania Johns Hopkins Bayview Medical Center, Baltimore,
Regional Anesthesia of the Head and Neck Maryland
Emergency Cardiac Pacing
Heatherlee Bailey, MD, FAAEM, FCCM
Assistant Professor of Emergency Medicine, Director of Courtney A. Bethel, MD
Critical Care Education, and Medical Student Critical Clinical Assistant Professor of Emergency Medicine,
Care Clerkship Director, Department of Emergency Drexel University College of Medicine—Medical
Medicine, Drexel University College of Medicine, College of Pennsylvania and Hahnemann Medical
Philadelphia, Pennsylvania School; Staff Physician, Mercy Catholic Medical
Mechanical Ventilation Center, Philadelphia, Pennsylvania
Burn Care Procedures
J. Dave Barry, MD
Clinical Assistant Adjunct Professor, Department of Barbara K. Blok, MD
Surgery and Emergency Medicine, University of Assistant Professor, Division of Emergency Medicine,
Texas Health Science Center at San Antonio, San University of Colorado Denver School of Medicine,
Antonio, Texas; Adjunct Assistant Professor, Aurora; Assistant Residency Director, Denver Health
Department of Military and Emergency Medicine, Residency in Emergency Medicine, Denver Health
Uniformed Services University of the Health Medical Center, Denver, Colorado
Sciences, Bethesda, Maryland; Faculty Emergency Thoracentesis
Physician, Department of Emergency Medicine, and
Associate Program Director, San Antonio Uniformed Michael E. Boczar, DO
Services Health Education Consortium (SAUSHEC) Assistant Clinical Professor, Department of Emergency
Emergency Medicine Residency Program, Brooke Medicine, University of Michigan, Ann Arbor, and
Army Medical Center, Fort Sam Houston, Texas Hurley Hospital, Flint, Michigan
Vital Signs Measurement Resuscitative Thoracotomy vii C
s Sudip Bose, MD, FACEP, FAAEM Sharon K. Carney, MD
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ut Assistant Clinical Professor, Department of Emergency Clinical Assistant Professor of Emergency Medicine,
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Medicine, Advocate Christ Medical Center, Oak Director, Department of Emergency Medicine, Mercy
Lawn, Illinois; Former Major, United States Army Fitzgerald Hospital, Darby, Pennsylvania
Cricothyrotomy and Transtracheal Jet Ventilation Intravenous Regional Anesthesia
Merle A. Carter, MD, FACEP
Thomas A. Brabson, DO, MBA, FACOEP,
Director, Emergency Medicine Residency Program,
FACEP
Albert Einstein Medical Center; Assistant Professor,
Clinical Associate Professor, Department of Emergency Jefferson Medical College, Thomas Jefferson
Medicine, Philadelphia College of Osteopathic University, Philadelphia, Pennsylvania
Medicine, Philadelphia, Pennsylvania; Medical
Compartment Syndrome Evaluation
Director, Department of Emergency Medicine, City
Campus, and Department of Emergency Medical
Theodore C. Chan, MD
Services, AtlantiCare Regional Medical Center,
Professor of Clinical Medicine, University of California,
Atlantic City, New Jersey
San Diego; Medical Director, Department of
Prehospital Immobilization
Emergency Medicine, University of California, San
Diego, Hospitals, San Diego, California
Basic Electrocardiographic Techniques
William J. Brady, MD
Professor of Emergency Medicine and Medicine,
Theodore A. Christopher, MD
University of Virginia; Vice Chair, Department of
Professor and Chairman, Department of Emergency
Emergency Medicine, University of Virginia
Medicine, Thomas Jefferson University, Philadelphia,
Hospitals, Charlottesville, Virginia
Pennsylvania
Basic Electrocardiographic Techniques
Injection Therapy of Bursitis and Tendinitis
G. Richard Braen, MD Carl R. Chudnofsky, MD
Professor and Chairman, Department of Emergency Chairman, Department of Emergency Medicine, Albert
Medicine, and Assistant Dean of Graduate Medical Einstein Medical Center; Associate Professor,
viii Education, University at Buffalo School of Medicine, Jefferson Medical College, Philadelphia, Pennsylvania
Buffalo, New York Splinting Techniques
Culdocentesis
Joseph E. Clinton, MD
Professor and Head, Department of Emergency
N. Adam Brown, MD Medicine, University of Minnesota School of
Clinical Instructor, Robert Wood Johnson, New Medicine; Chief, Department of Emergency
Brunswick; Attending Physician, Robert Wood Medicine, Hennepin County Medical Center,
Johnson at Rahway, Rahway, New Jersey Minneapolis, Minnesota
Otolaryngologic Procedures Basic Airway Management and Decision-Making
Wendy C. Coates, MD
James H. Bryan, MD, PhD
Professor of Medicine, and Chair, Acute Care College,
Assistant Professor of Emergency Medicine, Oregon
David Geffen School of Medicine at UCLA, Los
Health and Science University; Assistant Chief,
Angeles; Director, Medical Education, Department of
Emergency Medicine, Veterans Affairs Medical
Emergency Medicine, Harbor-UCLA Medical
Center, Portland, Oregon
Center, Torrance, California
Alternative Methods of Drug Administration
Anorectal Procedures
Kenneth H. Butler, DO Catherine B. Custalow, MD, PhD
Associate Professor of Emergency Medicine, Department Associate Professor, Retired, Department of Emergency
of Emergency Medicine, University of Maryland Medicine, University of Virginia School of Medicine,
School of Medicine; Associate Director, Emergency Charlottesville, Virginia
Medicine Residency, University of Maryland Medical Educational Aspects of Emergency Department Procedures
Center, Baltimore, Maryland
Incision and Drainage Anthony J. Dean, MD
Assistant Professor of Emergency Medicine and Assistant
Professor of Emergency Medicine in Radiology,
Stacie E. Byers, DO, FACEP Director, Division of Emergency Ultrasonography,
Attending Physician, Emergency Medicine, St. Anthony University of Pennsylvania Medical Center,
Medical Center, Denver, Colorado Philadelphia, Pennsylvania
C Splinting Techniques Bedside Laboratory and Microbiologic Procedures
Paul T. DeFlorio, MD Michael T. Fitch, MD, PhD C
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Adjunct Assistant Professor, Department of Military and Associate Professor of Emergency Medicine, Wake n
Emergency Medicine, Uniformed Services University Forest University School of Medicine, Winston- trib
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of the Health Sciences, Bethesda, Maryland; Staff Salem, North Carolina to
Emergency Physician, Wilford Hall Medical Center, Abdominal Hernia Reduction rs
Lackland Air Force Base, Texas
Central Venous Catheterization and Central Venous Pressure
Brenda A. Foley, MD, FACEP
Monitoring
Clinical Assistant Professor, Department of Emergency
Medicine, Thomas Jefferson University, Philadelphia;
Kenneth Deitch, DO Attending Physician, Department of Emergency
Assistant Professor, Jefferson Medical College, Thomas Medicine, Doylestown Hospital, Doylestown,
Jefferson University; Associate Research Director, and Pennsylvania
Attending Physician, Department of Emergency Injection Therapy of Bursitis and Tendinitis
Medicine, Albert Einstein Medical Center,
Philadelphia, Pennsylvania
Robert T. Gerhardt, MD, MPH, FACEP,
Intraosseous Infusion
FAAEM
Associate Professor, Department of Military and
William R. Dennis, MD, MPH Emergency Medicine, Uniformed Services University
Head of EMS for Navy Medicine East and National of the Health Sciences, Bethesda, Maryland; Staff
Capital Area, Emergency Medicine, Naval Medical Physician, San Antonio Uniformed Services Health
Center Portsmouth, Portsmouth, Virginia Education Consortium (SAUSHEC) Emergency
Ophthalmologic Procedures Medicine Residency Program, Brooke Army Medical
Center, Fort Sam Houston, Texas
Assessment of Implantable Devices
Denis J. Dollard, MD
Clinical Assistant Professor, Department of Emergency
Medicine, Drexel University College of Medicine; Diane L. Gorgas, MD
Director, Emergency Medicine, Mercy Hospital of Associate Professor and Residency Director, Department
Philadelphia, Philadelphia, Pennsylvania of Emergency Medicine, The Ohio State University;
Radiation in Pregnancy and Clinical Issues of Radiocontrast The Ohio State University Medical Center,
Agents Columbus, Ohio
ix
Vital Signs Measurement; Transfusion Therapy: Blood and
Blood Products and Reversal of Warfarin-Induced
Timothy B. Erickson, MD, FACEP, FAACT,
Coagulopathy
FACMT
Professor, Emergency Medicine and Clinical
Toxicology, Associate Head, Department of Steven M. Green, MD, FACEP
Emergency Medicine, and Director, Division of Professor of Emergency Medicine and Pediatrics, Loma
Clinical Toxicology, University of Illinois at Chicago, Linda University, Loma Linda, California
Chicago, Illinois Systemic Analgesia and Sedation for Procedures
Procedures Pertaining to Hypothermia and Hyperthermia
Brett S. Greenfield, DO, FACOEP/CAQ-EMS
Brian D. Euerle, MD Medical Director, MidAtlantic MedEvac, and Attending
Associate Professor, University of Maryland School of Physician, Department of Emergency Medicine,
Medicine; Attending Physician, Emergency AtlantiCare Regional Medical Center, Atlantic City,
Department, University of Maryland Medical Center, New Jersey
Baltimore, Maryland Prehospital Immobilization
Spinal Puncture and Cerebrospinal Fluid Examination
Maria Halluska-Handy, MD
Charles J. Fasano, DO Assistant Director, Emergency Medicine Residency
Assistant Professor, Department of Emergency Medicine, Program, Albert Einstein Medical Center;
Jefferson Medical College; Attending Physician, Department of Emergency Medicine, Jefferson
Department of Emergency Medicine, Albert Einstein Medical College, Thomas Jefferson University,
Medical Center, Philadelphia, Pennsylvania Philadelphia, Pennsylvania
Physical and Chemical Restraint Management of Amputations
Lisa Mackowiak Filippone, MD Richard J. Harper, MS, MD
Assistant Professor, Emergency Medicine, UMDNJ Associate Professor, Emergency Medicine, Oregon
Robert Wood Johnson Medical School; Attending Health and Science University; Chief, Emergency
Physician, Emergency Medicine, Cooper University Medicine Service, Portland Veterans Affairs Medical
Hospital, Camden, New Jersey Center, Portland, Oregon
Ultrasound-Guided Procedures Pericardiocentesis C
s Richard A. Harrigan, MD John J. Kelly, DO, FACEP, FAAEM
or
ut Professor of Emergency Medicine, Temple University; Associate Chair, Department of Emergency Medicine,
b
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Pennsylvania Philadelphia, Pennsylvania
Basic Electrocardiographic Techniques Nerve Blocks of the Thorax and Extremities
Randy B. Hebert, MD Kevin P. Kilgore, MD
Attending Physician, Advocate Illinois Masonic Medical Assistant Clinical Professor, University of Minnesota
Center, Chicago, Illinois School of Medicine, Minneapolis; Senior Staff
Cricothyrotomy and Transtracheal Jet Ventilation Physician, Department of Emergency Medicine,
Regions Hospital, St. Paul, Minnesota
Jerris R. Hedges, MD, MS Regional Anesthesia of the Head and Neck
Professor and Dean, John A. Burns School of Medicine,
University of Hawaii—Manoa, Honolulu, Hawaii;
Thomas D. Kirsch, MD, MPH
Professor and Vice-Dean, Emeritus, Department
Associate Professor, and Director of Operations,
of Emergency Medicine, Oregon Health and
Department of Emergency Medicine, The Johns
Science University School of Medicine, Portland,
Hopkins School of Medicine, Baltimore,
Oregon
Maryland
Ophthalmologic Procedures
Tube Thoracostomy
Christopher P. Holstege, MD
Kevin J. Knoop, MD, MS, Capt, MC, USN
Associate Professor, Departments of Emergency
Assistant Professor of Military and Emergency Medicine,
Medicine and Pediatrics, and Chief, Division of
Department of Military and Emergency Medicine,
Medical Toxicology, University of Virginia School of
Uniformed Services University of the Health
Medicine; Medical Director, Blue Ridge Poison
Sciences, Bethesda, Maryland; Executive Officer, US
Center, University of Virginia Health System,
Naval Hospital, Yokosuka, Japan
Charlottesville, Virginia
Ophthalmologic Procedures
Decontamination of the Poisoned Patient
Laura R. Hopson, MD Frederick K. Korley, MD
x Assistant Professor, Clinical Track, University of The Robert E. Meyerhoff Assistant Professor,
Michigan Health System, Ann Arbor, Michigan Department of Emergency Medicine, The Johns
Hopkins School of Medicine; Attending Physician,
Pharmacologic Adjuncts to Intubation
Department of Emergency Medicine, The Johns
Hopkins Hospital, Baltimore, Maryland
J. Stephen Huff, MD
Management of Increased Intracranial Pressure and
Associate Professor of Emergency Medicine and
Intracranial Shunts
Neurology, University of Virginia Health System,
Charlottesville, Virginia
Special Neurologic Tests and Procedures Baruch Krauss, MD, EdM, FAAP, FACEP
Associate Professor of Pediatrics, Harvard Medical
Charlene Babcock Irvin, MD, FACEP School; Senior Associate Physician in Medicine,
Research Director, Emergency Medicine Department, Division of Emergency Medicine, Children’s Hospital
St. John Hospital and Medical Center; Associate Boston, Boston, Massachusetts
Clinical Professor, Wayne State University School of Devices for Assessing Oxygenation and Ventilation; Systemic
Medicine, Detroit, Michigan Analgesia and Sedation for Procedures
Autotransfusion
Diann M. Krywko, MD
Tim Janchar, MD Assistant Professor and Emergency Medicine Residency
Emergency Physician, Legacy Emmanuel Hospital, Curriculum Director, Medical University of South
Portland, Oregon Carolina, Charleston, South Carolina; Graduate
Arterial Puncture and Cannulation Lecturer, University of Michigan School of Health
Professions, Flint, Michigan
Lewis J. Kaplan, MD, FACS Indwelling Vascular Devices: Emergency Access and
Associate Professor of Surgery, Director, Emergency Management
General Surgery, Yale University School of Medicine,
New Haven, Connecticut Richard L. Lammers, MD
Mechanical Ventilation Professor of Emergency Medicine, Michigan State
University College of Human Medicine, East
Eric D. Katz, MD Lansing; Research Director, Kalamazoo Center for
Program Director and Vice-Chair for Education, Medical Studies, Kalamazoo, Michigan
Maricopa Medical Center, Phoenix, Arizona Principles of Wound Management; Methods of Wound
C Commonly Used Formulas and Calculations Closure