Pocket Emergency Medicine PDF
Preview Pocket Emergency Medicine
2 Pocket Emergency MEDICINE Third Edition JOHN D. ANDERSON, MD NIR HARISH, MD, MBA Denver Health Residency in Emergency Medicine NICHOLAS G. MALDONADO, MD ALEXANDER Y. SHENG, MD The Harvard Affiliated Emergency Medicine Residency Program Edited by RICHARD D. ZANE, MD, FAAEM Professor and Chair Department of Emergency Medicine University of Colorado School of Medicine Aurora, Colorado JOSHUA M. KOSOWSKY, MD Assistant Professor, Harvard Medical School Vice Chair for Clinical Affairs, Department of Emergency Medicine Brigham and Women’s Hospital Boston, Massachusetts 3 4 Acquisitions Editor: Jamie M. Elfrank Product Development Editor: Ashley Fischer Production Product Manager: Bridgett Dougherty Senior Manufacturing Manager: Beth Welsh Marketing Manager: Stephanize Manzo Creative Director: Doug Smock Production Service: Aptara, Inc. © 2015 by Wolters Kluwer Health Two Commerce Square 2001 Market Street Philadelphia, PA 19103 USA LWW.com All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form by any means, including photocopying, 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 o(cid:637)cial duties as U.S. government employees are not covered by the above-mentioned copyright. Printed in China Library of Congress Cataloging-in-Publication data available on request from the publisher. Care has been taken to con(cid:633)rm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of the information in a particular situation remains the professional responsibility of the practitioner. The authors, editors, and publisher have exerted every e(cid:643)ort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant (cid:635)ow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device 5 planned for use in their clinical practice. To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320. International customers should call (301) 223-2300. Visit Lippincott Williams & Wilkins on the Internet: at LWW.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6 pm, EST. 10 9 8 7 6 5 4 3 2 1 6 CONTRIBUTORS John D. Anderson, MD Denver Health Residency in Emergency Medicine Denver Health Medical Center Department of Emergency Medicine University of Colorado School of Medicine Denver, Colorado Nir Harish, MD, MBA Denver Health Residency in Emergency Medicine Denver Health Medical Center Department of Emergency Medicine University of Colorado School of Medicine Denver, Colorado Nicholas G. Maldonado, MD The Harvard Affiliated Emergency Medicine Residency Program Department of Emergency Medicine Brigham and Women’s Hospital Massachusetts General Hospital Boston, Massachusetts Alexander Y. Sheng, MD The Harvard Affiliated Emergency Medicine Residency Department of Emergency Medicine Brigham and Women’s Hospital Boston, Massachusetts 7 ACKNOWLEDGMENTS To our patients who trust that we are always there and know what to do, when to do it, and allow us the privilege of caring for them during the most vulnerable moments of their lives. For Siobhan, Jake, Gaby, and Finn whose support made everything possible. RICHARD D. ZANE, MD To all those from whom I continue to gain wisdom—my teachers, my colleagues, my students, and perhaps foremost, my patients. And to Devorah, Harry, Jake, and Judah, whose support means the world to me. JOSHUA M. KOSOWSKY, MD 8 PREFACE Sir William Olser wrote, “He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.” Emergency medicine is a thrilling specialty, demanding exceptional abilities and an increasingly expansive fund of knowledge—patterns of illness and injury, a whole range of diagnostics and therapeutics, all at one’s (cid:633)ngertips in real time at the bedside with lives on the line. In this context, we have designed Pocket Emergency Medicine as a life raft for the busy physician, resident, physician assistant, nurse practitioner, or student. Unlike many traditional textbooks, we have chosen to organize chapters around presenting conditions rather than diagnoses. In this way, the book mirrors the way patients present to the emergency department and allows the reader to develop the thought processes that guide appropriate diagnostic and therapeutic interventions. Each chapter begins with a general approach to a particular condition, followed by a succinct discussion of important diagnostic categories, highlighting essential elements of the history, physical examination, testing, and treatment speci(cid:633)c to these diagnoses. Sprinkled throughout the text are “clinical pearls”—focused bullet points, emphasizing important clinical (cid:633)ndings or warning about common clinical errors. This book was written by a group of talented emergency medicine residents from the Denver Health and Harvard A(cid:637)liated Emergency Medicine Residency programs. The residents undertook studious research on their individual topics, guided by an acute awareness of the needs of busy emergency department providers. Chapters were edited by an experienced team of senior emergency medicine faculty from the Departments of Emergency Medicine at The University of Colorado School of Medicine, Brigham and Women’s Hospital and Harvard Medical School. The editors bring over 25 years of experience in clinical and academic emergency medicine, ensuring the accuracy and integrity of the text. The result, we think you’ll agree, is a supremely useful immediate reference for the emergency medicine practitioner. RICHARD D. ZANE, MD JOSHUA M. KOSOWSKY, MD 9 CONTENTS SECTION I: CARDIOVASCULAR Electrocardiography Chest Pain Acute Coronary Syndrome (Overview) STEMI UA/NSTEMI Prinzmetal’s (Variant) Angina Cocaine-induced Angina Stress Testing Cardiac Catheterization Post-PCI Complications Post-MI Complications Pulmonary Embolism and DVT CHF/Acute Pulmonary Edema Aortic Dissection Thoracic Aortic Aneurysm Pericarditis and Pericardial Effusion Cardiac Tamponade Myocarditis Syncope Hypertension and Hypertensive Emergencies Hypotension and Shock Hypovolemic Shock Cardiogenic Shock Septic Shock Neurogenic Shock Dysrhythmia Bradycardia AV Node Block Tachycardia/Palpitations Pacemaker and AICD Malfunction SECTION II: PULMONARY Cough Dyspnea (Shortness of Breath) Hemoptysis SECTION III: GASTROINTESTINAL Abdominal Pain Nausea and Vomiting Gastrointestinal Bleed 10
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