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CURRENT EMERGENCY DIAGNOSIS & TREATMENT - 5th Ed. (2004) FRONT MATTER Title Page a LANGE medical book CURRENT EMERGENCY Diagnosis & Treatment fifth edition Edited by C. Keith Stone, MD Professor and Chairman Department of Emergency Medicine Texas A&M University Health Science Center Scott & White Memorial Hospital Temple, Texas Roger Humphries, MD Assistant Professor and Residency Director Department of Emergency Medicine University of Kentucky College of Medicine Lexington, Kentucky Lange Medical Books/McGraw-Hill Medical Publishing Division New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright Page Current Emergency Diagnosis & Treatment 2004, 5th Edition Copyright © 2004 by The McGraw-Hill Companies, Inc. Copyright © 1978 by the American College of Physicians. All rights reserved. Printed in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a data base or retrieval system, without the prior written permission of the publisher.
Previous editions copyright © 1992, 1990 by Appleton & Lange; copyright © 1985, 1983 by Lange Medical Publications. 1 2 3 4 5 6 7 8 9 0 DOC/DOC 0 9 8 7 6 5 4 3 ISBN: 0-8385-1450-2 ISSN: 084-2293 Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The editors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the editors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. This book was set in Adobe Garamond by Pine Tree Composition, Inc. The editors were Shelley Reinhardt, Harriet Lebowitz, and Nicky Fernando. The production supervisor was Philip Galea. The book designer was Eve Siegel. The cover designer was Mary McKeon. The index was prepared by Coughlin Indexing Services, Inc. RR Donnelley was the printer and binder. This book is printed on acid-free paper. INTERNATIONAL EDITION ISBN 0-07-121975-7 Copyright © 2004. Exclusive rights by The McGraw-Hill Companies, Inc., for manufacture and export. This book cannot be reexported from the country to which it is consigned by McGraw-Hill. The International Edition is not available in North America. Contents Pharmacotherapy in Advanced Cardiac Life Support (See Table 7-2.) Authors vii
Page 1 and 2: CURRENT Emergency Diagnosis & Treat
Page 3 and 4: SECTION I - SPECIAL ASPECTS OF EMER
Page 5 and 6: SECTION II - MANAGEMENT OF COMMON E
Page 7 and 8: EPISODIC LOSS OF CONSCIOUSNESS TABL
Page 9 and 10: III. GENERAL ORTHOPEDIC PRINCIPLES
Page 11 and 12: IMMEDIATE MANAGEMENT OF LIFE-THREAT
Page 13: Thomas M. Huhn, MD 1 General Consid
Page 17 and 18: Chapter 15. Diarrhea & Vomiting 296
Page 19 and 20: Chapter 45. Poisoning 963 D. Shanno
Page 21 and 22: Attending Staff Physician and Instr
Page 23 and 24: Inside Front Cover: Drugs Commonly
Page 25 and 26: maproc01@hotmail.com Obstetric & Gy
Page 27 and 28: David C. Van, MD, MS Assistant Clin
Page 29 and 30: throughout this project. In additio
Page 31 and 32: emergency medicine appears to be at
Page 33 and 34: follow-up plan; and communicate eff
Page 35 and 36: contributor to the obtundation. Ref
Page 37 and 38: Table 1-1. Timeline of emergency me
Page 39 and 40: Table 1-3. Emergency physician pers
Page 41 and 42: critical element in the development
Page 43 and 44: immediate callback and location inf
Page 45 and 46: A. Report of the Emergency In many
Page 47 and 48: Off-line medical direction is the o
Page 49 and 50: y intermediate or paramedic EMTs. B
Page 51 and 52: A pillow, rolled-up blanket, or oth
Page 53 and 54: intubation, needle thoracostomy, cr
Page 55 and 56: Trauma 1997;42:723. [PMID: 9137264]
Page 57 and 58: comments about prehospital care. BM
Page 59 and 60: Table 2-2. Alternative EMS system d
Page 61 and 62: Figure 2-2. Standing orders for tre
Page 63 and 64: 3. Nuclear, Biologic, & Chemical Ag
Page 65 and 66:
kill 50% of those exposed) is appro
Page 67 and 68:
form of anthrax. Symptoms include h
Page 69 and 70:
Patients may require intensive medi
Page 71 and 72:
Significant person-to-person transm
Page 73 and 74:
A. Antibiotics Most cases of C burn
Page 75 and 76:
A. Symptoms and Signs Disease begin
Page 77 and 78:
A. Specific Therapy Ribavirin is a
Page 79 and 80:
occurs after ingesting food already
Page 81 and 82:
The treatment of ricin toxicity dep
Page 83 and 84:
A. Symptoms and Signs After exposur
Page 85 and 86:
effects of vapor exposure do not te
Page 87 and 88:
Treatment A. Bed Rest Any activity,
Page 89 and 90:
preferred method of decontamination
Page 91 and 92:
An elevated blood cyanide concentra
Page 93 and 94:
Table 3-1. Clinical findings and tr
Page 95 and 96:
Table 3-2. Levels of protection req
Page 97 and 98:
Table 3-4. Clinical findings associ
Page 99 and 100:
4. Multicasualty Incidents & Disast
Page 101 and 102:
Casualties are related to trauma fr
Page 103 and 104:
adiation levels. In nuclear acciden
Page 105 and 106:
community emergency response. Acad
Page 107 and 108:
Patients are most efficiently extri
Page 109 and 110:
and intravenous lines for volume or
Page 111 and 112:
Many communities and rural areas ha
Page 113 and 114:
arrangement, mutual aid, and the li
Page 115 and 116:
themselves without many basic neces
Page 117 and 118:
Triage for Incoming Victims An expe
Page 119 and 120:
airway and circulatory support and
Page 121 and 122:
Table 4-1. Sudden natural disasters
Page 123 and 124:
Figure 4-1. Epicenters of significa
Page 125 and 126:
Figure 4-3. The Incident Command Sy
Page 127 and 128:
Figure 4-5. START triage algorithm.
Page 129 and 130:
Figure 4-7. Hazmat scene organizati
Page 131 and 132:
against public interest, such as th
Page 133 and 134:
STATUTE OF LIMITATIONS The statute
Page 135 and 136:
A series of abuses of the privilege
Page 137 and 138:
appropriate. The physician-oriented
Page 139 and 140:
transmitted diseases, or chemical d
Page 141 and 142:
estraints, it risks incurring liabi
Page 143 and 144:
events are reportable and the proce
Page 145 and 146:
cases, the emergency physician and
Page 147 and 148:
clinical skills are under constant
Page 149 and 150:
manner and should not exclude any r
Page 151 and 152:
6. Emergency Procedures 1 - William
Page 153 and 154:
• Lymphangitis of the extremity.
Page 155 and 156:
7. If venous blood is not obtained
Page 157 and 158:
• Mosquito clamps (2) (useful for
Page 159 and 160:
13. Allow blood to fill the cathete
Page 161 and 162:
tapping over the vein may help to d
Page 163 and 164:
• Scalp vein needle of appropriat
Page 165 and 166:
• Silk skin suture (size 3-0) on
Page 167 and 168:
the central needle at this point, a
Page 169 and 170:
• Straight scissors. • Plastic-
Page 171 and 172:
vein lumen. This method permits dil
Page 173 and 174:
• Lidocaine, 1%, with 10-mL syrin
Page 175 and 176:
while pulling back on the plunger o
Page 177 and 178:
• Adhesive dressing. B. Femoral V
Page 179 and 180:
SAPHENOUS VEIN CUTDOWN Indications
Page 181 and 182:
4. Drape the skin. 5. Anesthetize t
Page 183 and 184:
the midline. Procedure 1. Sterilize
Page 185 and 186:
Allen Test The Allen test should be
Page 187 and 188:
through the oropharynx is difficult
Page 189 and 190:
2. Check the laryngoscope and blade
Page 191 and 192:
when the tube passes through the vo
Page 193 and 194:
• Lubricant. • Suction syringe
Page 195 and 196:
direct vision. INSERTION OF SENGSTA
Page 197 and 198:
3. Make sure that all necessary equ
Page 199 and 200:
One person can perform cricothyroto
Page 201 and 202:
tape too tightly can cause erosion
Page 203 and 204:
THORACENTESIS Indications Indicatio
Page 205 and 206:
1. Attach a 30-mL syringe to the ca
Page 207 and 208:
Tubes are usually inserted laterall
Page 209 and 210:
skin. Cover the tube with two 10-
Page 211 and 212:
vessel occur. Procedure 1. Prepare
Page 213 and 214:
spinal needle) for aspiration. It i
Page 215 and 216:
ing the needle back to the subcutan
Page 217 and 218:
to view the Morison pouch. Keep the
Page 219 and 220:
for ascites to pool in the dependen
Page 221 and 222:
• Lidocaine, 1%, with 5-mL syring
Page 223 and 224:
and instill 1 L of sterile, warm Ri
Page 225 and 226:
Positioning of the Patient A. Femal
Page 227 and 228:
15. Obtain a specimen for appropria
Page 229 and 230:
• Silk suture (size 3-0) on a cur
Page 231 and 232:
Contraindications Contraindications
Page 233 and 234:
Procedure 1. Observe sterile techni
Page 235 and 236:
A. Massive Obesity If the patient i
Page 237 and 238:
ANTERIOR & POSTERIOR NASAL PACKING
Page 239 and 240:
A. Anterior Nasal Pack 1. Assemble
Page 241 and 242:
the septum. (7) After the posterior
Page 243 and 244:
7. Penetrate the skin at the select
Page 245 and 246:
F. Small Joints of the Hands and Fe
Page 247 and 248:
Personnel Required One person can u
Page 249 and 250:
9. Irrigate the abscess with saline
Page 251 and 252:
4. Begin at 70-80 mA current output
Page 253 and 254:
Table 6-2. Pigmentation of the cere
Page 255 and 256:
Figure 6-2. Venotomy technique. Exe
Page 257 and 258:
Figure 6-4. A: Technique of removin
Page 259 and 260:
Figure 6-6. A: Scalp vein needle in
Page 261 and 262:
Figure 6-8. Anatomic relationships
Page 263 and 264:
Figure 6-10. Internal jugular vein
Page 265 and 266:
Page 267 and 268:
Page 269 and 270:
Figure 6-16. Technique of radial ar
Page 271 and 272:
Figure 6-18. Technique of nasogastr
Page 273 and 274:
Figure 6-20. Securing tamponade tub
Page 275 and 276:
Figure 6-22. 50-psi oxygen source i
Page 277 and 278:
Figure 6-24. Technique of thoracent
Page 279 and 280:
Figure 6-26. Diagram of pericardioc
Page 281 and 282:
Figure 6-28. Insertion site for abd
Page 283 and 284:
Figure 6-30. Sagittal section of fe
Page 285 and 286:
Figure 6-32. Decubitus position for
Page 287 and 288:
Figure 6-34. Aspiration of the knee
Page 289 and 290:
Figure 6-36. Anterior approach to s
Page 291 and 292:
Figure 6-38. Determination of the n
Page 293 and 294:
THE TEAM APPROACH TO CARDIAC ARREST
Page 295 and 296:
Early Prevention Early prevention i
Page 297 and 298:
4. Cricoid pressure application—C
Page 299 and 300:
defibrillator must be placed in the
Page 301 and 302:
Advanced airway techniques include
Page 303 and 304:
pharmacologic therapy in the pulsel
Page 305 and 306:
lidocaine received treatment from A
Page 307 and 308:
9044489] Kulkarni RG, Thomas SH: Se
Page 309 and 310:
equires a continual flow of oxygen.
Page 311 and 312:
"Lifestick" CPR A combination of th
Page 313 and 314:
Table 7-1. Differentiating ventricu
Page 315 and 316:
Start at 8-12 µg/min, then titrate
Page 317 and 318:
Figure 7-2. Opening the airway and
Page 319 and 320:
Figure 7-4. Ventilation technique u
Page 321 and 322:
Figure 7-6. Clearing airway in cons
Page 323 and 324:
Figure 7-8. Contact points for defi
Page 325 and 326:
Figure 7-10. Algorithm for usage of
Page 327 and 328:
espiratory rate, tidal volume, acce
Page 329 and 330:
The mouth-to-mask technique is anot
Page 331 and 332:
to massive bleeding or trauma that
Page 333 and 334:
Lighted stylet and light wand devic
Page 335 and 336:
elatively easily learned. With atte
Page 337 and 338:
about 30 degrees caudad. Aspiration
Page 339 and 340:
1. Lidocaine—Topical lidocaine ma
Page 341 and 342:
from pretreatment with atropine. Pr
Page 343 and 344:
a. One of the NDMBDs that can be us
Page 345 and 346:
g. Use in pregnancy only if clearly
Page 347 and 348:
a. May cause hypotension in the hyp
Page 349 and 350:
. Muscle rigidity, which may occur
Page 351 and 352:
A. Unique Features • In infants,
Page 353 and 354:
Until age 10 years, children should
Page 355 and 356:
Patients with severe facial and upp
Page 357 and 358:
Complications that may occur while
Page 359 and 360:
SECTION II - MANAGEMENT OF COMMON E
Page 361 and 362:
Table 8-2. Essential airway managem
Page 363 and 364:
Table 8-4. Complications of esophag
Page 365 and 366:
Table 8-6. Alternative methods of i
Page 367 and 368:
Table 8-8. Properties of local anes
Page 369 and 370:
Table 8-10. Rapid-sequence inductio
Page 371 and 372:
Figure 8-1. Management of the compr
Page 373 and 374:
Figure 8-3. A: Oral airway. B: Nasa
Page 375 and 376:
Figure 8-5. Landmarks for locating
Page 377 and 378:
9. Shock 1 - Peter W. Greenwald, MD
Page 379 and 380:
D. Distributive Shock The chief abn
Page 381 and 382:
If trauma is present, the above ste
Page 383 and 384:
B. Seek Evidence of Aortic Dissecti
Page 385 and 386:
EMERGENCY TREATMENT OF SPECIFIC CAU
Page 387 and 388:
soon as possible in patients with m
Page 389 and 390:
helpful if gross blood is found or
Page 391 and 392:
An intra-aortic balloon pump may pr
Page 393 and 394:
Digitalis glycosides have no role i
Page 395 and 396:
Systemic Inflammatory Response Synd
Page 397 and 398:
frequently and vary depending on ho
Page 399 and 400:
Treatment Begin treatment as soon a
Page 401 and 402:
Clinical Findings The symptoms and
Page 403 and 404:
Table 9-2. Classification of shock
Page 405 and 406:
Table 9-4. Indices of successful re
Page 407 and 408:
Figure 9-1. Management of a clinica
Page 409 and 410:
the airway, breathing, and circulat
Page 411 and 412:
further classified as mild, moderat
Page 413 and 414:
infection, hypothermia, coagulopath
Page 415 and 416:
3. Autotransfusion—Autotransfusio
Page 417 and 418:
Essentials of Diagnosis • Respira
Page 419 and 420:
Treatment Careful monitoring of oxy
Page 421 and 422:
ecommended as screening tools becau
Page 423 and 424:
History, including mechanism of inj
Page 425 and 426:
Treatment An initial goal is to ach
Page 427 and 428:
• Immobilize to prevent further d
Page 429 and 430:
Table 10-2. Indications for arterio
Page 431 and 432:
Figure 10-2. Trauma scores used to
Page 433 and 434:
(eg, saturation < 90%) or ventilato
Page 435 and 436:
Disposition Hospitalize these patie
Page 437 and 438:
(Chapters 33 and 34). Determination
Page 439 and 440:
Barton ED: Tension pneumothorax. Cu
Page 441 and 442:
to pain should trigger intervention
Page 443 and 444:
B. Hemothorax In hemothorax due to
Page 445 and 446:
Patients with AIDS may develop pneu
Page 447 and 448:
A foreign body should be removed if
Page 449 and 450:
control values. Selected patients m
Page 451 and 452:
Clinical Findings The diagnosis is
Page 453 and 454:
Table 11-1. Essentials of diagnosis
Page 455 and 456:
Figure 11-2. The radiographic appea
Page 457 and 458:
Figure 11-4. Large left-sided hemot
Page 459 and 460:
Figure 11-6. Radiographic appearanc
Page 461 and 462:
Clinical Findings The patient is in
Page 463 and 464:
pericardiocentesis (under ultrasoun
Page 465 and 466:
a. Nitroglycerin—Give nitroglycer
Page 467 and 468:
I. Other Tests Obtain additional te
Page 469 and 470:
MANAGEMENT OF SPECIFIC DISORDERS CA
Page 471 and 472:
An accurate diagnosis of pleurisy i
Page 473 and 474:
Esophageal disorders such as esopha
Page 475 and 476:
PANCREATITIS (See Chapter 13.) Chol
Page 477 and 478:
Clinical Findings The patient compl
Page 479 and 480:
Ng SM et al: Ninety-minute accelera
Page 481 and 482:
Table 12-2. Distinguishing features
Page 483 and 484:
May have occurred Usually strong pl
Page 485 and 486:
13. Abdominal Pain 1 - Roger Humphr
Page 487 and 488:
Mode of Onset of Abdominal Pain (Se
Page 489 and 490:
poisoning, acute gastritis, acute p
Page 491 and 492:
entire hand. Careful one-finger pal
Page 493 and 494:
Serum Amylase & Lipase Serum amylas
Page 495 and 496:
nodes, pancreas, aorta, or other so
Page 497 and 498:
the ability to diagnose acute surgi
Page 499 and 500:
antibiotics. Immediate hospitalizat
Page 501 and 502:
A. For the Seriously Ill Patient or
Page 503 and 504:
upper quadrant sonography is the di
Page 505 and 506:
flank, low back, or groin. Faintnes
Page 507 and 508:
Insert at least 2 large-bore (= 16-
Page 509 and 510:
Treatment No specific treatment is
Page 511 and 512:
3. Ruptured Ovarian Follicle Cyst C
Page 513 and 514:
clotting factors as needed. Disposi
Page 515 and 516:
Table 13-2. Differential diagnosis
Page 517 and 518:
Table 13-3. Routine for physical ex
Page 519 and 520:
Figure 13-1. Algorithmic approach t
Page 521 and 522:
Figure 13-3. Performing the iliopso
Page 523 and 524:
Figure 13-5. Obliteration of the ps
Page 525 and 526:
Figure 13-7. Abdominal x-ray showin
Page 527 and 528:
Figure 13-9. Upright anteroposterio
Page 529 and 530:
14. Gastrointestinal Bleeding 1 - C
Page 531 and 532:
Also, perform a cardiac and pulmona
Page 533 and 534:
distal to the ligament of Treitz is
Page 535 and 536:
1. Anoscopy/proctosigmoidoscopy—E
Page 537 and 538:
PEPTIC ULCER DISEASE Peptic ulcer d
Page 539 and 540:
Treatment Provide emergency managem
Page 541 and 542:
All patients with the above diagnos
Page 543 and 544:
present. The diagnosis should be co
Page 545 and 546:
elderly and have chronic constipati
Page 547 and 548:
Figure 14-1. Immediate management o
Page 549 and 550:
Figure 14-3. Hematochezia or suspec
Page 551 and 552:
investigation if the cause is uncer
Page 553 and 554:
include an electrocardiogram, conti
Page 555 and 556:
must be ruled out in patients with
Page 557 and 558:
BACTERIAL GASTROENTERITIS Essential
Page 559 and 560:
coli 0157:H7. Salmonella and Shigel
Page 561 and 562:
1997;92(11):1962. [PMID: 9362174] E
Page 563 and 564:
Table 15-1. Conditions that may cau
Page 565 and 566:
Table 15-3. Differential diagnostic
Page 567 and 568:
Table 15-4. Differential diagnostic
Page 569 and 570:
Figure 15-1. Approach to the patien
Page 571 and 572:
16. Coma 1 - Steven D. Kelley, MD,
Page 573 and 574:
elevation in PCO 2 levels that are
Page 575 and 576:
• Confusion: a state of impaired
Page 577 and 578:
Spontaneous blinking indicates inta
Page 579 and 580:
the same serious prognosis as the m
Page 581 and 582:
Clinical Findings Intracerebral hem
Page 583 and 584:
A. Symptoms and Signs Coma is seldo
Page 585 and 586:
• Coma, altered mental status.
Page 587 and 588:
to walk or stand. Caution: Early st
Page 589 and 590:
Essentials of Diagnosis • Patient
Page 591 and 592:
Unlike other organs, the brain reli
Page 593 and 594:
Treatment is primarily supportive a
Page 595 and 596:
ange from as few as 10 monocytes/mL
Page 597 and 598:
The slow, conjugate roving eye move
Page 599 and 600:
Feske SK: Coma and confusional stat
Page 601 and 602:
Page 603 and 604:
Table 16-4. Common findings in pati
Page 605 and 606:
Figure 16-1. Approach to the uncons
Page 607 and 608:
17. Syncope, Seizures, & Other Caus
Page 609 and 610:
epilepticus may also produce a mild
Page 611 and 612:
Check stool specimens for blood (gr
Page 613 and 614:
Seizures can result from a primary
Page 615 and 616:
B. Syncope Brain hypoperfusion caus
Page 617 and 618:
QT interval. However, a single ECG,
Page 619 and 620:
this condition are similar to those
Page 621 and 622:
ischemia, syncope, vertigo, diplopi
Page 623 and 624:
Psychogenic hyperventilation is a f
Page 625 and 626:
12180243] Mack G, Silberbach M: Aor
Page 627 and 628:
Table 17-2. Drug treatment of statu
Page 629 and 630:
Table 17-3. Common causes of seizur
Page 631 and 632:
Table 17-4. Summary of anticonvulsa
Page 633 and 634:
Table 17-6. Common causes of syncop
Page 635 and 636:
Figure 17-1. Assessment of patients
Page 637 and 638:
intubation and mechanical ventilati
Page 639 and 640:
Treatment & Disposition Hospitalize
Page 641 and 642:
2. Gila monsters—Gila monster bit
Page 643 and 644:
een eliminated. A history of hyster
Page 645 and 646:
Essentials of Diagnosis • Majorit
Page 647 and 648:
B. Laboratory Findings Lumbar punct
Page 649 and 650:
should be referred to a neurologist
Page 651 and 652:
Subjective and objective sensory di
Page 653 and 654:
(See also Chapter 45.) Symptomatic
Page 655 and 656:
Cerebrospinal fluid and peripheral
Page 657 and 658:
Clostridium botulinum toxin attacks
Page 659 and 660:
• Respiratory paresis. General Co
Page 661 and 662:
Treatment Immediately evaluate the
Page 663 and 664:
failure and marked elevations of se
Page 665 and 666:
neurologic disorder in adults and o
Page 667 and 668:
suggestive of giant cell arteritis.
Page 669 and 670:
Bella I et al: Neuromuscular disord
Page 671 and 672:
Aneurysmal rebleeding may be second
Page 673 and 674:
Essentials of Diagnosis • Seconda
Page 675 and 676:
• Persistent numbness or tingling
Page 677 and 678:
C. Clopidogrel Clopidogrel works by
Page 679 and 680:
heparin in acute ischemic stroke.)
Page 681 and 682:
Page 683 and 684:
Table 18-4. Symptoms and signs of b
Page 685 and 686:
Table 18-6. Drug therapy of stable
Page 687 and 688:
Table 18-8. Common causes of rhabdo
Page 689 and 690:
Table 18-10. Risk factors for ather
Page 691 and 692:
Figure 18-2. A noncontrast head CT
Page 693 and 694:
19. Headache 1 - C. Keith Stone, MD
Page 695 and 696:
Even after careful initial history
Page 697 and 698:
A. Vital Signs 1. Fever—The prese
Page 699 and 700:
• Symptoms related to vasculature
Page 701 and 702:
puncture. J Pediatr Oncol Nurs 2001
Page 703 and 704:
Essentials of Diagnosis • Mild to
Page 705 and 706:
sections) because involvement is se
Page 707 and 708:
scintillations that enlarge and spr
Page 709 and 710:
ipsilateral cranial autonomic sympt
Page 711 and 712:
Figure 19-1. Management of complain
Page 713 and 714:
C. Treat Shock Hypotension and shoc
Page 715 and 716:
the fluctuating hemiparesis that ma
Page 717 and 718:
confusion. Wernicke encephalopathy
Page 719 and 720:
decrease or cessation of alcohol co
Page 721 and 722:
tachycardia, and agitation). Patien
Page 723 and 724:
Beaver TM et al: Treatment of acute
Page 725 and 726:
evaluation. 2. Transient Global Amn
Page 727 and 728:
Essentials of Diagnosis • All for
Page 729 and 730:
Location In Book: CURRENT EMERGENCY
Page 731 and 732:
Page 733 and 734:
Table 20-4. Sedative drugs reported
Page 735 and 736:
Table 20-6. Causes of amnestic synd
Page 737 and 738:
Figure 20-1. Assessment of delirium
Page 739 and 740:
Involvement of 1-3 joints in an asy
Page 741 and 742:
A. Symptoms and Signs There is sudd
Page 743 and 744:
Septic arthritis is one of the more
Page 745 and 746:
RHEUMATIC FEVER & POSTSTREPTOCOCCAL
Page 747 and 748:
Initial treatment is with NSAIDs. S
Page 749 and 750:
The acute arthritis of systemic lup
Page 751 and 752:
therapy or in the hospital. Patient
Page 753 and 754:
C. X-ray and Laboratory Findings Ob
Page 755 and 756:
• Often acute on chronic flare-up
Page 757 and 758:
Essentials of Diagnosis • Usually
Page 759 and 760:
Table 21-1. Some common syndromes o
Page 761 and 762:
Table 21-3. Revised Jones criteria
Page 763 and 764:
Table 21-5. Neurologic findings in
Page 765 and 766:
Figure 21-2. Assessment of patients
Page 767 and 768:
mask airway, in the patient who is
Page 769 and 770:
If blood pressures are elevated, ev
Page 771 and 772:
Studies have shown that 40-100% of
Page 773 and 774:
Clinical Findings Basilar skull fra
Page 775 and 776:
Essentials of Diagnosis • Diagnos
Page 777 and 778:
Various methods have been proposed
Page 779 and 780:
Table 22-1. Concussion grading and
Page 781 and 782:
Figure 22-2. Severely depressed fro
Page 783 and 784:
Figure 22-4. Small left subdural he
Page 785 and 786:
Figure 22-6. Right temporal subarac
Page 787 and 788:
23. Maxillofacial & Neck Trauma 1 -
Page 789 and 790:
of large amounts of soft tissue wit
Page 791 and 792:
Airway injury may be manifested by
Page 793 and 794:
C. Auditory Nerve Test hearing in b
Page 795 and 796:
jaw, or ears? Point to where it hur
Page 797 and 798:
Le Fort I is a fracture parallel to
Page 799 and 800:
flattening of the normal malar prom
Page 801 and 802:
General Considerations The nasal bo
Page 803 and 804:
and orbital fractures. Treatment Wh
Page 805 and 806:
evaluation and surgery. Immediate o
Page 807 and 808:
Patients with temporal bone fractur
Page 809 and 810:
irrigated completely and conservati
Page 811 and 812:
Figure 23-1. Location of nerves pas
Page 813 and 814:
Figure 23-3. Area of the face where
Page 815 and 816:
Figure 23-5. Anterior (left) and la
Page 817 and 818:
Figure 23-7. Three-dimensionally re
Page 819 and 820:
Figure 23-9. Reduction of nasal fra
Page 821 and 822:
Pain may impair chest wall expansio
Page 823 and 824:
General Considerations Injury to th
Page 825 and 826:
Salem K, Mulji A, Lonn E: Echocardi
Page 827 and 828:
use of intravenous fluids to ensure
Page 829 and 830:
Essentials of Diagnosis • Delayed
Page 831 and 832:
Shanmuganathan K, Mirvis SE: Imagin
Page 833 and 834:
Clinical Findings A. Symptoms and S
Page 835 and 836:
[PMID: 10858676] (Review.) SYSTEMIC
Page 837 and 838:
increase the amount of uncontrolled
Page 839 and 840:
Figure 24-1. An ill-advised chest x
Page 841 and 842:
Figure 24-3. Blunt trauma patient w
Page 843 and 844:
Figure 24-5. A: Chest x-ray of hypo
Page 845 and 846:
site prior to obtaining x-rays. Do
Page 847 and 848:
most dependent parts of the abdomen
Page 849 and 850:
Hemodynamically stable patients wit
Page 851 and 852:
Essentials of Diagnosis • May occ
Page 853 and 854:
Figure 25-1. Positive FAST exam dem
Page 855 and 856:
Figure 25-3. Adult female blunt tra
Page 857 and 858:
Figure 25-5. Adult male blunt traum
Page 859 and 860:
In 1989, a 10-year prospective stud
Page 861 and 862:
• Often accompanied by other abdo
Page 863 and 864:
containing urine (urinoma) or blood
Page 865 and 866:
and a urethrogram should be perform
Page 867 and 868:
Treatment Immediate urologic consul
Page 869 and 870:
Figure 26-1. Algorithm for staging
Page 871 and 872:
Figure 26-3. Algorithm for the eval
Page 873 and 874:
Figure 26-5. Adult blunt trauma pat
Page 875 and 876:
Figure 26-7. Adult blunt trauma pat
Page 877 and 878:
Figure 26-9. Adult male blunt traum
Page 879 and 880:
Figure 26-11. Adult male patient wi
Page 881 and 882:
Note: Neck alignment and immobility
Page 883 and 884:
Avoid excess fluid administration,
Page 885 and 886:
absence of spinal pain does not eli
Page 887 and 888:
Note: The presence of brain-stem si
Page 889 and 890:
of body). The shoulder of the adduc
Page 891 and 892:
Spinal cord injury with or without
Page 893 and 894:
Ralston ME et al: Role of flexion-e
Page 895 and 896:
Location In Book: CURRENT EMERGENCY
Page 897 and 898:
Abductor pollicis brevis Median (C7
Page 899 and 900:
Table 27-4. Commonly used landmarks
Page 901 and 902:
Table 27-6. Cervical spine injuries
Page 903 and 904:
Figure 27-1. Cutaneous innervation.
Page 905 and 906:
28. Orthopedic Emergencies - Luis E
Page 907 and 908:
in other patients. The diagnosis ca
Page 909 and 910:
SPRAINS & STRAINS Sprains are injur
Page 911 and 912:
and chest radiographs should be exa
Page 913 and 914:
Often the clavicle is deformed, and
Page 915 and 916:
instances CT scanning may be necess
Page 917 and 918:
Obtain a shoulder series, including
Page 919 and 920:
• Occurs after FOOSH. • Elbow d
Page 921 and 922:
the presence of a fat pad (especial
Page 923 and 924:
performed. As noted earlier in this
Page 925 and 926:
The patient may present with wrist
Page 927 and 928:
placed in an ulnar gutter splint (F
Page 929 and 930:
B. X-ray Findings Occasionally an a
Page 931 and 932:
• May have large amount of bleedi
Page 933 and 934:
prehospital setting. Disposition Mo
Page 935 and 936:
common. Treatment Adequate pain con
Page 937 and 938:
displaced fractures require surgica
Page 939 and 940:
used to delineate the extent of the
Page 941 and 942:
A. Symptoms and Signs Visual deform
Page 943 and 944:
Orthopedic follow-up is indicated f
Page 945 and 946:
• Assess for compartment syndrome
Page 947 and 948:
Essentials of Diagnosis • Inversi
Page 949 and 950:
Page 951 and 952:
consultation from an orthopedist. 7
Page 953 and 954:
fractures. The Boehler angle is for
Page 955 and 956:
General Considerations Fractures an
Page 957 and 958:
• Fractures and dislocations are
Page 959 and 960:
Table 28-1. Potential blood loss fr
Page 961 and 962:
Figure 28-2. Salter-Harris classifi
Page 963 and 964:
Figure 28-5. Posterior plaster spli
Page 965 and 966:
Figure 28-6. Reduction of posterior
Page 967 and 968:
Figure 28-9. Volar splint for immob
Page 969 and 970:
Figure 28-10. Volar wrist and hand
Page 971 and 972:
Figure 28-12. Stress examination of
Page 973 and 974:
Figure 28-14. The Allis technique f
Page 975 and 976:
Figure 28-16. The Lachman test for
Page 977 and 978:
Figure 28-18. Combined sugar-tong s
Page 979 and 980:
29. Hand Trauma 1 - Adam Saperston,
Page 981 and 982:
27, or 30 gauge should be used with
Page 983 and 984:
generally able to contract independ
Page 985 and 986:
1. Motor testing— a. High median
Page 987 and 988:
C. Sling No patient should leave th
Page 989 and 990:
the phalanx proper should be consid
Page 991 and 992:
• Suspect if bruising is present
Page 993 and 994:
The wrist joint is the principal jo
Page 995 and 996:
As with any hand infection, the pat
Page 997 and 998:
cause overwhelming sepsis in immuno
Page 999 and 1000:
the finger or thumb goes through an
Page 1001 and 1002:
prophylactically indicated and for
Page 1003 and 1004:
are started, the more effective the
Page 1005 and 1006:
of consistency in appropriate cases
Page 1007 and 1008:
involvement, distortion, and signif
Page 1009 and 1010:
Figure 29-1. Digital block. (1) Use
Page 1011 and 1012:
Figure 29-3. Palmar hand with skin
Page 1013 and 1014:
Figure 29-5. Terminology of bones a
Page 1015 and 1016:
Figure 29-8. A and B: The shaded ar
Page 1017 and 1018:
Figure 29-9. Position of function o
Page 1019 and 1020:
Figure 29-11. Methods of tenorrhaph
Page 1021 and 1022:
Figure 29-13. Boutonniere deformity
Page 1023 and 1024:
Figure 29-15. Incision and drainage
Page 1025 and 1026:
Figure 29-17. Sensory distribution
Page 1027 and 1028:
Simple cutaneous lacerations are us
Page 1029 and 1030:
C. How Did the Injury Occur? The me
Page 1031 and 1032:
probing. Make sure that no tourniqu
Page 1033 and 1034:
adial nerve blocks; digital nerve b
Page 1035 and 1036:
than no irrigation at all. Normal s
Page 1037 and 1038:
nose, require a conservative approa
Page 1039 and 1040:
its tensile strength within 2 weeks
Page 1041 and 1042:
enhance tape adhesion, it is solubi
Page 1043 and 1044:
subjected to increased tension duri
Page 1045 and 1046:
Immobilization of the wound enhance
Page 1047 and 1048:
Debridement Dressings are frequentl
Page 1049 and 1050:
The risk of tetanus is greater with
Page 1051 and 1052:
1-mL intramuscular doses of human d
Page 1053 and 1054:
5. Close the external skin with int
Page 1055 and 1056:
Treatment To ensure the most expedi
Page 1057 and 1058:
Hospitalize patients with suspected
Page 1059 and 1060:
Vasilevski D et al: High-pressure i
Page 1061 and 1062:
Table 30-2. Choice of antimicrobial
Page 1063 and 1064:
Table 30-4. Rabies postexposure pro
Page 1065 and 1066:
Table 30-6. Timing of suture remova
Page 1067 and 1068:
Figure 30-2. Radial nerve block, in
Page 1069 and 1070:
Figure 30-5. Infraorbital nerve blo
Page 1071 and 1072:
Figure 30-6. Supraorbital nerve blo
Page 1073 and 1074:
Figure 30-8. Layered cutaneous clos
Page 1075 and 1076:
Figure 30-10. Algorithm for managem
Page 1077 and 1078:
Funduscopy is used to check the ret
Page 1079 and 1080:
Leibowitz HM: The red eye. N Engl J
Page 1081 and 1082:
dioxide). Other modalities to be co
Page 1083 and 1084:
involving the sclera as well as oth
Page 1085 and 1086:
Banker AS et al: Retinal detachment
Page 1087 and 1088:
Essentials of Diagnosis • Pain an
Page 1089 and 1090:
Essentials of Diagnosis • Most fr
Page 1091 and 1092:
Essentials of Diagnosis • Redness
Page 1093 and 1094:
Hyphema is characterized by sudden
Page 1095 and 1096:
Essentials of Diagnosis • Painles
Page 1097 and 1098:
Bhagat N: Central retinal vein occl
Page 1099 and 1100:
Acid burns as a rule cause damage m
Page 1101 and 1102:
Treatment & Disposition Hospitalize
Page 1103 and 1104:
Check the vitreous for hemorrhage o
Page 1105 and 1106:
floor displacement. Treatment Provi
Page 1107 and 1108:
Mester V et al: Intraocular foreign
Page 1109 and 1110:
The main considerations are good il
Page 1111 and 1112:
OCULAR DISORDERS Dangers in the Use
Page 1113 and 1114:
Page 1115 and 1116:
Table 31-3. Some known causes of sp
Page 1117 and 1118:
Table 31-5. Commonly used ophthalmi
Page 1119 and 1120:
Figure 31-2. Assessment of acute pa
Page 1121 and 1122:
Figure 31-4. Acute dacryocystitis.
Page 1123 and 1124:
32. ENT Emergencies: Disorders of t
Page 1125 and 1126:
classification usually can be resol
Page 1127 and 1128:
clothing and eyewear and set up a h
Page 1129 and 1130:
Clinical Findings A. History In chi
Page 1131 and 1132:
socket. Compare to the shape of mir
Page 1133 and 1134:
cases. Otolaryngol Head Neck Surg 2
Page 1135 and 1136:
3. Third-degree injuries exhibit de
Page 1137 and 1138:
fungal infections. Treatment recomm
Page 1139 and 1140:
patients with negative aspirates as
Page 1141 and 1142:
Though myriad disorders involve the
Page 1143 and 1144:
• Inability to close mouth. • O
Page 1145 and 1146:
Table 32-1. Diagnosis and treatment
Page 1147 and 1148:
Table 32-2. Causes of sudden hearin
Page 1149 and 1150:
Table 32-4. Causes of peripheral ve
Page 1151 and 1152:
Table 32-6. Diagnosis and treatment
Page 1153 and 1154:
Figure 32-1. In the Webber test, vi
Page 1155 and 1156:
Figure 32-3. Cauterization of bleed
Page 1157 and 1158:
Figure 32-5. Asymmetric tonsillar p
Page 1159 and 1160:
Figure 32-7. The Ellis tooth fractu
Page 1161 and 1162:
Figure 32-9. Needle drainage sites
Page 1163 and 1164:
Figure 32-11. Tooth anatomy. Locati
Page 1165 and 1166:
possible nonpulmonary sources of bl
Page 1167 and 1168:
Traumatic pneumothoraces are common
Page 1169 and 1170:
General Considerations COPD is an u
Page 1171 and 1172:
typically thin smokers who are not
Page 1173 and 1174:
Patients with many other conditions
Page 1175 and 1176:
3. Systemic corticosteroids—Adult
Page 1177 and 1178:
unit. If these patients have respon
Page 1179 and 1180:
D-Dimer assay, which has not been s
Page 1181 and 1182:
Thrombolytic agents such as strepto
Page 1183 and 1184:
Associated conditions such as pneum
Page 1185 and 1186:
A. Symptoms and Signs The patient m
Page 1187 and 1188:
eview including pathophysiology and
Page 1189 and 1190:
the patient has significant comorbi
Page 1191 and 1192:
C. Laboratory Findings 1. Cultures
Page 1193 and 1194:
PULMONARY ASPIRATION SYNDROME Essen
Page 1195 and 1196:
intervention, and treatment of the
Page 1197 and 1198:
intussusception (barium enema), rig
Page 1199 and 1200:
Table 33-1. Conditions causing hemo
Page 1201 and 1202:
Table 33-3. Conditions that predisp
Page 1203 and 1204:
34. Cardiac Emergencies 21 - Roger
Page 1205 and 1206:
Troponin is a complex of three spec
Page 1207 and 1208:
tablets. • Patient is alert and o
Page 1209 and 1210:
danger of recurring thrombosis. Hep
Page 1211 and 1212:
ecause thrombolytics are ineffectiv
Page 1213 and 1214:
4. Myocardial Rupture The chief cau
Page 1215 and 1216:
Myocardial ischemia (with attendant
Page 1217 and 1218:
4. ß-Blockers—Add a ß-adrenergi
Page 1219 and 1220:
A. Symptoms and Signs Frank pulmona
Page 1221 and 1222:
C. Electrocardiographic Findings Al
Page 1223 and 1224:
increases uterine blood flow. The d
Page 1225 and 1226:
Treatment Begin electrocardiographi
Page 1227 and 1228:
10-20 minutes, and then continue th
Page 1229 and 1230:
Classification of congenital heart
Page 1231 and 1232:
Congestive heart failure in infancy
Page 1233 and 1234:
Immediate Management
Page 1235 and 1236:
Table 34-2. Classification of cardi
Page 1237 and 1238:
35. Cardiac Arrhythmias - David A.
Page 1239 and 1240:
prove useful in formulating treatme
Page 1241 and 1242:
(1) Verapamil—The initial dose of
Page 1243 and 1244:
1. Anticoagulants—Prophylactic an
Page 1245 and 1246:
Metoprolol can be a first-line agen
Page 1247 and 1248:
Emerg Med Clin North Am 1998;16:389
Page 1249 and 1250:
Early recognition and discontinuati
Page 1251 and 1252:
1998;16:405. [PMID: 9621850] (Compl
Page 1253 and 1254:
Sick sinus syndrome is a manifestat
Page 1255 and 1256:
patients with symptomatic bradycard
Page 1257 and 1258:
1137398] (Diagnosis and management
Page 1259 and 1260:
Lead Complications A number of comp
Page 1261 and 1262:
Treat venous access complications a
Page 1263 and 1264:
MRI is contraindicated in patients
Page 1265 and 1266:
Typically, 2:1 AV conduction occurs
Page 1267 and 1268:
Failure to capture occurs when an a
Page 1269 and 1270:
Table 35-2. Commonly used pacing co
Page 1271 and 1272:
Figure 35-2. Normal sinus rhythm at
Page 1273 and 1274:
Figure 35-4. Sinus bradycardia at a
Page 1275 and 1276:
Figure 35-6. Automatic atrial tachy
Page 1277 and 1278:
Figure 35-8. A: AV nodal reentrant
Page 1279 and 1280:
Figure 35-10. Paroxysmal supraventr
Page 1281 and 1282:
Figure 35-12. A: Atrial fibrillatio
Page 1283 and 1284:
Figure 35-14. A: Atrial flutter wit
Page 1285 and 1286:
Figure 35-16. The rhythm strip show
Page 1287 and 1288:
Figure 35-18. Polymorphic ventricul
Page 1289 and 1290:
Figure 35-20. Sinus rhythm with pre
Page 1291 and 1292:
Figure 35-22. A: Atrial fibrillatio
Page 1293 and 1294:
Figure 35-24. Sinus rhythm with sec
Page 1295 and 1296:
Figure 35-26. Sinus bradycardia wit
Page 1297 and 1298:
Figure 35-28. Sinus rhythm with sec
Page 1299 and 1300:
Figure 35-30. Third-degree AV block
Page 1301 and 1302:
Figure 35-32. Asynchronous ventricu
Page 1303 and 1304:
Figure 35-34. AV sequential pacing
Page 1305 and 1306:
Figure 35-36. A: Single-chamber ven
Page 1307 and 1308:
36. Obstetric & Gynecologic Emergen
Page 1309 and 1310:
• History of salpingitis • Hist
Page 1311 and 1312:
occasionally present. Syncope or li
Page 1313 and 1314:
follow-up appointment for reevaluat
Page 1315 and 1316:
not. D. Missed Abortion (Retained C
Page 1317 and 1318:
usually age 50 years or older, but
Page 1319 and 1320:
Clinical Findings Ruptured ovarian
Page 1321 and 1322:
MITTELSCHMERZ Midcycle pain (mittel
Page 1323 and 1324:
Obtain and record the history in th
Page 1325 and 1326:
established rape counseling program
Page 1327 and 1328:
test, and an IUD is still in place,
Page 1329 and 1330:
trimester of pregnancy without evid
Page 1331 and 1332:
1. Abruptio placentae—Premature s
Page 1333 and 1334:
err on the side of hospitalization,
Page 1335 and 1336:
complete maternal cardiopulmonary r
Page 1337 and 1338:
Cut the umbilical cord after ligati
Page 1339 and 1340:
during treatment, obtain serum crea
Page 1341 and 1342:
Table 36-1. Causes of abnormal vagi
Page 1343 and 1344:
Table 36-3. Clinical manifestations
Page 1345 and 1346:
Figure 36-1. Bedside endovaginal ul
Page 1347 and 1348:
Figure 36-3. Diagnostic algorithm f
Page 1349 and 1350:
Figure 36-5. Bedside transabdominal
Page 1351 and 1352:
other underlying disease that might
Page 1353 and 1354:
Ensure adequate hydration. In an ad
Page 1355 and 1356:
shows pyuria and possibly bacteriur
Page 1357 and 1358:
General Considerations Common cause
Page 1359 and 1360:
See Chapter 40. C. Vaginitis See Ch
Page 1361 and 1362:
See Chapter 26. B. Urinary Tract In
Page 1363 and 1364:
urolithiasis, gout, hypercalcemia).
Page 1365 and 1366:
DISEASES OF THE MALE GENITOURINARY
Page 1367 and 1368:
• Fever, pain, edema, and erythem
Page 1369 and 1370:
CURRENT EMERGENCY DIAGNOSIS & TREAT
Page 1371 and 1372:
Table 37-2. Diagnostic clues to the
Page 1373 and 1374:
Table 37-4. Diagnostic clues to com
Page 1375 and 1376:
Figure 37-1. Torsion of the testicl
Page 1377 and 1378:
Figure 37-3. Unenhanced helical CT
Page 1379 and 1380:
Figure 37-5. Method of performing a
Page 1381 and 1382:
Begin intravenous infusion of cryst
Page 1383 and 1384:
Principles of Diagnosis A. Physical
Page 1385 and 1386:
Blunt Trauma Blunt trauma to the ca
Page 1387 and 1388:
with pulmonary vascular injury. Tre
Page 1389 and 1390:
Venous injury is usually manifested
Page 1391 and 1392:
heart, but they may come from anywh
Page 1393 and 1394:
ACUTE PERIPHERAL ISCHEMIA DUE TO VE
Page 1395 and 1396:
2. X-ray findings—Upright plain f
Page 1397 and 1398:
occlusion—a consensus document. A
Page 1399 and 1400:
Congenital aneurysm occurs in young
Page 1401 and 1402:
Although the chest x-ray may show a
Page 1403 and 1404:
General Considerations Occlusion or
Page 1405 and 1406:
diagnosing DVT and should not be us
Page 1407 and 1408:
Patients with mild, localized super
Page 1409 and 1410:
• Constant systolic and diastolic
Page 1411 and 1412:
thorax, or lateral aspect of the sh
Page 1413 and 1414:
sympathectomy may be required. INTR
Page 1415 and 1416:
Table 38-1. X-ray findings associat
Page 1417 and 1418:
Table 38-3. Aortic dissection class
Page 1419 and 1420:
Table 38-5. Factors predisposing to
Page 1421 and 1422:
Figure 38-1. Zones of vascular inju
Page 1423 and 1424:
39. Hematologic Emergencies - J. St
Page 1425 and 1426:
and platelet counts less than 50,00
Page 1427 and 1428:
decreased haptoglobin, elevated ret
Page 1429 and 1430:
2-day half-life. Ticlopidine and cl
Page 1431 and 1432:
everywhere. Another concern with th
Page 1433 and 1434:
common, and its presence influences
Page 1435 and 1436:
80% of uremic patients. Cryoprecipi
Page 1437 and 1438:
gastrointestinal tract, genitourina
Page 1439 and 1440:
Regardless of the cause of anemia,
Page 1441 and 1442:
autoantibodies, but significant RBC
Page 1443 and 1444:
anisocytosis, poikilocytosis, polyc
Page 1445 and 1446:
Autoimmune drug-related AIHA result
Page 1447 and 1448:
who frequently present to the emerg
Page 1449 and 1450:
hemoglobin level usually between 6
Page 1451 and 1452:
population (Table 39-14). ß-Thalas
Page 1453 and 1454:
[PMID: 11921020] Hermiston ML, Ment
Page 1455 and 1456:
VI. WHITE CELL DISORDERS NEUTROPENI
Page 1457 and 1458:
immunochemical staining. Dispositio
Page 1459 and 1460:
approximately 85% sensitivity and a
Page 1461 and 1462:
Consider hyperviscosity for any Wal
Page 1463 and 1464:
transfusions or pregnancies, (2) to
Page 1465 and 1466:
Other possible indications for FFP
Page 1467 and 1468:
outinely tested for CMV unless the
Page 1469 and 1470:
Dodd RY: Current viral risks of blo
Page 1471 and 1472:
Table 39-2. Specialized tests of he
Page 1473 and 1474:
Table 39-4. Conditions associated w
Page 1475 and 1476:
Table 39-6. Available products for
Page 1477 and 1478:
Table 39-8. Classification of von W
Page 1479 and 1480:
Table 39-10. Normal red blood cell
Page 1481 and 1482:
Table 39-12. Causes of secondary au
Page 1483 and 1484:
Table 39-14. Drugs that produce oxi
Page 1485 and 1486:
Table 39-16. Acute transfusion reac
Page 1487 and 1488:
Figure 39-1. Coagulation cascade. C
Page 1489 and 1490:
The classical clinical pattern of a
Page 1491 and 1492:
without serious organ dysfunction a
Page 1493 and 1494:
Anonymous: Practice parameters for
Page 1495 and 1496:
Page 1497 and 1498:
for less than 24 hours and are rapi
Page 1499 and 1500:
Concurrent meningitis is frequent i
Page 1501 and 1502:
pneumonias in older children, excep
Page 1503 and 1504:
children: bronchiolitis and croup.
Page 1505 and 1506:
Osteomylitis is an infection of bon
Page 1507 and 1508:
General Considerations Acute pharyn
Page 1509 and 1510:
Essentials of Diagnosis • Dysuria
Page 1511 and 1512:
are completed and urologic referral
Page 1513 and 1514:
B. General Measures If vomiting or
Page 1515 and 1516:
DISEASES OF THE FEMALE GENITOURINAR
Page 1517 and 1518:
vaginosis), and gonococci (in prepu
Page 1519 and 1520:
• Fluctuant lesion. General Consi
Page 1521 and 1522:
swelling, or fluctuance is present.
Page 1523 and 1524:
GONORRHEA N. gonorrhoeae causes pri
Page 1525 and 1526:
ecause dual infection with Chlamydi
Page 1527 and 1528:
SYPHILIS Essentials of Diagnosis
Page 1529 and 1530:
considered for any patient who has
Page 1531 and 1532:
5. Cellulitis—Cellulitis is an ac
Page 1533 and 1534:
Clinical Findings Clostridial anaer
Page 1535 and 1536:
General supportive measures include
Page 1537 and 1538:
Treatment A. Antibiotics Empiric tr
Page 1539 and 1540:
correct diagnosis before progressiv
Page 1541 and 1542:
Essentials of Diagnosis • Fever.
Page 1543 and 1544:
Treatment & Disposition Remove the
Page 1545 and 1546:
for 15-30 days. For more serious di
Page 1547 and 1548:
H. Drug Reactions See Table 40-15.
Page 1549 and 1550:
Table 40-1. Organisms and empiric t
Page 1551 and 1552:
Table 40-3. Cerebrospinal fluid (CS
Page 1553 and 1554:
Table 40-5. Recommended empiric ant
Page 1555 and 1556:
Table 40-7. Treatment of pneumonia.
Page 1557 and 1558:
Table 40-9. Empiric antibiotic ther
Page 1559 and 1560:
Table 40-11. Antimicrobial therapy
Page 1561 and 1562:
Table 40-13. Duke criteria for diag
Page 1563 and 1564:
Table 40-15. Side effects of HIV an
Page 1565 and 1566:
A. History Determine if the patient
Page 1567 and 1568:
of severe dehydration, even to the
Page 1569 and 1570:
enzymes to rule out cardiac ischemi
Page 1571 and 1572:
cerebral edema, especially in child
Page 1573 and 1574:
Treatment A growing body of literat
Page 1575 and 1576:
• Impaired counter-regulatory hor
Page 1577 and 1578:
longest-acting insulin, typically 3
Page 1579 and 1580:
B. Fluids BR>Rapid infusion of 1 L
Page 1581 and 1582:
Treatment A. Glucose After giving t
Page 1583 and 1584:
initiated when a patient with prior
Page 1585 and 1586:
elative adrenal insufficiency that
Page 1587 and 1588:
Treatment A. General and Supportive
Page 1589 and 1590:
Primary adrenocortical insufficienc
Page 1591 and 1592:
An ACTH stimulation test, however,
Page 1593 and 1594:
Neurocutaneous syndromes such as ne
Page 1595 and 1596:
• Rare disease with variable pres
Page 1597 and 1598:
prior to surgery. Also covers gener
Page 1599 and 1600:
3. Severe SIADH (serum sodium < 105
Page 1601 and 1602:
Hypernatremia and hyperosmolality a
Page 1603 and 1604:
Table 41-1. Risk factors for hyperg
Page 1605 and 1606:
1. Body water— Table 42-1 lists t
Page 1607 and 1608:
etween the intracellular and the ex
Page 1609 and 1610:
3. Hyponatremia with Isovolemia Cli
Page 1611 and 1612:
• Renal failure • Drugs (eg, de
Page 1613 and 1614:
Potassium is the principal intracel
Page 1615 and 1616:
Occasionally patients may have hypo
Page 1617 and 1618:
Treatment The speed with which trea
Page 1619 and 1620:
B. Laboratory Findings An arterial
Page 1621 and 1622:
furosemide will diminish calcium ex
Page 1623 and 1624:
Hospitalization is invariably neces
Page 1625 and 1626:
Reserve parenteral administration o
Page 1627 and 1628:
Kapoor et al: Fluid and electrolyte
Page 1629 and 1630:
In contrast to the almost immediate
Page 1631 and 1632:
• Anion gap acidosis caused by ke
Page 1633 and 1634:
treatment unless the pH falls below
Page 1635 and 1636:
signs, twitching, and tetany. Metab
Page 1637 and 1638:
with a chronic respiratory acidosis
Page 1639 and 1640:
APPENDIX: USEFUL EQUATIONS & FORMUL
Page 1641 and 1642:
Table 42-1. Volume of body fluid co
Page 1643 and 1644:
Table 42-3. Conditions causing hypo
Page 1645 and 1646:
Table 42-5. Potassium content of th
Page 1647 and 1648:
Table 42-7. Causes of hyperkalemia.
Page 1649 and 1650:
Table 42-9. Causes of hypercalcemia
Page 1651 and 1652:
Table 42-11. Causes of hypomagnesem
Page 1653 and 1654:
Table 42-13. Causes of respiratory
Page 1655 and 1656:
Figure 42-1. Emergency evaluation o
Page 1657 and 1658:
Figure 42-3. Correlation between se
Page 1659 and 1660:
43. Burns & Smoke Inhalation 1 - Me
Page 1661 and 1662:
Gueugniaud PY et al: Current advanc
Page 1663 and 1664:
are minimal. Cardiac arrhythmias an
Page 1665 and 1666:
B. Chemical Injury Chemical injury
Page 1667 and 1668:
The often-described cherry-red skin
Page 1669 and 1670:
and injury may continue; further ir
Page 1671 and 1672:
exposure to the sun in the future a
Page 1673 and 1674:
All patients with deep circumferent
Page 1675 and 1676:
IMMEDIATE MANAGEMENT OF LIFE-THREAT
Page 1677 and 1678:
Table 43-2. Determinants of burn se
Page 1679 and 1680:
Table 43-4. Rule of nines (rapid me
Page 1681 and 1682:
Table 43-6. Common toxic products o
Page 1683 and 1684:
Figure 43-2. Burn size may be estim
Page 1685 and 1686:
44. Disorders Due to Physical & Env
Page 1687 and 1688:
care unit are required for all vict
Page 1689 and 1690:
2-3 minutes. This technique causes
Page 1691 and 1692:
A. Classification Frostbite is inju
Page 1693 and 1694:
6. Hyperbaric oxygen—Considerable
Page 1695 and 1696:
anticholinergic drugs; or failure t
Page 1697 and 1698:
hyponatremic form results from exce
Page 1699 and 1700:
and cool by fanning. Alcohol sponge
Page 1701 and 1702:
2. Punctate burns—Punctate burns
Page 1703 and 1704:
Essentials of Diagnosis • Direct
Page 1705 and 1706:
or significant burn wounds. Fahmy F
Page 1707 and 1708:
transient aspermatogenesis, and lar
Page 1709 and 1710:
esulting atelectasis and perfusion
Page 1711 and 1712:
2000;18:9. [PMID: 10674523] (Retros
Page 1713 and 1714:
the diver to descend and maintain l
Page 1715 and 1716:
Treatment The most effective treatm
Page 1717 and 1718:
sufficient), although it is best to
Page 1719 and 1720:
cerebral edema.) Levine BD et al: E
Page 1721 and 1722:
snake if possible. Check complete b
Page 1723 and 1724:
diphenhydramine as well as intraven
Page 1725 and 1726:
associated lymphadenopathy and low-
Page 1727 and 1728:
Hospitalize all patients with C. ex
Page 1729 and 1730:
F. Hyperbaric Oxygen Hyperbaric oxy
Page 1731 and 1732:
A. Box Jellyfish Due to the rapidit
Page 1733 and 1734:
Sea urchins are egg-shaped, globula
Page 1735 and 1736:
2. Scombroid Poisoning General Cons
Page 1737 and 1738:
y various planktonic dinoflagellate
Page 1739 and 1740:
Table 44-1. Indications and dosages
Page 1741 and 1742:
45. Poisoning 1 - D. Shannon Waters
Page 1743 and 1744:
was actually swallowed, especially
Page 1745 and 1746:
gastric contents, inhalation of cer
Page 1747 and 1748:
It is also of value in correcting p
Page 1749 and 1750:
cases of refractory hypotension. Mo
Page 1751 and 1752:
evaluation of the poisoned patient.
Page 1753 and 1754:
(Retrospective case series evaluati
Page 1755 and 1756:
• Ingestion produces many symptom
Page 1757 and 1758:
Treatment A. General Management Gen
Page 1759 and 1760:
C. Other Measures In hypotensive pa
Page 1761 and 1762:
ut their value in preventing late n
Page 1763 and 1764:
toxicity. If countershock is unavoi
Page 1765 and 1766:
C. Pharmacologic Treatment No studi
Page 1767 and 1768:
patients with cocaine-associated ch
Page 1769 and 1770:
Vitamin B 12A (hydroxocobalamin) ha
Page 1771 and 1772:
methemoglobinemia. Methylene blue s
Page 1773 and 1774:
paint stripper, antifreeze, automob
Page 1775 and 1776:
unavailable. The dosing is the same
Page 1777 and 1778:
Treatment A. General Management Pro
Page 1779 and 1780:
toxicity. Highly toxic arsine gas i
Page 1781 and 1782:
irth defects. B. Laboratory Finding
Page 1783 and 1784:
Clinical Findings Symptoms suggesti
Page 1785 and 1786:
delayed lower airway destruction wi
Page 1787 and 1788:
Ramero JA et al: Isoniazid overdose
Page 1789 and 1790:
OPIATES Essentials of Diagnosis •
Page 1791 and 1792:
• Toxicity and potency vary widel
Page 1793 and 1794:
• Rapid onset of action. • Vert
Page 1795 and 1796:
(12-30 hours); dialysis is not effe
Page 1797 and 1798:
Table 45-19 describes specific trea
Page 1799 and 1800:
11824773] (Retrospective analysis o
Page 1801 and 1802:
Rehydration and rapid correction of
Page 1803 and 1804:
gamma-hydroxybutyric acid with reco
Page 1805 and 1806:
1999;159:989. [PMID: 10326941] (Pro
Page 1807 and 1808:
Disposition Hospitalize all symptom
Page 1809 and 1810:
erratic absorption and hematoma for
Page 1811 and 1812:
Table 45-2. Toxidromes. 1 Represent
Page 1813 and 1814:
Table 45-4. Calculation of the osmo
Page 1815 and 1816:
Table 45-6. Drugs and toxins that m
Page 1817 and 1818:
Table 45-8. Indications for hemodia
Page 1819 and 1820:
Table 45-10. Selected examples of p
Page 1821 and 1822:
Table 45-12. Digoxin immune Fab dos
Page 1823 and 1824:
Table 45-14. Prepackaged cyanide an
Page 1825 and 1826:
Table 45-16. Recommended treatment
Page 1827 and 1828:
Table 45-18. Clinical features of t
Page 1829 and 1830:
Table 45-20. Some nontoxic plants.
Page 1831 and 1832:
Table 45-22. Interactions of warfar
Page 1833 and 1834:
Figure 45-2. Supraventricular tachy
Page 1835 and 1836:
Angioedema is edema that forms in t
Page 1837 and 1838:
conjunctivitis, and a disseminated
Page 1839 and 1840:
Rothe MJ et al: Erythroderma. Derma
Page 1841 and 1842:
and the affected area is typically
Page 1843 and 1844:
mg/kg/d of prednisone. Prednisone d
Page 1845 and 1846:
Tanner TL: Rhus (Toxicodendron) der
Page 1847 and 1848:
Several dangerous complications can
Page 1849 and 1850:
others around the area of moist or
Page 1851 and 1852:
stages of development in the epider
Page 1853 and 1854:
General Considerations Dermatophyte
Page 1855 and 1856:
e central clearing. The subsequent
Page 1857 and 1858:
47. Psychiatric Emergencies - Grego
Page 1859 and 1860:
Citrome L, Volavka J: Violent patie
Page 1861 and 1862:
toxidrome should immediately point
Page 1863 and 1864:
treatment of choice for the acutely
Page 1865 and 1866:
CNS event. Patients may present wit
Page 1867 and 1868:
• Labile affect, often presenting
Page 1869 and 1870:
BORDERLINE PERSONALITY DISORDER Bor
Page 1871 and 1872:
and able to communicate, but they a
Page 1873 and 1874:
Dyskinesias are treated with diphen
Page 1875 and 1876:
General Considerations Disposition
Page 1877 and 1878:
Figure 47-1. Decision-making algori
Page 1879 and 1880:
sized equipment. Table 48-2 itemize
Page 1881 and 1882:
mg/kg intravenous 5% dextrose in wa
Page 1883 and 1884:
Tachycardia, while sensitive to car
Page 1885 and 1886:
composition of ORT as set by the Wo
Page 1887 and 1888:
hypotensive, or hypoxic patient (pu
Page 1889 and 1890:
department pediatric patients. Resp
Page 1891 and 1892:
influenzae), retropharyngeal or per
Page 1893 and 1894:
11826639] (Review.) LOWER AIRWAY DI
Page 1895 and 1896:
mg) may be preferred by children wh
Page 1897 and 1898:
hospital admission for observation
Page 1899 and 1900:
electrolytes, ammonia, and pertinen
Page 1901 and 1902:
3. Lumbar puncture—Both bacterial
Page 1903 and 1904:
temperature in both bacteremic and
Page 1905 and 1906:
intracranial pressure, focal neurol
Page 1907 and 1908:
• Loss of mobility of the tympani
Page 1909 and 1910:
eta-analysis.) &dopt=Abstract">eta-
Page 1911 and 1912:
Disposition A repeat examination is
Page 1913 and 1914:
Disposition Children with acute ons
Page 1915 and 1916:
elief. Outpatient therapy can be in
Page 1917 and 1918:
infants with bloody diarrhea and an
Page 1919 and 1920:
Hospitalize children with suspected
Page 1921 and 1922:
Abdominal pain can originate from 3
Page 1923 and 1924:
Pearl RH et al: The approach to com
Page 1925 and 1926:
lood) and melena (black stool) usua
Page 1927 and 1928:
infuse type O, Rh-negative blood. P
Page 1929 and 1930:
Disposition Obtain consultation wit
Page 1931 and 1932:
Wethers DL: Sickle cell disease in
Page 1933 and 1934:
A. General Management The key to tr
Page 1935 and 1936:
years are suspicious. Minor falls,
Page 1937 and 1938:
Approach the child in a compassiona
Page 1939 and 1940:
Table 48-1. Predictive model: acute
Page 1941 and 1942:
Table 48-3. Equipment and sizes ava
Page 1943 and 1944:
Table 48-5. Daily maintenance requi
Page 1945 and 1946:
Table 48-7. Treatment of common ped
Page 1947 and 1948:
Table 48-9. Management of complete
Page 1949 and 1950:
Table 48-11. Suggested drug treatme
Page 1951 and 1952:
Table 48-13. Common causes of menin
Page 1953 and 1954:
Table 48-15. Drugs used for the tre
Page 1955 and 1956:
Table 48-17. Causes and antibiotic
Page 1958:
Table 48-19. Common nontraumatic ca
Page 1961 and 1962:
Table 48-21. Equipment required for
Page 1963 and 1964:
Table 48-23. Sexually transmitted d
Page 1965 and 1966:
Figure 48-2. Treatment algorithm fo
Page 1967 and 1968:
Figure 48-4. Lateral soft tissue x-
Page 1969 and 1970:
Figure 48-6. Management of status e
Page 1971 and 1972:
Figure 48-8. Algorithm for the mana
Page 1973 and 1974:
Figure 48-10. Antibiotic choices fo
Page 1975 and 1976:
Figure 48-12. Treatment algorithm f
Page 1977 and 1978:
Figure 48-14. Posteroanterior (A) a
Page 1979:
Figure 48-16. Algorithmic guide to
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