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CURRENT EMERGENCY DIAGNOSIS & TREATMENT - 5th Ed. (2004) FRONT MATTER Title Page Copyright Page Contents Authors Preface SECTION I - SPECIAL ASPECTS OF EMERGENCY MEDICINE SECTION II - MANAGEMENT OF COMMON EMERGENCY PROBLEMS SECTION III - TRAUMA EMERGENCIES SECTION IV - NONTRAUMA EMERGENCIES
SECTION I - SPECIAL ASPECTS OF EMERGENCY MEDICINE 1. Approach to the Emergency Department Patient - Mary Nan S. Mallory, MD, RDMS & Robert Perry Pringle, Jr., MD WHAT IS EMERGENCY MEDICINE? BIRTH & GROWTH OF EMERGENCY MEDICINE SCOPE OF PRACTICE PRINCIPLES OF EMERGENCY MEDICINE CONCLUSION TABLES 2. Prehospital Emergency Medical Services 1 - Eric M. Sergienko, MD, & Thomas N. Bottoni, MD INTRODUCTION COMPONENTS OF THE EMERGENCY MEDICAL SERVICES SYSTEM PREHOSPITAL SKILLS & TECHNIQUES TABLES FIGURES 3. Nuclear, Biologic, & Chemical Agents; Weapons of Mass Destruction - Michael W. Stava, MD, & Joachim Franklin, MD INTRODUCTION NUCLEAR WEAPONS BIOLOGIC WEAPONS CHEMICAL WEAPONS (See Table 3-5.) TABLES 4. Multicasualty Incidents & Disasters 1 - Louis James Kroot, MD, & Robert B. Gray, MD INTRODUCTION EPIDEMIOLOGY OF DISASTERS PREHOSPITAL MANAGEMENT OF MULTICASUALTY INCIDENTS & DISASTERS EMERGENCY DEPARTMENT DISASTER MANAGEMENT STRESS MANAGEMENT & PSYCHOLOGICAL SUPPORT TABLES FIGURES 5. Legal Aspects of Emergency Care - Charles A. Eckerline, Jr, MD, FACEP, & Steven D. Rothert, MD, JD INTRODUCTION GENERAL LEGAL PRINCIPLES COMMON LEGAL PROBLEMS IN THE EMERGENCY DEPARTMENT 6. Emergency Procedures 1 - William Randall Partin, MD GENERAL INSTRUCTIONS FOR SKIN PREPARATION & STERILE TECHNIQUE UPPER EXTREMITY VENIPUNCTURE EMERGENCY ANTECUBITAL FOSSA VENOUS CUTDOWN PERIPHERAL VENOUS CATHETERIZATION WITH A CATHETER-CLAD NEEDLE PERIPHERAL VENOUS CATHETERIZATION WITH A SCALP VEIN (BUTTERFLY) NEEDLE EXTERNAL JUGULAR VEIN CATHETERIZATION INTERNAL JUGULAR VEIN CATHETERIZATION
Page 1: CURRENT Emergency Diagnosis & Treat
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 and 14: Thomas M. Huhn, MD 1 General Consid
Page 15 and 16: Previous editions copyright © 1992
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
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intubation, needle thoracostomy, cr
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Trauma 1997;42:723. [PMID: 9137264]
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comments about prehospital care. BM
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Table 2-2. Alternative EMS system d
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Figure 2-2. Standing orders for tre
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3. Nuclear, Biologic, & Chemical Ag
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kill 50% of those exposed) is appro
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form of anthrax. Symptoms include h
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Patients may require intensive medi
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Significant person-to-person transm
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A. Antibiotics Most cases of C burn
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A. Symptoms and Signs Disease begin
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A. Specific Therapy Ribavirin is a
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occurs after ingesting food already
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The treatment of ricin toxicity dep
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A. Symptoms and Signs After exposur
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effects of vapor exposure do not te
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Treatment A. Bed Rest Any activity,
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preferred method of decontamination
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An elevated blood cyanide concentra
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Table 3-1. Clinical findings and tr
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Table 3-2. Levels of protection req
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Table 3-4. Clinical findings associ
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4. Multicasualty Incidents & Disast
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Casualties are related to trauma fr
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adiation levels. In nuclear acciden
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community emergency response. Acad
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Patients are most efficiently extri
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and intravenous lines for volume or
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Many communities and rural areas ha
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arrangement, mutual aid, and the li
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themselves without many basic neces
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Triage for Incoming Victims An expe
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airway and circulatory support and
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Table 4-1. Sudden natural disasters
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Figure 4-1. Epicenters of significa
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Figure 4-3. The Incident Command Sy
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Figure 4-5. START triage algorithm.
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Figure 4-7. Hazmat scene organizati
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against public interest, such as th
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STATUTE OF LIMITATIONS The statute
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A series of abuses of the privilege
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appropriate. The physician-oriented
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transmitted diseases, or chemical d
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estraints, it risks incurring liabi
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events are reportable and the proce
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cases, the emergency physician and
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clinical skills are under constant
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manner and should not exclude any r
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6. Emergency Procedures 1 - William
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• Lymphangitis of the extremity.
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7. If venous blood is not obtained
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• Mosquito clamps (2) (useful for
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13. Allow blood to fill the cathete
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tapping over the vein may help to d
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• Scalp vein needle of appropriat
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• Silk skin suture (size 3-0) on
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the central needle at this point, a
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• Straight scissors. • Plastic-
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vein lumen. This method permits dil
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• Lidocaine, 1%, with 10-mL syrin
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while pulling back on the plunger o
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• Adhesive dressing. B. Femoral V
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SAPHENOUS VEIN CUTDOWN Indications
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4. Drape the skin. 5. Anesthetize t
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the midline. Procedure 1. Sterilize
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Allen Test The Allen test should be
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through the oropharynx is difficult
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2. Check the laryngoscope and blade
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when the tube passes through the vo
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• Lubricant. • Suction syringe
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direct vision. INSERTION OF SENGSTA
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3. Make sure that all necessary equ
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One person can perform cricothyroto
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tape too tightly can cause erosion
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THORACENTESIS Indications Indicatio
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1. Attach a 30-mL syringe to the ca
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Tubes are usually inserted laterall
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skin. Cover the tube with two 10-
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vessel occur. Procedure 1. Prepare
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spinal needle) for aspiration. It i
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ing the needle back to the subcutan
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to view the Morison pouch. Keep the
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for ascites to pool in the dependen
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• Lidocaine, 1%, with 5-mL syring
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and instill 1 L of sterile, warm Ri
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Positioning of the Patient A. Femal
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15. Obtain a specimen for appropria
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• Silk suture (size 3-0) on a cur
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Contraindications Contraindications
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Procedure 1. Observe sterile techni
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A. Massive Obesity If the patient i
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ANTERIOR & POSTERIOR NASAL PACKING
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A. Anterior Nasal Pack 1. Assemble
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the septum. (7) After the posterior
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7. Penetrate the skin at the select
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F. Small Joints of the Hands and Fe
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Personnel Required One person can u
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9. Irrigate the abscess with saline
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4. Begin at 70-80 mA current output
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Table 6-2. Pigmentation of the cere
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Figure 6-2. Venotomy technique. Exe
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Figure 6-4. A: Technique of removin
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Figure 6-6. A: Scalp vein needle in
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Figure 6-8. Anatomic relationships
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Figure 6-10. Internal jugular vein
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Figure 6-16. Technique of radial ar
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Figure 6-18. Technique of nasogastr
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Figure 6-20. Securing tamponade tub
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Figure 6-22. 50-psi oxygen source i
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Figure 6-24. Technique of thoracent
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Figure 6-26. Diagram of pericardioc
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Figure 6-28. Insertion site for abd
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Figure 6-30. Sagittal section of fe
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Figure 6-32. Decubitus position for
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Figure 6-34. Aspiration of the knee
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Figure 6-36. Anterior approach to s
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Figure 6-38. Determination of the n
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THE TEAM APPROACH TO CARDIAC ARREST
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Early Prevention Early prevention i
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4. Cricoid pressure application—C
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defibrillator must be placed in the
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Advanced airway techniques include
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pharmacologic therapy in the pulsel
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lidocaine received treatment from A
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9044489] Kulkarni RG, Thomas SH: Se
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equires a continual flow of oxygen.
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"Lifestick" CPR A combination of th
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Table 7-1. Differentiating ventricu
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Start at 8-12 µg/min, then titrate
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Figure 7-2. Opening the airway and
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Figure 7-4. Ventilation technique u
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Figure 7-6. Clearing airway in cons
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Figure 7-8. Contact points for defi
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Figure 7-10. Algorithm for usage of
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espiratory rate, tidal volume, acce
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The mouth-to-mask technique is anot
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to massive bleeding or trauma that
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Lighted stylet and light wand devic
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elatively easily learned. With atte
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about 30 degrees caudad. Aspiration
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1. Lidocaine—Topical lidocaine ma
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from pretreatment with atropine. Pr
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a. One of the NDMBDs that can be us
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g. Use in pregnancy only if clearly
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a. May cause hypotension in the hyp
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. Muscle rigidity, which may occur
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A. Unique Features • In infants,
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Until age 10 years, children should
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Patients with severe facial and upp
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Complications that may occur while
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SECTION II - MANAGEMENT OF COMMON E
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Table 8-2. Essential airway managem
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Table 8-4. Complications of esophag
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Table 8-6. Alternative methods of i
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Table 8-8. Properties of local anes
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Table 8-10. Rapid-sequence inductio
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Figure 8-1. Management of the compr
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Figure 8-3. A: Oral airway. B: Nasa
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Figure 8-5. Landmarks for locating
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9. Shock 1 - Peter W. Greenwald, MD
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D. Distributive Shock The chief abn
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If trauma is present, the above ste
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B. Seek Evidence of Aortic Dissecti
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EMERGENCY TREATMENT OF SPECIFIC CAU
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soon as possible in patients with m
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helpful if gross blood is found or
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An intra-aortic balloon pump may pr
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Digitalis glycosides have no role i
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Systemic Inflammatory Response Synd
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frequently and vary depending on ho
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Treatment Begin treatment as soon a
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Clinical Findings The symptoms and
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Table 9-2. Classification of shock
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Table 9-4. Indices of successful re
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Figure 9-1. Management of a clinica
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the airway, breathing, and circulat
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further classified as mild, moderat
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infection, hypothermia, coagulopath
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3. Autotransfusion—Autotransfusio
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Essentials of Diagnosis • Respira
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Treatment Careful monitoring of oxy
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ecommended as screening tools becau
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History, including mechanism of inj
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Treatment An initial goal is to ach
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• Immobilize to prevent further d
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Table 10-2. Indications for arterio
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Figure 10-2. Trauma scores used to
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(eg, saturation < 90%) or ventilato
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Disposition Hospitalize these patie
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(Chapters 33 and 34). Determination
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Barton ED: Tension pneumothorax. Cu
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to pain should trigger intervention
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B. Hemothorax In hemothorax due to
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Patients with AIDS may develop pneu
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A foreign body should be removed if
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control values. Selected patients m
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Clinical Findings The diagnosis is
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Table 11-1. Essentials of diagnosis
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Figure 11-2. The radiographic appea
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Figure 11-4. Large left-sided hemot
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Figure 11-6. Radiographic appearanc
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Clinical Findings The patient is in
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pericardiocentesis (under ultrasoun
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a. Nitroglycerin—Give nitroglycer
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I. Other Tests Obtain additional te
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MANAGEMENT OF SPECIFIC DISORDERS CA
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An accurate diagnosis of pleurisy i
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Esophageal disorders such as esopha
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PANCREATITIS (See Chapter 13.) Chol
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Clinical Findings The patient compl
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Ng SM et al: Ninety-minute accelera
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Table 12-2. Distinguishing features
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May have occurred Usually strong pl
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13. Abdominal Pain 1 - Roger Humphr
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Mode of Onset of Abdominal Pain (Se
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poisoning, acute gastritis, acute p
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entire hand. Careful one-finger pal
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Serum Amylase & Lipase Serum amylas
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nodes, pancreas, aorta, or other so
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the ability to diagnose acute surgi
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antibiotics. Immediate hospitalizat
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A. For the Seriously Ill Patient or
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upper quadrant sonography is the di
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flank, low back, or groin. Faintnes
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Insert at least 2 large-bore (= 16-
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Treatment No specific treatment is
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3. Ruptured Ovarian Follicle Cyst C
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clotting factors as needed. Disposi
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Table 13-2. Differential diagnosis
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Table 13-3. Routine for physical ex
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Figure 13-1. Algorithmic approach t
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Figure 13-3. Performing the iliopso
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Figure 13-5. Obliteration of the ps
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Figure 13-7. Abdominal x-ray showin
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Figure 13-9. Upright anteroposterio
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14. Gastrointestinal Bleeding 1 - C
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Also, perform a cardiac and pulmona
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distal to the ligament of Treitz is
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1. Anoscopy/proctosigmoidoscopy—E
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PEPTIC ULCER DISEASE Peptic ulcer d
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Treatment Provide emergency managem
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All patients with the above diagnos
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present. The diagnosis should be co
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elderly and have chronic constipati
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Figure 14-1. Immediate management o
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Figure 14-3. Hematochezia or suspec
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investigation if the cause is uncer
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include an electrocardiogram, conti
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must be ruled out in patients with
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BACTERIAL GASTROENTERITIS Essential
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coli 0157:H7. Salmonella and Shigel
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1997;92(11):1962. [PMID: 9362174] E
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Table 15-1. Conditions that may cau
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Table 15-3. Differential diagnostic
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Table 15-4. Differential diagnostic
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Figure 15-1. Approach to the patien
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16. Coma 1 - Steven D. Kelley, MD,
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elevation in PCO 2 levels that are
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• Confusion: a state of impaired
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Spontaneous blinking indicates inta
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the same serious prognosis as the m
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Clinical Findings Intracerebral hem
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A. Symptoms and Signs Coma is seldo
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• Coma, altered mental status.
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to walk or stand. Caution: Early st
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Essentials of Diagnosis • Patient
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Unlike other organs, the brain reli
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Treatment is primarily supportive a
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ange from as few as 10 monocytes/mL
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The slow, conjugate roving eye move
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Feske SK: Coma and confusional stat
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Table 16-4. Common findings in pati
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Figure 16-1. Approach to the uncons
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17. Syncope, Seizures, & Other Caus
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epilepticus may also produce a mild
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Check stool specimens for blood (gr
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Seizures can result from a primary
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B. Syncope Brain hypoperfusion caus
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QT interval. However, a single ECG,
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this condition are similar to those
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ischemia, syncope, vertigo, diplopi
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Psychogenic hyperventilation is a f
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12180243] Mack G, Silberbach M: Aor
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Table 17-2. Drug treatment of statu
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Table 17-3. Common causes of seizur
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Table 17-4. Summary of anticonvulsa
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Table 17-6. Common causes of syncop
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Figure 17-1. Assessment of patients
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intubation and mechanical ventilati
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Treatment & Disposition Hospitalize
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2. Gila monsters—Gila monster bit
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een eliminated. A history of hyster
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Essentials of Diagnosis • Majorit
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B. Laboratory Findings Lumbar punct
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should be referred to a neurologist
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Subjective and objective sensory di
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(See also Chapter 45.) Symptomatic
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Cerebrospinal fluid and peripheral
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Clostridium botulinum toxin attacks
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• Respiratory paresis. General Co
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Treatment Immediately evaluate the
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failure and marked elevations of se
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neurologic disorder in adults and o
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suggestive of giant cell arteritis.
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Bella I et al: Neuromuscular disord
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Aneurysmal rebleeding may be second
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Essentials of Diagnosis • Seconda
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• Persistent numbness or tingling
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C. Clopidogrel Clopidogrel works by
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heparin in acute ischemic stroke.)
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Table 18-4. Symptoms and signs of b
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Table 18-6. Drug therapy of stable
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Table 18-8. Common causes of rhabdo
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Table 18-10. Risk factors for ather
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Figure 18-2. A noncontrast head CT
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19. Headache 1 - C. Keith Stone, MD
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Even after careful initial history
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A. Vital Signs 1. Fever—The prese
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• Symptoms related to vasculature
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puncture. J Pediatr Oncol Nurs 2001
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Essentials of Diagnosis • Mild to
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sections) because involvement is se
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scintillations that enlarge and spr
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ipsilateral cranial autonomic sympt
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Figure 19-1. Management of complain
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C. Treat Shock Hypotension and shoc
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the fluctuating hemiparesis that ma
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confusion. Wernicke encephalopathy
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decrease or cessation of alcohol co
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tachycardia, and agitation). Patien
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Beaver TM et al: Treatment of acute
Page 725 and 726:
evaluation. 2. Transient Global Amn
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Essentials of Diagnosis • All for
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Location In Book: CURRENT EMERGENCY
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Table 20-4. Sedative drugs reported
Page 735 and 736:
Table 20-6. Causes of amnestic synd
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Figure 20-1. Assessment of delirium
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Involvement of 1-3 joints in an asy
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A. Symptoms and Signs There is sudd
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Septic arthritis is one of the more
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RHEUMATIC FEVER & POSTSTREPTOCOCCAL
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Initial treatment is with NSAIDs. S
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The acute arthritis of systemic lup
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therapy or in the hospital. Patient
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C. X-ray and Laboratory Findings Ob
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• Often acute on chronic flare-up
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Essentials of Diagnosis • Usually
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Table 21-1. Some common syndromes o
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Table 21-3. Revised Jones criteria
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Table 21-5. Neurologic findings in
Page 765 and 766:
Figure 21-2. Assessment of patients
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mask airway, in the patient who is
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If blood pressures are elevated, ev
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Studies have shown that 40-100% of
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Clinical Findings Basilar skull fra
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Essentials of Diagnosis • Diagnos
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Various methods have been proposed
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Table 22-1. Concussion grading and
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Figure 22-2. Severely depressed fro
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Figure 22-4. Small left subdural he
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Figure 22-6. Right temporal subarac
Page 787 and 788:
23. Maxillofacial & Neck Trauma 1 -
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of large amounts of soft tissue wit
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Airway injury may be manifested by
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C. Auditory Nerve Test hearing in b
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jaw, or ears? Point to where it hur
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Le Fort I is a fracture parallel to
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flattening of the normal malar prom
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General Considerations The nasal bo
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and orbital fractures. Treatment Wh
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evaluation and surgery. Immediate o
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Patients with temporal bone fractur
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irrigated completely and conservati
Page 811 and 812:
Figure 23-1. Location of nerves pas
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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
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Figure 23-9. Reduction of nasal fra
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Pain may impair chest wall expansio
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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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