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MD SECTION III - TRAUMA EMERGENCIES 22. Head Injuries - Stephen C. Ausband, MD, FACEP, & Ritu Sahni, MD, MPH IMMEDIATE MANAGEMENT OF LIFE-THREATENING PROBLEMS MANAGEMENT OF OTHER SYMPTOMS EMERGENCY TREATMENT OF SPECIFIC HEAD INJURIES MINOR HEAD INJURIES SPECIAL CONSIDERATIONS FOR PEDIATRICS INDICATIONS FOR HOSPITALIZATION DISCHARGE INSTRUCTIONS INTOXICATED PATIENTS TABLES FIGURES 23. Maxillofacial & Neck Trauma 1 - Fermin S. Godinez, DO, & Susan J. Letterle, I. IMMEDIATE MANAGEMENT OF LIFE-THREATENING PROBLEMS II. FURTHER DIAGNOSIS & EVALUATION III. EMERGENCY MANAGEMENT OF SPECIFIC INJURIES FIGURES 24. Chest Trauma - James Svenson, MD, MS, & Desiree LaCharite, MD INTRODUCTION IMMEDIATE MANAGEMENT OF LIFE-THREATENING PROBLEMS IMMEDIATELY LIFE-THREATENING THORACIC INJURIES IDENTIFIED ON PRIMARY SURVEY POTENTIALLY LIFE-THREATENING INJURIES IDENTIFIED ON SECONDARY SURVEY OTHER INJURIES PENETRATING TRAUMA FIGURES 25. Abdominal Trauma - Luis E. Rodriguez, MD, & John E. Gough, MD, FACEP IMMEDIATE MANAGEMENT OF LIFE-THREATENING INJURIES EMERGENCY TREATMENT OF SPECIFIC INJURIES FIGURES 26. Genitourinary Trauma - Geoffrey A. Wiss, MD, Claudia Whitaker, MD, & Robert K. Dunne, MD, FACEP IMMEDIATE MANAGEMENT OF LIFE-THREATENING INJURIES EMERGENCY TREATMENT OF SPECIFIC INJURIES FIGURES 27. Vertebral Column & Spinal Cord Trauma 1 - Robert Casey Wilson, MD, & Louis J. Kroot, MD IMMEDIATE MANAGEMENT OF THE PATIENT WITH SUSPECTED SPINAL INJURY FURTHER EVALUATION OF THE PATIENT WITH SPINAL INJURY EMERGENCY TREATMENT OF SPECIFIC SPINAL INJURIES TABLES FIGURES 28. Orthopedic Emergencies - Luis E. Rodriguez, MD, & John E. Gough, MD, FACEP I. IMMEDIATE MANAGEMENT OF LIFE-THREATENING INJURIES II. IMMEDIATE MANAGEMENT OF LIMB-THREATENING INJURIES
III. GENERAL ORTHOPEDIC PRINCIPLES IV. MANAGEMENT OF SPECIFIC ORTHOPEDIC INJURIES V. COMMON PITFALLS TABLES FIGURES 29. Hand Trauma 1 - Adam Saperston, MD, MS EMERGENCY EVALUATION & TREATMENT EXAMINATION OF THE HAND & ASSESSMENT OF FUNCTION (See Figures 29-3 & 29-4. ) EQUIPMENT & MATERIALS FOR TREATMENT MANAGEMENT OF SPECIFIC TYPES OF HAND INJURIES SPECIAL EMERGENCY DEPARTMENT PROBLEMS FIGURES 30. Wound Care 1 - Louis J. Kroot, MD, & David Hurst, MD EMERGENCY MANAGEMENT OF LIFE-THREATENING PROBLEMS WOUND ASSESSMENT EMERGENCY TREATMENT OF SPECIFIC TYPES OF WOUNDS TABLES FIGURES
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: EPISODIC LOSS OF CONSCIOUSNESS TABL
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
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
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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
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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
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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
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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
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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
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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