Practice of Emergency Medicine (Second Edition)

799 Pages·2016·14.38 MB·English

Practice of
Emergency Medicine
Second Edition
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Dr. Fu-tat LEE
Dr. Ling-pong LEUNG
Dr. Axel SIU
© Copyright. Hong Kong College of Emergency Medicine
Published in October 2016
ISBN: 978-988-15349-2-7
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in
any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior
permission of the copyright owner.
The editors and the authors of this book have taken care to make certain that the information and doses of drugs
are correct and compatible with the generally accepted standard at the time of publication. However, in view of
the possibility of human error or change in the medical sciences, the editors, authors and any party who has
been involved in the preparation or publication of the book do not warrant that the information contained herein
is in every respect accurate or complete. The reader is advised to confirm the information herein with other
sources such as the instruction and information material that accompanied each equipment, drug or therapeutic
agent before usage. This advice is especially important when using new or infrequently used equipment and
drugs. The publisher, editors, authors and any party who has been involved in the preparation or publication of
the book disclaim any liability, loss, injury or damage incurred as a consequence, directly or indirectly of the use
and application of any part of the book.
CONTENTS
Preface
................................................................................. v 3.4 Acute Aortic Syndrome
Ronnie LO..............................................................93
Editors and Contributors ..................................... vii 3.5 Abdominal Aortic Aneurysm
Ronnie LO..............................................................96
Section 1: Prehospital and Disaster 3.6 Congestive Heart Failure and Acute Pulmonary
Edema
1.1 Emergency Medical Services in Hong Kong
Chui-ling LAU.........................................................99
Willis KWOK............................................................3
3.7 Acute Pulmonary Embolism
1.2 Inter-hospital Patient Transport
Ronnie LO............................................................102
Larry LEE.................................................................5
3.8 Hypertension
1.3 Disaster Medicine
Jackson POON...................................................107
Chi-biu LO..............................................................10
3.9 Acute Limb Ischemia
1.4 Aeromedical Transfer
Ronald WONG.....................................................111
William WOO..........................................................16
1.5 HAZMAT
Section 4: Respiratory Emergencies
Jimmy CHAN.........................................................19
4.1 Asthma
Section 2: Resuscitation Gary CHU............................................................117
4.2 Chronic Obstructive Airway Disease
2.1 Adult Basic Life Support (BLS) and Pediatric Basic
Gary CHU............................................................119
Life Support
4.3 Pneumothorax
Yin-yi LEUNG........................................................35
2.2 Advanced Cardiovascular Life Support Chi-shing PAK.....................................................121
Ralph CHEUNG and Axel SIU...........................43 4.4 Pneumonia
2.3 Resuscitation on Special Groups Francis CHU........................................................125
Man-ho NG.............................................................47 4.5 Hemoptysis
2.4 Orotracheal Intubation and Difficult Airway Chi-wai CHAU.....................................................127
Management in Adult 4.6 Non-Invasive Positive Pressure Ventilation
Yiu-key MAK, Chak-wah KAM, Constantine AU...................................................130
Chung-yung HUNG..............................................52
Section 5: GI Emergencies
2.5 Post Cardiac Arrest Care
Colin A GRAHAM.................................................60 5.1 Approach to Abdominal Pain
2.6 Shock Kevin GO..............................................................135
Kwan-leong AU YEUNG......................................66 5.2 Gastroenteritis and Food Poisoning
Albert FUNG........................................................140
Section 3: Cardiovascular Emergencies
5.3 Intestinal Obstruction and Constipation
3.1 Approach to Chest Pain in the Emergency Herman LEE........................................................145
Department 5.4 Gastrointestinal Bleeding
Ka-yuen TANG.....................................................77 Ho-chuen LAM and Yiu-ming CHOW..............150
3.2 Acute Coronary Syndrome 5.5 Jaundice
Ka-yuen TANG......................................................83 Anfernee YIM.......................................................153
3.3 Cardiac Arrhythmia 5.6 Anorectal Disorder
Rocky WONG........................................................88 Kin-wah CHUNG................................................157
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5.7 Swallowed Foreign Body 9.4 Cardiovascular Drug Poisoning
Ka-lok YAN...........................................................161 Anfernee YIM.......................................................276
9.5 Pesticides Poisoning
Section 6: Neurological Emergencies
Sze-hong NG.......................................................279
6.1 Cerebrovascular Accident / Stroke 9.6 Abusive Drug Poisoning
Kam-leung LAW and AKB KITCHELL............167 Vember NG..........................................................282
6.2 Convulsion 9.7 Ethanol and Toxic Alcohols Poisoning
Chun-kwong LI....................................................173 Chi-keung CHAN................................................285
6.3 Central Nervous System (CNS) Infections 9.8 Carbon Monoxide Poisoning
Chu-leung LAU....................................................178 Joe LEUNG..........................................................287
6.4 Syncope 9.9 Cyanide Poisoning
Chu-leung LAU....................................................185 Sik-hon TSUI........................................................290
6.5 Dizziness and Vertigo
Section 10: Environmental Emergencies
Kwong-leung LEUNG and Ching-him CHOY......197
6.6 Headache 10.1 Heat-related Illnesses
Kwong-hung LAU................................................201 Arthur CHEUNG.................................................295
10.2 Hypothermia
Section 7: Endocrine and Metabolic Emergencies
Tin-yan LI..............................................................301
7.1 Diabetic Emergencies 10.3 Animal Bites and Rabies
William WONG....................................................209 Kam-chuen SHEK..............................................306
7.2 Thyroid Emergencies 10.4 Stings and Bites
Yu-kwan LI............................................................213 Hin-tat FUNG......................................................313
7.3 Adrenal Emergencies 10.5 Diving Medicine
Chin-san LEUNG................................................216 Kwan-leong AU YEUNG....................................319
7.4 Acid Base Disorder 10.6 Lightning Injuries
William WONG....................................................220 Hin-tat FUNG......................................................325
7.5 Electrolyte Disturbances 10.7 High Altitude Related Illness
William WONG....................................................223 Man-kam HO.......................................................329
Section 8: Infectious Disease Section 11: Haemtological and Oncological
Emergencies
8.1 Principles of Infection Control
Cindy CHOI and Wai-shing KWOK.................233 11.1 Anemia
8.2 Approach to Acute Undifferentiated Fever King-hung MAN...................................................337
Hok-hang CHAN.................................................239 11.2 Approach to Bleeding Disorder
8.3 Novel Influenza Virus Tung-ning CHAN.................................................341
Ludwig TSOI........................................................244 11.3 Blood Transfusion
8.4 SARS and MERS Tze-ho CHAN......................................................345
Ludwig TSOI........................................................248 11.4 Oncological Emergencies
8.5 Ebola Virus Disease Henry WONG......................................................351
Jackson POON...................................................252
Section 12: Paediatric Emergencies
8.6 Antibiotic Use in Emergency Department
Jackson POON...................................................255 12.1 General Principle in Pediatric Emergency
8.7 Needlestick Injury Man-kam HO.......................................................359
Wai-shing KWOK and Cindy CHOI.................257 12.2 Pediatric Respiratory Emergencies
Chun-wah LAM...................................................363
Section 9: Toxicology
12.3 Pediatric Gastrointestinal Emergencies
9.1 General Approach to Poisoned Patients Man-kam HO and Sara HO ..............................368
Rick LAU..............................................................265 12.4 Pediatric CNS Emergencies
9.2 Analgesic Poisoning Yuen-hung LEUNG.............................................377
Man-li TSE............................................................269 12.5 Non-accidental Injuries in Children
9.3 Psychiatric Drug Poisoning Lap-wa CHAN.....................................................380
Yiu-cheung CHAN..............................................272
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12.6 Sudden Infant Death Syndrome and Acute Life- 15.12Burn
threatening Events Wai-ting YIM.........................................................523
Chamy LOK.........................................................385
Section 16: Non-trauma Musculoskeletal
12.7 Approach to Crying Baby
Condition
Maria SY...............................................................388
12.8 Management of Neonatal Jaundice in Emergency 16.1 Neck
Department Chung-hong LEUNG..........................................533
Man-kam HO and Chi-yin LAW........................390 16.2 Back
12.9 Infectious Diseases in Pediatric Patients Chung-hong LEUNG..........................................535
Wai-shing KWOK................................................394 16.3 Shoulder
Ho-yin CHAN.......................................................538
Section 13: Obstetric and Gynaecological
16.4 Elbow
Emergencies
Ho-yin CHAN.......................................................540
13.1 Obstetric Emergencies 16.5 Wrist and Hand
William WOO........................................................409 Ho-yin CHAN.......................................................542
13.2 Gynecological Emergencies 16.6 Hip
William WOO........................................................419 Chui-ling LAU.......................................................545
13.3 Managing Adult Victim of Sexual Assault 16.7 Knee
P NG.....................................................................430 Chui-ling LAU.......................................................550
16.8 Foot and Ankle
Section 14: Renal and GU Emergencies
Chui-ling LAU.......................................................556
14.1 Urinary Tract Infection
Section 17: Wound Management
Anthony NG and Fong YU.................................435
14.2 Ureteric Colic and Urolithiasis 17.1 Evaluation of Wound
Anthony NG and Fong YU.................................441 Chun-wah LAM...................................................563
14.3 Acute Urinary Retention and BPH 17.2 Suturing Materials and Techniques
Anthony NG and Fong YU.................................447 Hon-shing CHIU and Chun-wah LAM.............566
14.4 Male Genitalia Emergencies 17.3 Management of Specific Wounds
Anthony NG and Fong YU.................................452 Ka-leung MOK.....................................................577
17.4 Soft Tissue Infection
Section 15: Trauma
Tommy LEE..........................................................585
15.1 Trauma Team 17.5 Post-repair Wound Management
Nai-kwong CHEUNG.........................................463 Peter CHEE.........................................................590
15.2 Head Trauma 17.6 Tetanus and Tetanus Prophylaxis
Kenneth WU.........................................................466 Sam-Lim LAM......................................................593
15.3 Spinal Injury 17.7 Pain Management
Kwan-leong AU YEUNG....................................472 Thomas AU and Franco LAU............................597
15.4 Chest Trauma 17.8 Local and Regional Anesthesia
Colin A GRAHAM...............................................476 Thomas AU and Franco LAU............................605
15.5 Abdominal Trauma 17.9 Procedural Sedation and Analgesia
Raymond CHENG..............................................487 Jacky SIA.............................................................608
15.6 Maxillofacial Trauma
Section 18: Emergency Imaging
Shin-yan MAN.....................................................492
15.7 Upper Limb Injury 18.1 Plain Radiography of Head and Neck
Chung-yung CHAN............................................497 Eddie YUEN.........................................................613
15.8 Lower Limb Injury 18.2 Plain Radiography of Chest and Abdomen
Patrick LEUNG...................................................506 Eddie YUEN.........................................................620
15.9 Pediatric Trauma 18.3 Plain Radiography of Pelvic and Thoraco-lumbar
Chi-on TANG........................................................512 Spine
15.10Geriatrics Trauma Alex NG................................................................624
Chi-on TANG........................................................517 18.4 Plain Radiography of Upper and Lower limbs
15.11Trauma in Pregnancy Eddie YUEN.........................................................628
William WOO........................................................520
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Section 20: Miscellaneous
18.5 CT in Emergency Medicine
Lawrence TAN.....................................................636 20.1 General Eye Assessment in Emergency
18.6 Trauma Ultrasound Department
Gordon LEE..........................................................653 Kin-wa WONG.....................................................729
18.7 Ultrasound of Abdominal Aorta 20.2 Non-traumatic Eye Emergencies
Ralph CHEUNG..................................................658 Kin-wa WONG.....................................................731
18.8 Hepatobiliary Sonography 20.3 Eye Trauma
Dora LEE..............................................................667 Kin-wa WONG.....................................................737
18.9 Renal and Bladder Ultrasound 20.4 Ear Emergencies
Ka-leung MOK.....................................................676 Chui-ling LAU.......................................................742
18.10Obstetrics & Gyncology Ultrasound 20.5 Nose Emergencies
Puisy CHAN........................................................683 Chui-ling LAU and Thomas AU.........................746
18.11Echocardiography and Hemodynamic Monitoring 20.6 Throat Emergencies
Chi-kit YUEN.......................................................692 Chui-ling LAU.......................................................750
20.7 Dental Emergencies
Section 19: Psychiatric Emergencies
Thomas AU...........................................................753
19.1 Approach to Violent Patient 20.8 Dermatological Emergencies
Kent-shek CHEUNG..........................................707 Wei-ming CHING................................................757
19.2 Acute Psychosis 20.9 Application of Evidence-based Medicine in
Kent-shek CHEUNG..........................................711 Emergency Medicine
19.3 Deliberate Self-harm and Attempted Suicidal Thomas AU...........................................................767
Kent-shek CHEUNG..........................................715 20.10Professionalism in Emergency Medicine
19.4 Mental State Examination Abraham WAI.......................................................770
Wai-lam YIP..........................................................718
Index
19.5 Psychotropic Drugs .................................................................................780
Wai-lam YIP..........................................................723
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Preface
Like many books written in emergency medicine, the original edition was composed in a way as collection of
various case scenarios, clinical guidelines, pitfalls, pearls and stories during the practice of this branch of
medicine for the purpose of training of young post-graduate residents. This 2nd edition of Practice of Emergency
Medicine is no exception. The content of the 1st edition of Core Manual for Training in Emergency Medicine
written in 1994 followed by a 2nd edition in 1998, the forerunner of the 1st edition of Practice of Emergency
Medicine published in 2010, originated from the clinical teaching materials used for induction of new recruits
at those days. As the specialty of emergency medicine progresses and matures, the content of learning has to
take care not only 'breath' but also 'depth' of this young specialty. For authors and editors, it is always a
challenging dilemma in deciding comprehensiveness versus conciseness of the topics. This edition will see a
well balance between the two attributes and will be suitable for the novice practitioners like interns, young
residents in emergency medicine or other specialties and more experienced higher trainees and specialists.
The 20 chapters in this edition continue the approach set in the first edition with all major topics in emergency
medicine covered. Emergency medicine is a specialty with no boundaries. Competent emergency physician
has to deal with acute care, to subacute care and even chronic care occasionally. We are prepared to take
care of acutely ill patients in every specialty. This book differs from other emergency medicine texts in that the
general approach sessions are integrated into each chapter. More succinct account of the topic is a hallmark
of this edition. This edition continues the evidence based approach with updates added since the last edition.
More inter-disciplinary collaboration is required for many acute illnesses presenting to emergency department.
Recognition, initial resuscitation and stabilization are the starting point for such collaboration. The success of
which may guarantee a higher chance for favorable outcome. Disposition decision and clearer communication
are important elements of emergency medicine practice and are well described in this textbook.
Readers can appreciate the collaborative efforts of the young and experienced emergency medicine specialists
in this edition. A useful text for bedside reference has to combine good evidence with thoughtful experience.
Overseas versus local practices have to be understood in a way commensurate to cultural, social, economical
as well as legal constraints. I have to congratulate the chief editors and contributors for their success in
integrating all the different facets of modern emergency medicine into this new edition. I am sure that it will be
an invaluable reference for those who practice emergency care of patients either as a full time emergency
physician or at certain time point of their clinical practice.
Dr. Hiu-fai HO
President
Hong Kong College of Emergency Medicine
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EDITORS AND CONTRIBUTORS
Editor-in-chief Section 6: Neurological Emergencies
Dr. James CHANG
Dr. Fu-tat LEE A&E Department, North District Hospital
A&E Department, Princess Margaret Hospital
Dr. Gordon LEUNG
Dr. Ling-pong LEUNG A&E Department, North District Hospital
Emergency Medicine Unit, Lee Ka Shing Faculty of
Medicine, University of Hong Kong Section 7: Endocrine and Metabolic Emergencies
Dr. William WONG
Dr. Axel SIU A&E Department, Princess Margaret Hospital
A&E Department, North District Hospital
Section 8: Infectious Disease
Dr. Jackson POON
A&E Department, Tseung Kwan O Hospital
Section Editors
Dr. Ludwig TSOI
Section 1: Prehospital and Disaster A&E Department, Queen Mary Hospital
Dr. Willis KWOK
A&E Department, Yan Chai Hospital Section 9: Toxicology
Dr. Yiu-cheung CHAN
Dr. Larry LEE Hong Kong Poison Information Centre
A&E Department, Alice Ho Miu Ling Nethersole
Hospital Section 10: Environmental Emergencies
Dr. Jeffrey FUNG
Section 2: Resuscitation A&E Department, Tuen Mun Hospital
Dr. Kwan-leong AU YEUNG
A&E Department, Queen Elizabeth Hospital Dr. Willis KWOK
A&E Department, Yan Chai Hospital
Dr. Ralph CHEUNG
A&E Department, Prince of Wales Hospital Section 11: Hematological and Oncological
Emergencies
Section 3: Cardiovascular Emergencies Dr. Terry LAU
Dr. Rocky WONG A&E Department, Tuen Mun Hospital
A&E Department, Caritas Medical Centre
Section 12: Pediatric Emergencies
Section 4: Respiratory Emergencies Dr. Man-kam HO
Dr. Henry LEE A&E Department, North District Hospital
A&E Department, Queen Elizabeth Hospital
Section 13: Obstetric and Gynecological
Section 5: GI Emergencies Emergencies
Dr. Albert FUNG Dr. Paulin NG
A&E Department, United Christian Hospital A&E Department, Tuen Mun Hospital
Dr. Herman LEE Dr. William WOO
A&E Department, United Christian Hospital A&E Department, North Lantau Hospital
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