Emergency Medicine: Clinical Essentials

2207 Pages·2012·96.56 MB·English

by  James G. Adams et al.

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Editor
James G. Adams, MD
Professor and Chair, Department of Emergency Medicine, Northwestern University Feinberg
School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
Associate Editors
Erik D. Barton, MD, MBA
Chief of Emergency Medicine, Division of Emergency Medicine, University of Utah Health
Care; Associate Professor, University of Utah School of Medicine, Salt Lake City, Utah
Jamie L. Collings, MD
Associate Professor, Executive Director, Innovative Education, Department of Emergency
Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Peter M.C. DeBlieux, MD
Professor of Clinical Medicine, Louisiana State University Health Sciences Center; Professor
of Clinical Surgery, Tulane University School of Medicine, New Orleans, Louisiana
Michael A. Gisondi, MD, FACEP
Associate Professor, Residency Program Director, Department of Emergency Medicine,
Northwestern University Feinberg School of Medicine, Chicago, Illinois
Eric S. Nadel, MD
Associate Professor, Harvard Medical School; Program Director, Harvard Affiliated
Emergency Medicine Residency, Brigham and Women’s Hospital/Massachusetts General
Hospital, Boston, Massachusetts
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
EMERGENCY MEDICINE: CLINICAL ESSENTIALS ISBN: 978-1-4377-3548-2
Copyright © 2013, 2008 by Saunders, an imprint of Elsevier Inc.
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Notices
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical treatment may
become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds, or experiments described herein. In using such information
or methods, they should be mindful of their own safety and the safety of others, including parties for
whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered to verify the recommended dose or formula, the method and duration of administration, and
contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge
of their patients, to make diagnoses, to determine dosages and the best treatment for each individual
patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assume
any liability for any injury and/or damage to persons or property as a matter of products liability,
negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.
Chapter 45, “Emergency Biliary Ultrasonography”: Beatrice Hoffman retains copyright to her original images.
Chapter 139, “Venomous Snakebites in North America”: Robert L. Norris retains copyright to his original
images.
Library of Congress Cataloging-in-Publication Data
Emergency medicine : clinical essentials / editor, James G. Adams ; associate editors, Erik D. Barton …
[et al.].—2nd ed.
p. ; cm.
Includes bibliographical references.
ISBN 978-1-4377-3548-2 (hardcover : alk. paper)
I. Adams, James, 1962 May 8-
[DNLM: 1. Emergency Medicine—methods. 2. Emergencies. WB 105]
616.02′5—dc23
2012023682
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To my immediate and extended family, for their love, support, patience,
and encouragement. To my friends, mentors, and colleagues, from whom
I continue to learn so much. To the faculty and residents, whose great
talent and dedication invigorate me. To the authors and editors of this
text, in recognition of their knowledge, skill, wisdom, and generosity.
JGA
To my family, friends, and faculty, who better understand the virtues of
patience and without whose support I could never achieve anything
great! I am very blessed to be surrounded by such amazing souls.
Thanks for being part of this success!
EDB
To Mark, Keaton, and Kameron, you are what is most important in my
life. Thanks for supporting me in everything I do. To my students and
residents, you give me inspiration and motivation, and you never fail
to make “work” fun!
JLC
To Karen, Joshua, and Zachary for your love and undying patience with
my educational pursuits and being a constant reminder that you are my
main thing. To my patients at Charity Hospital, who inspire me to help
others. You have taught me best what it means to be a physician. To my
students, residents, peer faculty, and especially Keith Van Meter.
Thanks for the opportunity to work and learn with all of you.
PMCD
To Derek and Abby, with all my love. Thank you for your support,
encouragement, love, and advice—here’s to many, many years of
continued adventures.
MAG
To the HAEMR residents and dedicated faculty, who keep me motivated
and humble as we perpetuate the cycle of teaching and learning. To my
colleagues, who have shared their experience and wisdom to expand the
foundation of our field with this text. To my family and friends, who have
supported me along the way. To my mother, Harriet, who was always
proud and would continue to be so. To my wife, Marianne, and our
children, Josh, Emily, and Henry, for their love, patience, and laughter.
ESN
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Preface
We hope that this edition of Emergency Medicine: Clinical clinical practice. The next era of clinical physician evaluation
Essentials will cover the core content of the specialty of will be to assess whether we are practicing according to
emergency medicine in a practical and useful way. The style evidence-based or consensus-based standards. This text
and format are constructed with emergency medicine resi- emphasizes these areas of practical, applied decision making.
dents in mind. The table of contents specifically mirrors the It offers explicit, current, and practical recommendations that
key topic areas of emergency medicine. The chapters are will be useful for practicing physicians.
written by physicians who provide lucid explanations and Our clinical practice is rapidly changing as diagnostic tools
make the information clinically relevant. The authors are increasingly incorporated, new therapies applied, and
are experts, leading educators on the topic, and particularly entirely new disorders emerge. Some types of emergencies
talented academicians. The chapter format favors short seg- were unknown a decade ago, such as those related to novel
ments, highly readable prose, and many subheadings. Maximal implanted devices, complications of new surgical procedures
use of pedagogic tools such as boxes, tables, figures, and such as organ transplantation or bariatric surgery, and even
algorithms helps summarize and synthesize key themes. This fertility treatment. The use of diagnostic testing, whether
facilitates initial learning and later enables quick references magnetic resonance imaging, computed tomography, or
and resetting of the learning, especially when used in the bedside ultrasound, is changing. Time-dependent therapeutic
electronic version. This text is constructed to be easy to use interventions for resuscitation and even standards of treatment
on electronic reading devices, recognizing that books have for serious infectious disease have evolved. All these areas
quickly evolved from static print to dynamic, interactive elec- and more are covered in the text as core information for the
tronic tools. emergency medicine specialist.
This book is designed so that it can be part of a curriculum In summary, this textbook is well suited as a stand-alone text
and embedded into a training program. There is probably no or a reference tool but also can be used as a component of an
way to master this specialty’s huge amount of content other emergency medicine residency curriculum. The link to the
than continuous, deliberate, concentrated study, so this book specialty core content, the readable design, and the content
hopes to make the study easier through straightforward writing selection is meant to be useful, accessible, and functional, in
and clear tables and figures. It is never easy to learn large addition to forward looking as technology transforms our
amounts of material and stay current with latest treatment methods of teaching, learning, and evaluation. We are prepar-
guidelines. This text brings both the latest recommendations ing for the electronic future, where this text fits neatly into a
and succinct explanations. Eventually, throughout the course world in which reading is done online, a quick retrieval of
of a residency, the core information can be covered in its information is desired, and a screen-friendly format is appreci-
entirety, at least once but usually twice. The residency pro- ated. The world will continue to change quickly, and so will
gram’s clinical experiences, case conferences, simulation this text.
exercises, and other parts of the curriculum will reinforce
themes, teach additional knowledge, assess judgment, and James G. Adams
evaluate practical skills. Faculty members can refer to the text Erik D. Barton
to refresh their own knowledge or to use the tables and algo- Jamie L. Collings
rithms for clinical teaching in the emergency department. Peter M.C. DeBlieux
This textbook is also intended to be relevant to the practic- Michael A. Gisondi
ing physician, from whom society expects the highest level of Eric S. Nadel
vii
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Contributors
Michael K. Abraham, MD Paul J. Allegretti, DO, FACOEP, FACOI John Bailitz, MD
Clinical Assistant Professor, Department of Professor and Program Director, Department of Emergency Ultrasound Director, Department of
Emergency Medicine, University of Maryland Emergency Medicine, Midwestern University, Emergency Medicine, John H. Stroger Hospital
School of Medicine, Baltimore, Maryland; Downers Grove, Illinois; Professor and Program of Cook County; Assistant Professor,
Attending Physician, Department of Emergency Director, Department of Emergency Medicine, Department of Emergency Medicine, Rush
Medicine, Upper Chesapeake Health System, Provident Hospital of Cook County, Chicago, University Medical Center, Chicago, Illinois
Bel Air, Maryland Illinois Thoracic Trauma
Lung Transplant Complications Vasculitis Syndromes
Patricia Baines, MD
Fredrick M. Abrahamian, DO, FACEP Jennifer F. Anders, MD Assistant Professor, Medical Director of
Clinical Professor of Medicine, David Geffen Assistant Professor, Department of Pediatrics, Forensic Program, Department of Emergency
School of Medicine at University of California, Johns Hopkins University School of Medicine; Medicine, Emory University, Atlanta, Georgia
Los Angeles, Los Angeles, California; Director Fellowship Program Director, Division of Gastrointestinal Bleeding
of Education, Department of Emergency Pediatric Emergency Medicine, Johns Hopkins
Medicine, Olive View–UCLA Medical Center, Children’s Center, Baltimore, Maryland Aaron E. Bair, MD
Sylmar, California Pediatric Gynecologic Disorders Associate Professor, Department of Emergency
Infections in the Immunocompromised Host Medicine, UC Davis Medical Center,
Jana L. Anderson, MD Sacramento, California
Mohammed A. Abu Aish, MD, MEd, FRCPC Instructor in Emergency Medicine and Advanced Airway Techniques
Pediatric Emergency Medicine Physician, Pediatrics, Departments of Emergency
Division of Pediatric Emergency Medicine, Medicine and Pediatrics, Mayo Clinic, Katherine Bakes, MD
British Columbia Children’s Hospital, Rochester, Minnesota Director, Denver Emergency Center for
Vancouver, British Columbia, Canada Child with a Fever Children, Associate Director, Emergency
Submersion Injuries Department, Denver Health Medical Center,
Phillip Andrus, MD, FACEP, RDMS Denver, Colorado; Associate Professor,
Bruce D. Adams, MD, FACEP Assistant Professor of Emergency Medicine, Department of Emergency Medicine, University
Professor of Surgery, Chief, The Center for Mount Sinai School of Medicine, New York, of Colorado School of Medicine, Aurora,
Emergency Medicine, University of Texas New York Colorado
Health Science Center at San Antonio, San Peripheral Nerve Disorders Neonatal Cardiopulmonary Resuscitation
Antonio, Texas Pediatric Resuscitation
Rhabdomyolysis Christian Arbelaez, MD, MPH Pediatric Trauma
Assistant Residency Director, Harvard Affiliated
James G. Adams, MD Emergency Medicine Residency, Department of Aaron N. Barksdale, MD
Professor and Chair, Department of Emergency Emergency Medicine, Brigham and Women’s Assistant Professor, Department of Emergency
Medicine, Northwestern University Feinberg Hospital; Assistant Professor of Medicine, Medicine, Truman Medical Center/University
School of Medicine, Northwestern Memorial Harvard Medical School, Boston, of Missouri, Kansas City, School of Medicine;
Hospital, Chicago, Illinois Massachusetts Clinical Instructor, Department of Emergency
Preface Health Care Disparities and Diversity in Medicine, Children’s Mercy Hospital/
Systemic Lupus Erythematosus Emergency Medicine University of Missouri, Kansas City, School of
Medicine, Kansas City, Missouri
Nima Afshar, MD Charles B. Arbogast, DO Allergic Disorders
Assistant Professor of Medicine, University of Chief of Nephrology, William Beaumont Army
California, San Francisco, San Francisco, Medical Center, El Paso, Texas William G. Barsan, MD
California Rhabdomyolysis Professor, Department of Emergency Medicine,
Aortic Dissection University of Michigan, Ann Arbor, Michigan
Chandra D. Aubin, MD, RDMS Altered Mental Status and Coma
James Ahn, MD Assistant Professor, Assistant Residency Director,
Clinical Instructor, Department of Medicine, Department of Emergency Medicine, Erik D. Barton, MD, MBA
University of Chicago, Chicago, Illinois Washington University School of Medicine, Chief of Emergency Medicine, Division of
Inflammatory Bowel Disease St. Louis, Missouri Emergency Medicine, University of Utah Health
Hernias Care; Associate Professor, University of Utah
Amer Z. Aldeen, MD, FACEP School of Medicine, Salt Lake City, Utah
Assistant Professor, Associate Residency Jennifer Avegno, MD Preface
Director, Department of Emergency Medicine, Clinical Assistant Professor, Department of
Northwestern University Feinberg School of Medicine, Section of Emergency Medicine, Benjamin S. Bassin, MD
Medicine, Northwestern Memorial Hospital, Louisiana State University Health Sciences Clinical Instructor, Department of Emergency
Chicago, Illinois Center, New Orleans, Louisiana Medicine, University of Michigan, Ann Arbor,
Epidemic Infections in Bioterrorism Emergency Medical Services and Disaster Michigan
Medicine Altered Mental Status and Coma
ix