Field Guide to Urgent and Ambulatory Care Procedures

365 Pages·2001·6.507 MB·English

by  David M. James MD

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FIELD GUIDE TO URGENT
AND AMBULATORY CARE
PROCEDURES
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FIELD GUIDE TO URGENT
AND AMBULATORY CARE
PROCEDURES
David M. James, M.D., C.C.F.P.(E.M.)
Associate Professor
Departments of Family Medicine and Emergency Medicine
Faculty of Medicine
School of Medicine and Biomedical Sciences
State University of New York at Buffalo
and
Medical Director
Deaconess Family Medicine Center
Buffalo, New York
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©2001 by LIPPINCOTT WILLIAMS & WILKINS
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All rights reserved. This book is protected by copyright. No part of this book may be
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Printed in the USA
Library of Congress Cataloging-in-Publication Data
Field guide to urgent and ambulatory care procedures / editor, David M. James.
p. ; cm.
Includes index.
ISBN 0-7817-2823-1
1. Medical emergencies—Handbooks, manuals, etc. 2. Critical care
medicine—Handbooks, manuals, etc. 3. Ambulatory medical care—Handbooks, manuals,
etc. I. James, David M. (David Michael), 1958–
[DNLM: 1. Emergency Medical Services—methods. 2. Ambulatory Care—methods.
WX 215 F453 2001]
RC86.8 .F54 2001
616.02(cid:2)5—dc21
2001029216
Care has been taken to confirm the accuracy of the information presented and to
describe generally accepted practices. However, the authors, editor, and publisher are not
responsible for errors or omissions or for any consequences from application of the
information in this book and make no warranty, expressed or implied, with respect to the
currency, completeness, or accuracy of the contents of the publication. Application of this
information in a particular situation remains the professional responsibility of the
practitioner.
The authors, editor, and publisher have exerted every effort to ensure that drug
selection and dosage set forth in this text are in accordance with current
recommendations and practice at the time of publication. However, in view of ongoing
research, changes in government regulations, and the constant flow of information
relating to drug therapy and drug reactions, the reader is urged to check the package
insert for each drug for any change in indications and dosage and for added warnings and
precautions. This is particularly important when the recommended agent is a new or
infrequently employed drug.
Some drugs and medical devices presented in this publication have Food and Drug
Administration (FDA) clearance for limited use in restricted research settings. It is the
responsibility of the health care provider to ascertain the FDA status of each drug or
device planned for use in their clinical practice.
10 9 8 7 6 5 4 3 2 1
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CONTENTS
Contributing Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
I. THE EYE
1. Use of the Slit Lamp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2. Tonometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
3. Foreign-Body Removal from the Eye . . . . . . . . . . . . . . . . . . . . . . . . . 9
II. THE NOSE
4. Nasal Foreign-Body Removal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
5. Urgent Management of Nasal Fracture . . . . . . . . . . . . . . . . . . . . . . . . 17
6. Epistaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
III. THE EAR
7. Management of a Foreign Body in the Ear Canal and Removal of
Impacted Cerumen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
8. Lacerations of the Ear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
9. Management of Auricular Hematoma . . . . . . . . . . . . . . . . . . . . . . . . . 33
IV. THE MOUTH
10. Immediate Management of Tooth Fracture and Avulsion . . . . . . . . . 36
11. Lip Laceration and Vermilion Border Repair . . . . . . . . . . . . . . . . . . . 40
12. Reduction of a Dislocated Mandible . . . . . . . . . . . . . . . . . . . . . . . . . . 44
13. Urgent Management of Dental Abscess . . . . . . . . . . . . . . . . . . . . . . . . 48
14. Intraoral Anesthetic Techniques and Supraperiosteal Dental
Nerve Block . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
V. AIRWAY PROCEDURES
15. Laryngoscopy: Direct, Indirect, and Flexible Fiberoptic
Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
16. Rapid-Sequence Intubation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
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CONTENTS
17. Endotracheal Intubation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Brian F. Connolly and David M. James
18. Cricothyroidotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Brian F. Connolly and David M. James
VI. THE CHEST
19. Intercostal Nerve Blocks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
20. Needle Thoracentesis Procedures: Tension Pneumothorax
and Pleural Effusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
21. Insertion of a Chest Tube . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
VII. CARDIOVASCULAR
22. Intravenous Access Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
A. Peripheral Venous Access Procedures for Limb Veins . . . . . . . 93
B. Percutaneous Internal Jugular Vein Catheterization . . . . . . . . . . 95
C. Percutaneous Subclavian Vein Catheterization . . . . . . . . . . . . . 102
D. Percutaneous Femoral Vein Catheterization . . . . . . . . . . . . . . . 107
E. Intraosseous Venous Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
F. Venous Cutdown Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
23. Arterial Puncture: Radial, Femoral, and Brachial . . . . . . . . . . . . . . . . 120
24. Pericardiocentesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
25. Defibrillation and Emergent Cardioversion . . . . . . . . . . . . . . . . . . . . . 130
26. Temporary Pacing Techniques: External and Transvenous . . . . . . . . . 136
VIII. GASTROINTESTINAL
27. Anoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
28. Nasogastric Tube Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
29. Temporary Gastrostomy Tube Replacement with a Foley
Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
30. Urgent Management of Thrombosed Hemorrhoids . . . . . . . . . . . . . . . 152
Thomas C. Rosenthal and David M. James
31. Incision and Drainage of a Perianal Abscess . . . . . . . . . . . . . . . . . . . . 155
32. Abdominal Paracentesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
33. Peritoneal Lavage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
34. Incision and Drainage of a Pilonidal Abscess . . . . . . . . . . . . . . . . . . . 165
35. Urgent Management of Inguinal Hernia . . . . . . . . . . . . . . . . . . . . . . . 168
IX. GENITOURINARY
36. Urgent Management of a Bartholin’s Abscess/Cyst, Including
Word Catheter Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
37. Postcoital Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
38. Foley Catheter Insertion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
39. Urgent Management of Phimosis and Paraphimosis . . . . . . . . . . . . . . 182
vi
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CONTENTS
40. Urgent Management of Priapism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
Kennon Miller, Vejay Kotha, and David M. James
41. Suprapubic Bladder Aspiration and Placement of a
Suprapubic Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
X. THE SKIN
42. Incision and Drainage of an Abscess . . . . . . . . . . . . . . . . . . . . . . . . . . 194
43. Urgent Management of Minor Burns and Frostbite . . . . . . . . . . . . . . . 198
44. Repair of Lacerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
45. Urgent Management of a Sebaceous Cyst . . . . . . . . . . . . . . . . . . . . . . 213
46. Regional Anesthetic Techniques: Field Blocks and Peripheral
Nerve Blocks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
47. Tick Removal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
48. Fishhook and Skin Foreign-Body Removal . . . . . . . . . . . . . . . . . . . . . 227
XI. MUSCULOSKELETAL
49. Aspiration and Injection of a Joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
50. Casting Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
A. The Hand and Wrist
51. Incision and Drainage of a Paronychia and Felon . . . . . . . . . . . . . . . . 242
52. Urgent Management of Simple Dislocation or Fracture
of a Finger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
53. Ring Removal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
54. Urgent Management of Simple Metacarpal Fractures . . . . . . . . . . . . . 255
55. Urgent Management of Fingertip Amputations . . . . . . . . . . . . . . . . . . 260
56. Urgent Management of Nail and Nailbed Injuries . . . . . . . . . . . . . . . . 264
57. Urgent Management of Extensor Tendon Injuries of the Hand . . . . . . 269
B. The Elbow
58. Management of a Subluxed Radial Head: Nursemaid’s Elbow . . . . . . 274
59. Urgent Management of a Dislocated Elbow . . . . . . . . . . . . . . . . . . . . 276
C. The Shoulder
60. Urgent Management of a Shoulder Dislocation . . . . . . . . . . . . . . . . . . 279
D. Pelvis and Hip
61. Urgent Management of Hip Dislocation . . . . . . . . . . . . . . . . . . . . . . . 284
E. The Knee
62. Urgent Management of a Dislocated Patella . . . . . . . . . . . . . . . . . . . . 287
F. The Ankle and Foot
63. Splinting of Ankle Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290
64. Urgent Management of an Ingrown Toenail . . . . . . . . . . . . . . . . . . . . 294
65. Urgent Management of Simple Metatarsal Fractures . . . . . . . . . . . . . 297
66. Urgent Management of Simple Toe Fractures and Dislocations . . . . . 300
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CONTENTS
XII. ADVANCED PROCEDURES
67. Lumbar Puncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
68. Ultrasound Techniques in the Urgent Care Setting . . . . . . . . . . . . . . . 310
Kenneth R. Patton, Dietrich Jehle, and David M. James
69. Emergent Childbirth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
Frederick Beck and David M. James
70. Conscious Sedation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322
Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
viii
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CONTRIBUTING AUTHORS
Frederick Beck, M.D., F.A.C.O.G. Clinical Instructor, Faculty of Medicine,
School of Medicine and Biomedical Sciences, State University of New York at
Buffalo, Buffalo, New York
Brian F. Connolly, M.D., C.M., C.C.F.P.(E.M.) Associate Professor & Vice
Chairman, Department of Family Medicine, School of Medicine and Biomedi-
cal Sciences, State University of New York at Buffalo, Buffalo, New York
David M. James, M.D., C.C.F.P.(E.M.) Associate Professor, Departments of
Family Medicine and Emergency Medicine, Faculty of Medicine, School of
Medicine and Biomedical Sciences, State University of New York at Buffalo;
Medical Director, Deaconess Family Medicine Center, Buffalo, New York
Dietrich Jehle, M.D., F.A.C.E.P. Associate Professor & Vice Chairman,
Department of Emergency Medicine, School of Medicine and Biomedical
Sciences, State University of New York at Buffalo; Director, Department of
Emergency Medicine, Erie County Medical Center, Buffalo, New York
Vejay Kotha, M.D. Clinical Instructor, Department of Surgery, School of
Medicine and Biomedical Sciences, State University of New York at Buffalo,
Buffalo, New York
Kennon Miller, M.D. Assistant Professor, Department of Urology, Faculty
of Medicine, School of Medicine and Biomedical Sciences, State University of
New York at Buffalo, Buffalo, New York
Kenneth R. Patton, D.O. Clinical Instructor, Department of Emergency
Medicine, Erie County Medical Center, Buffalo, New York
Thomas C. Rosenthal, M.D. Professor & Chairman, Department of Family
Medicine, Faculty of Medicine, School of Medicine and Biomedical Sciences,
State University of New York at Buffalo, Buffalo, New York
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