Table Of Contenti-xxxviii_FM_Greenberg 10/11/04 3:38 PM Page i
Greenberg’s
TEXT-ATLAS OF
EMERGENCY
MEDICINE
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ASSOCIATE EDITORS
Robert G. Hendrickson, MD
Assistant Professor
Department of Emergency Medicine
Oregon Health and Science University
Medical Toxicologist
Oregon Poison Center
Portland, Oregon
Mark Silverberg, MD
Assistant Professor
Department of Emergency Medicine
SUNY Downstate Medical Center
Director of Senior Medical Student Education
Department of Emergency Medicine
Kings County Hospital Center
Brooklyn, NY
ASSISTANT EDITORS
Colleen J. Campbell, MD
Associate Clinical Professor
Department of Emergency Medicine
University of California, San Diego
San Diego, CA
Anthony P. Morocco, MD
EMS Medical Director
Guam Department of Public Health and Social Services
Mangilao, Guam
Attending Physician, Medical Toxicologist
Department of Emergency Medicine
Guam Memorial Hospital
Oka, Tamuning, Guam
Christy Ann Salvaggio, MD
Assistant Professor
Department of Emergency Medicine
Director of Pediatric Emergency Medicine
Drexel University College of Medicine
Pediatric Emergency Medicine Attending
St. Christopher’s Hospital for Children
Philadelphia, PA
Matthew T. Spencer, MD
Assistant Professor
Department of Emergency Medicine
University of Rochester School of Medicine and Dentistry
Associate Residency Director
Department of Emergency Medicine
Strong Memorial Hospital
Rochester, NY
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EDITOR-IN-CHIEF
Michael I. Greenberg, MD, MPH
Professor of Emergency Medicine
Department of Emergency Medicine
Drexel University College of Medicine
Professor of Public Health
Drexel University School of Public Health
Clinical Professor of Emergency Medicine
Department of Emergency Medicine
Temple University School of Medicine
Philadelphia, PA
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Acquisitions Editor: Anne Sydor
Developmental Editor: Kerry Barrett
Production Editor:Bridgett Dougherty
Manufacturing Manager:Benjamin Rivera
Marketing Manager:Adam Glazer
Cover Designer: Bill Donnelly
Compositor:Graphic World Publishing Services
Printer: Quebecor World Kingsport
©2005 by LIPPINCOTT WILLIAMS & WILKINS
530 Walnut Street
Philadelphia, PA 19106 USA
LWW.com
All rights reserved. This book is protected by copyright. No part of this book may be
reproduced in any form or by any means, including photocopying, or utilized by any
information storage and retrieval system without written permission from the copyright
owner, except for brief quotations embodied in critical articles and reviews. Materials
appearing in this book prepared by individuals as part of their official duties as U.S.
government employees are not covered by the above-mentioned copyright.
Printed in the USA
Library of Congress Cataloging in Publication
Greenberg’s text-atlas of emergency medicine / editor-in-chief, Michael I. Greenberg ;
associate editors, Robert G. Hendrickson, Mark Silverberg ; assistant editors, Colleen
Campbell . . . [et al.].
p. ; cm.
Includes bibliographical references and index.
ISBN 0-7817-4586-1
1. Emergency medicine. 2. Emergency medicine--Atlases. I. Title: Text-atlas of
emergency medicine. II. Greenberg, Michael I.
[DNLM: 1. Emergencies--Atlases. 2. Wounds and Injuries--Atlases. 3. Emergency
Medicine--methods--Atlases. WB 17 G798 2005]
RC86.7.G745 2005
616.0295--dc22
2004048553
Care has been taken to confirm the accuracy of the information presented and to
describe generally accepted practices. However, the authors 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 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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This work is dedicated to Annette Toni Marie Gara and Jeffrey Scott McCabe,
whose love changed my life for the better in ways that words simply cannot ade-
quately express.
It is also dedicated to the memory of two people who I think about each and every
day and whose incredible lives have helped me define my own: my daughter,
Alexandra Jane Greenberg and my father, Alex Ellis Greenberg.
Michael I. Greenberg, MD, MPH
Wayne, Pennsylvania, July, 2004
To my wife, Jen, for her support, her energy, and her incredible ability to melt away
the stresses of a long day at work with her smile. To all of the students, residents,
and colleagues whose unending interest in emergency medicine are the source of
my professional inspiration and motivation. And thank you to our patients who al-
low us to photograph their ailments for the benefit of others.
Robert G. Hendrickson, MD
Portland, Oregon, July, 2004
I dedicate this book to the physicians and colleagues who profoundly influenced
my academic career, especially Dr. Rich Sinert, Dr. Lewis Kohl and my Department
Chair, Dr. Michael Lucchesi. In addition, I dedicate this work to all the Emergency
Medicine residents at Kings County Hospital who contributed written topics to this
atlas and who searched tirelessly to find many of the images, x-rays, CTs and ul-
trasounds included in this atlas.
Mark Silverberg, MD, MMB, FACEP
Brooklyn, New York, July 2004
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CONTENTS
Foreword by Dr. Christopher H. Linden, xvii 2-3 Hazardous Materials Placards, 36
Acknowledgments, xix 2-4 Vehicular Extrication, 37
2-5 Immobilization, 38
Contributing Authors, xxi
2-6 Pneumatic Antishock Garment, 39
Image Contributors, xxxi
SECTION III.
SECTION I.
MEDICAL AND SURGICAL
ABCs, 1
EMERGENCIES, 41
1 AIRWAY, BREATHING, CIRCULATION, 3
3 NEUROLOGIC, 43
1-1 Normal Airway, 4
3-1 Intracranial Hemorrhage, 44
1-2 Difficult Airway, 5
3-2 Subarachnoid Hemorrhage, 45
1-3 ACE Inhibitor-Associated Angioedema, 6
3-3 Cerebellar Hemorrhage, 46
1-4 Ludwig’s Angina, 7
3-4 Cerebrovascular Accident, 47
1-5 Epiglottitis, 8
3-5 Lacunar Cerebral Vascular Accident, 48
1-6 Orofacial Trauma, 10
3-6 Cavernous Sinus Thrombosis, 49
1-7 Laryngeal Trauma, 11
3-7 Acute Subdural Hematoma, 50
1-8 Subglottic Stenosis, 12
3-8 Epidural Hematoma, 51
1-9 Airway Mass, 13
3-9 Spinal Epidural Hematomas, 52
1-10 Cricothyroidotomy, 14
3-10 Decorticate and Decerebrate Posturing, 53
1-11 Transtracheal Jet Ventilation, 15
3-11 Glasgow Coma Scale, 54
1-12 Retrograde Intubation, 16
3-12 Cerebral Ventricular Shunt Failure, 55
1-13 Fiberoptic Intubation, 17
3-13 Seizures, 56
1-14 Tracheal Foreign Body, 18
3-14 Brain Abscess, 57
1-15 Laryngospasm, 19
3-15 Spinal Epidural Abscess, 58
1-16 Flail Chest, 20
3-16 Meningioma, 59
1-17 Escharotomy, 21
3-17 Glioblastoma Multiforme, 60
1-18 Emergency Department Thoracotomy, 22
3-18 Brain Metastases, 61
1-19 Cardiogenic Shock, 23
3-19 Pseudotumor Cerebri, 62
1-20 Anaphylactic Shock, 24
3-20 Horner’s Syndrome, 63
1-21 Hypovolemic/Hemorrhagic Shock, 26
3-21 Migraines/Cluster Headaches, 64
1-22 Neurogenic Shock, 27
3-22 Multiple Sclerosis, 65
1-23 Interosseous Access, 28
3-23 Myasthenia Gravis, 66
1-24 Pericardiocentesis, 29
3-24 Cranial Third Nerve Neuropathy
(Oculomotor), 67
SECTION II. 3-25 Cranial Fourth Nerve Neuropathy
(Trochlear), 68
EMERGENCY MEDICAL SERVICES, 31
3-26 Cranial Sixth Nerve Neuropathy
(Abducens), 69
2 EMERGENCY MEDICAL SERVICES AND 3-27 Bell’s Palsy, 70
PRE-HOSPITAL CARE, 33 3-28 Central Cord Syndrome, 71
2-1 Vehicular Rollover, 34 3-29 Anterior Cord Syndrome, 72
2-2 Significant Mechanism of Injury, 35 3-30 Brown-Séquard Syndrome, 73
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5-7 Orbital Floor Fracture, 131
4 OPHTHALMOLOGIC, 75 5-8 Nasal Septal Hematoma, 132
4-1 Corneal Abrasion, 76 5-9 Parotitis, 133
4-2 Corneal Laceration, 77 5-10 Temporomandibular Joint Syndrome, 134
4-3 Traumatic Iritis, 78 5-11 Acute Mastoiditis, 135
4-4 Ruptured Globe, 79 5-12 Perichondritis, 136
4-5 Penetrating Foreign Body of the Globe, 80 5-13 Cauliflower Ear, 137
4-6 Hordeolum, 81 5-14 Otitis Externa, 138
4-7 Optic Nerve Avulsion, 82 5-15 Malignant Otitis Externa, 139
4-8 Corneal/Conjunctival Foreign Body, 83 5-16 Otitis Media, 140
4-9 Tarsal Plate Foreign Body, 84 5-17 Serous Otitis Media, 141
4-10 Subconjunctival Hemorrhage, 85 5-18 Bullous Myringitis, 142
4-11 Corneal Rust Ring, 86 5-19 Ramsay Hunt Syndrome, 143
4-12 Chalazion, 87 5-20 Cholesteatoma, 144
4-13 Dacryoadenitis/Dacryocystitis, 88 5-21 Tympanosclerosis, 145
4-14 Blepharitis, 89 5-22 Tympanic Membrane Rupture, 146
4-15 Goncoccal Conjunctivitis, 90 5-23 Mandibular Dislocation, 147
4-16 Bacterial Conjunctivitis, 91 5-24 Mandible Fracture, 148
4-17 Viral Conjunctivitis, 92 5-25 Sialolithiasis (Parotid Duct Stone), 149
4-18 Herpes Simplex Keratitis, 93 5-26 Exudative Pharyngitis, 150
4-19 Herpes Zoster Ophthalmicus, 94 5-27 Viral Pharyngitis, 151
4-20 Corneal Ulcer, 95 5-28 Peritonsillar Abscess, 152
4-21 Hyphema, 96 5-29 Uvulitis, 153
4-22 Chemosis, 97 5-30 Retropharyngeal Abscess, 154
4-23 Episcleritis and Scleritis, 98 5-31 Herpes Gingivostomatitis, 155
4-24 Periorbital Cellulitis, 99 5-32 Herpangina, 156
4-25 Orbital Cellulitis, 100 5-33 Leukoplakia, 157
4-26 Ocular Alkali Injury, 101 5-34 Geographic Tongue, 158
4-27 Hypopyon, 102 5-35 Aphthous Stomatitis, 159
4-28 Macular Degeneration, 103 5-36 Black Hairy Tongue, 160
4-29 Vitreous Hemorrhage, 104 5-37 Branchial Cleft Cyst, 161
4-30 Central Retinal Artery Occlusion, 105 5-38 Lymphadenitis, 162
4-31 Central Retinal Vein Occlusion, 106 5-39 Thyroid Mass, 163
4-32 Hypertensive Retinopathy, 107 5-40 Thyroglossal Duct Cyst, 164
4-33 Diabetic Retinopathy, 108 5-41 Cleft Lip and Palate, 165
4-34 Cytomegalovirus Retinitis, 109
4-35 Optic Neuritis, 110 6 DENTAL, 167
4-36 Papilledema, 111 6-1 Acute Necrotizing Ulcerative Gingivitis, 168
4-37 Arcus Senilis, 112 6-2 Dental Abscess, 169
4-38 Retinal Detachment, 113 6-3 Dental Caries, 170
4-39 Kayser-Fleischer Rings, 114 6-4 Postextraction Bleeding, 171
4-40 Anisocoria, 115 6-5 Alveolar Osteitis, 172
4-41 Sympathetic Ophthalmia, 116 6-6 Dental Fracture, 173
4-42 Pterygium, 117 6-7 Luxation Injuries (Avulsion), 174
4-43 Entropion, 118 6-8 Alveolar Fracture, 175
4-44 Closed-Angle Glaucoma, 119 6-9 Tooth Wear from Bruxism, 176
4-45 Marcus Gunn Pupil, 120 6-10 Gingival Hyperplasia, 177
4-46 Retinoblastoma, 121 6-11 Tooth Discoloration, 178
4-47 Xanthelasma Palpebrarum, 122 6-12 Hutchinson’s Teeth, 179
5 EAR, NOSE, AND THROAT, 123 7 CARDIOVASCULAR, 181
5-1 Sinusitis, 124 7-1 Acute Myocardial Infarction, 182
5-2 Allergic Rhinitis, 126 7-2 Unstable Angina, 184
5-3 Viral Rhinitis, 127 7-3 Ventricular Aneurysm, 185
5-4 Anterior Epistaxis, 128 7-4 Pericarditis, 186
5-5 Posterior Epistaxis, 129 7-5 Pericardial Effusion and Tamponade, 188
5-6 Zygomatic Arch Fracture, 130 7-6 Congestive Heart Failure, 189
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7-7 Dilated Cardiomyopathy, 190 9 GASTROINTESTINAL, 261
7-8 Hypertrophic Cardiomyopathy, 192 9-1 Thermal Esophageal Injury, 262
7-9 High-Output Cardiac Failure, 193 9-2 Gastroesophageal Reflux Disease, 263
7-10 Abdominal Aortic Aneurysm, 194 9-3 Esophageal Foreign Body, 264
7-11 Aortic Dissection, 196 9-4 Barrett’s Esophagus, 266
7-12 Thoracic Aortic Aneurysm, 198 9-5 Esophageal Stricture, 267
7-13 Septal Wall Rupture, 199 9-6 Esophageal Diverticula, 268
7-14 Papillary Muscle Rupture, 200 9-7 Achalasia, 269
7-15 Aortic Regurgitation, 201 9-8 Candidal Esophagitis, 270
7-16 Aortic Stenosis, 202 9-9 Mallory-Weiss Syndrome, 271
7-17 Phlegmasia Cerulea and Alba Dolens, 203 9-10 Boerhaave’s Syndrome, 272
7-18 Deep Venous Thrombosis, 204 9-11 Peptic Ulcer Disease, 273
7-19 Acute Arterial Occlusion, 206 9-12 Bezoars, 274
7-20 Peripheral Vascular Disease (Arteriosclerosis 9-13 Upper Gastrointestinal Bleeding, 275
Obliterans), 207
9-14 Lower Gastrointestinal Bleeding, 276
7-21 Venous Stasis Ulcer, 208
9-15 Black Stool, 277
7-22 Gangrene, 210
9-16 Ingested Foreign Bodies, 278
7-23 Rheumatic Heart Disease, 211
9-17 Small Bowel Obstruction, 279
7-24 Bacterial Endocarditis, 212
9-18 Large Bowel Obstruction, 280
7-25 Patent Ductus Arteriosus, 214
9-19 Ileus, 281
7-26 Aortic Coarctation, 215
9-20 Volvulus, 282
7-27 Ventricular Septal Defect, 216
9-21 Abdominal Hernia, 284
7-28 Atrial Septal Defect, 217
9-22 Abdominal Abscess, 285
7-29 Atrial Myxoma, 218
9-23 Acute Appendicitis, 286
7-30 Supraventricular Tachycardia, 220
9-24 Crohn’s Disease, 287
7-31 Ventricular Tachyarrhythmias, 222
9-25 Ulcerative Colitis, 288
7-32 Atrial Fibrillation, 223
9-26 Diverticulosis, 289
7-33 Atrial Flutter, 224
9-27 Diverticulitis, 290
7-34 Wolff-Parkinson-White Syndrome, 226
9-28 Hirschsprung’s Disease, 291
7-35 Multifocal Atrial Tachycardia, 227
9-29 Intestinal Perforation, 292
7-36 Sinus Tachycardia, 228
9-30 Ischemic Colitis, 293
7-37 Torsades de Pointes, 229
9-31 Meckel’s Diverticulum, 294
7-38 Atrioventricular Blocks, 230
9-32 Carcinoid Syndrome, 295
7-39 Sinus Bradycardia, 232
9-33 Peutz-Jeghers Syndrome, 296
7-40 Pacemaker Failure, 233
9-34 Gallstone Ileus, 297
7-41 Mitral Valve Prolapse, 234
9-35 Cholelithiasis, 298
7-42 Situs Inversus and Dextrocardia, 235
9-36 Acute Cholecytitis, 300
9-37 Acute Pancreatitis, 302
8 RESPIRATORY, 237 9-38 Peliosis Hepatis, 304
8-1 Asthma, 238 9-39 Budd-Chiari Syndrome, 305
8-2 Chronic Obstructive Pulmonary Disease, 240 9-40 Cirrhosis/Portal Hypertension, 306
8-3 Pulmonary Embolism, 242 9-41 Hepatorenal Syndrome, 308
8-4 Spontaneous Pneumothorax, 243 9-42 Rectal Foreign Bodies, 309
8-5 Severe Acute Respiratory Syndrome, 244 9-43 Anorectal Abscesses, 310
8-6 Hospital-Acquired Pneumonia, 245 9-44 Hemorrhoids, 311
8-7 Community-Acquired Pneumonia, 246 9-45 Inguinal Hernia, 312
8-8 Aspiration Pneumonia, 248 9-46 Femoral Hernias, 313
8-9 Acute Bronchitis, 249 9-47 Rectal Prolapse, 314
8-10 Chemical Pneumonitis, 250 9-48 Osler-Weber-Rendu Syndrome, 315
8-11 Aspirated Foreign Body, 251
8-12 Lung Abscess, 252 10 GENITOURINARY/RENAL, 317
8-13 Sarcoidosis, 253 10-1 Penile Fracture, 318
8-14 Tuberculosis, 254 10-2 Penile Amputation, 319
8-15 Pleural Effusion, 256 10-3 Male Genital Degloving Injury, 320
8-16 Empyema, 257 10-4 Penetrating Genital Trauma (Male), 321
8-17 Pulmonary Fibrosis, 258 10-5 Scrotal Hematoma, 322
8-18 Lung Cancer, 259 10-6 Penile Zipper Injury, 323
8-19 Pancoast Tumor, 260 10-7 Constricting Penile Ring, 324
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10-8 Priapism, 325 13-10 Placental Abruption, 387
10-9 Phimosis, 326 13-11 Spontaneous Abortion, 388
10-10 Balanitis, 327 13-12 Breech Delivery, 389
10-11 Pearly Penile Papules, 328 13-13 Nuchal Cord, 390
10-12 Testicular Torsion, 329 13-14 Postpartum Hemorrhage, 391
10-13 Testicular Cancer, 330
10-14 Epididymitis, 331 14 DERMATOLOGIC, 393
10-15 Varicocele, 332 14-1 Rashes, 394
10-16 Hydrocele, 333 14-2 Erythema Multiforme, 395
10-17 Orchitis, 334 14-3 Stevens-Johnson Syndrome, 396
10-18 Bladder and Urethral Foreign Body, 336 14-4 Toxic Epidermal Necrolysis, 397
10-19 Rhabdomyolysis, 337 14-5 Erysipelas, 398
10-20 Hematuria, 338 14-6 Shingles, 399
10-21 Urinary Tract Infections and Pyelonephritis, 340 14-7 Urticaria, 400
10-22 Renal Stones, 341 14-8 Eczema, 401
10-23 Acute Urinary Retention, 342 14-9 Contact Dermatitis, 402
10-24 Acute Renal Failure, 344 14-10 Nickel Dermatitis, 403
10-25 Chronic Renal Failure, 346 14-11 Psoriasis, 404
10-26 Nephrotic Syndrome, 347 14-12 Atopic Dermatitis, 405
14-13 Hidradenitis Suppurativa, 406
11 GYNECOLOGIC, 349 14-14 Cutaneous Abscess, 407
11-1 Bartholin Gland Abscess, 350 14-15 Scabies, 408
11-2 Bacterial Vaginosis, 351 14-16 Head Lice, 409
11-3 Vulvovaginal Candidiasis, 352 14-17 Pubic Lice, 410
11-4 Uterine Prolapse, 353 14-18 Pityriasis Rosea, 411
11-5 Ovarian Cysts and Masses, 354 14-19 Bullous Impetigo, 412
11-6 Ovarian Torsion, 355 14-20 Pemphigus Vulgaris, 413
11-7 Uterine Fibroids, 356 14-21 Pyogenic Granuloma, 414
11-8 Polycystic Ovary Syndrome, 357 14-22 Diabetic Dermopathy, 415
11-9 Endometriosis, 358 14-23 Necrobiosis Lipoidica, 416
11-10 Breast Masses, 359 14-24 Lichen Planus, 417
11-11 Breast Infections, 360 14-25 Phytophotodermatitis, 418
14-26 Pilonidal Cyst, 419
12 SEXUALLY TRANSMITTED DISEASES, 361 14-27 Tinea Cruris, 420
12-1 Urethritis, 362 14-28 Tinea Capitis, 421
12-2 Pelvic Inflammatory Disease, 363 14-29 Tinea Barbae, 422
12-3 Tubo-ovarian Abscess, 364 14-30 Tinea Versicolor, 423
12-4 Chancroid, 365 14-31 Tinea Pedis, 424
12-5 Condyloma Acuminata, 366 14-32 Intertriginous Candidiasis, 425
12-6 Lymphogranuloma Venereum, 367 14-33 Tinea Corporis, 426
12-7 Granuloma Inguinale, 368 14-34 Viral Warts, 427
12-8 Gonococcal Arthritis, 369 14-35 Herpetic Whitlow, 428
12-9 Syphilis, 370 14-36 Plantar Warts, 429
12-10 Condylomata Latum, 372 14-37 Malignant Melanoma, 430
12-11 Trichomoniasis, 373 14-38 Squamous Cell Carcinoma, 431
12-12 Herpes Genitalis, 374 14-39 Basal Cell Carcinoma, 432
14-40 Mycosis Fungoides, 433
13 OBSTETRICS, 375 14-41 Kerion, 434
13-1 Pelvic Ultrasonography, 376 14-42 Erythema Nodosum, 435
13-2 Preeclampsia/Eclampsia, 378 14-43 Acanthosis Nigricans, 436
13-3 Melasma (Mask of Pregnancy), 380 14-44 Dermatographia, 437
13-4 Hyperemesis Gravidarum, 381 14-45 Actinic Keratosis, 438
13-5 Pruritic Uticarial Papules and Plaques of 14-46 Radiodermatitis, 439
Pregnancy, 382 14-47 Vitiligo, 440
13-6 Herpes Gestationis, 383 14-48 Decubitus Ulcers, 441
13-7 Hydatidiform Mole, 384 14-49 Alopecia, 442
13-8 Ectopic Pregnancy, 385 14-50 Neurofibromatosis, 443
13-9 Placenta Previa, 386 14-51 Lipoma, 444
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