Manual of Emergency Medicine

718 Pages·2011·3.821 MB·English

by  Dr. G. Richard Braen MD

MANUAL OF EMERGENCY
MEDICINE
6th Edition
Editor
G. Richard Braen, MD, FACEP
Professor and Chair, Department of Emergency Medicine, Assistant Dean,
Graduate Medical Education, School of Medicine and Biomedical Sciences,
State University of New York at Buffalo, Buffalo, New York
Editor Emeritus
Jon L. Jenkins, MD, FACEP
Former Chairman, Department of Emergency Medicine
Wakefi eld Hospital, Melrose, Massachusetts
Assistant Editors
Jeanne Basior, MD, FACEP
Associate Professor of Clinical Emergency Medicine, Assistant Residency Director,
Department of Emergency Medicine, School of Medicine and Biomedical Sciences,
University of Buffalo, Buffalo, New York
Samuel Cloud, DO, FACEP
Assistant Professor of Clinical Emergency Medicine, Assistant Residency Director,
Department of Emergency Medicine, School of Medicine and Biomedical Sciences,
University of Buffalo, Buffalo, New York
Christian DeFazio, MD, FACEP
Assistant Professor of Clinical Emergency Medicine, Residency Director,
Department of Emergency Medicine, School of Medicine and Biomedical Sciences,
University of Buffalo, Buffalo, New York
Robert McCormack, MD, FACEP
Associate Professor of Clinical Emergency Medicine, Department of Emergency Medicine
School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, New York;
Director, Department of Emergency Medicine, Buffalo General Hospital, Buffalo, New York
BBrraaeenn__FFMM..iinndddd ii 22//2266//22001111 77::5588::4422 AAMM
Senior Acquisitions Editor: Frances DeStefano
Product Director: Julia Seto
Vendor Manager: Bridgett Dougherty
Senior Manufacturing Manager: Benjamin Rivera
Senior Marketing Manager: Angela Panetta
Design Coordinator: Terry Mallon
Production Services: SPi Global
© 2011 by LIPPINCOTT WILLIAMS & WILKINS, a WOLTERS KLUWER business
Two Commerce Square
2001 Market Street
Philadelphia, PA 19103 USA
LWW.com
All rights reserved. This book is protected by copyright. No part of this book may be reproduced in
any form 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 offi cial duties as U.S. government employees are not covered by the above-mentioned copyright.
Printed in China
Library of Congress Cataloging-in-Publication Data
Manual of emergency medicine / editor, G. Richard Braen. — 6th ed.
p. ; cm.
Includes index.
ISBN 978-1-60831-249-8
1. Emergency medicine—Handbooks, manuals, etc. I. Braen, G. Richard.
[DNLM: 1. Emergency Medicine—Handbooks. 2. Emergencies —Handbooks. WB 39]
RC86.8.J46 2010
616.02'5—dc22
2010045968
Care has been taken to confi rm the accuracy of the information presented and to describe gener-
ally accepted practices. However, the authors, editors, 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 the information in a particular situation remains the
professional responsibility of the practitioner.
The authors, editors, 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 fl ow 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 the publication have Food and Drug Admin-
istration (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.
To purchase additional copies of this book, call our customer service department at [phone]
or fax orders to [phone]. International customers should call [phone].
Visit Lippincott Williams & Wilkins on the Internet: at LWW.com. Lippincott Williams &
Wilkins customer service representatives are available from 8:30 am to 6 pm, EST.
10 9 8 7 6 5 4 3 2 1
BBrraaeenn__FFMM..iinndddd iiii 22//2266//22001111 77::5588::4422 AAMM
To our spouses from whom we get our love and support:
Kate, Brian, Heather, Marsilia, and Maria.
BBrraaeenn__FFMM..iinndddd iiiiii 22//2266//22001111 77::5588::4422 AAMM
Contents
Contributors xi
Preface xiii
Editor’s Note xiv
Acknowledgment xiv
Part I Cardiopulmonary Resuscitation 1
Cardiopulmonary Resuscitation 1
1
Rapid Sequence Intubation 18
2
Part II Trauma 27
Initial Assessment of the Multiple
3
Trauma Patient 27
Head, Neck, and Facial Trauma 40
4
Eye and Periorbital Trauma 58
5
Chest Trauma 64
6
Abdominal Trauma 78
7
Pelvic Trauma 82
8

Genitourinary Trauma 84
9
Extremity Trauma 87
10
Trauma in Pregnancy 124
11
iv
BBrraaeenn__FFMM..iinndddd iivv 22//2266//22001111 77::5588::4422 AAMM
CONTENTS v
Part III Eye, Ear, Nose, and Throat Disorders 129
Ear Pain 129
12
Epistaxis 139
13
Facial Pain—Atraumatic 142
14
Hoarseness 146
15
Sore Throat 149
16
Red Eye 156
17
Visual Disturbances 164
18
Part IV Respiratory Disorders 173
Cough 173
19
Hemoptysis 182
20
Shortness of Breath 187
21
Mechanical Ventilation 205
22
BBrraaeenn__FFMM..iinndddd vv 22//2266//22001111 77::5588::4422 AAMM
vi CONTENTS
Part V Cardiovascular Disorders 211
Chest Pain 211
23
Hypertension 230
24
Palpitations 234
25
Part VI Gastrointestinal Disorders 243
Abdominal Pain 243
26
Constipation and Diarrhea 260
27
Gastrointestinal Bleeding 270
28
Hiccups (Singultus) 275
29
Jaundice 276
30
Nausea and Vomiting 282
31
Part VII Genitourinary and Pregnancy-Related Disorders 287
Hematuria 287
32
Sexually Acquired Disorders 291
33
BBrraaeenn__FFMM..iinndddd vvii 22//2266//22001111 77::5588::4422 AAMM
CONTENTS vii
HIV Disease and AIDS 301
34
Sexual Assault 317
35
Testicular, Scrotal, and Inguinal Pain or
36
Swelling 322
Vaginal Bleeding 327
37
Childbirth and Emergency Delivery 334
38
Part VIII Neurologic Disorders 339
Coma, Seizures, and Other Disorders of
39
Consciousness 339
Stroke and Syncope 354
40
Dizziness 367
41
Headache 372
42
Weakness 382
43
BBrraaeenn__FFMM..iinndddd vviiii 22//2266//22001111 77::5588::4433 AAMM
viii CONTENTS
Part IX Musculoskeletal and Soft-Tissue Disorders 395
Abscesses 395
44
Back Pain 398
45
Extremity Pain and Swelling—
46
Atraumatic 409
Joint Pain—Atraumatic 436
47
Abrasions, Avulsions, Lacerations, and
48
Puncture Wounds 447
Part X Environmental Emergencies 467
Diving Accidents 467
49
Near Drowning 471
50
Electrical and Lightning Injuries 474
51
High-Altitude Illness 480
52
Radiation Injury 486
53
Smoke Inhalation 499
54
BBrraaeenn__FFMM..iinndddd vviiiiii 22//2266//22001111 77::5588::4433 AAMM
CONTENTS ix
Burns 503
55
Heat Illness and Cold Exposure 511
56
Bites and Stings 521
57
Part XI Selected Pediatric Emergencies 537
Child Abuse 537
58
Fever 541
59
Pediatric Sedation 544
60
Part XII Other Emergencies 551
Foreign Bodies 551
61
Oncologic Emergencies 559
62
Pain Management 566
63
Poisoning and Ingestions 569
64
Rashes 624
65
BBrraaeenn__FFMM..iinndddd iixx 22//2266//22001111 77::5588::4433 AAMM
x CONTENTS
Part XIII Psychiatric Emergencies 643
Evaluation of Psychiatric Patients in the
66
Emergency Department 643
Managing Agitation and Aggression in the
67
Emergency Department 655
Evaluating the Suicidal Patient in the
68
Emergency Department 658
Evaluation and Management of Drug
69
and Alcohol Problems in the Emergency
Department 665
Index 679
BBrraaeenn__FFMM..iinndddd xx 22//2266//22001111 77::5588::4433 AAMM