Pocket Emergency Medicine

698 Pages·2014·20.38 MB·English

by  Richard D. Zane

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Pocket Emergency
MEDICINE
Third Edition
JOHN D. ANDERSON, MD
NIR HARISH, MD, MBA
Denver Health Residency in Emergency Medicine
NICHOLAS G. MALDONADO, MD
ALEXANDER Y. SHENG, MD
The Harvard Affiliated Emergency Medicine Residency Program
Edited by
RICHARD D. ZANE, MD, FAAEM
Professor and Chair
Department of Emergency Medicine
University of Colorado School of Medicine
Aurora, Colorado
JOSHUA M. KOSOWSKY, MD
Assistant Professor, Harvard Medical School
Vice Chair for Clinical Affairs, Department of Emergency Medicine
Brigham and Women’s Hospital
Boston, Massachusetts
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Care has been taken to con(cid:633)rm the accuracy of the information presented and to
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CONTRIBUTORS
John D. Anderson, MD
Denver Health Residency in Emergency Medicine
Denver Health Medical Center
Department of Emergency Medicine
University of Colorado School of Medicine
Denver, Colorado
Nir Harish, MD, MBA
Denver Health Residency in Emergency Medicine
Denver Health Medical Center
Department of Emergency Medicine
University of Colorado School of Medicine
Denver, Colorado
Nicholas G. Maldonado, MD
The Harvard Affiliated Emergency Medicine Residency Program
Department of Emergency Medicine
Brigham and Women’s Hospital
Massachusetts General Hospital
Boston, Massachusetts
Alexander Y. Sheng, MD
The Harvard Affiliated Emergency Medicine Residency
Department of Emergency Medicine
Brigham and Women’s Hospital
Boston, Massachusetts
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ACKNOWLEDGMENTS
To our patients who trust that we are always there and know what to do, when to do it, and
allow us the privilege of caring for them during the most vulnerable moments of their lives.
For Siobhan, Jake, Gaby, and Finn whose support made everything possible.
RICHARD D. ZANE, MD
To all those from whom I continue to gain wisdom—my teachers, my colleagues, my
students, and perhaps foremost, my patients. And to Devorah, Harry, Jake, and Judah,
whose support means the world to me.
JOSHUA M. KOSOWSKY, MD
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PREFACE
Sir William Olser wrote, “He who studies medicine without books sails an uncharted sea, but
he who studies medicine without patients does not go to sea at all.” Emergency medicine is
a thrilling specialty, demanding exceptional abilities and an increasingly expansive fund of
knowledge—patterns of illness and injury, a whole range of diagnostics and therapeutics, all
at one’s (cid:633)ngertips in real time at the bedside with lives on the line. In this context, we have
designed Pocket Emergency Medicine as a life raft for the busy physician, resident, physician
assistant, nurse practitioner, or student.
Unlike many traditional textbooks, we have chosen to organize chapters around
presenting conditions rather than diagnoses. In this way, the book mirrors the way patients
present to the emergency department and allows the reader to develop the thought
processes that guide appropriate diagnostic and therapeutic interventions. Each chapter
begins with a general approach to a particular condition, followed by a succinct discussion
of important diagnostic categories, highlighting essential elements of the history, physical
examination, testing, and treatment speci(cid:633)c to these diagnoses. Sprinkled throughout the
text are “clinical pearls”—focused bullet points, emphasizing important clinical (cid:633)ndings or
warning about common clinical errors.
This book was written by a group of talented emergency medicine residents from the
Denver Health and Harvard A(cid:637)liated Emergency Medicine Residency programs. The
residents undertook studious research on their individual topics, guided by an acute
awareness of the needs of busy emergency department providers. Chapters were edited by
an experienced team of senior emergency medicine faculty from the Departments of
Emergency Medicine at The University of Colorado School of Medicine, Brigham and
Women’s Hospital and Harvard Medical School. The editors bring over 25 years of
experience in clinical and academic emergency medicine, ensuring the accuracy and
integrity of the text. The result, we think you’ll agree, is a supremely useful immediate
reference for the emergency medicine practitioner.
RICHARD D. ZANE, MD
JOSHUA M. KOSOWSKY, MD
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CONTENTS
SECTION I: CARDIOVASCULAR
Electrocardiography
Chest Pain
Acute Coronary Syndrome (Overview)
STEMI
UA/NSTEMI
Prinzmetal’s (Variant) Angina
Cocaine-induced Angina
Stress Testing
Cardiac Catheterization
Post-PCI Complications
Post-MI Complications
Pulmonary Embolism and DVT
CHF/Acute Pulmonary Edema
Aortic Dissection
Thoracic Aortic Aneurysm
Pericarditis and Pericardial Effusion
Cardiac Tamponade
Myocarditis
Syncope
Hypertension and Hypertensive Emergencies
Hypotension and Shock
Hypovolemic Shock
Cardiogenic Shock
Septic Shock
Neurogenic Shock
Dysrhythmia
Bradycardia
AV Node Block
Tachycardia/Palpitations
Pacemaker and AICD Malfunction
SECTION II: PULMONARY
Cough
Dyspnea (Shortness of Breath)
Hemoptysis
SECTION III: GASTROINTESTINAL
Abdominal Pain
Nausea and Vomiting
Gastrointestinal Bleed
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