usmle roadmap emergency medicine

557 Pages·2009·13.33 MB·English

LANGE
N
USMLE
ROAD MAP
Emergency
Medicine
SCOTT C. SHERMAN, MD JOSEPH M. WEBER, MD
Assistant Residency Director EMS Director
M4 Clerkship Director Department of Emergency Medicine
Department of Emergency Medicine Cook County Hospital (Stroger)
Cook County Hospital (Stroger) Assistant Professor of Emergency Medicine
Assistant Professor of Emergency Medicine Rush Medical College
Rush Medical College Chicago, IL
Chicago, IL
Lange Medical Books/McGraw-Hill
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ISBN: 978-0-07-159338-0
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C O N T E N T S
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Acknowledgements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Contributing Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
I. Common Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1. Incision and Drainage 3
2. Arterial Blood Gas 7
3. Central Venous Access 10
4. Procedural Sedation 16
5. Lumbar Puncture 19
6. Laceration Repair 22
7. Needle and Tube Thoracostomy 28
8. Ultrasonography 32
II. Resuscitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
9. Cardiopulmonary Arrest 39
10. Airway Management 44
11. Shock 52
III. Cardiovascular Emergencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
12. Chest Pain 61
13. Acute Coronary Syndrome 66
14. Congestive Heart Failure 74
15. Arrhythmia 80
16. Aortic Dissection 89
17. Hypertensive Emergencies 94
18. Syncope 100
IV. Pulmonary Emergencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
19. Dyspnea 107
20. Asthma 113
21. Pneumonia 119
22. Pneumothorax 125
23. Pulmonary Embolism 130
V. Abdominal Emergencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
24. Acute Abdominal Pain 137
25. Appendicitis 144
26. Acute Cholecystitis 149
27. Abdominal Aortic Aneurysm 154
28. Gastrointestinal Bleeding 159
29. Intestinal Obstruction 165
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iv Contents
VI. Infectious Disease Emergencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
30. Fever 173
31. Sepsis 177
32. Meningitis and Encephalitis 182
33. Soft Tissue Infections 187
34. HIV Emergencies 192
VII. Genitourinary Emergencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
35. Nephrolithiasis 203
36. Testicular Torsion 208
37. Penile Disorders 213
VIII. Obstetric and Gynecologic Emergencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
38. Vaginal Bleeding 221
39. Preeclampsia and Eclampsia 227
40. Emergency Delivery 232
IX. Pediatric Emergencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
41. The Pediatric Patient 241
42. Pediatric Fever 246
43. Respiratory Distress 252
44. Abdominal Pain 260
45. Dehydration 267
46. Otitis Media 272
X. Toxicology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
47. The Poisoned Patient 279
48. Toxic Alcohols 286
49. Acetaminophen Toxicity 291
50. Salicylate Toxicity 297
51. Carbon Monoxide Poisoning 302
XI. Environmental Emergencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
52. Hypothermia 309
53. Heat-related Illness 314
XII. Metabolic and Endocrine Emergencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
54. Diabetic Emergencies 321
55. Potassium Disorders 326
56. Thyroid Emergencies 331
57. Adrenal Emergencies 336
XIII. Hematologic and Oncologic Emergencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
58. Oncologic Emergencies 343
59. Sickle Cell Emergencies 348
60. Anticoagulant Therapy and its Complications 353
XIV. HEENT Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
61. Slit Lamp Examination 361
62. Red Eye 364
63. Acute Visual Loss 371
Contents v
64. Epistaxis 379
65. Dental Emergencies 385
XV. Neurologic Emergencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393
66. Altered Mental Status 395
67. Headache 400
68. Dizziness 406
69. Cerebrovascular Accident 414
70. Seizures and Status Epilepticus 422
XVI. Trauma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429
71. Trauma Principles 431
72. Head Injuries 438
73. Cervical Spine Injuries 445
74. Thoracic Trauma 452
75. Abdominal Trauma 460
76. Burns 467
XVII. Orthopedic Emergencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473
77. Upper Extremity Injuries 475
78. Lower Extremity Injuries 484
79. Low Back Pain 493
80. Compartment Syndrome 499
81. Septic Arthritis 503
82. Splinting 508
XVIII. Dermatologic Emergencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 513
83. Life-threatening Dermatoses 515
84. Allergic Reactions 520
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 525
To Michelle and Mason.
Scott C Sherman, MD
To my wife, Bridget, for her love and encouragement throughout this endeavor and to my parents, Lois
and Bill, whose example I strive to emulate.
Joseph M Weber, MD
U S I N G T H E
U S M L E R OA D M A P S E R I E S
F O R S U C C E S S F U L R E V I E W
What is the Road Map Series?
Short of having your own personal tutor, the USMLE Road MapSeries is the best source for efficient review of
major concepts and information in the medical sciences.
Why Do You Need A Road Map?
It allows you to navigate quickly and easily through your course notes and prepares you for USMLE and course
examinations.
How Does the Road Map Series Work?
Outline Form:Connects the facts in a conceptual framework so that you understand the ideas and retain the in-
formation.
Color and Boldface: Highlights words and phrases that trigger quick retrieval of concepts and facts.
Clear Explanations: Are fine-tuned by years of student interaction. The material is written by authors selected
for their excellence in teaching and their experience in preparing students for board examinations.
Illustrations: Provide the vivid impressions that facilitate comprehension and recall.
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P R E F A C E
We wrote this book because we remember our own experiences rotating through the Emergency Department in
medical school. The ED is a unique environment requiring knowledge and skills often not covered in the core
third-year clerkships. In this book, we attempt to create a resource for the fourth-year medical student to be used
both during their Emergency Medicine clerkship and while preparing for the USMLE Step 2. The book’s length
and outline format are designed to allow the student to easily digest the broad range of topics inherent to Emer-
gency Medicine. Features including Procedural Pearls, Key Complaints,Clinical Skills Tips,andRule Outdiagnoses
help highlight important information for the reader. Diagnostic Algorithms are included in each chapter for both
quick reference and to give the student a succinct overview of ED management for easier recall. Case Presentations
andSummary Pointsare used to exemplify the process of medical decision-making and reinforce essential informa-
tion. We hope this book will enhance the emergency medicine experience of all its users.
Scott C Sherman, MD
Joseph M Weber, MD
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