Rosen’s Emergency Medicine Concepts and Clinical Practice

Cover
Rosen’s Emergency Medicine Concepts and Clinical Practice
Copyright
Acknowledgments
Contributors
Preface to the Tenth Edition
Preface to the Ninth Edition
How This Medical Textbook Should Be Viewed by the Practicing Clinician and Judicial System
Part I: Fundamental Clinical Concepts
Section One: Resuscitation and Analgesia
Chapter 1: Airway
Principles
Background
Anatomy, Physiology, and Pathophysiology
Failure to Maintain or Protect the Airway
Failure of Ventilation or Oxygenation
Anticipated Clinical Course
Identification of the Difficult Airway
Difficult Direct Laryngoscopy: LEMON
L—look externally
E—evaluate 3-3-2
M—Mallampati scale
O—obstruction or obesity
N—neck mobility
Difficult Bag-Mask Ventilation: ROMAN
Difficult Extraglottic Device Placement: RODS
Difficult Cricothyrotomy: SMART
Measurement and Incidence of Intubation Difficulty
Confirmation of Endotracheal Tube Placement
Management
Decision Making
Difficult Airway
Failed Airway
Methods of Intubation
Rapid Sequence Intubation
Preparation
Preoxygenation
Preintubation optimization
Paralysis with induction
Positioning
Placement of tube
Postintubation management
Delayed Sequence Intubation
Awake Oral Intubation
Oral Intubation Without Pharmacologic Agents
Pharmacologic Agents
Neuromuscular Blocking Agents
Succinylcholine
Uses and dosing
Cardiovascular effects
Fasciculations
Hyperkalemia
Masseter spasm
Malignant hyperthermia
Competitive agents
Rocuronium
Paralysis after intubation
Induction Agents
Etomidate
Ketamine
Propofol
Other induction agents
Special Clinical Circumstances
Status Asthmaticus
Hemodynamic Consequences of Intubation
Elevated Intracranial Pressure
Hypotension and Shock
Potential Cervical Spine Injury
Airway Devices and Techniques
Direct Laryngoscopy Versus Videolaryngoscopy
Videolaryngoscopes
Flexible Intubating Scopes
Extraglottic Devices
Laryngeal mask airways
Other extraglottic devices
Surgical Airway Management
Needle Cricothyrotomy with Transtracheal Jet Ventilation
Cricothyrotomy
Outcomes
References
Chapter 2: Mechanical Ventilation and Noninvasive Ventilatory Support
Foundations
Physiology of Positive-Pressure Breathing
Invasive Mechanical Ventilation: Control Variable and Ventilator Mode
Positive End-Expiratory Pressure
Noninvasive Techniques
Management
Decision Making: Noninvasive Versus Invasive Ventilation
Approach to Initial Ventilator Settings
Noninvasive Ventilation
High-Flow Nasal Cannula
Mechanical Ventilation of the Intubated Patient
Ongoing Management
Pharmacology: Analgesia and Sedation of the Ventilated Patient
Ventilator-Associated Pneumonia Prevention
Troubleshooting the Ventilator
Special Clinical Circumstances
Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Status Asthmaticus
Acute Respiratory Distress Syndrome
Outcomes
Complications
References
Chapter 3: Shock
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Specific Causes
Hemorrhagic Shock
Septic Shock
Cardiogenic Shock
Neurogenic Shock
Management
Decision Making
Quantitative Resuscitation
Pharmacology
Volume Replacement
Crystalloids
Colloids and hypertonic saline
Blood products
Vasopressors
Inotropes
Antimicrobial Therapy
Corticosteroids
Special Cases
Devices and Procedures
Ventilation
Source Control
Mechanical Circulatory Support and Percutaneous Coronary Intervention
Pericardiocentesis and Thrombectomy
Outcomes
References
Chapter 4: Brain Resuscitation
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Elevated Intracranial Pressure
Management
Decision Making
Pharmacology
Intracranial Pressure Management
Seizure Management
Devices and Techniques
Cardiopulmonary Resuscitation
Reperfusion
Optimizing perfusion and oxygenation
Elevated Intracranial Pressure
Medical treatment
Surgical treatment
Maintenance of Body Temperature
Targeted Temperature Management
Outcomes
References
Chapter 5: Adult Resuscitation
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Management
Decision Making
Prehospital
History and Physical Examination
Resuscitation
Ventricular Fibrillation and Pulseless Ventricular Tachycardia
Pulseless Electrical Activity
Asystole
Pharmacology
Devices and Techniques
Monitoring
End-Tidal Carbon Dioxide
Central Venous Oxygen Saturation
Echocardiography
Extracorporeal Cardiopulmonary Resuscitation
Laboratory Testing
Arterial Blood Pressure and Coronary Perfusion Pressure
Outcomes
Post–Cardiac Arrest Care
Hypothermic Targeted Temperature Management
Coronary Angiography and Primary Percutaneous Coronary Intervention
Antidysrhythmic Therapy
Oxygen Debt and Hemodynamic Management
References
Chapter 6: Pain Management
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Pain Conduction Pathways
Pain Detection
Information Transmission
Peripheral nerve fibers
Pain Transmission
Dorsal horn
Visceral pain
Ascending tracts associated with pain
Pain Modulation
Central Sensitization
Pain Expression
Reflex Responses to Pain
Endorphin System
Acute Versus Chronic Pain
Management
Decision Making
Pain Assessment
Oligoanalgesia
Pain Measurement
Treatment Groups
Acute pain
Chronic pain
Recurrent pain
Chronic pain of malignancy
Neuropathic pain
Pharmacologic Therapy
Opioids
Mechanism of action and toxic effects
Drug-seeking behavior
Administration of pain control
Specific agents
Morphine
Meperidine
Hydromorphone
Fentanyl
Sufentanil
Buprenorphine
Oxycodone
Hydrocodone
Codeine
Methadone
Naloxone
Tramadol
Tapentadol
Opioid use for acute abdominal pain
Nonopioid Analgesic Agents
Acetaminophen
Nonsteroidal Antiinflammatory Drugs
Drug interactions with nonsteroidal antiinflammatory drugs
Aspirin
Oral anticoagulants
Angiotensin-converting enzyme inhibitors
Diuretics
Glucocorticoids
Lithium
Nonselective cyclooxygenase inhibitor selection
Ketorolac tromethamine
Ibuprofen
Skeletal muscle relaxants
Nitrous oxide–oxygen mixtures
Ketamine
Local/Regional Anesthesia
Mechanism of action
Classes of local anesthetic agents
Allergic reactions
Local and systemic toxicity
Local toxicity
Systemic toxicity
Reducing the pain of local anesthetic injection
Topical Anesthesia
Topical anesthetics applied to intact skin
Eutectic mixture of local anesthetics
Ethyl chloride and fluoromethane sprays
Agents applied to mucosal surfaces
Cocaine
Lidocaine
Tetracaine
Benzocaine
Agents applied to open skin: lidocaine, epinephrine, and tetracaine
Nonpharmacologic Interventions
Transcutaneous Electrical Nerve Stimulation
Out-of-Hospital Analgesia
Outcomes: Treatment Endpoints
References
Chapter 7: Procedural Sedation and Analgesia
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Management
Decision Making
Patient Assessment
Preprocedural Fasting
Personnel
Devices and Techniques
Supplies and Equipment
Recovery
Post-procedure Recovery and Discharge
Pharmacology
Routes of Administration
Opioids
Fentanyl
Morphine
Benzodiazepines
Midazolam
Ketamine
Sedative-Hypnotics
Etomidate
Propofol
Ketamine plus propofol
Ultra–fast-acting agents
Reversal and Rescue Agents
Naloxone
Flumazenil
Drug Selection and Administration
References
Section Two: Signs, Symptoms, and Presentations
Chapter 8: Fever in the Adult Patient
Foundations
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms
Signs
Ancillary Testing
Diagnostic Algorithm
Empirical Management
Disposition
References
Chapter 9: Weakness
Foundations
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Considerations
Diagnostic Algorithm
Critical and Emergent Diagnoses
Specific Presentations of Neuromuscular Disorders
Unilateral Weakness
Combination of arm, hand, or leg with ipsilateral facial involvement
Combination of arm, hand, or leg with contralateral facial involvement
Combination of arm, hand, or leg without facial involvement
Isolated extremity weakness (monoparesis or monoplegia)
Bilateral Weakness
Lower extremities only (paraparesis or paraplegia)
Upper extremities only
All four extremities without facial involvement (quadriparesis or quadriplegia)
Proximal portions of extremities only
Distal portions of extremities only
Facial Weakness Without Extremity Involvement
Unilateral facial droop
Facial weakness not limited to cranial nerve VII
Empiric Management
Disposition
References
Chapter 10: Cyanosis
Foundations
Epidemiology
Pathophysiology
Diagnostic Approach
Pivotal Findings
Presentation and Symptoms
Signs
Ancillary Testing
Imaging
Electrocardiography and Echocardiography
Diagnostic Algorithm
Critical Diagnoses
Emergent Diagnoses
Empiric Management
Methemoglobinemia and Sulfhemoglobinemia
Other Causes of Cyanosis
Patient Disposition
Admission
Discharge
References
Chapter 11: Syncope
Foundations
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms
Signs
Ancillary Testing
Electrocardiogram
Laboratory Testing
Urine Testing
Imaging
Chest Imaging
Neuroimaging
Echocardiography
Diagnostic and Management Algorithm
Risk-Stratification
Empiric Management
References
Chapter 12: Depressed Consciousness and Coma
Foundations
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms
Signs
Ancillary Testing
Diagnostic Algorithm
Empirical Management
References
Chapter 13: Confusion
Foundations
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms
Signs
Ancillary Testing
Diagnostic Algorithm
Empirical Management
References
Chapter 14: Seizures
Foundations
Epidemiology
Pathophysiology
Diagnostic Approach
Pivotal Findings
History Taking and Physical Exam
Ancillary Testing
Laboratory Testing
Imaging Studies
Electroencephalography
Cardiac Monitoring
Differential diagnoses
Diagnostic Algorithm
Empiric Management
Disposition
References
Chapter 15: Dizziness and Vertigo
Foundations
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms
Physical Examination
Vital signs
Head and neck
Neurologic examination
Positional testing
Head Impulse Test, Nystagmus, Test of Skew
Ancillary Testing
Radiologic imaging
Diagnostic Algorithm
Empirical Management
Disposition
References
Chapter 16: Headache
Foundations
Background and Importance
Pathophysiology
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms
Signs
Ancillary Testing
Diagnostic Algorithm
Empirical Management
References
Chapter 17: Diplopia
Foundations
Pathophysiology
Diagnostic Approach
Differential Considerations
Pivotal Findings
History
Physical Exam
The external eye exam
Pupil exam
Extraocular muscle exam
Funduscopic exam (posterior chamber exam)
Slit lamp exam (anterior chamber exam)
Signs and Symptoms
Monocular diplopia
Binocular diplopia
Structural orbitopathy or myositis
Isolated oculomotor nerve palsy
Neuroaxial process involving the brainstem and related cranial nerves
Neuromuscular disorder
Ancillary Testing
Diagnostic Algorithm
Empirical Management
Management Algorithm
References
Chapter 18: Red and Painful Eye
Foundations
Epidemiology and Pathophysiology
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms
Signs
Visual Acuity
Visual Field Testing
External Examination
Extraocular Muscle Function
Pupillary Evaluation
Pressure Determination
Ancillary Testing
Swinging Flashlight Test
Slit-Lamp Examination
Direct Funduscopic Examination
Topical Anesthetics
Imaging
Laboratory Testing
Diagnostic Algorithm
Critical Diagnoses
Emergent Diagnoses
Urgent Diagnoses
Empiric Management
References
Chapter 19: Sore Throat
Foundations
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms and Signs
Ancillary Testing
Imaging
Diagnostic Algorithm
Critical and Emergent Diagnoses
Empiric Management
References
Chapter 20: Hemoptysis
Foundations
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms
Signs
Ancillary Testing
Diagnostic Algorithm
Critical Diagnoses
Bronchoscopy
Empirical Management
References
Chapter 21: Dyspnea
Foundations
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Diagnosis Considerations
Pivotal Findings
Symptoms
Quality of symptoms
Duration and onset of dyspnea
Positional changes
Associated symptoms
Signs
Ancillary Testing
Diagnostic Algorithm
Critical Diagnoses
Emergent Diagnoses
Empirical Management
References
Chapter 22: Chest Pain
Foundations
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Considerations
Pivotal Findings
History
Physical Examination
Ultrasound
Ancillary Studies
Diagnostic Algorithm
Empirical Management
References
Chapter 23: Abdominal Pain
Foundations
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms
Signs
Ancillary Testing
Laboratory Tests
Imaging Studies
Diagnostic Algorithm
Critical Diagnoses
Emergent Diagnoses
Empiric Management
References
Chapter 24: Jaundice
Epidemiology
Pathophysiology
Normal Bilirubin Metabolism
Abnormalities in Bilirubin Metabolism
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms
Signs
Laboratory Tests
Imaging
Diagnostic Algorithm
Empirical Management
References
Chapter 25: Nausea and Vomiting
Foundations
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Diagnosis Considerations
Pivotal Findings
Symptoms
Signs
Ancillary Studies
Diagnostic Algorithm
Empirical Management
Adults
Pediatrics
Special Situations
Opioid-Induced Vomiting
Headache
Pregnancy
Chemotherapy
Cyclical Vomiting Syndrome and Cannabinoid Hyperemesis Syndrome
Vertigo
Gastroparesis
Disposition
References
Chapter 26: Gastrointestinal Bleeding
Foundations
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms
Signs
Ancillary Testing
Laboratory Testing
Electrocardiogram
Nasogastric Aspirate Testing
Imaging
Diagnostic Algorithm
Management
Empiric Treatment
Resuscitation
Blood Product Transfusion
Pharmacologic Therapy
Balloon Tamponade
Definitive Treatment
References
Chapter 27: Diarrhea
Foundations
Introduction
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Considerations
Pivotal Findings
Signs and Symptoms
Ancillary Testing
Blood tests
Stool studies
Testing for specific pathogens
Testing for bacterial infection
Clostridioides difficile assay
Escherichia coli O157:H7 toxin assay (Shiga toxin)
Stool examination for ova and parasites
Giardia antigen assay and serologic testing for amebiasis
Radiographic studies
Gastrointestinal Referral
Diagnostic Algorithm
Critical Diagnoses
Emergent Diagnoses
Empiric Management
Rehydration
Antibiotics
Antimotility Agents
Probiotics
Disposition
References
Chapter 28: Constipation
Foundations
Pathophysiology
Diagnostic Approach
Differential Considerations
Pivotal Findings
Ancillary Testing
Critical Diagnoses
Emergent Diagnoses
Empirical Management
References
Chapter 29: Acute Pelvic Pain
Foundations
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms
Signs
Ancillary Testing
Laboratory Tests
Imaging
Diagnostic Algorithm
Empirical Management
References
Chapter 30: Vaginal Bleeding
Foundations
Background and Importance
Pathophysiology
Nonpregnant Patients
Pregnant Patients
Diagnostic Approach
Differential Considerations
Nonpregnant Patients
Pregnant Patients
Pivotal Findings
Symptoms
Signs
Ancillary Testing
Diagnostic Algorithm
Empiric Management
Disposition
References
Chapter 31: Back Pain
Foundations
Background and Importance
Pathophysiology
Diagnostic Approach
Differential Considerations
Myelopathy
Radiculopathy
Spondylosis
Disc Herniation
Spinal Infections
Spinal Tumors
Cauda Equina Syndrome
Acute Transverse Myelitis
Mechanical Back Pain
Chronic Back Pain
Pivotal Findings
Symptoms
Signs
Ancillary Testing
Laboratory Tests
Imaging Studies
Abdominal Ultrasound
Plain Film Radiographs
Computed Tomography Scan
Magnetic Resonance Imaging
Diagnostic and Management Algorithms
Critical Diagnoses
Emergent Diagnoses
Empiric Management
Mild to Moderate Back Pain
Severe Back Pain
Chronic Back Pain
Disposition
Acknowledgments
References
Part II: Trauma
Section One: General Concepts and System Injuries
Chapter 32: Multiple Trauma
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Clinical Features
Primary Survey
Secondary Survey
Differential Diagnoses
Diagnostic Testing
Laboratory Evaluation
Radiographic Evaluation
Management
Out-of-Hospital Management
Emergency Department Management
Disposition
References
Chapter 33: Head Trauma
Foundations
Background and Importance
Anatomy and Pathophysiology
Anatomy
Scalp and cranium
Brain and cerebrospinal fluid
Pathophysiology
Cerebral hemodynamics and increased intracranial pressure
Increased intracranial pressure
Cushing reflex
Altered Levels of Consciousness
Definitions and Patterns of Injury
Traumatic Brain Injuries: Severe, Moderate, and Mild
Direct and Indirect Injuries
Direct injury
Indirect injury
Neurochemical Cascade
Penetrating Head Trauma
Scalp Wounds
Skull Fractures
Linear Fractures
Depressed Fractures
Basilar Fractures
Extra-Axial and Intra-Axial Intracranial Injuries
Extra-Axial Injury
Epidural hematoma
Subdural hematoma
Traumatic subarachnoid hemorrhage
Subdural hygroma
Intra-Axial Injury
Diffuse axonal injury and traumatic axonal injury
Cerebral contusions
Intracerebral hematoma
Intracerebellar hematoma
Primary and Secondary Brain Injuries
Secondary Systemic Insults
Hypotension
Hypoxia
Hypocarbia and hypercarbia
Anemia
Hyperpyrexia
Cerebral Herniation Syndromes
Uncal Herniation
Central Transtentorial Herniation
Cerebellotonsillar Herniation
Upward Transtentorial Herniation
Moderate and Severe Traumatic Brain Injury
Clinical Features
Physical Examination
Acute Neurologic Examination
General
Glasgow Coma Scale
Pupillary examination
Motor examination
Brainstem function
Common Presentations of Specific Lesions
Epidural Hematoma
Subdural Hematoma
Traumatic Subarachnoid Hemorrhage
Subdural Hygroma
Traumatic Axonal Injury
Cerebral Contusion
Intracerebral Hematoma
Traumatic Intracerebellar Hematoma
Differential Diagnoses
Diagnostic Testing
Laboratory Tests
Neuroimaging
Skull radiography
Computed tomography
Pneumocephalus
Epidural hematoma
Subdural hematoma
Traumatic subarachnoid hemorrhage
Subdural hygroma
Traumatic axonal injury
Cerebral contusions
Intracerebral hematoma
Traumatic intracerebellar hematoma
Cerebral edema
Management
Out-of-Hospital Care
Airway
Hypotension
Agitation
Emergency Department Management
General
Airway
Hypotension
Brain-directed hyperosmolar therapy
Hyperventilation
Cranial decompression
Reversal of anticoagulation
Hemostatic agents
Induced hypothermia
Seizure prophylaxis
Antibiotic prophylaxis
Other therapies
Corticosteroids
Barbiturates
Monitoring of intracranial pressure and cerebral spinal fluid drainage
Erythropoietin
Progesterone
Hyperbaric oxygen therapy
Management of Specific Injuries
Scalp wounds
Skull fractures
Linear fractures
Depressed fractures
Basilar skull fractures
Extra-axial lesions
Epidural hematoma
Subdural hematoma
Traumatic subarachnoid hemorrhage
Subdural hygroma
Intra-axial lesions
Cerebral contusion
Intracerebral hematoma
Intracerebellar hematoma
Complications and Outcome
Central Nervous System Infections
Meningitis after basilar fractures
Brain abscess
Cranial osteomyelitis
Medical Complications
Disseminated intravascular coagulation
Respiratory complications
Cardiac dysfunction
Disposition
Mild Traumatic Brain Injury (Also Known as Concussion)
Clinical Features
Physical Examination
Head and Neck
Mental Status and Alertness
Cranial Nerves
Cognitive Function (Attention, Memory, Concentration)
Vestibular Function (Balance, Gait, and Eye Movements)
Differential Diagnoses
Diagnostic Testing
Neuroimaging in the Emergency Department with Computed Tomography
Other Neuroimaging Modalities
Structural magnetic resonance imaging
Susceptibility-weighted imaging
Diffusion tensor imaging
Computed tomography angiography and magnetic resonance angiography
Ancillary Studies
Laboratory testing
Neuropsychological testing
Disposition
Complications
Postconcussive Syndrome
Seizures
Posttraumatic Transient Cortical Blindness
Special Populations with Mild Traumatic Brain Injury
Mild Traumatic Brain Injury and Sports-­Related Concussion
Military Personnel and Blast Injury
Anticoagulated Patients
Patients on anticoagulant medications
Patients with inherent bleeding disorders
Head Trauma in Older Adults
References
Chapter 34: Facial Trauma
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Bones
Nerve Supply
Ears
Eyes
Nose
Mouth
Temporomandibular Joint
Soft Tissue, Vasculature, and Specialized Glands
Pathophysiology
Clinical Features
History
Physical Examination
Eyes and orbits
Oropharynx
Ears
Nose
Neurologic Examination
Differential Diagnoses Based on Anatomic Sites
Soft Tissue Injuries and Lacerations
Mouth
Cheeks
Nose
Ears
Eyes
Fractures and Dislocations
Forehead
Orbit
Midface
Zygoma
Mandible
Dental and Alveolar Trauma
Temporomandibular Joint
Diagnostic Testing
Imaging
Management
Out-of-Hospital Care
Emergency Department Treatment
Disposition
References
Chapter 35: Spinal Trauma
Foundations
Background and Importance
Anatomy and Physiology
Pathophysiology
Classification of Spinal Column Injuries
Flexion
Shear injury
Flexion-rotation
Extension
Vertical compression
Classification of Spinal Cord Injuries
Primary spinal cord injury
Secondary spinal cord injury
Classification of Cervical Soft Tissue Injuries
Clinical Features
Neurologic Evaluation
Spinal Cord Lesions
Complete Spinal Cord Lesions
Incomplete Spinal Cord Lesions
Differential Diagnoses
Diagnostic Testing
Radiographic Evaluation
Indications
Cervical Plain Radiographs
Thoracolumbar Plain Radiographs
Interpretation of spinal plain radiographs
Advanced Imaging: Computed Tomography and Magnetic Resonance
Management
Spinal Column Stabilization
Out-of-Hospital Care
Emergency Department
Airway Management
Spinal Shock
Pharmacologic Treatment for Incomplete Cord Injury
Associated Injuries
Cardiopulmonary
Gastrointestinal and Genitourinary
Skin
Definitive Treatment and Prognosis
Disposition
Cervical Soft Tissue Injuries
Minor Fractures
References
Chapter 36: Neck Trauma
Foundations
Background and Importance
Anatomy and Physiology
Pathophysiology
Vascular Injuries
Pharyngoesophageal Injuries
Laryngotracheal Injuries
Hanging
Clinical Features
Vascular Injuries
Pharyngoesophageal Injuries
Penetrating injury
Blunt Injury
Laryngotracheal Injuries
Penetrating injury
Blunt injury
Hanging
Miscellaneous
Differential Diagnoses
Diagnostic Testing
Vascular Injuries
Penetrating Injury
Blunt injury
Pharyngoesophageal Injuries
Penetrating injury
Blunt Injury
Laryngotracheal Injuries
Penetrating injury
Blunt Injury
Hanging
Management
Vascular Injuries
Penetrating injury
Blunt injury
Pharyngoesophageal Injuries
Penetrating injury
Blunt Injury
Laryngotracheal Injuries
Hanging
Miscellaneous
Disposition
Penetrating Injury
Blunt Injury
References
Chapter 37: Thoracic Trauma
Chest Wall Injury
Rib Fracture
Foundations
Background and Importance
Anatomy and Physiology
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Sternal Fracture
Foundations
Background and Importance
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Nonpenetrating Ballistic Injury
Foundations
Background and Importance
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Disposition
Pulmonary Injuries
Pulmonary Contusion and Laceration
Foundations
Background and Importance
Pathophysiology
Clinical Features
Diagnostic Testing
Laboratory
Radiology
Management
Pneumothorax
Foundations
Background and Importance
Pathophysiology
Simple pneumothorax
Communicating pneumothorax
Tension pneumothorax
Clinical Features
Diagnostic Testing
Occult Pneumothorax
Management
Simple Pneumothorax
Communicating Pneumothorax
Tension Pneumothorax
Hemothorax
Foundations
Background and Importance
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Tracheobronchial Injury
Foundations
Background and Importance
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Diaphragmatic Injury
Foundations
Background and Importance
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Cardiovascular Trauma
Blunt Cardiac Trauma
Myocardial Concussion
Foundations
Background and Importance
Pathophysiology
Clinical Features
Diagnostic Testing
Laboratory Tests and Electrocardiogram
Management
Disposition
Myocardial Contusion
Foundations
Background and Importance
Pathophysiology
Clinical Features
Diagnostic Testing
Laboratory Tests and Electrocardiogram
Electrocardiogram
Cardiac biomarkers
Imaging
Management
Disposition
Myocardial Rupture
Foundations
Background and Importance
Anatomy and Physiology
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Penetrating Cardiac Trauma
Acute Pericardial Tamponade
Foundations
Background and Importance
Pathophysiology
Clinical Features
Diagnostic Testing
Radiology
Ultrasound
Radiography
Electrocardiography
Management
Emergency Department Thoracotomy
Indications for emergency department thoracotomy
Blunt Aortic Injury
Foundation
Background and Importance
Pathophysiology
Clinical Features
Diagnostic Testing
Chest Radiography
Chest Computed Tomography Scan
Management
Stabilization and Empirical Therapy
Definitive Management
Endovascular repair
Esophageal Perforation
Foundations
Background and Importance
Pathophysiology
Clinical Features
Iatrogenic
Foreign Bodies
Caustic Burns
Penetrating and Blunt Trauma
Spontaneous Rupture
Diagnostic Testing
Radiology
Endoscopy
Management
References
Chapter 38: Abdominal Trauma
Foundations
Background and Importance
Penetrating Abdominal Trauma
Blunt Abdominal Trauma
Anatomy and Physiology
Pathophysiology
Penetrating Abdominal Trauma
Stab wounds
Gunshot wounds
Blunt Abdominal Trauma
Seatbelt injuries
Iatrogenic injuries
Clinical Features
Specific Clinical Presentations
Penetrating Abdominal Trauma
Stab wounds
Gunshot wounds
Blunt Abdominal Trauma
Physical Examination
Penetrating Abdominal Trauma
Stab wounds
Gunshot wounds
Blunt Abdominal Trauma
Differential Diagnoses
Diagnostic Testing
Ultrasonography
Laboratory Testing
Radiology
Plain Radiographs
Computed Tomography
Magnetic Resonance Imaging
Management
Penetrating Abdominal Trauma
Stab Wounds
Anterior abdomen
Step I: Clinical indications for emergent laparotomy
Step II: Peritoneal violation
Step III: Injury requiring laparotomy
Thoracoabdominal penetration
Flank and back
Gunshot Wounds
Anterior abdomen
Thoracoabdominal
Flank and back
Blunt Abdominal Trauma
Operative Versus Nonoperative Management
Pelvic Fracture
Multiple System Injury
Bedside Procedures
Diagnostic Peritoneal Lavage
Local Wound Exploration
Resuscitative Endovascular Balloon Occlusion of the Aorta
Therapeutic Angioembolization
Disposition
Consultation
Transfer
References
Chapter 39: Genitourinary Trauma
Foundations
Background and Importance
Anatomy and Physiology
Pathophysiology
Renal Trauma
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Ureteral Trauma
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Bladder Trauma
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Urethral Trauma
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Genital Trauma
Clinical Features
Differential Diagnoses
Diagnostic Testing
Imaging
Management
Disposition
References
Chapter 40: Peripheral Vascular Trauma
Foundations
Background and Importance
Anatomy and Physiology
Upper Extremity
Lower Extremity
Pathophysiology
Penetrating Trauma
Blunt Trauma
Vascular Injuries
Complete occlusive injury
Transection
Thrombosis
Reversible arterial spasm
Nonocclusive injuries
Intimal flap
Pseudoaneurysm
Arteriovenous fistula
Compartment Syndrome
Clinical Features
Hard Findings of Vascular Injury
Soft Findings of Vascular Injury
Asymptomatic High-­Risk Wounds
History
Physical Examination
Differential Diagnoses
Diagnostic Testing
Plain Radiography
Pulse Oximetry and Near-Infrared Spectroscopy
Handheld Doppler
Arterial Pressure Index and Ankle-Brachial Index
Ultrasound
Computed Tomography and Magnetic Resonance Imaging
Arteriography
Diagnosis of Specific Vascular Injuries
Management
Major Vascular Injuries
Upper Extremity Arterial Injuries
Lower Extremity Arterial Injuries
Late Complications of Arterial Injury
Venous Injuries
Minor Vascular Injuries
Arterial Spasm
Antibiotics
Disposition
References
Section Two: Orthopedic Injuries
Chapter 41: General Principles of Orthopedic Injuries
Overall Foundations
Background and Importance
Fractures
Foundations
Anatomic Location of a Fracture: Nomenclature
Anatomic Descriptors
Descriptive Modifiers
Fracture Eponyms and Mechanistic Names
Epiphyseal Fractures
Clinical Features of Fractures
Fracture Healing
Complications of Fractures
Infection (Osteomyelitis)
Hemorrhage
Vascular Injuries
Nerve Injuries
Compartment Syndrome
Pathophysiology
Anatomic considerations and risk factors
Clinical presentation
Diagnostic testing
Treatment, complications, and disposition of compartment
syndrome
Avascular Necrosis
Fat Embolism Syndrome
Fracture Blisters
Complications of Immobilization and Hospitalization
Damage Control Orthopedic Surgery
Differential Diagnoses
Diagnostic Testing
Plain Radiography
Special Imaging Techniques
Computed tomography
Magnetic resonance imaging
Ultrasound imaging
Laboratory Testing
Management
Field Care
Splinting and bandaging
Emergency Department Care
Upper Extremity
Sling-and- swathe bandages
Clavicle fractures
Plaster and fiberglass splints
Casts
Forearm and Wrist Splints
Lower Extremity
Ankle
Thermal Therapy
Disposition
Subluxation and Dislocations
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Soft Tissue Injuries
Sprains
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Plain radiography
Magnetic resonance imaging
Management
Disposition
Strains
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Tendinitis and Tendinosis
Foundations
Clinical Features
Differential Diagnosis
Diagnostic testing
Management
Disposition
Bursitis
Foundations
Clinical Features
Diagnostic Modalities
Management
Disposition
Other Soft Tissue Conditions
References
Chapter 42: Hand Injuries
Foundations: A General Approach to Hand Injuries
Anatomy
Surface Anatomy and Skin
Fingertip and Nail
Skeletal Anatomy and Ligaments
Musculature and Tendons
Intrinsic Musculature
Extrinsic Musculature
Extensor Muscles and Tendons
Flexor Muscles and Tendons
Digital Flexor Sheath
Blood Supply
Arterial Supply
Venous and Lymphatic System
Innervation and Sensory Systems
Regional Blocks
Digital Block
Metacarpal and Transthecal Blocks
Wrist Blocks
Radial Nerve Block
Median Nerve Block
Ulnar Nerve Block
Splinting
Ring Removal
Specific Hand Injuries
Phalanx and Metacarpal Fractures
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Phalanx Fractures
Distal Phalanx Fractures
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Middle Phalanx Fractures
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Proximal Phalanx Fractures
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Metacarpal Fractures
Clinical Features
Differential Diagnosis
Diagnostic Imaging
Management
Thumb Fractures
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Joint Injuries
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Interphalangeal Joint Injuries
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Metacarpophalangeal Joint Injuries
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Carpometacarpal Joint Injuries
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Thumb Dislocations and Ligamentous Injuries
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Tendon Injuries
Extensor Tendon Injuries
Clinical Features
Zone I Extensor Injuries
Zone II Extensor Injuries
Zone III Extensor Injuries
Zone IV Extensor Injuries
Zone V Extensor Injuries
Zone VI Extensor Injuries
Zone VII Extensor Injuries
Differential Diagnoses
Diagnostic Testing
Management
Zone I Extensor Injuries Management
Zone II Extensor Injuries Management
Zone III Extensor Injuries Management
Zone IV Extensor Injuries Management
Zone V Extensor Injuries Management
Zone VI Extensor Injuries Management
Zone VII Extensor Injuries Management
Disposition
Flexor Tendon Injuries
Clinical Features
Differential Diagnoses
Diagnostic Studies
Management
Disposition
Trigger Finger
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Finger and Nail Bed Injuries
Nail Bed Injuries
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Amputations
Fingertip Amputations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Degloving Injuries
Mutilating Hand Injuries
Skin and Soft Tissue Injuries
Clinical Features
Diagnostic Testing
Management
Laceration of the Extensor Tendon
Disposition
Clenched Fist Injuries
Infectious Disorders of the Hand
General Hand Infections
Paronychia
Onychomycosis
Felon
Herpetic Whitlow
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Purulent Flexor Tenosynovitis
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Deep Space Infections
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Skin and Soft Tissue Disorders
Onycholysis
High-Pressure Injury
Ganglion Cysts
Dupuytren Contracture
Acknowledgments
References
Chapter 43: Wrist and Forearm Injuries
Wrist
Foundations
Anatomy, Physiology, and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Carpal Injuries
Scaphoid Fractures
Foundations
Clinical features
Diagnostic testing
Management and disposition
Lunate fractures
Foundations
Clinical features
Diagnostic testing
Management and disposition
Triquetral Fractures
Foundations
Clinical features
Diagnostic testing
Management and disposition
Pisiform Fractures
Foundations
Clinical features
Diagnostic testing
Management and disposition
Hamate Fractures
Foundations
Clinical features
Diagnostic testing
Management and disposition
Trapezium Fractures
Foundations.
Clinical features
Diagnostic testing
Management and disposition
Capitate Fractures
Foundations
Clinical features
Diagnostic testing
Management and disposition
Trapezoid Fractures
Foundations
Clinical features
Diagnostic testing
Management and disposition
Carpal Instability
Foundations
Clinical features
Diagnostic testing
Management and disposition
Radiocarpal Dislocation
Foundations
Clinical features
Diagnostic testing
Management and disposition
Distal Radius and Ulna Injuries
Colles Fracture
Foundations
Clinical features
Diagnostic testing
Management and disposition
Smith Fracture
Foundations
Clinical features
Diagnostic testing
Management and disposition
Barton Fracture
Foundations
Clinical features
Diagnostic testing
Management and disposition
Hutchinson Fracture
Foundations
Clinical features
Diagnostic testing
Management and disposition
Distal Radioulnar Joint Disruption
Foundations
Clinical features
Diagnostic testing
Management and disposition
Soft Tissue Injuries of the Wrist
Carpal Tunnel and Acute Carpal Tunnel Syndrome
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
De Quervain Disease
Foundations
Clinical Features
Diagnostic Testing
Management and Disposition
Intersection Syndrome
Foundations
Clinical Features
Diagnostic Testing
Management and Disposition
Forearm
Foundations
Anatomy, Physiology, and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing: Radiology
Shaft Fractures of Radius and Ulna
Foundations
Clinical Features
Diagnostic Testing
Management and Disposition
Ulna Shaft Fractures
Foundations
Clinical Features
Diagnostic Testing
Management and Disposition
Monteggia Fracture
Foundations
Clinical Features
Diagnostic Testing
Management and Disposition
Galeazzi Fracture
Foundations
Clinical Features
Diagnostic Testing
Management and Disposition
Essex-Lopresti Lesion
Foundations
Clinical Features
Diagnostic Testing
Management and Disposition
Acknowledgment
References
Chapter 44: Humerus and Elbow Injuries
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
General Clinical Features
General Differential Diagnoses
General Diagnostic Testing
General Management
General Disposition
Specific Fractures
Shaft of the Humerus
Clinical features of humeral shaft fractures
Diagnostic testing for humeral shaft fractures
Management of humeral shaft fractures
Disposition of humeral shaft fractures
Distal Humerus
Supracondylar fractures
Extension type supracondylar fractures
Clinical features of extension type supracondylar fractures
Diagnostic testing of extension-type supracondylar fractures
Management and disposition of extension type supracondylar fractures
Flexion type supracondylar fractures
Clinical features of flexion type supracondylar fractures
Diagnostic of flexion type supracondylar fractures
Management of flexion type supracondylar fractures
Transcondylar Fractures
Clinical features of intercondylar fractures
Diagnostic testing of intercondylar fractures
Management and disposition of intercondylar fractures
Intercondylar Fractures
Clinical features of intercondylar fractures
Diagnostic testing of intercondylar fractures
Management and disposition of intercondylar fractures
Condylar Fractures
Clinical Features of condylar fractures
Diagnostic testing of condylar fractures
Management and disposition of condylar fractures
Capitellum and Trochlea Fractures
Clinical features of capitellum and trochlea fractures
Diagnostic testing of capitellum and trochlea fractures
Management and disposition of capitellum and trochlea fractures
Epicondylar Fractures
Clinical features of epicondylar fractures
Diagnostic testing of epicondylar fractures
Management and disposition of epicondylar fractures
Olecranon
Clinical features of olecranon fractures
Diagnostic testing of olecranon fractures
Management and disposition of olecranon fractures
Radial Head and Neck
Clinical features of radial head and neck fractures
Diagnostic testing of radial head and neck fractures
Management and disposition of radial head and neck fractures
Dislocations/Subluxations
Elbow
Clinical features of elbow dislocations/subluxations
Diagnostic testing of elbow dislocations/subluxations
Management and disposition of elbow dislocations/subluxations
Radial Head Subluxation
Clinical features of radial head subluxation
Diagnostic testing of radial head subluxation
Management and disposition of radial head subluxation
Soft Tissue Disorders
Epicondylitis
Clinical features of epicondylitis
Diagnostic testing of epicondylitis
Management and disposition of epicondylitis
Olecranon Bursitis
Clinical features of olecranon bursitis
Diagnostic testing of olecranon bursitis
Management and disposition of olecranon bursitis
Biceps Tendon Rupture
Clinical features of biceps tendon rupture
Diagnostic testing for biceps tendon rupture
Management and disposition of biceps tendon rupture
Acknowledgments
References
Chapter 45: Shoulder Injuries
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Clinical Features
History
Physical Examination
Differential Diagnoses
Diagnostic Testing
Radiology
Specific Injuries
Fractures
Clavicle
Foundations
Clinical features
Differential diagnoses
Diagnostic testing
Management
Disposition
Scapula
Foundations
Clinical features
Differential diagnoses
Diagnostic testing
Radiology
Management
Proximal Humerus
Foundations
Clinical features
Differential diagnoses
Diagnostic testing
Management
Pediatric Proximal Humeral Fracture
Foundations
Clinical features
Differential diagnoses
Diagnostic testing
Management
Dislocations
Sternoclavicular
Foundations
Clinical features
Differential diagnoses
Diagnostic testing
Management
Acromioclavicular Joint
Foundations
Clinical features
Differential diagnoses
Diagnostic testing
Radiology
Management
Glenohumeral Dislocations
Foundations
Anterior Dislocations
Pathophysiology
Clinical features
Differential diagnoses
Diagnostic testing
Radiology
Management
Posterior Dislocation
Pathophysiology
Clinical features
Differential diagnoses
Diagnostic testing
Radiology
Management
Inferior Glenohumeral Dislocation (Luxatio Erecta)
Pathophysiology
Clinical features
Differential diagnoses
Diagnostic testing
Radiology
Management
Scapulothoracic Dissociation
Foundations
Clinical features
Differential diagnoses
Diagnostic testing
Management
Soft Tissue Conditions
Impingement Syndrome
Foundations
Clinical features
Differential diagnoses
Diagnostic testing
Management
Rotator Cuff Tears
Foundations
Clinical features
Differential diagnoses
Diagnostic testing
Radiology
Management
Lesions of the Biceps Muscle
Bicipital Tendinitis
Pathophysiology
Clinical features
Differential diagnoses
Diagnostic testing
Radiology
Management
Ruptures of the Biceps Tendon
Foundations
Clinical features
Differential diagnoses
Diagnostic testing
Radiology
Management
Calcific Tendinitis
Foundations.
Clinical features
Differential diagnoses
Diagnostic testing
Radiology
Management
Adhesive Capsulitis
Foundations
Clinical features
Differential diagnoses
Diagnostic testing
Management
Injection Therapy
References
Chapter 46: Pelvic Injuries
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Bony and Ligamentous Anatomy
Vascular Anatomy
Neurologic Anatomy
Pathophysiology and Key Patterns of Pelvic Fracture
Stable Injuries (Tile Type A)
Nondisplaced or minimally displaced fractures of the pelvic ring
Transverse fractures of the sacrum
Avulsion fractures
Stress fractures
Pathologic and insufficiency fractures
Partially Stable and Unstable Injuries (Tile Types B and C)
Anteroposterior compression
Lateral compression
Vertical shear
Vertical sacral fractures
Open Pelvic Fractures
Penetrating Pelvic Trauma
Associated Pelvic Injuries
Urologic Injury
Neurologic Injury
Gynecologic Injury
Associated Non-­Pelvic Injuries
Acetabular Fractures
Coccyx Fractures
Clinical Features
History
Physical Examination
Deep Venous Thrombosis
Differential Diagnosis
Diagnostic Testing
Radiology
Plain Radiography
Computed Tomography
Evaluation of Hemorrhage
Diagnostic Peritoneal Lavage
Ultrasound
Computed Tomography
Management
Resuscitation
Control of Hemorrhage
Stabilizing the Pelvis
Noninvasive techniques
Formal external fixation
Angiography and Embolization
Hemodynamically Unstable Patients With Pelvic and Intra-Abdominal Hemorrhage
Disposition
References
Chapter 47: Femur and Hip Injuries
General Information
Foundations
Anatomy of the Hip and Femur
Skeletal Anatomy
Musculature
Arterial Supply
Venous System
Nerves
Pathophysiology and Key Patterns of Injury
Fractures and Trauma of the Femur and Hip
Osteoporosis of the Femur
Osteoarthritis of the hip
Avascular Necrosis
Myositis Ossificans
Calcific Bursitis and Calcifying Peritendinitis
Neoplastic Disease in the Hip
Clinical Features of Hip and Femur Pathology
History
Physical Examination
Differential Diagnoses
Diagnostic Testing
Radiographic Evaluation
Occult Hip Fracture
Management
Traction and Immobilization
Open Fracture Care
Compartment Syndrome
Pain Management
Systemic Analgesia
Pharmacologic Approaches
Femoral Nerve Block
Specific Fractures of the Hip and Femur
Avulsion Fractures
Foundations
Clinical features
Differential diagnoses
Management
Proximal Femur Fracture
Femoral Neck Fractures
Foundations
Clinical presentation
Diagnostic testing
Management
Disposition
Intertrochanteric Fractures
Foundation
Clinical presentation
Diagnostic testing
Management
Disposition
Isolated Fractures of the Greater or Lesser Trochanter
Foundations
Clinical presentation
Diagnostic testing
Management
Disposition
Subtrochanteric Fractures
Foundation
Diagnostic testing
Management
Disposition
Femoral Shaft Fractures
Foundation
Clinical presentation
Diagnostic testing
Management
Disposition
Stress Fractures
Foundation
Clinical presentation
Diagnostic testing
Management
Disposition
Dislocations and Fracture-­Dislocations of the Hip and Femur
Hip Dislocations
Foundations
Clinical presentation
Diagnostic testing
Management
Disposition
Fracture-Dislocation of the Femoral Head
Foundations
Clinical presentation
Diagnostic studies
Management
Disposition
Dislocation of Hip Prosthetics
Foundations
Clinical presentation
Diagnostic studies
Management
Disposition
Soft Tissue Injuries
Muscular Injuries
Foundations
Clinical features
Differential diagnoses
Diagnostic testing
Management
Disposition
Tendon Injuries
Foundations
Clinical features
Differential diagnoses
Diagnostic studies
Management
Disposition
Osteitis Pubis
Foundation
Clinical features
Differential diagnoses
Diagnostic testing
Management
Disposition
Vascular Injuries
Foundations
Clinical features
Differential diagnoses
Diagnostic testing
Management
Disposition
Neurologic Injuries
Foundation
Clinical features
Diagnostic testing
Management
Disposition
References
Chapter 48: Knee and Lower Leg Injuries
Knee Injuries—Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Femur
The Tibia
Cruciate Ligaments (ACL and PCL)
Collateral Ligaments (MCL and LCL)
Knee Compartments
Fabella
Popliteal Fossa
Popliteal Artery
Tibial Nerve
Extensor Mechanism
Meniscus
The Iliotibial band
The Popliteus
Bursae
Knee Injuries—Clinical Features
Physical Examination
Knee Injuries—Differential Diagnoses
Dislocation
Effusion
Anterior Knee Pain
Medial and Lateral Pain
Posterior Knee Pain
Knee Injuries—Examination Maneuvers
Anterior Drawer/Lachman Test
Posterior Drawer Test
Posterior Sag Sign Test
Collateral Ligament Stress Test
Assessing for Meniscal Tears
McMurray Test
Apley Test
Knee Injuries—Diagnostic Testing
Radiologic Evaluation
Vascular Imaging
Arthroscopy
Joint Injection
Arthrocentesis
Specific Knee Injuries
Knee Dislocations—Foundations
Knee Dislocations—Clinical Features
Knee Dislocations—Diagnostic Testing
Knee Dislocations—Management and Disposition
Distal Femur Fractures—Foundations
Distal Femur Fractures—Clinical Features
Distal Femur Fracture—Diagnostic Testing
Distal Femur Fractures—Management and Disposition
Tibial Plateau Fractures—Foundations
Tibial Plateau Fractures—Clinical Features
Tibial Plateau Fractures—Diagnostic Testing
Tibial Plateau Fractures—Management and Disposition
Tibial Spine Fractures—Clinical Features
Tibial Spine Fractures—Diagnostic Testing
Tibial Spine Fractures—Management and Disposition
Osteochondritis Dissecans—Foundations
Osteochondritis Dissecans—Clinical Features
Osteochondritis Dissecans—Diagnostic Testing
Osteochondritis Dissecans—Management and Disposition
Extensor Mechanism Injuries: Quadriceps and Patellar Tendon Ruptures—Foundations
Quadriceps and Patellar Tendon Ruptures—Clinical Features
Quadriceps and Patellar Tendon Ruptures—Diagnostic Testing
Quadriceps and Patellar Tendon Ruptures—Management and Disposition
Patellar Fractures—Foundations
Patellar Fractures—Clinical Features
Patellar Fractures—Diagnostic Testing
Patellar Fractures—Management and Disposition
Patellar Dislocation—Foundations
Patellar Dislocation—Clinical Features
Patellar Dislocation—Diagnostic Testing
Patellar Dislocation—Management and Disposition
Cruciate and Collateral Ligament Injuries—Foundations
Cruciate and Collateral Ligament Injuries—Clinical Features
Cruciate and Collateral Ligament Injuries—Diagnostic Testing
Cruciate and Collateral Ligament Injuries—Management and Disposition
Meniscal Injuries—Foundations
Meniscal Injuries—Clinical Features
Meniscal Injuries—Diagnostic Testing
Meniscal Injuries—Management and Disposition
Overuse Syndromes
Patellofemoral Pain Syndrome—Foundations
Patellofemoral Pain Syndrome—Clinical Features
Patellofemoral Pain Syndrome—Diagnostic Testing
Patellofemoral Pain Syndrome—Management and Disposition
Iliotibial Band Syndrome—Foundations
Iliotibial Band Syndrome—Clinical Features
Iliotibial Band Syndrome—Diagnostic Testing
Iliotibial Band Syndrome—Management and Disposition
Patellar Tendinopathy—Foundations
Patellar Tendinopathy—Clinical Features
Patellar Tendinopathy—Diagnostic Testing
Patellar Tendinopathy—Management and Disposition
Plica Syndrome—Foundations
Plica Syndrome—Clinical Presentation
Plica Syndrome—Diagnostic Testing
Plica Syndrome—Management and Disposition
Popliteus Tendinopathy—Foundations
Popliteus Tendinopathy—Clinical Presentation
Popliteus Tendinopathy—Diagnostic Testing
Popliteus Tendinopathy—Management and Disposition
Bursitis—Foundations
Bursitis—Clinical Features
Bursitis—Diagnostic Testing
Bursitis—Management and Disposition
Arthritis
Osteoarthritis—Foundations
Osteoarthritis—Clinical Features
Osteoarthritis—Diagnostic Testing
Osteoarthritis—Management and Disposition
Septic Arthritis—Foundations
Septic Arthritis—Clinical Features
Septic Arthritis—Diagnostic Testing
Septic Arthritis—Management and Disposition
Baker Cyst
Baker Cyst—Foundations
Baker Cyst—Clinical Features
Baker Cyst—Diagnostic Testing
Baker Cyst—Management and Disposition
Leg
Foundations
Anatomy, Physiology, Pathophysiology
Tibia and Fibula
Vascular Supply
Fascial Compartments
Leg Injuries Differential Diagnoses
Specific Leg Injuries
Proximal Extra-articular Tibial Fractures
Subcondylar Tibial Fractures—Foundations
Subcondylar Tibial Fractures—Clinical Features
Subcondylar Tibial Fractures—Diagnostic Testing
Subcondylar Tibial Fractures—Management and Disposition
Tibial Tubercle Fractures—Foundations
Tibial Tubercle Fractures—Clinical Features
Tibial Tubercle Fractures—Diagnostic Testing
Tibial Tubercle Fractures—Management and Disposition
Tibial Shaft Fractures—Foundations
Tibial Shaft Fractures—Clinical Features
Tibial Shaft Fractures—Diagnostic Testing
Tibial Shaft Fractures—Management and Disposition
Proximal Fibula Fractures—Foundations
Proximal Fibula Fractures—Clinical Features
Proximal Fibula Fractures—Diagnostic Testing
Proximal Fibula Fractures—Management and Disposition
Proximal Tibiofibular Joint Dislocations—Foundations
Proximal Tibiofibular Joint Dislocations—Clinical Features
Proximal Tibiofibular Joint Dislocations—Diagnostic Testing
Proximal Tibiofibular Joint Dislocations—Management and Disposition
Stress Fractures—Foundations
Stress Fractures—Clinical Features
Stress Fractures—Diagnostic Testing
Stress Fractures—Management and Disposition
Medial Tibial Stress Syndrome—Foundations
Medial Tibial Stress Syndrome—Clinical Features
Medial Tibial Stress Syndrome—Diagnostic Testing
Medial Tibial Stress Syndrome—Disposition and Management
Compartment Syndrome
Soft Tissue Injuries Involving the Lower Leg
Gastrocnemius and plantaris injury—foundations
Gastrocnemius and plantaris injury—clinical features
Gastrocnemius and plantaris injury—diagnostic testing
Gastrocnemius and plantaris injury—management and disposition
Foreign bodies
References
Chapter 49: Ankle and Foot Injuries
Ankle
Foundations
Background and Importance
Anatomy
Physiology and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Radiology
Other Imaging Techniques
Ankle Fractures and Dislocations
General Considerations
Unimalleolar Fractures
Lateral Malleolar Fractures
Medial Malleolar Fractures
Posterior Malleolar Fractures
Bimalleolar Fractures
Trimalleolar Fractures
Open Fractures
Pilon Fractures
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Dislocations
Anatomy, Physiology, and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Ligamentous Injuries
Foundations
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Tendon Injuries
Differential Diagnoses
Achilles Tendon Rupture
Background and Importance, Physiology, and Pathophysiology
Clinical Features
Diagnostic Testing
Management
Peroneal Tendon Dislocation or Rupture
Foundations and Clinical Features
Diagnostic Testing
Management
Tibialis Posterior Tendon Rupture
Foundations and Clinical Features
Diagnostic Testing
Management
Other Tendon Injuries
Foot
Foundations
Anatomy, Physiology, and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Specific Pathologic Conditions
Hindfoot Injuries
Differential Diagnoses
Talar Fractures
Anatomy, Physiology, and Pathophysiology
Clinical Features
Talar Neck Fractures
Talar Head Fractures
Talar Body Fractures
Diagnostic Testing: Radiology
Management.
Disposition
Osteochondral Lesions
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Subtalar Dislocations
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Disposition
Pantalar Dislocation
Calcaneal Fractures
Anatomy and Pathophysiology
Intraarticular Calcaneal Fractures
Extraarticular Calcaneal Fractures
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Midtarsal Joint Injuries
Foundations and Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Nontraumatic Hindfoot Pain
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Midfoot Injuries
Differential Diagnoses
Navicular Fractures
Anatomy
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing: Radiology
Management
Disposition
Cuboid Fractures
Cuneiform Fractures
Dislocations of the Navicular, Cuboid, and Cuneiforms
Lisfranc (Tarsometatarsal) Fractures and Dislocations
Anatomy
Physiology and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing: Radiology
Management
Disposition
Nontraumatic Midfoot Pain
Forefoot Injuries
Differential Diagnoses
Diagnostic Testing
Metatarsal Fractures
Foundations
Fractures of the First Metatarsal
Fractures of the Middle Metatarsals (Two to Four)
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Fractures of the Fifth Metatarsal
Fifth Metatarsal Shaft Fractures
Fifth Metatarsal Base Fractures
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Phalangeal Fractures
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Sesamoid Fractures
Metatarsophalangeal Dislocations
Foundations and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing: Radiology
Management
Disposition
Interphalangeal Joint Dislocations
Nontraumatic Forefoot Pain
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Special Considerations
Complex Regional Pain Syndrome
Stress Fractures
Foundations and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Tendon Injuries
Compartment Syndrome of the Foot and Ankle
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing: Special Procedures
Management and Disposition
References
Section Three: Soft Tissue Injuries
Chapter 50: Wound Management Principles
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Clinical Features
History
Physical Examination
Differential Diagnoses
Diagnostic Testing
Management
Anesthesia
Anesthetic Agents
Allergy
Skin Preparation
Wound Preparation
Debridement
Wound Cleansing
Irrigation
Wound Closure
Decision-Making
Wound Tension
Suture Technique
Simple sutures
Procedure
Intradermal (buried) sutures
Procedure
Scalp laceration repair
Procedure
Skin tears
Vertical mattress sutures
Procedure
Horizontal mattress sutures
Procedure
Dog-ear deformity repair
Procedure
Corner stitch (half-buried horizontal mattress sutures)
Procedure
V-Y wound closure
Procedure
Materials
Suture
Needles
Tape
Staples
Tissue adhesives
Antibiotic Prophylaxis
Contamination, crush, and host factors
Open fractures, joint wounds, and gunshot wounds
Bites and puncture wounds
Cat bites
Dog bites
Hand bites
Intraoral lacerations
Puncture wounds of the foot
Drains, Dressings, and Immobilization
Drains
Dressings
Immobilization
Disposition
Wound Care Instructions
Tetanus Immunization
References
Chapter 51: Foreign Bodies
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Specific Disorders
Eye
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Ear
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Nose
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Airway
Foundations
Background and Importance
Anatomy and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Gastrointestinal Tract
Foundations
Pharynx and Esophagus
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Stomach and Bowel
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Rectum
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Genitourinary Tract
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Soft Tissues
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Chapter 52: Mammalian Bites
Foundations
Background and Importance
Dog Bites
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Clinical Features
Capnocytophaga canimorsus
Diagnostic Testing
Differential Diagnoses
Management
Prophylactic antibiotics
Disposition
Cat Bites
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Clinical Features
Pasteurella multocida
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Other Mammals
Monkeys
Foundations
Background and Importance
Anatomy, physiology, and pathophysiology
Clinical features
Differential diagnoses
Management
Disposition
Rodents
Foundations
Background and importance
Anatomy, physiology, and pathophysiology
Clinical features
Differential diagnoses
Management
Disposition
Uncommon Animal Bites
Ferrets
Domestic Herbivores
Sheep, Cattle, and Pigs
Horses
Camels
Wild Animals
Bears
Wild Cats
Coyotes and Wolves
Management
Human Bites
Foundations
Background and importance
Anatomy, physiology, and pathophysiology
Clinical features
Other human bites
Differential diagnoses
Diagnostic testing
Management
Prophylactic Antibiotics
Disposition
References
Chapter 53: Venomous Animal Injuries
Foundations
Venom Delivery
Venomous Reptiles
Snakes
Foundations
Classification and Characteristics
Anatomy and Identification
Other Reptiles
Pathophysiology and Toxins
Venom Delivery
Clinical Features
Crotalids (Pit Vipers)
Coral Snakes
Infection
Differential Diagnoses
Diagnostic Testing
Management
Out-of-Hospital Care
Emergency Department Care
Patient History
Patient Examination
Initial Medical Care
Pit Viper Envenomation Classification
Antivenom
Dosage and Precautions
Coral and Exotic Snakes
Wound Care
Serum Sickness
Heloderma Envenomation
Disposition
Venomous Arthropods
Foundations
Hymenoptera
Spiders and Scorpions
Black Widow Spider
Brown Recluse Spider
Scorpions
Clinical Features
Hymenoptera
Africanized Bees
Fire Ants
Black Widow Spider
Brown Recluse Spider
Scorpions
Differential Diagnoses
Hymenoptera
Black Widow Spider
Brown Recluse Spider
Scorpions
Diagnostic Testing
Hymenoptera
Black Widow Spider
Brown Recluse Spider
Scorpions
Management
Prehospital Care
Hymenoptera
Black Widow Spider
Brown Recluse Spider
Scorpions
Emergency Department Care
Hymenoptera
Black Widow Spider
Latrodectus Antivenom
Brown Recluse Spider
Scorpions
Disposition
Hymenoptera
Black Widow Spider
Brown Recluse Spider
Scorpions
Other Arthropods
Venomous Marine Animals
Foundations
Pathophysiology and Venom Delivery
Bites
Nematocyst
Toxicity
Clinical Features
Stings
Sea Urchins
Cone Shells
Stingrays
Bony Fishes
Differential Diagnoses
Diagnostic Testing
Management
Bites
Nematocysts
Stings
Disposition
Acknowledgments
References
Chapter 54: Thermal Injuries
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Pathophysiology of Burns
Cutaneous Injury
Inhalation Injury
Clinical Features
Classification and Diagnosis of Burns
Depth
Size
Inhalation Injury
Differential Diagnoses
Diagnostic Testing
Management
Initial First Aid
Airway Management
Breathing Management
Circulation Management and Fluid Resuscitation
Escharotomy
Local Wound Therapies
Pain Management
Disposition
References
Chapter 55: Chemical Injuries
General Approach to a Hazmat Event
Foundations
Background and Importance
Community Preparedness and HazMat Response
Contingency Plan
Anatomy, Physiology, and Pathophysiology
Clinical Features and Differential Diagnoses
Diagnostic Testing
Management
Disposition
Ocular Injuries
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Specific Toxins
Hydrofluoric Acid
Foundations
Background and importance
Anatomy, physiology, and pathophysiology
Clinical Features
Inhalational Exposure
Gastrointestinal Exposure
Ocular Exposure
Dermal Exposure
Differential Diagnoses
Diagnostic Testing
Management
Infiltration Therapy
Subcutaneous
Intravenous and intra-arterial
Respiratory Exposures
Ocular Exposures
Systemic Toxicity
Disposition
Formic Acid
Foundations
Background and importance
Anatomy, physiology, and pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Anhydrous Ammonia
Foundation
Background and importance
Anatomy, physiology, and pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Cement
Phenol and Derivatives
Foundations
Background and importance
Anatomy, physiology, and pathophysiology
Clinical features
Differential Diagnoses
Diagnostic Testing
Management
Treatment of Systemic Toxicity
Disposition
Phosphorus
Foundations
Background and importance
Anatomy, physiology, and pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Nitrates and Nitrites
Foundations
Background and importance
Anatomy, physiology, and pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Hydrocarbons
Foundations
Background and importance
Anatomy, physiology, and pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Tar
Foundations
Background and importance
Clinical Features
Management
Disposition
Elemental Metals
Chromium
Miscellaneous
Chlorine, Chloramine, Phosgene, Nitrogen Oxide and Phosphide
Foundations
Background and importance
Anatomy, physiology, and pathophysiology
Clinical Features
Management
Disposition
Chemical Terrorism
Response During a Chemical Attack
Chemical Agents
Nerve Agents
Foundations
Background and importance
Anatomy, physiology, and pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Vesicants
Foundations
Background and importance
Anatomy, physiology, and pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Cyanide
Foundations
Background and importance
Anatomy, physiology, and pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Part III: Emergency Medicine by System
Section One: Head and Neck
Chapter 56: Oral Medicine
Introduction
Disorders of the Tooth
Foundations
Anatomy, Physiology, and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Disorders of the Gingiva and Periodontium
Foundations
Anatomy, Physiology, and Pathophysiology
Gingivitis and Periodontitis
Pericoronitis
Gingival Hyperplasia
Clinical Features
Differential Diagnoses
Diagnostic Testing
Gingivitis and Periodontitis
Pericoronitis
Management
Gingivitis and Periodontitis
Pericoronitis
Disposition
Gingivitis and Periodontitis
Pericoronitis
Disorders Involing Dental Procedures
Foundations
Anatomy, Physiology, and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Odontogenic and Deep Neck Infections
Foundations
Anatomy, Physiology, and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Dentoalveolar Trauma
Foundations
Anatomy, Physiology, and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Dental Fractures
Tooth Avulsion
Luxation and Alveolar Fractures
Soft Tissue Injuries
Disposition
Temporomandibular Joint Disorder and Dislocation
Foundations
Anatomy, Physiology, and Pathophysiology
Temporomandibular Joint Disorder
Temporomandibular Joint Dislocation
Clinical Features
Temporomandibular Joint Disorder
Temporomandibular Joint Dislocation
Differential Diagnoses
Diagnostic Testing
Management
Temporomandibular Joint Disorder
Temporomandibular Joint Dislocation
Disposition
References
Chapter 57: Ophthalmology
Overview
Traumatic Conditions
Foundations
Periorbital Contusions and Eyelid Lacerations
Clinical Features and Differential Diagnoses
Diagnostic Testing
Management and Disposition
Conjunctival and Scleral Injuries: Subconjunctival Hemorrhage, Conjunctival Laceration, and Scleral Laceration
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Corneal Injuries: Corneal Abrasions, Foreign Bodies, and Lacerations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Corneal abrasions
Corneal foreign bodies
Corneal lacerations
Anterior Segment Injuries: Traumatic Hyphema, Iritis, Cyclodialysis, and Lens Dislocation
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Traumatic iritis, hyphema, and cyclodialysis
Lens subluxation and dislocation
Posterior Segment/Ocular Injuries: Commotio Retinae, Retinal Detachment, Intraocular Foreign Body, and Perforated Globe
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Retinal injuries
Intraocular foreign bodies and globe rupture
Retrobulbar and Peribulbar Injuries: Orbital Wall Fracture, Retrobulbar Hemorrhage, and Optic Nerve Injury
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Orbital wall fractures
Retrobulbar hemorrhage
Optic nerve injury
Chemical Exposures and Glues
Clinical Features and Differential Diagnoses
Diagnostic Testing
Management and Disposition
Inflammatory Conditions
Foundations
The Conjunctiva and Cornea: Keratitis, Pterygium, and Pinguecula
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Superficial punctate keratitis and radiation keratitis
Pterygium and pinguecula
Disposition
The Globe: Uveitis, Scleritis, and Episcleritis
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
The Orbit: Orbital Pseudotumor, Orbital Apex Syndrome, and Thyroid Orbitopathy
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Infectious Conditions
Foundations
The Conjunctiva: Allergic, Viral and Bacterial Conjunctivitis, and Ophthalmia Neonatorum
Clinical Features and Differential Diagnoses
Diagnostic Testing
Management and Disposition
Allergic and viral conjunctivitis
Bacterial conjunctivitis
Ophthalmia neonatorum
The Cornea: Corneal Ulcers, Herpes Simplex Keratitis, and Herpes Zoster Keratitis
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Corneal ulcers and infiltrates
Herpes simplex keratitis
Herpes zoster keratitis
Disposition
The Eyelids and Periorbital Area: Hordeolum, Chalazion, Dacryocystitis, Blepharitis, and Cellulitis
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Hordeolum and chalazion
Dacryocystitis
Blepharitis
Periorbital cellulitis
Disposition
The Globe: Endophthalmitis
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Acute Angle-Closure Glaucoma
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Primary Disorders of Vision
Foundations
Blurred Vision: Optic Neuritis, Toxic and Metabolic Disturbances, and Papilledema
Clinical Features
Differential Diagnoses
Diagnostic Testing
Optic neuritis
Toxic and metabolic visual disturbances
Papilledema
Management
Disposition
Floaters, Flashes, and Field Deficits: Vitreous and Retinal Disorders
Clinical Features
Differential Diagnoses
Diagnostic Testing
Vitreous hemorrhage and detachment
Retinal detachment
Chiasmal and cortical disturbances
Management
Disposition
Sudden Monocular Vision Loss: Retinal Artery and Vein Occlusion, and Ischemic Optic Neuropathy
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Central retinal artery occlusion
Central retinal vein occlusion
Ischemic optic neuropathy
Disposition
Functional Vision Loss
Diplopia
Anisocoria
Foundations
Clinical Features
Adie’s and Argyll Robertson Pupils
Pharmacologic Mydriasis and Miosis
Third-Nerve Palsy
Horner Syndrome
Physiologic and Headache-Associated Anisocoria
Diagnostic Testing, Management, and Disposition
Nystagmus
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
References
Chapter 58: Otolaryngology
Otitis Media
Foundations
Background and Importance
Anatomy and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Otitis Externa
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Necrotizing (Malignant) External Otitis
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Mastoiditis
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Sudden Hearing Loss
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Epistaxis
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Sialolithiasis
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Neck Masses
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Disclaimer
References
Section Two: Pulmonary System
Chapter 59: Asthma
Foundations
Background and Importance
Anatomy and Physiology
Pathophysiology
Clinical Features
Signs and Symptoms
Risk Factors
Specific Contexts
Cough Variant
Cigarette Smokers
Athletes
Perimenstrual Asthma
Elderly
Obesity
Aspirin-Exacerbated Respiratory Disease
Differential Diagnoses
Diagnostic Testing
Peak Expiratory Flow
Pulse Oximetry
Capnography
Blood Gas
Other Blood Testing
Radiology
Point of Care Ultrasound
Electrocardiogram
Management
Oxygen Administration
Adrenergic Medications
Inhaled Beta2 Agonists
Long-Acting Beta-2 Agonists
Intravenous Beta2 Agonists
Subcutaneous Beta2 Agents
Epinephrine
Corticosteroids
Systemic Corticosteroids
Inhaled Corticosteroids
Corticosteroids and Discharged Patients
Anticholinergic Medications
Magnesium
Methylxanthines
Leukotriene Modifiers
Antibiotics
Sedatives
Ketamine
Heliox
High-Flow Nasal Canula
Noninvasive Ventilation
Mechanical Ventilation
Extracorporeal Membrane Oxygenation
Other and Future Therapies
Special Situations
Pregnancy
Near Fatal Asthma
Clinical Approach to Acute Severe Asthma
Disposition
References
Chapter 60: Chronic Obstructive Pulmonary Disease
Foundations
Background
Anatomy/Physiology/Pathophysiology
Clinical Features
Acute Exacerbations
Respiratory Failure
Differential Diagnosis for the Emergency Presentation
Diagnostic Testing
Chest Radiography
Pulse Oximetry
Blood Gas Analysis
Electrocardiogram
Laboratory Tests
Management
Short-Acting Beta Agonists
Glucocorticoids
Antibiotics
Adjunctive Treatments
Respiratory Support
Oxygenation
Non-Invasive Ventilation
High-Flow Nasal Cannula
Invasive Ventilation
Disposition
References
Chapter 61: Upper Respiratory Tract Infections
Pharyngitis
Foundations
Clinical Features
Differential Diagnosis for Emergency Presentation
Diagnostic Testing
Management
Disposition
Laryngitis
Foundations
Clinical Features
Differential Diagnosis for Emergency Presentation
Diagnostic Testing
Management
Disposition
Epiglottitis
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Peritonsillitis: Peritonsillar Cellulitis and Abscess
Foundations
Clinical Features
Differential Diagnosis for Emergency Presentation
Diagnostic Testing
Management
Disposition
Ludwig Angina
Foundations
Clinical Features
Differential Diagnosis for Emergency Presentation
Diagnostic Testing
Management
Disposition
Retropharyngeal Abscess
Foundations
Clinical Features
Differential Diagnosis for Emergency Presentation
Diagnostic Testing
Management
Disposition
Parapharyngeal Abscess
Foundations
Clinical Features
Differential Diagnosis for Emergency Presentation
Diagnostic Testing
Management
Disposition
Rhinosinusitis
Foundations
Clinical Features
Differential Diagnosis for Emergency Presentation
Diagnostic Testing
Management
Disposition
References
Chapter 62: Pneumonia
Principles
Background and Importance
Anatomy and Physiology
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Chapter 63: Pleural Disease
Introduction
Spontaneous Pneumothorax
Foundations
Background and Importance
Anatomy and Physiology
Clinical Features
Differential Diagnosis
Diagnostic Testing
Point of Care Ultrasound
Management
Primary Spontaneous Pneumothorax
Secondary Spontaneous Pneumothorax
Tension Pneumothorax
Disposition
Pleural Effusion
Foundations
Background and Importance
Anatomy and Physiology
Pathophysiology
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
References
Section Three: Cardiac System
Chapter 64: Acute Coronary Syndromes
Foundations
Epidemiology
Spectrum of Illness: Coronary Artery Disease and Acute Coronary Syndrome
Stable Angina
Unstable Angina
Acute Myocardial Infarction
Pathophysiology
Clinical Features
Prehospital Evaluation
Emergency Department Evaluation
History
Nontraditional History
Physical Examination of the ACS Patient
Early Complications of Acute Myocardial Infarction
Differential Diagnoses
Diagnostic Testing
Electrocardiography
Electrocardiographic Abnormalities in Acute Coronary Syndromes
Anatomic Location of Acute Myocardial Infarction
Electrocardiographic Differential Diagnosis of ST Segment Elevation
Non–ST Segment Elevation Myocardial Infarction
Electrocardiographic Adjuncts in the Diagnosis of Acute Coronary Syndrome
Limitations of Electrocardiography in Acute Coronary Syndrome
Chest Radiography
Serum Markers
Troponin Testing
Other Serum Markers
Exercise Stress Testing
Echocardiography
Myocardial Scintigraphy (Nuclear Imaging)
Coronary Computed Tomography Angiography
Risk Stratification Instruments
ED Evaluation of the Chest Pain Patient with Suspected ACS
Management
Pharmacologic Intervention
Oxygen
Nitroglycerin
Morphine and Other Opioid Analgesic Agents
Beta-Adrenergic Blockers
Angiotensin-Converting Enzyme Inhibitors
HMG–Coenzyme A Reductase Inhibitors
Calcium Channel Blockers
Antiplatelet Therapy
Aspirin
P2Y12 Receptor Inhibitor Agents
Glycoprotein IIb/IIIa Receptor Inhibitors
Antithrombins
Heparins
Other Antithrombins: Bivalirudin and Fondaparinux
Reperfusion Therapies
Fibrinolytic Therapy
Fibrinolytic Agent Selection
Eligibility Criteria for Fibrinolytic Agent Therapy
12-Lead Electrocardiogram
Patient Age
Time from Symptom Onset
Blood Pressure Extremes
Retinopathy
Cardiac Arrest Requiring Cardiopulmonary Resuscitation
Previous Stroke or Transient Ischemic Attack
Previous Myocardial Infarction or Coronary Artery Bypass Graft
Recent Surgery or Trauma
Menstruation
Percutaneous Coronary Intervention
Rescue Percutaneous Coronary Intervention
Facilitated Percutaneous Coronary Intervention
Choice of Reperfusion Therapy
Reperfusion Therapy in Cardiogenic Shock
Resuscitated Cardiac Arrest with Suspected ACS
Management Summary: Potential Pharmacologic Management Approach
Disposition
Transfer of a Patient with Acute Coronary Syndrome
Missed Diagnosis of Acute Coronary Syndrome
References
Chapter 65: Dysrhythmias
Foundations
Cardiac Cellular Electrophysiology
Anatomy and Conduction
Mechanisms of Dysrhythmia Formation
Classification of Antidysrhythmic Drugs
Class IA Agents
Procainamide
Class IB Agents
Lidocaine
Class IC Agents
Flecainide
Propafenone
Class II Agents
Esmolol
Metoprolol
Class III Agents
Amiodarone
Ibutilide
Sotalol
Dofetilide
Dronedarone
Class IV Agents
Diltiazem
Verapamil
Miscellaneous Agents
Adenosine
Digoxin
Magnesium
Isoproterenol
Clinical Features
Initial Assessment of Stable Patients
Differential Diagnosis
Management
Sinus Bradycardia and Sinoatrial and Atrioventricular Block
Sinus Bradycardia
Sinus Dysrhythmia
Sinus Arrest and Sinoatrial Exit Block
Sick Sinus Syndrome
Atrioventricular Block
First-Degree Atrioventricular Block
Second-Degree Atrioventricular Block
Type I Second-Degree Atrioventricular Block
Type II Second-Degree Atrioventricular Block
Third-Degree Atrioventricular Block
Extrasystoles
Premature Atrial Contractions
Premature Ventricular Contractions
Narrow-Complex Tachycardia
Sinus Tachycardia
Atrial Tachycardia
Atrial Fibrillation
Atrial Flutter
Atrioventricular Nodal Reentrant Tachycardia
Junctional Tachycardia
Preexcitation and Accessory Pathway Syndromes
Wide-Complex Tachycardia
Ventricular Tachycardia
Torsades de Pointes
Brugada Syndrome
Disposition
References
Chapter 66: Implantable Cardiac Devices
Permanent Pacemakers
Principles
Clinical Features
Pacemaker Terminology
Pacemaker Components
History
Physical Examination
12-Lead Electrocardiogram
Differential Diagnosis
Complications of Implantation
Infection
Venous Thrombosis and Stenosis
Complications of Existing Pacemakers
The “Pacemaker Syndrome”
Complications Unique to Biventricular Pacing
Pacemaker Malfunction
Failure to Capture
Inappropriate Sensing
Inappropriate Pacemaker Rate
Diagnostic Testing
Chest Radiograph
12-Lead Electrocardiogram
Pacemaker Interrogation
Magnetic Resonance Imaging in Patients with a Pacemaker
Management
Resuscitation
Disposition
Implantable Cardioverter-Defibrillators
Principles
Clinical Features
Terminology and Components
Differential Diagnosis
Complications of Implantation
Malfunction
Diagnostic Testing
Management
ICD Defibrillation
Resuscitation
Disposition
Mechanical Circulatory Support Devices
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
References
Chapter 67: Heart Failure
Foundations
Background and Importance
Epidemiology
Myocardial Physiology and the Cardiac Cycle in Heart Failure
Abnormal Loading Conditions and Elevated Filling Pressures
Congestion and Preload
Afterload
Disorganized Contraction
Right Ventricular Dysfunction and Pulmonary Hypertension
Myocardial Infarction Versus Injury
Cardiorenal Syndrome
Other Factors
Clinical Features
History and Physical Exam
Precipitants
Differential Diagnosis
Diagnostic Testing
Electrocardiogram
Chest Radiography
Laboratory Testing
Lung Ultrasound
Echocardiography
Management
Initial Evaluation
Blood Pressure Considerations
Vascular Phenotype
Cardiac Phenotype
Disposition
References
Chapter 68: Pericardial and Myocardial Disease
Myocardial Disease
Dilated Cardiomyopathy
Foundations
Clinical Features
Diagnostic Testing
Differential Diagnosis
Management and Disposition
Disposition
Hypertrophic Cardiomyopathy
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Restrictive Cardiomyopathy
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Peripartum Cardiomyopathy
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Takotsubo Syndrome
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Arrhythmogenic Right Ventricular Cardiomyopathy
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Channelopathies
Myocarditis
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Chagas Disease
Cocaine Cardiotoxicity
Sudden Death
Pericardial Disease
Pericarditis
Foundations
Clinical Findings
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Uremic Pericardial Disease
Post–Myocardial Infarction Pericarditis
Postinjury Pericarditis
Neoplastic Pericardial Disease
Radiation-Induced Pericarditis
Miscellaneous Causes of Pericarditis
Pericardial Effusion
Purulent Pericarditis
Constrictive Pericarditis
Cardiac Tamponade
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Pneumopericardium
References
Chapter 69: Infective Endocarditis and Valvular Heart Disease
Infective Endocarditis
Foundations
Background and Importance
Pathophysiology and Microbiology
Clinical Features and Differential Diagnosis
Diagnostic Testing
Management
Disposition
Prophylaxis
Rheumatic Fever
Foundations
Background and Importance
Pathophysiology
Clinical Features and Differential Diagnosis
Diagnostic Testing
Management and Disposition
Valvular Heart Disease
Foundations
Anatomy and Physiology
Mitral Stenosis
Pathophysiology
Clinical Features
Management
Mitral Regurgitation
Pathophysiology
Clinical Features
Acute Mitral Regurgitation
Chronic Mitral Regurgitation
Management
Mitral Valve Prolapse
Pathophysiology
Clinical Features
Management
Aortic Stenosis
Pathophysiology
Clinical Features
Management
Aortic Regurgitation
Pathophysiology
Clinical Features
Acute Aortic Regurgitation
Chronic Aortic Regurgitation
Management
Complications of Prosthetic Valves
Structural Failure
Valve Thrombosis
Systemic Embolization
Hemolysis
Endocarditis
Disposition
References
Section Four: Vascular System
Chapter 70: Hypertension
Foundations
Background and Importance
Importance
Definition of Hypertension and Relevant Terminology
Physiology of Hypertension
Neurohormonal Dysregulation
Vascular Modulation
Sodium Intake
Psychosocial Stress
Obesity
Pathophysiology of Target-Organ Damage
Clinical Features
Hypertensive Emergency
Hypertensive Encephalopathy
Other Hypertension-Related Emergencies
Acute Target Organ Damage in the Context of Systemic Illness
Absence of Target Organ Dysfunction
Differential Diagnoses
Diagnostic Testing
Management
Acute Blood Pressure Control
Antihypertensive Therapy
Blood Pressure Goals
Acute Coronary Syndrome and Acute Heart Failure
Aortic Dissection
Acute Ischemic Stroke
Spontaneous Intracranial Hemorrhage
Hypertensive Encephalopathy
Acute Kidney Injury
Preeclampsia and Eclampsia
Sympathetic Crises
Chronic Antihypertensive Therapy
Disposition
References
Chapter 71: Aortic Dissection
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
References
Chapter 72: Abdominal Aortic Aneurysm
Principles
Epidemiology
Pathophysiology
Natural History
Clinical Features
Unruptured Aneurysms
Ruptured Aneurysms
Pain-Hypotension-Mass Triad
Aortoenteric Fistula
Arteriovenous (Aortocaval) Fistula
Differential Diagnoses
Diagnostic Testing
Abdominal Radiography
Ultrasonography
Computed Tomography
Other Diagnostic Modalities
Management
Ruptured Aneurysms
Fluid Resuscitation
Diagnostic Confirmation
Surgery and Mortality
Intact Asymptomatic Aneurysms
Traditional Repair
Endovascular Repair
Survival
Late Complications of Repair
Graft Infection
Aortoenteric Fistula
Pseudoaneurysm (Anastomotic Aneurysm)
Complications of Endovascular Aneurysm Repair
Disposition
References
Chapter 73: Peripheral Arteriovascular Disease
Foundations
Background
Arterial Anatomy
Pathophysiology
Atherosclerosis
Arterial Embolism
Thromboembolism
Atheroembolism
Arterial Thrombosis
Aneurysms
Inflammation
Trauma
Vasospasm
Arteriovenous Fistulae
Clinical Features
History
Physical Examination
Inflammation
Vasospasm
Differential Diagnosis
Diagnostic Testing
Noninvasive Assessment
Contrast Arteriography
Computed Tomography and Magnetic Resonance Imaging
Management
Noninvasive Therapy
Acute Anticoagulation with Heparin
Fibrinolytic Therapy
Invasive Therapy
Fogarty Catheter Thrombectomy
Peripheral Percutaneous Transluminal Angioplasty
Grafting
Hyperbaric Therapy
Disposition
Specific Arteriovascular Diseases
Diseases of Chronic Arterial Insufficiency
Arteriosclerosis Obliterans
Clinical Features
History
Physical Exam
Differential Diagnosis
Management
Buerger Disease (Thromboangiitis Obliterans)
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Diseases of Acute Arterial Occlusion
Arterial Embolism
Clinical Features
History
Physical Examination
Differential Diagnosis
Management
Atheroembolism (Blue Toe Syndrome)
Clinical Features
Differential Diagnosis
Management
Arterial Thrombosis
Physical Exam
Management
Peripheral Arterial Aneurysms
Lower Extremity
Upper Extremity
Viscera
Splenic Artery Aneurysms
Hepatic Artery Aneurysms
Superior Mesenteric Artery Aneurysms
Traumatic Aneurysms
Infected Aneurysms
Mycotic Aneurysms
Atherosclerotic Arteries
Preexisting Aneurysms
Post-Traumatic Pseudoaneurysms
Vasospastic Disorders
Thoracic Outlet Syndrome
Clinical Features
Physical Examination
Ancillary Evaluation
Differential Diagnosis
Management
Disposition
Peripheral Arteriovenous Fistulae
Physical Exam
Differential Diagnosis
Management
Vascular Abnormality Caused by Drug Abuse
Principles
Clinical Features
Management
References
Chapter 74: Pulmonary Embolism and Deep Vein Thrombosis
Foundations
Background and Importance
Anatomy, Pathology, and Pathophysiology of VTE
Deep Vein Thrombosis
Clinical Features
Differential Diagnosis
Diagnostic Testing
Pretest Probability Estimation
Laboratory Evaluation
Radiographic Evaluation
Management
Assessing Bleeding Risk
Superficial Vein Thrombophlebitis
Isolated Calf Vein Thrombosis
Phlegmasia Cerulean and Alba Dolens
Upper Extremity Venous Thromboses
Complications
Disposition
Pulmonary Embolism
Clinical Features
Symptoms
Vital Signs
Physical Examination
Differential Diagnosis
Diagnostic Testing
Bedside Assessment
Pretest Probability Assessment
Pulmonary Embolism Rule-Out Criteria
D-Dimer Testing
Computed Tomography Pulmonary Angiography
Ventilation/Perfusion Scan
Pregnant Women
Clinical Course
Management
Airway, Oxygenation, and Ventilation
Hemodynamic Resuscitation
Pulmonary Vasodilators
Standard Anticoagulation
Reversal of Anticoagulation
Thrombolytic (Fibrinolytic) Therapy
Catheter-Directed Interventions
Surgical Embolectomy
Inferior Vena Cava Filters
Pulmonary Embolism Response Teams (PERT)
Mortality and Morbidity
Disposition
References
Chapter 75: Esophagus, Stomach, and Duodenum
Dysphagia
Foundations
Anatomy and Pathophysiology
Oropharyngeal Dysphagia
Neuromuscular Disorders
Structural Disorders
Esophageal Dysphagia
Mechanical Disorders
Motor Disorders
Clinical Features
Oropharyngeal Dysphagia
Esophageal Dysphagia
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Foreign Bodies
Foundations
Background
Anatomy and Physiology
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Overview
Upper Esophagus
Lower Esophagus
Stomach
Disposition
Esophageal Perforation
Foundations
Background
Anatomy and Physiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Esophagitis
Foundations
Gastroesophageal Reflux Disease
Eosinophilic Esophagitis
Infectious Esophagitis
Pill Esophagitis
Radiation-Induced Esophagitis
Clinical Features
Gastroesophageal Reflux Disease
Eosinophilic Esophagitis
Infectious Esophagitis
Pill Esophagitis
Differential Diagnoses
Diagnostic Testing
Management
Gastric Reflux
Eosinophilic Esophagitis
Infectious Esophagitis
Pill Esophagitis
Disposition
Gastritis and Peptic Ulcer Disease
Foundations
Background
Pathophysiology
Clinical Features
Complications
Differential Diagnoses
Diagnostic Testing
Management
Antacids
Histamine Blockers
Proton Pump Inhibitors
Prostaglandins
Other Agents
Disposition
Gastric Volvulus
Foundations
Clinical Features
Complications
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Chapter 76: Liver and Biliary Tract Disorders
Hepatic Disorders
Hepatitis
Viral Hepatitis
Foundations
Hepatitis A
Hepatitis B
Hepatitis C and E
Hepatitis D
Hepatitis E and G
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Prevention and Postexposure Management
Disposition
Alcoholic Hepatitis
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Autoimmune Hepatitis
Foundations
Diagnosis
Management
Disposition
Cirrhosis
Foundations
Clinical Features
Diagnostic Testing
Management
Ascites
Gastrointestinal Bleeding
Hepatorenal Syndrome
Hepatic Encephalopathy
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Spontaneous Bacterial Peritonitis
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Hepatic Abscesses
Pyogenic Abscess
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Amebic Abscess
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Miscellaneous Disorders and Conditions of the Liver
Liver Disease of Pregnancy
Benign Cholestasis
Acute Fatty Liver
Budd-Chiari Syndrome
Liver Transplantation
Biliary Tract Disorders
Cholelithiasis
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Special Considerations
Disposition
Cholecystitis
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Special Considerations
Acalculous Cholecystitis
Emphysematous Cholecystitis
Disposition
Cholangitis
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Sclerosing Cholangitis
Aids Cholangiopathy
References
Section Five: Gastrointestinal System
Chapter 77: Pancreas
Pancreatitis
Anatomy, Physiology, and Pathophysiology
Acute Pancreatitis
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Laboratory Tests
Radiologic Tests
Predicting Disease Severity
Management
Disposition
Chronic Pancreatitis
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Pancreatic Cancer
Foundations
Clinical Features
Diagnostic Testing
Management
References
Chapter 78: Small Intestine
Small Bowel Obstruction
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Pathophysiology
Clinical Features
History
Physical Examination
Differential Diagnosis
Diagnostic Testing
Laboratory
Imaging
Management
Disposition
Acute Mesenteric Ischemia
Foundations
Background and Importance
Anatomy and Physiology
Pathophysiology
Mesenteric Arterial Embolism
Mesenteric Arterial Thrombosis
Nonocclusive Mesenteric Ischemia
Mesenteric Venous Thrombosis
Unusual Causes of Mesenteric Ischemia
Clinical Features
History
Physical Examination
Differential Diagnosis
Diagnostic Testing
Laboratory Tests
Imaging
Management
Complications
Disposition
References
Chapter 79: Acute Appendicitis
Principles
Background
Anatomy and Physiology
Pathophysiology
Clinical Features
History
Physical Examination
Differential Diagnosis
Diagnostic Testing
General Principles
Laboratory Testing
White Blood Cell Count
C-Reactive Protein
Urinalysis
Other Laboratory Tests
Combined Laboratory Tests
Clinical Decision Instruments
Imaging
General Principles
Plain Radiographs
Graded Compression Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Summary of Imaging Methods
Nonpregnant Patients
Pregnant Patients
Management
Supportive Care
Antibiotic Therapy
Definitive Treatment
Uncomplicated Appendicitis
Complicated Appendicitis
Disposition
References
Chapter 80: Gastroenteritis
Overview
Foundations
Background and Importance
Pathophysiology
Clinical Features
Patient History
Physical Examination
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Bacterial Gastroenteritis
Invasive Bacteria
Campylobacter Enteritis
Epidemiology
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Salmonellosis
Epidemiology
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Shigellosis
Epidemiology
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Yersinia enterocolitica Gastroenteritis
Epidemiology
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Vibrio parahaemolyticus Gastroenteritis
Epidemiology
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Shiga Toxin–Producing Escherichia coli
Epidemiology
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Noninvasive Toxin-Forming Bacteria
Staphylococcus spp.
Epidemiology
Pathophysiology
Clinical Features
Management
Clostridium perfringens
Epidemiology
Pathophysiology
Clinical Features
Management
Bacillus cereus
Epidemiology
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Cholera and Noncholera Vibrio Species
Epidemiology
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Enterotoxigenic Escherichia coli
Epidemiology
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Clostridium difficile Colitis
Epidemiology
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Viral Gastroenteritis
Norovirus
Epidemiology
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Rotavirus
Epidemiology
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Parasites
Giardia
Epidemiology
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Amebiasis
Epidemiology
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Food Poisoning
Foundations
Clinical Features
Diagnostic Testing
Management
Scombroid Fish Poisoning
Epidemiology
Pathophysiology
Clinical Features
Management
Ciguatera Fish Poisoning
Epidemiology
Pathophysiology
Clinical Features
Management
Specific Groups With Gastroenteritis
Traveler’s Diarrhea
Epidemiology
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Gastroenteritis in the Immunocompromised Host with HIV/AIDS
Epidemiology and Pathophysiology
Clinical Features
Diagnostic Testing
Management
References
Chapter 81: Large Intestine
Irritable Bowel Syndrome
Foundations
Background
Anatomy, Physiology, and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Diverticular Disease
Foundations
Background
Anatomy, Physiology, and Pathophysiology
Clinical Features
Diverticulosis
Diverticulitis
Differential Diagnoses
Diagnostic Testing
Management
Diverticulosis
Uncomplicated Diverticulitis
Complicated Diverticulitis
Disposition
Large Bowel Obstruction
Foundations
Background
Anatomy, Physiology, and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Laboratory Tests
Imaging Studies
Plain Radiography
Computed Tomography
Colonoscopy and Water-Soluble Contrast Enema
Management
Disposition
Volvulus
Foundations
Background
Anatomy, Physiology, and Pathophysiology
Sigmoid Volvulus
Cecal Volvulus
Clinical Features
Sigmoid Volvulus
Cecal Volvulus
Differential Diagnoses
Diagnostic Testing
Sigmoid Volvulus
Cecal Volvulus
Management
Sigmoid Volvulus
Cecal Volvulus
Disposition
Intussusception
Foundation
Background
Anatomy, Physiology, and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Ultrasound Examination
Plain Radiography
Computed Tomography
Colonoscopy
Management
Disposition
Inflammatory Bowel Disease
Foundations
Background
Anatomy, Physiology, and Pathophysiology
Crohn Disease
Ulcerative Colitis
Clinical Features
Toxic Megacolon
Extraintestinal Manifestations
Differential Diagnoses
Diagnosis
Management
Crohn Disease
Mild to Moderate Disease
Moderate to Severe Disease
Severe to Fulminant Disease
Ulcerative Colitis
Mild to Moderate Disease
Moderate to Severe Disease
Managing Special Populations With Irritable Bowel Syndrome
Toxic Megacolon
Disposition
Colonic Ischemia
Foundations
Background
Anatomy, Physiology, and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Laboratory Tests
Imaging Studies
Plain Radiography
Computed Tomography
Colonoscopy
Angiography
Management
Disposition
Stercoral Colitis
Foundations
Background
Anatomy, Physiology, and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnosis
Management
Disposition
Radiation Proctocolitis
Foundations
Background
Anatomy, Physiology, and Pathophysiology
Acute Radiation Proctocolitis
Chronic Radiation Proctocolitis
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Acute Radiation Proctocolitis
Chronic Radiation Proctocolitis
Disposition
Neutropenic Enterocolitis
Foundations
Background
Anatomy, Pathology, and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Laboratory Tests
Radiologic Tests
Management
Disposition
References
Chapter 82: Anorectum
Foundations
Clinical Features
Specific Anorectal Problems
Hemorrhoids
Foundations
Clinical Features
Management
Anal Fissures
Foundations
Clinical Features
Management
Abscesses and Fistulae
Foundations
Management
Perirectal and Perianal Abscesses
Ischiorectal Abscess
Intersphincteric Abscess
Supralevator Abscess
Postanal Abscess
Horseshoe Abscess
Necrotizing Infection
Fistulae
Pilonidal Disease
Foundations
Management
Hidradenitis Suppurativa
Foundations
Clinical Findings
Differential Diagnosis
Management
Proctalgia
Levator Ani Syndrome
Proctalgia Fugax
Fecal Incontinence
Foundations
Clinical Features
Management
Pruritis Ani
Foundations
Diagnostic Testing
Management
Sexually Transmitted Disease and Proctitis
Foundations
Gonorrhea
Chlamydial Infection and Lymphogranuloma Venereum
Herpes Simplex Virus Infection
Syphilis
Chancroid
Condyloma Acuminatum
Ulcerative Lesions in HIV-Infected Patients
Management
Radiation Proctitis
Rectal Prolapse
Rectal Foreign Bodies
Foundations
Clinical Features
Diagnostic Testing
Management
References
Section Six: Genitourinary and Gynecologic Systems
Chapter 83: Renal Failure
Renal Failure
Acute Kidney Injury
Foundations
Clinical Features
Differential Diagnosis
Prerenal Azotemia
Postrenal (Obstructive) Acute Kidney Injury
Intrinsic Acute Kidney Injury
Acute Glomerulonephritis
Acute Interstitial Nephritis
Intrarenal Vascular Disease of the Kidney
Acute Tubular Necrosis
Diagnostic Testing
Urine Volume
Urinalysis
Heme
Protein
Serum and Urine Chemical Analysis
Creatinine and Blood Urea Nitrogen
Urine Sodium and Fractional Excretion of Sodium
Renal Imaging
Computed Tomography
Ultrasonography
Diagnosis
Management
Hyperkalemia and Other Metabolic Derangements
Hyperkalemia
Hypocalcemia
Hyperphosphatemia
Hypermagnesemia
Disturbances of Volume Regulation
Disposition
Chronic Kidney Disease
Foundations
Pathophysiology
Clinical Features
Cardiovascular System
Pulmonary Effects
Neurologic Features
Gastrointestinal System
Dermatologic Features
Musculoskeletal System
Immunologic Considerations
Hematologic Effects
Differential Diagnosis
Diagnostic Testing
Management
Hyperkalemia
Pulmonary Edema
Infection
Dialysis
Hemodialysis
Peritoneal Dialysis
Indications for Dialysis
Complications of Dialysis
Hemodialysis
Vascular Access–Related Complications
Non–Vascular Access–Related Complications of Dialysis
Hypotension
Shortness of Breath
Chest Pain.
Neurologic Dysfunction
Peritoneal Dialysis
References
Chapter 84: Sexually Transmitted Infections
Disorders Characterized by Genital Ulcers
Herpes
Background and Importance
Clinical Features
Diagnostic Testing
Management
Disposition
Syphilis
Background and Importance
Clinical Features
Diagnostic Testing
Management
Disposition
Chancroid
Background and Importance
Clinical Features
Diagnostic Testing
Management
Disorders Characterized by Genital Discharge
Foundations
Gonorrhea
Background and Importance
Clinical Features
Diagnostic Testing
Treatment
Disposition
Chlamydia
Background and Importance
Clinical Features
Diagnostic Testing
Management
Disposition
Nongonococcal Urethritis
Trichomoniasis
Background and Importance
Clinical Features
Diagnostic Testing
Management
Disposition
Pelvic Inflammatory Disease
Background and Importance
Clinical Features
Diagnostic Testing
Management
Disposition
Bacterial Vaginosis
Background and Importance
Clinical Features and Diagnostic Testing
Management
Vulvovaginal Candidiasis
Background and Importance
Clinical Features and Diagnostic Testing
Management
Epithelial Cell Infections
Condyloma Acuminata (Genital Warts)
Background and Importance
Clinical Findings
Diagnostic Testing
Management
Molluscum Contagiosum
Ectoparasites
Pediculosis Pubis
Scabies
References
Chapter 85: Urologic Disorders
Urinary Tract Infection in Adults
Background
Anatomy and Physiology
Pathophysiology
Clinical Features
Differential Diagnosis
Diagnostic Testing
Urinalysis and Urine Culture
Imaging
Management
Simple Urinary Tract Infection
Complex Urinary Tract Infection
Disposition
Complicated Urinary Tract Infection in High-Risk Populations
Pregnancy
Indwelling and Temporary Urinary Catheters
Prostatitis
Background
Clinical Features
Diagnostic Testing
Management
Renal Calculi
Background
Pathophysiology
Clinical Features
Differential Diagnosis
Diagnostic Testing
Urinalysis and Culture
Other Laboratory Tests
Imaging
Radiography of the Kidney, Ureter, and Bladder
Intravenous Pyelography
Computed Tomography
Ultrasonography
Management
Disposition
Indications for Admission
Outpatient Management
Bladder (Vesical) Calculus
Background
Clinical Features
Diagnostic Testing
Management
Acute Scrotal Pain
Background
Specific Disorders
Testicular Torsion
Background
Clinical Features
Differential Diagnosis
Diagnostic Testing
Urinalysis
Imaging
Management
Disposition
Torsion of Appendages of the Testis
Background
Clinical Features
Diagnostic Testing
Management and Disposition
Epididymitis
Background
Clinical Features
Diagnostic Testing
Management
Disposition
Orchitis
Background
Clinical Features
Diagnostic Testing
Management
Testicular Tumors
Background
Clinical Features
Diagnostic Testing
Management and Disposition
Testicular Trauma
Inguinal Hernia, Acute Hydrocele, Varicocele, and Spermatocele
Acute Urinary Retention
Background
Physiology and Pathophysiology
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Hematuria
Background
Clinical Features
Diagnostic Testing
Management and Disposition
References
Chapter 86: Gynecologic Disorders
Gynecologic Disorders
Adnexal Torsion
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Laboratory Tests
Imaging Tests
Ultrasonography
Computed tomography
Magnetic resonance imaging
Laparoscopy
Management and Disposition
Ovarian Cysts and Masses
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Laboratory Tests
Imaging Tests
Ultrasonography
Computed tomography
Magnetic resonance imaging
Management and Disposition
Abnormal Uterine Bleeding in the Nonpregnant Patient
Foundations
Clinical Features
History
Physical Examination
Differential Diagnoses
Diagnostic Strategies
Laboratory Tests
Imaging Tests
Management
Disposition
Emergency Contraception
References
Section Seven: Neurology
Chapter 87: Stroke
Foundations
Background and Importance
Ischemic Stroke
Transient Ischemic Attack
Hemorrhagic Stroke
Anatomy, Physiology, and Pathophysiology
Clinical Features
Ischemic Stroke
Chemoreceptor Trigger Zone for Emesis
Hemorrhagic Stroke
Differential Diagnoses
Ischemic Stroke
Hemorrhagic Stroke
Diagnostic Testing
Ischemic Stroke
Transient Ischemic Attack
Hemorrhagic Stroke
Management
Ischemic Stroke
Blood Pressure Management
Temperature
Blood Glucose
Reperfusion Therapy
Thrombolytic Therapy
Agent and Dosage
Time Window
Thrombolysis for Mild Disabling Versus Nondisabling Acute Ischemic Stroke
Thrombolysis in Patients on Anticoagulants Before the Stroke
Symptomatic Intracerebral Hemorrhage Following Thrombolysis
Cerebral Microbleeds
Mechanical Thrombectomy
Timing
Mechanical Thrombectomy and Thrombolysis
Spontaneous Intracerebral Hemorrhage (Hemorrhagic Stroke)
Monitoring
Blood Pressure Management
Reversal of Anticoagulation
Hemostatic Agents
Seizures
Prognosis
Increased Intracranial Pressure
Neurosurgical Intervention
Transient Ischemic Attack
Disposition
References
Chapter 88: Seizure
Foundations
Background and Classification
Anatomy, Physiology, and Pathophysiology
Clinical Features
Clinical History
Physical Examination
Differential Diagnosis
Diagnostic Testing
Laboratory Studies
Radiology
Special Procedures and Tests
Management
Stabilization and Empirical Therapy
Definitive Management
Special Cases
Alcohol-Related Seizures
Seizures Related to Other Toxins
Post-Traumatic Seizures
Seizures in Pregnancy
First-Time Seizures
Breakthrough Seizures
Post-Anoxic Seizures
Nonconvulsive Status Epilepticus
Inflammation-Related Seizures
Disposition
References
Chapter 89: Headache Disorders
Primary Headache Disorders
Migraine Headache
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Cluster Headache
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Tension-Type Headache
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Secondary Headache Disorders
Subarachnoid Hemorrhage
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Intracranial Neoplasm
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Giant Cell Arteritis
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Carotid and Vertebral Artery Dissection
Principles
Clinical Features
Carotid Artery Dissection
Vertebral Artery Dissection
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Cerebral Venous Thrombosis
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Idiopathic Intracranial Hypertension
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Post–Dural Puncture Headache and Other Low CSF Pressure Headaches
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Post-Traumatic Headache
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Hypertensive Headache
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Reversible Cerebral Vasoconstriction Syndrome
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Chapter 90: Delirium and Dementia
Overview
Delirium
Background
Pathophysiology
Clinical Features
Differential Diagnosis
Diagnostic Studies
Management
Disposition
Dementia
Principles
Background
Pathophysiology
Clinical Features
Differential Diagnosis
Senescent Forgetfulness
Delirium
Depression
Diagnostic Testing
Cognitive Evaluation
Laboratory Tests and Imaging Studies
Management
Disposition
References
Chapter 91: Brain and Cranial Nerve Disorders
Multiple Sclerosis
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Cerebral Venous Thrombosis
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Cranial Nerve Disorders
Trigeminal Neuralgia (Cranial Nerve V)
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Facial Nerve Paralysis (Cranial Nerve VII)
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Vestibular Schwannoma (Cranial Nerve VIII)
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Diabetic Cranial Mononeuropathy
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Chapter 92: Spinal Cord Disorders
Foundations
Anatomy
Classification of Spinal Cord Syndromes
Complete (Transverse) Spinal Cord Syndrome
Incomplete (Partial) Spinal Cord Lesions
Central Cord Syndrome
Brown-Séquard Syndrome
Anterior Cord Syndrome
Conus Medullaris and Cauda Equina Syndromes
Clinical Features
History
Physical Examination
Motor Function
Sensory Function
Reflexes
Differential Diagnoses
Diagnostic Testing
Management
Specific Disease Processes
Intrinsic Cord Lesions
Multiple Sclerosis
Transverse Myelitis
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Strategies
Management
Spinal Subarachnoid Hemorrhage
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Syringomyelia
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Human Immunodeficiency Virus Myelopathy
Spinal Cord Infarction
Surfer’s Myelopathy
Extrinsic Cord Lesions
Spinal Epidural Hematoma
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Spinal Epidural Abscess
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Discitis
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Neoplasm
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Chronic Complications of Spincal Cord Injury
Autonomic Dysreflexia
Foundations
Clinical Features
Management
Spasticity
Infection
References
Chapter 93: Peripheral Nerve Disorders
Overview
Principles
Differential Diagnosis
Diagnostic Testing
Specific Types of Neuropathies
Type 1: Demyelinating Polyneuropathy (Guillain-­Barré Syndrome)
Principles
Clinical Features
Diagnostic Testing
Management
Disposition
Type 2: Distal Symmetrical Polyneuropathy
Principles
Clinical Findings
Differential Diagnosis
Diagnostic Testing
Management
Type 3: Asymmetric Proximal and Distal Peripheral Neuropathies (Radiculopathies and Plexopathies)
Type 4: Isolated Mononeuropathies
Radial Mononeuropathy
Principles
Clinical Findings
Diagnostic Testing
Management
Ulnar Mononeuropathy
Principles and Clinical Findings
Diagnostic Testing
Management
Median Mononeuropathy
Principles
Clinical Findings
Diagnostic Testing
Management
Sciatic Mononeuropathy
Principles
Clinical Findings
Diagnostic Testing
Management
Lateral Femoral Cutaneous Mononeuropathy
Principles
Clinical Findings
Diagnostic Testing
Management
Common Peroneal Mononeuropathy
Principles
Clinical Findings
Diagnostic Testing
Management
Type 5: Mononeuropathy Multiplex
Principles
Clinical Findings
Lyme Disease
Diagnostic Testing
Management
Type 6: Amyotrophic Lateral Sclerosis
Principles
Clinical Findings
Diagnostic Testing
Management
Type 7: Sensory Neuronopathy (Ganglionopathy)
Principles
Clinical Findings
Diagnostic Testing
Management
References
Chapter 94: Neuromuscular Disorders
Foundations
Clinical Features
History
Physical Examination
Differential Diagnosis
Myelopathies
Motor Neuron Disease
Neuropathies
Diseases of the Neuromuscular Junction
Myopathies
Diagnostic Testing
Disorders of the Neuromuscular Junction
Myasthenia Gravis
Principles
Myasthenic crisis
Lambert-Eaton syndrome
Diagnostic Testing
Management
Disposition
Botulism
Principles
Clinical Features
Diagnostic Testing
Management
Disposition
Tick Paralysis
Principles
Clinical Features
Management
Disposition
Disorders of the Muscles
Inflammatory Disorders
Principles
Clinical Features
Diagnostic Testing
Management
Disposition
Metabolic Disorders
Periodic Paralysis
Principles
Clinical features
Diagnostic testing
Management
Disposition
References
Chapter 95: Central Nervous System Infections
Foundations
Background and Pathophysiology
Bacterial Meningitis
Viral Meningitis
Viral Encephalitis
Tuberculous Meningitis
Fungal Meningitis
Central Nervous System Abscess
Clinical Features
Meningitis
Encephalitis
Central Nervous System Abscess
CSF Shunt Infection
Differential Diagnoses
Diagnostic Testing
Blood Testing
Neuroimaging
Lumbar Puncture
Opening Pressure
Cerebrospinal Spinal Fluid Analysis
Cerebrospinal Spinal Fluid Cell Count
Gram Stain
Xanthochromia
Glucose
Protein
Other Stains
Lactic Acid
Antigen Detection
Bacterial Cultures
Additional Investigations
Management
Bacterial Meningitis
Tuberculous Meningitis
Fungal Meningitis
Viral Meningitis
Viral Encephalitis
Central Nervous System Abscess
CSF Shunt Infection
Chemoprophylaxis
Immunoprophylaxis
Disposition
References
Section Eight: Behavioral Disorders
Chapter 96: Thought Disorders
Foundations
Background and Importance
Pathophysiology
Clinical Features
Differential Diagnoses
Medical Disorders
Psychiatric Disorders
Diagnostic Testing
Management
Disposition
References
Chapter 97: Mood Disorders
Foundations
Background and Importance
Epidemiology
Neuroanatomy
Pathophysiology
Neurophysiology
Endocrine System
Genetics
Psychosocial Factors
Clinical Features
Major Depressive Disorder
Mood Disturbances
Disturbances in Psychomotor Activity
Vegetative Disturbances
Thought Process and Content
Masked Depression
Special Considerations
Children and Adolescents
Disruptive Mood Dysregulation Disorder
Geriatric Patients
Other Depressive Disorders
Peripartum Depression
Persistent Depressive Disorder
Premenstrual Dysphoric Disorder
Seasonal Affective Disorder
Bipolar Disorders
Manic Episode
Cyclothymic Disorder
Mood Disorders Caused by a General Medical Condition
Mood Disorders Caused by Medications or Other Substances
Differential Diagnoses
Medical Disorders, Medications, and Substance Abuse or Withdrawal
Grief and Bereavement
Adjustment Disorders
Borderline Personality Disorder
Dementia
Diagnostic Testing
Management
Disposition
References
Chapter 98: Anxiety Disorders
Foundations
Background and Importance
Epidemiology
Pathophysiology
Clinical Features
Panic Disorder
Generalized Anxiety Disorder
Post-Traumatic Stress Disorder
Specific Phobias
Obsessive-Compulsive Disorder
Hyperventilation Syndrome
Somatic Symptoms and Related Disorders
Differential Diagnosis
Cardiac Diseases
Endocrine Diseases
Respiratory Diseases
Neurologic Disorders
Drug Intoxication and Withdrawal States
Diagnostic Testing
Management
Pharmacologic Treatment
Nonpharmacologic Therapy
Disposition
References
Chapter 99: Somatic Symptoms and Related Disorders
Foundations
Clinical Features
Somatic Symptom Disorder
Illness Anxiety Disorder
Conversion Disorder
Factitious Disorder
Psychological Factors Affecting Medical Illness
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Chapter 100: Factitious Disorders and Malingering
Foundations
Clinical Features
Factitious Disorders
Factitious Disorders Imposed on Self
Psychological Symptoms
Physical Symptoms
Munchausen Syndrome
Factitious Disorder Imposed on Another
Perpetrator Characteristics
Victim Characteristics
Malingering
Differential Diagnoses
Diagnostic Testing
Factitious Disorder
Malingering
Management
Factitious Disorders
Malingering
Disposition
References
Chapter 101: Suicidal Behavior
Foundations
Background and Importance
Epidemiology
Risk Factors
Precipitating Factors
At Risk Populations
Mental Illness
Alcohol and Substance Abuse Disorders
Chronic Illness
Pathophysiology
Methods of Suicide
Clinical Features
Initial Recognition and Screening
History and Physical Examination
Differential Diagnoses
Normal Colloquialisms and Expressions of Suffering
Malingering
Non-Suicidal Self-Injury
Unintentional Injury or Ingestion
Substance Intoxication, Abuse, or Misuse
Suicidal Obsessions or Preoccupations
Diagnostic Testing
Management
Overview
Suicide Precautions
Pharmacologic Treatment
Risk Assessment
Documentation
Disposition
Psychiatric Hospitalization
Discharge
Brief Patient Education
Joint Safety Planning
Lethal Means Restriction Counseling
Referral for Outpatient Care
Caring Contacts
Additional Ethical Considerations
Do-Not-Resuscitate Orders
Physician-Assisted Dying
References
Section Nine: Immunologic and Inflammatory
Chapter 102: Arthritis
General Approach to Arthritis
Foundations
Background
Pathophysiology
Clinical Features and Differential Diagnosis
History
Physical Examination
General examination
Joint examination
Inspection
Palpation
Range of motion
Neurovascular evaluation
Diagnostic Testing
Radiographic Tests
Plain radiographs
Ultrasound
Computed Tomography and Magnetic Resonance Imaging
Laboratory Testing
Arthrocentesis and Synovial Fluid Analysis
Arthrocentesis
Indications and contraindications
Complications
Synovial fluid examination
General appearance
White blood cell count
Lactate and C-reactive protein
Crystal evaluation
Gram stain and culture
Management
Disposition
Acute Monoarticular Joint Pain
Nongonococcal Bacterial Septic Arthritis
Foundations
Clinical Features and Differential Diagnosis
Diagnostic testing
Management
Chronic Monoarticular Arthritis
Osteoarthritis
Foundations
Clinical Features
Diagnostic Testing
Management
Acute Polyarticular Joint Pain
Gonococcal Arthritis
Foundations
Clinical Features
Management
Gout
Foundations
Clinical Features
Diagnostic Testing
Management
Pseudogout
Foundations
Clinical Features
Diagnostic Testing
Management
Lyme Disease
Foundations
Clinical Features
Diagnostic Testing
Management
Acute Rheumatic Fever
Foundations
Clinical Features
Diagnostic Testing
Management
Chronic Polyarthritis
Rheumatoid Arthritis
Foundations
Clinical Features
Diagnostic Testing
Management
Seronegative Spondyloarthropathies
Foundations
Ankylosing Spondylitis
Clinical features
Management
Reactive Arthritis (Formerly Termed Reiter Syndrome)
Clinical features
Diagnostic testing
Management
Psoriatic Arthritis
Enteropathic Arthritis
References
Chapter 103: Tendinopathy and Bursitis
Tendinopathy
Foundations
Background and Importance
Pathophysiology
Clinical Features
General Tendinopathy
Specific Tendinopathies
Shoulder
Impingement Syndrome and Rotator Cuff Tendinopathies
Bicipital Tendinopathy
Calcific Tendinopathy
Elbow
Lateral Epicondylitis
Medial Epicondylitis
Wrist
de Quervain’s Tenosynovitis
Knee
Patellar Tendinopathy
Ankle
Achilles Tendinopathy
Achilles Tendon Rupture
Differential Diagnoses
Diagnostic Testing
Management
General Tendinopathy
Specific Tendinopathies
Impingement Syndrome and Rotator Cuff Tendinopathies
Calcific Tendinopathy
Lateral and Medial Epicondylitis
de Quervain’s Tenosynovitis
Achilles Tendinopathy and Rupture
Disposition
Bursitis
Foundations
Clinical Features
Olecranon and Prepatellar Bursitis
Subacromial Bursitis
Trochanteric Bursitis
Ischiogluteal Bursitis
Iliopsoas Bursitis
Pes Anserine Bursitis
Differential Diagnoses
Diagnostic Testing
Management
Septic Bursitis
Nonseptic Bursitis
Disposition
References
Chapter 104: Musculoskeletal Back Pain
Foundations
Background
Epidemiology
Anatomy and Physiology
Pathophysiology
Nonspecific or Uncomplicated Back Pain
Nerve Root Syndromes
Skeletal Causes of Back Pain
Clinical Features
History
Physical Examination
Differential Diagnoses
Diagnostic Testing
Laboratory Testing
Imaging Studies
Point-of-Care Ultrasound
Plain Radiographs
Computed Tomography
Magnetic Resonance Imaging
Computed Tomography Myelogram
Management
Nonspecific or Uncomplicated Back Pain
Disc Herniation and Nerve Root Pain
Epidural Abscess and Spinal Osteomyelitis
Epidural Hematoma
Cauda Equina Syndrome
Malignancy
Fracture
Disposition
References
Chapter 105: Systemic Lupus Erythematosus and the Vasculitides
Systemic Lupus Erythematosus
Foundations
Background and Importance
Etiology and Pathophysiology
Clinical Features
Overview
Specific Symptoms
Fever
Cardiopulmonary Presentations
Coronary Artery Disease
Pericardial and Myocardial Disease
Valvular Disease
Pulmonary Vascular Disease
Pleural Disease
Parenchymal Disease
Mechanical Respiratory Disease
Renal Disease
Gastrointestinal Presentations
Dermatologic Presentations
Musculoskeletal Presentations
Hematologic Disease
Complications Due To Medications
Differential Diagnosis
Diagnostic Testing
Laboratory Tests
Initial Diagnosis
Disease Activity
Evaluation for Infection
Imaging Studies
Management
Emergent Stabilization
General Systemic Disease Activity
Patients Diagnosed With Systemic Lupus Erythematosus
Patients Not Diagnosed With Systemic Lupus Erythematosus
Specific Presentations
Infection
Musculoskeletal Pain
Cutaneous Manifestations
Special Considerations
Antiphospholipid Syndrome
Foundations
Clinical Features
Diagnostic Testing
Management
Drug-Induced Lupus
Disposition
Vasculitis
Foundations
Large-Vessel Vasculitis
Giant Cell Arteritis
Background
Clinical Features
Diagnostic Testing
Management
Takayasu Arteritis
Background
Clinical Features
Diagnostic Testing
Management
Small And Medium Vessel Vasculitis
Background
Clinical Features
Differential Diagnosis
Specific Disorders
ANCA-Associated Vasculitis
Granulomatosis With Polyangiitis
Microscopic Polyangiitis
Eosinophilic Granulomatosis With Polyangiitis
Anti-Glomerular Basement Membrane Disease (Goodpasture Disease)
Immune Complex Mediated Vasculitis
IgA Vasculitis
Cryoglobulinemic Vasculitis
Polyarteritis Nodosa
Other Vasculitides
Behçet Disease
Cutaneous Vasculitis
References
Chapter 106: Allergy, Anaphylaxis, and Angioedema
Allergy
Foundations
Background and Terminology
Pathophysiology
Classification of Reactions
Anaphylaxis
Foundations
Epidemiology and Risk Factors
Common Triggers for Anaphylaxis
Foods
Drugs
Insect Stings
Natural Rubber Latex
Radiocontrast Media
Exercise-Induced Anaphylaxis
Idiopathic Anaphylaxis
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Overview
Positioning
Epinephrine
Airway
Volume Expansion
Antihistamines
Glucocorticoids
Patients Receiving Beta-­Blockade
Disposition
Urticaria and Angioedema
Pathophysiology and Clinical Features
Diagnostic Testing
Management
Angioedema With Urticaria
Angioedema Without Urticaria
Special Considerations
Disposition
References
Chapter 107: Dermatologic Presentations
Overview
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Clinical Features and Differential Diagnoses
Diagnostic Testing
Management
Disposition
Infectious Disorders
Bacterial Infections
Impetigo
Folliculitis
Cellulitis
Abscess
Methicillin-Resistant Staphylococcus aureus (MRSA)
Erythema Migrans
Necrotizing Fasciitis
Meningococcal Infection
Scarlet Fever
Syphilis
Disseminated Gonococcal Infection
Staphylococcal Scalded Skin Syndrome
Toxic Shock Syndrome
Rocky Mountain Spotted Fever
Viral Infections
Herpes Simplex Virus
Varicella-­Zoster Virus
Varicella
Herpes zoster
Viral Exanthems
Roseola infantum
Measles
Rubella
Erythema infectiosum
Fungal Infections
Tinea Corporis
Tinea Capitis
Kerion
Tinea Pedis
Tinea Versicolor
Tinea Unguium (Onychomycosis)
Candidiasis
Oral candidiasis
Cutaneous candidiasis
Vulvovaginal candidiasis
Sporotrichosis
Infestations
Scabies
Pediculosis
Bed Bugs
Allergic Reactions
Contact Dermatitis
Urticaria
Poison Ivy
Drug Reactions
Toxic Epidermal Necrolysis
Inflammatory Conditions
Atopic Dermatitis
Pityriasis Rosea
Kawasaki Disease
Erythema Multiforme
Erythema Nodosum
Lichen Planus
Autoimmune Disorders
Bullous Pemphigoid
Pemphigus Vulgaris
Cutaneous Malignancies
Skin Conditions Associated with Systemic Disease
References
Section Ten: Hematology and Oncology
Chapter 108: Blood and Blood Components
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Blood Banking
Blood Typing
Type and Screen
Type and Crossmatch
Titer Testing for Whole Blood Donation
Management
Decision Making
Pharmacology
Devices and Techniques
Whole Blood
Packed Red Blood Cells
Special Preparations of PRBCs
Washed RBCs
Leukocyte-Reduced RBCs
Irradiated RBCs
CMV Negative Blood
Fresh Frozen Plasma
Platelets
Cryoprecipitate
Prothrombin Complex Concentrate
Outcomes
Safety and Effectiveness
Massive Transfusion Protocols
Complications and Adverse Effects of Nonmassive RBC Transfusion
Acute Transfusion Reactions
Minor Allergic
Anaphylactic
Febrile (Nonhemolytic) Transfusion Reaction
Acute Hemolytic Transfusion Reaction
Transfusion-Related Acute Lung Injury
Transfusion Associated Circulatory Overload
Infectious Complications of Transfusions
Delayed Transfusion Reactions
Delayed Hemolytic Transfusion Reaction
Transfusion-Associated Graft-versus-Host Disease
Post-transfusion Purpura
References
Chapter 109: Anemia and Polycythemia
Anemia
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Anemias Due to Decreased Red Blood Cell Production
Foundations
Iron Deficiency Anemia
Foundations
Clinical Features
Diagnostic Testing
Management
Thalassemia
Foundations
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Sideroblastic Anemia
Foundations
Clinical Features
Differential Diagnoses
Management
Anemia of Chronic Disease
Foundations
Clinical Features
Diagnostic Testing
Management
Macrocytic and Megaloblastic Anemias
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Normochromic and Normocytic Anemias
Foundations
Clinical Features
Diagnostic Testing
Management
Increased Red Blood Cell Destruction
Foundations
Pathophysiology
Clinical Features
Differential Diagnoses
Intrinsic enzyme defects
Intrinsic Membrane Abnormality
Intrinsic Hemoglobin Abnormality
Extrinsic Alloantibodies
Extrinsic Autoantibodies
Extrinsic Mechanical Causes
Environmental Causes
Abnormal Sequestration
Diagnostic Testing
Management
Sickle Cell Disease
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Polycythemia
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
References
Chapter 110: White Blood Cell Disorders
Foundations
Background and Importance
Anatomy and Physiology
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Specific Disorders
Chronic Myeloid Leukemia
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Lymphocytic Leukocytosis
Foundations
Clinical Features
Diagnostic Testing
Management
Leukopenia
Foundations
Clinical Features
Diagnostic Testing and Management
Disposition
References
Chapter 111: Disorders of Hemostasis
Foundations
Anatomy and Physiology
Pathophysiology
Clinical Features
Differential Diagnosis
Diagnostic Testing
Complete Blood Count and Blood Smear
Platelet Count
Bleeding Time and Platelet Function Assay
Prothrombin Time
Partial Thromboplastin Time
Anti-Xa Assay
Fibrinogen
Thrombin Time
Clot Solubility
Factor Level Assays
Management
Thrombocytopenia
Immune Thrombocytopenia
Drug-Induced Thrombocytopenia
Heparin-Induced
Thrombocytopenia
Post-Transfusion Purpura
Thrombotic Microangiopathy
Thrombotic Thrombocytopenic Purpura
Dilutional Thrombocytopenia
Hereditary Thrombocytopenia and Thrombocytopathy
Thrombocytopathy
Adhesion Defects
Aggregation Defects
Secretory Defects
Thrombocytosis
Coagulation Disorders
Hemophilia A
Hemophilia B (Christmas Disease)
von Willebrand Disease
Miscellaneous Coagulation Disorders
Medication-­Induced Anticoagulation
Disseminated Intravascular Coagulation
Disposition
References
Chapter 112: Oncologic Emergencies
Foundations
Febrile Neutropenia
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Malignant Pericardial Disease
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Hypercalcemia
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Tumor Lysis Syndrome
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Leukostasis
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Superior Vena Cava Syndrome
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Monocloncal Antibody Therapies and Complications
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
T-Lymphocyte Checkpoint Inhibitor Therapies and Complications
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Adoptive Cell Transfer Therapies and Complications
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Section Eleven: Metabolism and Endocrinology
Chapter 113: Acid-Base Disorders
Foundations
Clinical Features
Differential Diagnosis and Diagnostic Testing
Diagnostic Testing
Basic Metabolic Panel Interpretation
Five-Step Acid-Base Approach to the BMP
BMP Step 1. Check for Abnormal Values
BMP Step 2. Check the Anion Gap
BMP Step 3. If a Metabolic Acidosis is Present, Apply the Rule of 15
BMP Step 4. If a Wide Anion Gap Metabolic Acidosis Is Present (Anion Gap ≥15), Check the Delta Gap
BMP Step 5. If a Wide Anion Gap Metabolic Acidosis Is Present (Anion Gap ≥15), But the Cause Is Not Evident, Check the Osmolar Gap
Blood Gas Interpretation
Three-Step Acid-Base Approach to the ABG
ABG Step 1. Determine if the Patient Is Acidemic or Alkalemic
ABG Step 2. Determine if a Predominant Respiratory or Metabolic Acid-Base Disturbance Is Present
ABG Step 3. If a Predominant Respiratory Acid-Base Disturbance Is Present, Determine If There Is a Concurrent Metabolic Disturbance
Differential Diagnosis of Acid-­Base Disorders
Metabolic Acidosis
Wide Anion Gap Metabolic Acidosis
Normal Anion Gap Metabolic Acidosis
Metabolic Alkalosis
Chloride-Responsive Metabolic Alkalosis
Chloride-Unresponsive Metabolic Alkalosis
Respiratory Acidosis
Respiratory Alkalosis
Management
Intravenous Fluids
Sodium Bicarbonate Therapy
Disposition
Acknowledgements
References
Acid-Base Disorder Sample Calculations
Rule of 15 Example 1
Rule of 15 Example 2
Rule of 15 Example 3
Rule of 15 Example 4
Delta Gap Example 1
Delta Gap Example 2
Chapter 114: Electrolyte Disorders
Hyperkalemia
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Hypokalemia
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Hypernatremia
Foundations
Clinical Features
Diagnostic Testing
Management
Disposition
Hyponatremia
Foundations
Pseudohyponatremia
Hypovolemic Hyponatremia
Hypervolemic Hyponatremia
Euvolemic Hyponatremia
Clinical Features
Diagnostic Testing
Management
Hypovolemic Hyponatremia
Hypervolemic Hyponatremia
Euvolemic Hyponatremia
Disposition
Hypercalcemia
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Hypocalcemia
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Hypermagnesemia
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Hypomagnesemia
Foundations
Clinical Features
Differential Diagnosis
Patients Maintained on Diuretics
Malnourished and Alcoholic Patients
Patients With Hypokalemia
Patients With Acute Coronary Artery Disease and Ventricular Arrhythmias
Patients Receiving Specific Medications
Diagnostic Testing
Management
Disposition
Hyperphosphatemia
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Hypophosphatemia
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
References
Chapter 115: Diabetes Mellitus and Disorders of Glucose Homeostasis
Diabetes Mellitus
Diabetes Mellitus Foundations
Background and Importance
Epidemiology
Anatomy, Physiology, and Pathophysiology
Normal Physiology
Insulin
Glucose Regulatory Mechanisms
Pathophysiology
Types of Diabetes
Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus
Gestational Diabetes
Diabetes of Other Causes
Prediabetes
Diabetes Mellitus Clinical Features
Type 1
Type 2
Diabetes Mellitus Differential Diagnosis
Diabetes Mellitus Diagnostic Testing
Serum Glucose Level
Glycosylated Hemoglobin
Urine Glucose Level
Urine Ketone Level
Dipstick Blood Glucose Level
Diabetes Mellitus Management
Management of Hyperglycemia
Management of Diabetes Mellitus
Oral Hypoglycemic Agents
Biguanides
Sulfonylureas
Thiazolidinediones
α-Glucosidase Inhibitors
Meglitinides
Glucagon-Like Peptide Analogs and Agonists
Dipeptidyl Peptidase-4 Inhibitors
Amylin Analog
Sodium-Glucose Cotransporter 2 Inhibitors
Insulin
Pancreas Transplantation
New Trends in Diabetes Management
Late Complications of Diabetes
Vascular Complications
Diabetic Nephropathy
Retinopathy
Neuropathy
The Diabetic Foot
Infections
Cutaneous Manifestations
Skin Conditions
Acanthosis Nigricans
Necrobiosis Lipoidica Diabeticorum
Xanthoma Diabeticorum
Bullosis Diabeticorum
Diabetic Dermopathy
Impetigo or Intertrigo
Diabetes Disposition
Diabetic Ketoacidosis
Foundations
Pathophysiology
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Intravenous Fluids
Potassium
Insulin
Magnesium
Sodium Bicarbonate
Complications
Diabetic Ketoacidosis Disposition
Hyperglycemic Hyperosmolar State
Foundations
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Intravenous Fluids
Electrolytes
Insulin
Other Considerations
Acute Complications
Hyperglycemic Hyperosmolar State Disposition
Diabetes in Pregnancy
Hypoglycemia
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Chapter 116: Rhabdomyolysis
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Clinical Features
Complications
Early Complications
Compartment Syndrome
Electrolyte Disorders and Acidosis
Hypovolemia
Hepatic laboratory abnormalities
Late Complications
Myoglobin-Induced Acute Kidney Injury
Disseminated Intravascular Coagulation
Differential Diagnosis
Diagnostic Testing
Serum Creatine Kinase
Serum and Urine Myoglobin
Urine Dipstick and Urinalysis
Other Laboratory Findings
Prognostic Tests in Rhabdomyolysis
Management
Fluid Replacement
Mannitol and Other Diuretics
Experimental Therapies
Renal Replacement Therapy
Disposition
Prognosis
References
Chapter 117: Thyroid and Adrenal Disorders
Hyperthyroidism
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Clinical Features
History and Physical Examination
Thyroid Storm
Differential Diagnoses
Diagnostic Testing
Management
Supportive Treatment
Symptomatic Treatment
Thyroid-Directed Treatment
Reducing Thyroid Hormone Production
Inhibiting Thyroid Hormone Release
Inhibiting Conversion of T4 to T3
Miscellaneous Therapies
Identification and Treatment of the Precipitating Event
Disposition
Hypothyroidism
Foundations
Background and Importance
Pathophysiology
Clinical Features
History and Physical Examination
Myxedema Coma
Differential Diagnoses
Diagnostic Testing
Management
Hypothyroidism
Myxedema Coma
Disposition
Adrenal Excess States
Foundations
Background and Importance
Cushing Syndrome
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Hyperaldosteronism
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Pheochromocytoma and Paraganglioma
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Adrenal Insufficiency
Foundations
Background and Importance
Anatomy and Physiology
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Section Twelve: Infectious Diseases
Chapter 118: Bacteria
Diphtheria
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Pertussis
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Acute Treatment
Vaccination
Tetanus
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Clinical Features
Generalized Tetanus
Localized Tetanus
Cephalic Tetanus
Neonatal Tetanus
Complications
Differential Diagnoses
Diagnostic Testing
Management
Supportive Care
Elimination of Unbound Toxin and Active Immunization
Prevention of Further Toxin Production
Vaccination
Botulism
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Pneumococcemia
Foundations
Background
Anatomy, Physiology, and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Acute Treatment
Vaccination
Disposition
Meningococcemia
Foundations
Background
Anatomy, Physiology, and Pathophysiology
Clinical Features
Occult Bacteremia
Meningococcal Meningitis
Meningococcal Septicemia
Fever and a Nonblanching Rash
Chronic Meningococcemia
Complications
Differential Diagnoses
Diagnostic Testing
Management
Acute Treatment
Antibiotic Prophylaxis and Vaccination
Disposition
Toxic Shock Syndrome
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Chapter 119: Viruses
Foundations
Vaccine-Preventable Infections of Childhood
Mumps
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management and Disposition
Measles (Rubeola)
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Rubella (German Measles)
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management and Disposition
Viral Infections with Vesicular Rash
Herpes Simplex
Clinical Features
Oral Infection
Genital Herpes
Central Nervous System Infection
Other Infections
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Varicella-Zoster Virus
Clinical Features
Varicella
Zoster
Differential Diagnosis
Diagnostic Testing
Management
Varicella
Zoster
Disposition
Viral Infections Causing Nonspecific Febrile Illness
Epstein-Barr Virus
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Cytomegalovirus
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Enteroviruses
Clinical Features
Poliovirus
Non-Polio Enteroviruses
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Viruses Associated With Respiratory Infections
Influenza
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Neuraminidase Inhibitors
Adamantane Antivirals
Other Antivirals
Disposition
Coronavirus
Rhinovirus
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management and Disposition
Adenovirus
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management and Disposition
Parainfluenza
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Respiratory Syncytial Virus
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Viruses Associated with Diarrheal Illness
Norovirus and Rotavirus
Clinical Features
Norovirus
Rotavirus
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Viral Infections With Neurologic Manifestations
Rabies
Epidemiology
Pathophysiology
Clinical Features
Encephalitic Rabies
Paralytic Rabies
Differential Diagnoses
Diagnostic Evaluation and Testing
Management
Preexposure Prophylaxis
Animal Bite Risk Assessment
Wound Care
Postexposure Prophylaxis
Management
Disposition
Arboviruses
Clinical Features
West Nile Virus
Eastern Equine Encephalitis Virus
St. Louis Encephalitis Virus
Powasson Virus
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Other Arboviral Infections
Dengue Virus
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Zika Virus
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management and Disposition
Chikungunya Virus
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management and Disposition
Viral Hemorrhagic Fevers
Yellow Fever Virus
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Ebola
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Marburg
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Lassa Fever
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
References
Chapter 120: Coronaviruses
Foundations
Transmission
Clinical Features
Coronavirus Disease 2019
Multisystem Inflammatory Syndrome in Children
Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome
Differential Diagnoses
Diagnostic Testing
Coronavirus Disease 2019
Multisystem Inflammatory Syndrome in Children
Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome
Management
Coronavirus Disease 2019
Oxygenation and Ventilation
Intubation and Mechanical Ventilation
Therapeutics
Antivirals
Convalescent Serum and Monoclonal Antibodies
Immunomodulatory Drugs Including Corticosteroids
Anticoagulation
Prevention and Vaccination
Multisystem Inflammatory Syndrome in Children
Middle East Respiratory Syndrome
Disposition
References
Chapter 121: HIV
Foundations
Background and Importance
Pathophysiology
Clinical Features
Acute HIV Infection
Chronic HIV Infection
AIDS
Clinical Manifestations by Organ System
Cardiac Manifestations
Pulmonary Manifestations
Oropharyngeal and Gastrointestinal Manifestations
Central Nervous System Manifestations
Renal Manifestations
Rheumatologic and Orthopedic Manifestations
Hematologic Manifestations
Cutaneous Manifestations
Differential Diagnoses
Initial Evaluation
Diagnostic Testing
HIV Testing
Management
Preexposure Prophylaxis
Postexposure Prophylaxis
ART Initiation and Linkage to Care
Disposition
References
Chapter 122: Parasites
Foundations
Malaria
Background and Importance
Pathophysiology
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Babesiosis
Background and Importance
Clinical Features
Diagnostic Testing
Management
Schistosomiasis and Katayama Fever
Background and Importance
Diagnostic Testing
Management
Cysticercosis
Background and Importance
Clinical Features
Diagnostic Testing
Management
African Trypanosomiasis
Background and Importance
Clinical Features
Diagnostic Testing
Management
Toxoplasmosis
Background and Importance
Clinical Features
Diagnostic Testing
Management
Eosinophilic Meningitis
Parasites Associated with Fever
Leishmaniasis
Amebic Abscess
Strongyloides
Whipworm And Hookworm
Tapeworm
Elephantiasis
Cutaneous Leishmaniasis
Cutaneous Larva Migrans
Swimmer’s Itch (Cercarial Dermatitis)
Strongyloides
Dracunculus medinensis
Parasites Associated With Ocular Manifestations
Onchocerciasis
Loiasis
Toxocara canis (Dog Roundworm)
Parasites Associated With Pulmonary Manifestations
Parasitic Diseases With Cardiovascular Manifestations
Chagas Disease
Parasitic Diseases With Gastrointestinal Manifestations
Diarrhea
Cryptosporidium and Cyclospora
Entamoeba histolytica
Balantidium coli
Giardia lamblia
Echinococcosis
Enterobius vermicularis
Parasitic Coinfections in Patients With HIV Infection and AIDS
Specific Parasitic Coinfections
References
Chapter 123: Tickborne Illnesses
Overview
Identification of Ticks
Physiology of Tick Feeding
Lyme Disease
Clinical Features
Early Lyme Disease
Acute Disseminated Infection
Neurologic Manifestations
Cardiac Manifestations
Arthritis
Ophthalmic Manifestations
Late Lyme Disease
Differential Diagnoses
Diagnostic Testing
Management
Early Disease
Early Disseminated Infection
Neurologic Disease
Cardiac Disease
Late Infection
Arthritis
Neurologic Disease
Lyme Disease and Pregnancy
Vaccination
Prophylaxis and Asymptomatic Tick Bites
Southern Tick-Associated Rash Illness
Relapsing Fever
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Tularemia
Clinical Features
Presentations
Ulceroglandular Tularemia
Glandular Tularemia
Oculoglandular Tularemia
Oropharyngeal Tularemia
Typhoidal Tularemia
Pulmonary Tularemia
Other Considerations
Diagnostic Testing
Management
Rocky Mountain Spotted Fever
Pathophysiology
Clinical Features
Cutaneous Manifestations
Cardiopulmonary Manifestations
Neurologic Manifestations
Differential Diagnoses
Diagnostic Testing
Skin Biopsy
Serologic Studies
Isolation of Organism
Management
Supportive Care
Antibiotics
Corticosteroids
Q Fever
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Ehrlichioses
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Babesiosis
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Colorado Tick Fever
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Other Tickborne Viruses
Tick Paralysis
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Tick Bite Prophylaxis With Insect Repellents
References
Chapter 124: Tuberculosis
Foundations
Background and Importance
Pathophysiology
Transmission
Pathogenesis
Stage 1
Stage 2
Stage 3
Stage 4
Clinical Features
Risk Factors
Physical Examination
Complications of Pulmonic Tuberculosis
Hemoptysis
Pneumothorax
Pleural Effusion
Empyema
Airway Tuberculosis
Superinfection with Fungi
Primary Tuberculous Pericarditis
Differential Diagnoses
Pulmonary Tuberculosis
Bacterial Pneumonia
Fungal and Nontuberculous Mycobacterial Infections
Pneumonias in Patients with HIV Infection
Cavitary Lesions
Mediastinal Lymphadenopathy
Extrapulmonary Tuberculosis
Lymphadenitis
Bone and Joint Infection
Renal Disease
Genital Disease
Multisystem Disease
Central Nervous System Disease
Gastrointestinal Disease
Diagnostic Testing
Laboratory Tests
White Cell Stimulation Tests
Serology
Diagnostic Imaging
Primary Tuberculosis
Postprimary Tuberculosis
Microbiologic Testing
Sputum Studies
Direct Microscopy
Nucleic Acid Amplification Tests
Culture
Tuberculin Skin Test
Management
Initial Management in the Emergency Department
Hemoptysis
Fever or Wasting
History of Tuberculosis, Therapy Discontinued
Antituberculosis Medications
First-Line Agents
Second-Line Agents
Corticosteroids
Initial Therapy
Drug-Resistant Tuberculosis
Multidrug-Resistant Tuberculosis
Extensively Drug-Resistant Tuberculosis
Vaccines for Mycobacterium tuberculosis
Disposition
Prevention of Transmission in the Emergency Department
Early Identification
Isolation and Environmental Control
Personal Respiratory Protection
Preventive Therapy After Inadvertent Exposure
References
Chapter 125: Bone and Joint Infections
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Causes and Microbiology
Osteomyelitis
Clinical Features
History and Physical Examination
Complications
Clinical Subsets of Osteomyelitis
Osteomyelitis in Children
Vertebral Osteomyelitis
Posttraumatic Osteomyelitis
Diabetic Foot Osteomyelitis
Osteomyelitis in Sickle Cell Disease
Chronic Osteomyelitis
Differential Diagnoses
Diagnostic Testing
Laboratory Tests
Diagnostic Imaging
Conventional Radiography
Radionuclide Bone Scanning
Computed Tomography
Magnetic Resonance Imaging
Microbiologic Diagnosis
Management
Disposition
Septic Arthritis
Foundations
Clinical Features
History and Physical Examination
Complications
Clinical Subsets of Septic Arthritis
Bites
Infants and Children
Gonococcal Septic Arthritis
Lyme Arthritis
Periprosthetic Joint Infections
Patients With Existing Joint Disease
Atypical Joints
Differential Diagnoses
Diagnostic Testing
Serum and Urine Tests
Joint Fluid Analysis
Imaging
Management
Disposition
References
Chapter 126: Skin and Soft Tissue Infections
Foundations
Background and Importance
Anatomy and Physiology
Pathophysiology
Clinical Features
Overview
Cellulitis
Clinical Features
Diabetic Foot Infections
Bite Wounds
Water-Borne Infections
Differential Diagnosis
Diagnostic Testing
Wound Cultures
Blood Cultures
Radiographic Studies
Surface Thermal Imaging
Management
Disposition
Abscess
Clinical Features
Differential Diagnosis and Diagnostic Testing
Management
Disposition
Impetigo
Clinical Features and Management
Folliculitis
Clinical Features and Management
Acne Vulgaris and Hidradenitis Suppurativa (Acne Inversa)
Clinical Features and Management
Necrotizing Skin and Soft Tissue Infections
Clinical Features
Differential Diagnosis and Diagnostic Testing
Management and Disposition
Toxic Shock Syndromes
Clinical Features
Streptococcal Toxic Shock Syndrome
Staphylococcal Toxic Shock Syndrome
Staphylococcal Scalded Skin Syndrome
Differential Diagnosis and Diagnostic Testing
Management
Disposition
Other Infections With Skin Manifestations
References
Chapter 127: Sepsis Syndrome
Foundations
Background
Pathophysiology
Mediators of Sepsis
Organ System Dysfunction
Neurologic Impairment
Cardiovascular Dysfunction
Pulmonary Involvement
Gastrointestinal Effects
Endocrine Disorders
Hematologic Abnormalities
Genetic Factors
Clinical Features
Symptoms and Signs
Diagnostic Considerations
Differential Diagnoses
Diagnostic Testing
Laboratory Testing
Hematology
Blood Chemistry
Urinalysis
Microbiology
Special Procedures
Radiology
Management
Respiratory Support
Cardiovascular Support
Fluid Resuscitation
Vasoactive Drug Therapy
Norepinephrine
Dopamine
Vasopressin
Epinephrine
Phenylephrine
Dobutamine
Bicarbonate
Antibiotics
Steroid Therapy
Disposition
References
Part IV: Environment and Toxicology
Section One: Environment
Chapter 128: Hypothermia, Frostbite, and Nonfreezing Cold Injuries
Accidental Hypothermia
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Temperature Regulation
Cardiovascular System
Central Nervous System
Renal System
Respiratory System
Predisposing Factors
Decreased Heat Production
Increased Heat Loss
Impaired Thermoregulation
Trauma
Clinical Features
Differential Diagnoses
Diagnostic Testing
Acid-Base Balance
Hematologic Evaluation
Hypothermic Coagulation
Imaging
Management
General Measures
Volume Resuscitation
Advanced Life Support
Pharmacologic Treatment
Cardiovascular Medications
Antibiotics
Failure to Rewarm
Rewarming
Passive External Rewarming
Active Rewarming
Active External Rewarming
Active Core Rewarming
Airway Rewarming
Peritoneal Dialysis
Heated Irrigation
Endovascular Rewarming
Diathermy
Extracorporeal Blood Rewarming
Disposition
Frostbite and Nonfreezing Cold Injuries
Frostbite
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Prehospital
Emergency Department
Prethaw
Thawing by Immersion in Warm Water
Postthaw
Disposition
Nonfreezing Cold Injuries
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Clinical Features
Immersion Injury
Pernio
Differential Diagnoses
Diagnostic Testing
Management
Immersion Injury
Pernio
Disposition
References
Chapter 129: Heat Illness
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Heat Production
Conduction
Convection
Radiation
Evaporation
Heat Regulation
Thermosensors
Central integrative area
Thermoregulatory effectors
Acclimatization
Predisposing Factors
Fever Versus Hyperthermia
Minor Heat Illnesses
Miliaria Rubra
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Heat Cramps
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Heat Edema
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Heat Syncope
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Major Heat Illnesses
Heat Exhaustion
Foundations
Background and importance
Anatomy, physiology and pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Heatstroke
Foundations
Background and importance
Anatomy, physiology and pathophysiology
Clinical Features
Classic heatstroke versus exertional heatstroke
Differential Diagnoses
Meningitis and encephalitis
Thyroid storm
Drug-induced heat illness
Exercised associated hyponatremia
Neuroleptic malignant syndrome
Serotonin syndrome
Diagnostic Testing
Management
Cooling
Resuscitation
Disposition
References
Chapter 130: Electrical and Lightning Injuries
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Electrical Injury
Current and Voltage
Current Type
Resistance of Tissue Affected
Path Taken by Current Through the Body
Duration of Contact
Lightning Injury
Conducted Energy Weapons
Clinical Features
Electrical Injury
Lightning Injury
Skin
Electrical Injury
Lightning Injury
Cardiovascular
Electrical Injury
Lightning Injury
Head and Neck
Electrical Injury
Lightning Injury
Extremities
Electrical Injury
Nervous System
Electrical Injury
Lightning Injury
Other Viscera
Electrical Injury
Lightning Injury
Conducted Electrical Weapon
Differential Diagnoses
Electrical Injury
Lightning Injury
Diagnostic Testing
Electrical Injury
Lightning Injury
Conducted Electrical Weapon
Management
Electrical Injury
Lightning Injury
Conducted Electrical Weapon
Disposition
Electrical Injury
Lightning Injury
Conducted Electrical Weapon
Acknowledgments
References
Chapter 131: Scuba Diving and Dysbarism
Foundations
Background and Importance
Physiology and Pathophysiology
Clinical Features
Disorders Related to Descent/Barotrauma
Middle Ear Barotrauma
External Ear Barotrauma
Inner Ear Barotrauma
Reverse Middle Ear Squeeze
Barosinusitis
Alternobaric Vertigo
Facial Barotrauma or Mask Squeeze
Disorders Arising at Depth
Nitrogen Narcosis
Oxygen Toxicity
Contaminated Air
Disorders Arising on Ascent
Alternobaric Vertigo
Barodontalgia
Gastrointestinal Barotrauma
Pulmonary Barotrauma
Decompression Sickness
Arterial Gas Embolism
Pulmonary Edema
Differential Diagnoses
Diagnostic Testing
Management
Diving Disorders Requiring Recompression Therapy
Diving Disorders Not Requiring Recompression Therapy
External Ear Barotrauma
Middle Ear Barotrauma
Internal Ear Barotrauma
Barosinusitis
Facial Barotrauma
Nitrogen Narcosis
Pulmonary Barotrauma
Alternobaric Vertigo
Disposition
References
Chapter 132: High-Altitude Medicine
Foundations
Background and Importance
Epidemiology
Definitions
Environmental Considerations
Anatomy, Physiology, and Pathophysiology
Acclimatization
Physiologic Response to Hypobaric Hypoxia
Acute Mountain Sickness
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Oxygen Therapy
Analgesics and Antiemetics
Acetazolamide
Dexamethasone
Disposition
Prevention
High-Altitude Pulmonary Edema
Clinical Features
Differential Diagnoses
Diagnostic Testing
Ultrasonography
Chest Radiographs
Electrocardiogram and Echocardiogram
Management
Descent
Oxygen Therapy
Nifedipine
Other Medications
Disposition
Prevention
High-Altitude Cerebral Edema
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Special Considerations
High-Altitude Retinal Hemorrhage
Carbon Monoxide Poisoning
Altitude and Underlying Medical Conditions
Respiratory Illnesses
Cardiovascular
Hypertension
Seizures
Sickle Cell Disease
Pregnancy
Radial Keratotomy
Acknowledgments
References
Chapter 133: Drowning
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Clinical Features
History and Physical Examination
Prognostic Factors
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Preventive Efforts and Discharge Education
References
Chapter 134: Radiation Injuries
Foundations
Background and Importance
Radiation Measurements
Radiation Protection
Radiation Sources
Anatomy, Physiology, and Pathophysiology
Routes of Exposure
Clinical Features
Acute Radiation Syndrome
Local Radiation Injury
Differential Diagnoses
Diagnostic Testing
Management
Prehospital Care
Emergency Department
Preparation
External Contamination
Internal Contamination
Acute Radiation Syndrome
Hematopoietic Sub-Syndrome
Gastrointestinal Sub-Syndrome
Neurovascular Sub-Syndrome
Local Radiation Injury
Psychological Consequences
Disposition
Additional Resources
References
Section Two: Toxicology
Chapter 135: Care of the Poisoned Patient
Principles of Toxicity
Clinical Features
Toxicologic History and Physical
Toxidromes
Sympathomimetic
Anticholinergic
Cholinergic
Sedative/Hypnotic
Opioid
Serotonin Syndrome
Neuroleptic Malignant Syndrome
Differential Diagnoses
Diagnostic Testing
Management
Decontamination
Syrup Of Ipecac
Gastric Lavage
Single-Dose Activated Charcoal
Whole Bowel Irrigation
Enhanced Elimination
Multiple-Dose Activated Charcoal
Serum Alkalinization
Intravenous Fat Emulsion (Intralipid)
Focused Therapy
Toxicology Consultation
Disposition
References
Chapter 136: Toxic Alcohols
Methanol
Foundations
Principles of Toxicology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Ethylene Glycol
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Isopropyl Alcohol
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Other Alcohols of Clinical Significance
References
Chapter 137: Alcohol-Related Disease
Foundations
Metabolism of Alcohol
Clinical Features
Alcohol Withdrawal Syndrome
Alcohol-Related Seizures
Alcohol Withdrawal Seizures
Alcoholic Hallucinosis
Cardiovascular Effects
Pulmonary Effects
Gastrointestinal and Hepatic Effects
Esophagus and Stomach
Gastrointestinal Bleeding
Liver Damage
Alcoholic Hepatitis
Cirrhosis
Pancreatitis and Malabsorption
Neurologic Effects
Neuropathy
Wernicke-Korsakoff
Syndrome
Alcoholic Cerebellar Degeneration
Infectious Disease
Endocrine Effects
Metabolic Effects
Carbohydrates
Lipids
Electrolytes
Alcoholic Ketoacidosis
Hematologic Effects
Anemia
Leukocyte Abnormalities
Platelet Disorders
Hemostasis
Oncologic Effects
Hypothermia
Psychiatric Effects
Toxicologic Effects
Disulfiram and Similar Reactions
Other Considerations—Patient Groups Affected
Adolescents
Older Patients
Pregnant Women
Trauma
Differential Diagnosis
Diagnostic Testing
Laboratory Tests
Alcohol Screening Questionnaires
Management
Alcohol Withdrawal Syndrome
Pharmacologic Treatment
Benzodiazepines
Butyrophenones
Other Agents
Neurologic Examination
New-Onset Seizures
Prior History of Seizures During Withdrawal
Abnormal Neurologic Examination
New-Onset Partial Seizures
Patients Taking Anticonvulsants
Disposition
Acute Intoxication
Alcohol Withdrawal
Seizures
Psychiatric and Social Problems
References
Chapter 138: Acetaminophen
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Risk Assessment With Acute Acetaminophen Ingestion
Risk Assessment With Chronic Ingestion
Risk Assessment in Pregnant Women
Management
Stabilization and Supportive Care
Decontamination
Enhanced Elimination
Antidote Therapy
N-Acetylcysteine
Use in Pregnancy
Duration of Therapy
Disposition
Need for Transplantation
References
Chapter 139: Aspirin and Nonsteroidal Agents
Aspirin
Principles of Toxicity
Overview
Epidemiology
Salicylate-Containing Products
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Stabilization and Supportive Care
Decontamination
Enhanced Elimination
Antidote Therapy
Disposition
Nonsteroidal Agents
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Stabilization and Supportive Care
Decontamination
Enhanced Elimination
Antidote Therapy
Disposition
References
Chapter 140: Anticholinergics
Principles of Toxicology
Overview
Clinical Features
Differential Diagnoses
Diagnostic Testing
Laboratory
Electrocardiogram
Management
Stabilization
Decontamination
Pharmacologic Intervention and Antidote Treatment
Disposition
Observation at Home
Emergency Department Observation
Hospital Admission
ICU Admission
Consultations
References
Chapter 141: Antidepressants
Principles Of Toxicity
Monoamine Oxidase Inhibitors
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Tricyclic Antidepressants
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Selective Serotonin Reuptake Inhibitors
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Serotonin-Norepinephrine Reuptake Inhibitors and Norepinephrine Reuptake Inhibitors
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Serotonin Modulators And Stimulators
Miscellaneous Antidepressants
Bupropion
Trazodone
Nefazodone
Serotonin Syndrome
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Discontinuation Syndromes
References
Chapter 142: Cardiovascular Drugs
Cardioactive Steroids (Digoxin)
Foundations
Clinical Features
Pediatric Considerations
Differential Diagnoses
Diagnostic Testing
Management
Fab Fragments (DigiFab)
Electrolyte Correction
Atropine
Pacing and Cardioversion
Phenytoin and Lidocaine
Extracorporeal Membrane Oxygenation
Disposition
Beta-Blockers
Foundations
Principles of Toxicity
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Hypotension, Bradycardia, and Atrioventricular Block
Calcium
Glucagon
High-Dose Insulin
Sodium Bicarbonate
Vasopressors and Other Inotropes
Intravenous Fat Emulsion (Intralipid)
Ventricular Dysrhythmias
Extracorporeal Elimination and Circulatory Assistance
Pediatric Considerations
Sequential Approach to Beta-Blocker Poisoning
Disposition
Calcium Channel Blockers
Foundations
Principles of Toxicity
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Hypotension and Bradycardia
Pediatric Considerations
Disposition
Clonidine and Other Central Alpha-2 Agonists
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Nitrates, Nitrites, and Methemoglobinemia
Foundations
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Chapter 143: Caustics
Foundations
Principles of Toxicity
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Special Cases
Povidone-Iodine
Phenol and Formaldehyde
Hydrogen Peroxide
Button Batteries
References
Chapter 144: Cocaine and Other Sympathomimetics
Foundations
Cocaine
Epidemiology
Formulation
Pathophysiology
Amphetamine and Its Derivatives
Epidemiology
Methamphetamine
Pathophysiology
Ephedrine and Ephedra
Caffeine
Novel Psychoactive Substances
Ecstasy
Bath Salts
Kratom
Clinical Features
Hyperthermia
Hypertensive Emergencies
Cardiac Dysrhythmias
Cocaine Use Disorder, Stimulant Use Disorder
Cardiomyopathy
Washout
Nontoxicologic sequelae
Differential Diagnoses
Diagnostic Testing
Urine Drug Screening for Amphetamines and Amphetamine Derivatives
Electrocardiogram
Management
Pharmacologic Sedation for Agitation
Hyperthermia
Acute Hypertensive Emergencies
Dysrhythmias
Hyponatremia
Cocaine-Related Chest Pain
Special Topics
Body Packers
Body Stuffers
Disposition
References
Chapter 145: THC and Hallucinogens
Serotonergic Agents
Principles of Toxicity
Lysergamides
Tryptamines
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Dissociative Agents
Principles of Toxicity
Phencyclidine
Ketamine
Methoxetamine
Dextromethorphan
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Cannabis and Synthetic Cannabinoids
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Other Agents
Mescaline
Nutmeg
Salvia
Kratom
Ibogaine
Isoxazole Mushrooms
References
Chapter 146: Iron and Heavy Metals
Iron
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Stabilization and Supportive Care
Decontamination
Enhanced Elimination
Antidotal Therapy
Disposition
Lead
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Stabilization and Supportive Care
Decontamination
Antidotal Therapy
Children
Adults
Disposition
Arsenic
Foundations
Clinical Features
Acute Arsenic Toxicity
Chronic Arsenic Toxicity
Arsine Gas
Differential Diagnoses
Diagnostic Testing
Management
Stabilization and Supportive Care
Decontamination and Enhanced Elimination
Antidotal Therapy
Acute Arsenic Poisoning
Chronic Arsenic Poisoning
Disposition
Mercury
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Stabilization and Supportive Care
Decontamination
Enhanced Elimination
Antidotal Therapy
Disposition
References
Chapter 147: Hydrocarbons
Foundations
Overview
Pathophysiology
Pulmonary Pathophysiology
Central Nervous System Pathophysiology
Cardiac Pathophysiology
Other Organ Systems
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Chapter 148: Inhaled Toxins
Simple Asphyxiants
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Pulmonary Irritants
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Smoke Inhalation
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Cyanide and Hydrogen Sulfide
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Hydrogen Cyanide
Hydrogen Sulfide
Disposition
Carbon Monoxide
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Simultaneous Carbon Monoxide and Cyanide Poisoning (Fire Victims)
Disposition
References
Chapter 149: Lithium
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Stabilization and Supportive Care
Decontamination
Enhanced Elimination
Disposition
References
Chapter 150: Antipsychotics
Foundations
Background
Pathophysiology
Toxicity
Clinical Features
Acute Overdose
Acute Extrapyramidal Syndromes
Tardive Syndromes
Neuroleptic Malignant Syndrome
Cardiovascular Toxicity
Agranulocytosis
Seizures
Differential Diagnoses
Diagnostic Testing
Management
General
Anticholinergic Toxidrome
Seizures
Acute Extrapyramidal Syndromes
Cardiotoxicity
Neuroleptic Malignant Syndrome
Disposition
References
Chapter 151: Opioids
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Stabilization and Supportive Care
Decontamination
Enhanced Elimination
Antidote Therapy
Disposition
Withdrawal
References
Chapter 152: Pesticides
Organophosphate Insecticides
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Decontamination
Stabilization and Supportive Care
Enhanced Elimination
Antidote Therapy
Disposition
Carbamate Insecticides
Chlorinated Hydrocarbons Insecticides
Foundations
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Decontamination
Stabilization and Supportive Care
Enhanced Elimination
Antidote Therapy
Disposition
Substituted Phenols
Foundations
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Decontamination
Stabilization and Supportive Care
Enhanced Elimination
Antidote Therapy
Disposition
Chlorophenoxy Herbicides
Foundations and Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Decontamination
Stabilization and Supportive Care
Enhanced Elimination
Antidote Therapy
Disposition
Bipyridyl Herbicides
Foundations and Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Decontamination
Stabilization and Supportive Care
Enhanced Elimination
Antidote Therapy
Disposition
Pyrethrin and Pyrethroid Insecticides
Foundations and Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Decontamination
Stabilization and Supportive Care
Enhanced Elimination
Antidote Therapy
Disposition
Glyphosate
Foundations and Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Decontamination
Stabilization and Supportive Care
Enhanced Elimination
Antidote Therapy
Disposition
DEET
Foundations and Principles of Toxicology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Decontamination
Stabilization and Supportive Care
Enhanced Elimination
Antidote Therapy
Disposition
Rodenticides
Foundations
Principles of Toxicology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Decontamination
Stabilization and Supportive Care
Enhanced Elimination
Antidote Therapy
Disposition
References
Chapter 153: Plants, Herbal Medications, and Mushrooms
Plants
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Plant Categories
Anticholinergics
Foundations
Principles of toxicity
Clinical features
Differential diagnoses
Diagnostic testing
Management
Disposition
Antimitotic Toxins
Foundations
Principles of toxicity
Clinical features
Differential diagnoses
Diagnostic testing
Management
Disposition
Cardiac Glycosides
Foundations
Principles of toxicity
Clinical features
Differential diagnoses
Diagnostic testing
Management
Disposition
Other Cardiotoxic Plants
Cicutoxin
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Other Toxic Plants
Nicotinic toxin
Raphides
Toxalbumins
Mushrooms
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Mushroom Categories
Hepatotoxic Mushrooms
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Gyromitrin-containing Mushrooms
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Other Mushroom Classes
Cholinergic Agonists
Disulfiram Reaction-Inducing Mushrooms
Hallucinogenic Mushrooms
Gastrointestinal Irritants
Renal Insufficiency
Rhabdomyolysis-­Inducing Mushrooms
Herbal Medications
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Chapter 154: Sedative-Hypnotics
Foundations
Benzodiazepines
Clinical Features
Pharmacokinetics
Differential Diagnoses
Diagnostic Testing
Management
Stabilization and Supportive Care
Antidote Therapy
Disposition
Benzodiazepine Withdrawal Syndrome
Barbiturates
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Supportive Care and Stabilization
Gastrointestinal Decontamination
Enhanced Elimination
Disposition
Individual Medications
Zolpidem, Zaleplon, and Zopiclone
Eszopiclone
Buspirone
Flunitrazepam
Chloral Hydrate
Clinical Features
Differential Diagnoses
Management
Disposition
Over-The-Counter Sleep Aids
Gamma-Hydroxybutyrate
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Withdrawal
References
Part V: Special Populations
Section One: The Pediatric Patient
Chapter 155: Care of the Pediatric Patient
Foundations
Pathophysiology
Temperature Regulation
Airway
Cardiovascular System
Musculoskeletal System
Immunologic System
Pharmacologic Considerations
Developmental Considerations
Young Infants
Infants (<12 Months)
Toddlers (1- to 2-Year-Olds)
Preschoolers (3- to 5-Year-Olds)
School-Age Children
Adolescents
Evaluation
Triage
History
Pediatric Assessment Triangle
Appearance
Work of Breathing
Circulation to the Skin
Length-Based Resuscitation Tape
Physical Examination
Specific Disorders
Common Neonatal Complaints
Neonatal Intensive Care Unit Graduate
Children With Special Health Care Needs
Child Abuse
Other Considerations
Consent for Emergency Care
Pediatric-Ready Emergency Department
Pediatric-Friendly Emergency Department
References
Chapter 156: Pediatric Airway Management
Foundations
Background and Importance
Anatomy
Physiology
Equipment
Management
Decision Making
Rapid Sequence Intubation
Pretreatment
Sedatives
Neuromuscular Blocking Agents
Devices and Techniques
Basic Airway Management
Advanced Airway Management
Preparation
Preoxygenation
Positioning
Placement of Tube
Post-Intubation Management
Video Laryngoscopy
Airway Rescue Devices for Children
Pediatric Surgical Airway Techniques
Outcomes
References
Chapter 157: Pediatric Sedation and Analgesia
Sedation
Foundations
Definitions
Specific Issues
Preparation
Preprocedural Fasting
Supplemental Oxygen and Capnography During Procedural Sedation and Analgesia
Specific Medications
Propofol
Ketamine
Use of Ketamine in Patients With Head Injury
Ketamine Recovery Agitation: Use of Benzodiazepines
Use of Anticholinergics With Ketamine
Use of Antiemetics with Ketamine
Ketofol: Ketamine Plus Propofol
Dexmedetomidine
Nitrous Oxide
Post-Sedation Monitoring
Outcomes
Pain Management
Foundations
Specific Issues
Pain Assessment
Nonpharmacologic Techniques
Pharmacologic Techniques
Topical Anesthetics
Local Anesthetics
Nerve Blocks
Nonopioid Systemic Analgesics
Opioid Analgesics
Opioid Prescribing and Use
Low Dose Ketamine for Treatment of Pain
Reversal Agents
Outcomes
References
Chapter 158: Pediatric Resuscitation
Cardiac Arrest
Foundations
Background
Pathophysiology
Clinical Features
Recognizing Imminent Arrest
Management
Compressions-Airway-Breathing
Compressions
Ventilation
Compression-Only Cardiopulmonary Resuscitation
Defibrillation
Pharmacology
Vascular Access
Termination of Resuscitation
E-CPR
Post-Arrest Care
Blood Pressure
Ventilation and Oxygenation
Targeted Temperature Management
Glucose
Arrhythmia and Seizures
Family Presence
Septic Shock in the Pediatric Patient
Foundations
Background
Pathophysiology
Clinical Features
Management
Monitoring Response to Therapy
Brief Resolved Unexplained Events
Background
Clinical Features
Management
Disposition
References
Chapter 159: Neonatal Resuscitation
Foundations
Transition From Fetal to Extrauterine Life
Specific Issues
Indications for Resuscitation
Hypoxia
Hypothermia
Hypoglycemia
Hypovolemia
Prematurity
Meconium-Stained Amniotic Fluid
Maternal Factors
Infection
Medications
Withholding and Discontinuing Resuscitation
Special Anatomic Anomalies
Diaphragmatic Hernia
Myelomeningocele and Omphalocele
Choanal Atresia
Pierre Robin Sequence
Congenital Cardiac Disease
Newborn Resuscitation Algorithm
Preparation
Dry, Warm, Stimulate, Position, Suction, and Assess Need for Further Intervention
Ventilation, Oxygen, Intubation
Chest Compressions
Vascular Access
Medications
Epinephrine
Volume Expanders
Antibiotics
Glucose
Dopamine
Therapeutic Hypothermia
Disposition
Outcomes
Safety
Effectiveness
Complications
References
Chapter 160: Pediatric Trauma
Foundations
Anatomy and Physiology
Clinical Features
Initial Assessment and Primary Survey
A—Airway and Cervical Spine Stabilization
B—Breathing and Ventilation
C—Circulation and Hemorrhage Control
D—Disability Assessment
E—Exposure and Environment
F—Family
Secondary Survey
Physical Examination
Pain Assessment
Diagnostic Testing
Laboratory Testing
Radiologic Imaging
Disposition
Specific Injuries
Head Injury
Clinical Features
Concussion
Scalp injuries
Skull fractures
Cerebral contusions
Epidural hematoma
Subdural hematoma
Diagnostic Testing
Skull radiographs
Cranial computed tomography
Management and Disposition
Skull fractures
Severe traumatic brain injury
Vertebral and Spinal Cord Injury
Foundations
Clinical Features
Diagnostic Testing
Management
Cardiothoracic Injury
Foundations
Diagnostic Testing
Pneumothorax
Hemothorax
Pulmonary contusion
Traumatic diaphragmatic hernia
Cardiac and vascular injuries
Abdominal and Pelvic Injury
Foundations
Clinical Features
Diagnostic Testing and Management
Splenic injury
Hepatic injury
Renal injury
Gastrointestinal injury
Pancreatic injury
Penetrating injury
Straddle injuries
Pelvic fractures
Musculoskeletal Injuries
References
Chapter 161: Pediatric Fever
Foundations
Background
Anatomy, Physiology, and Pathophysiology
Clinical Features
Diagnostic Testing
White Blood Cell Count
Inflammatory Markers
Blood Culture
Urinalysis and Urine Culture
Lumbar Puncture
Stool Studies
Chest Radiography
Rapid Viral Antigen Testing
Management
Approach to the Febrile Infant and Child
Infants 0 to 28 Days Old
Infants 29 to 90 Days Old
Infants 3 to 36 Months Old
Children 3 Years Old to Adulthood
Specific Disorders
Febrile Seizures
Fever and Petechiae
Kawasaki Disease (Mucocutaneous Lymph Node Syndrome
Toxic Shock Syndrome
Fever in Children With an Underlying Chronic Medical Illness
Oncology Patients
Patients With the Acquired Immunodeficiency Syndrome
Sickle Cell Disease
Congenital Heart Disease
Ventriculoperitoneal Shunts
References
Chapter 162: Pediatric Upper Airway Obstruction and Infections
Foundations
Clinical Features
Diagnostic Testing and Management
Specific Disorders
Supraglottic Airway Diseases
Congenital Lesions
Choanal atresia
Macroglossia
Micrognathia
Pharyngitis
Peritonsillar Abscess
Mononucleosis
Retropharyngeal Abscess
Clinical features
Diagnostic testing
Management
Ludwig’s Angina
Epiglottitis
Foundations
Clinical features
Diagnostic testing
Management
Trauma and Burns
Allergic Reactions
Diseases of the Larynx
Congenital lesions
Acquired lesions
Laryngeal papillomas
Subglottic tracheal disease
Viral Croup
Foundations
Clinical features
Management
Spasmodic or Atypical Croup
Diseases of the Trachea
Congenital lesions
Tracheomalacia
Tracheal stenosis
Tracheal compression
Vascular rings
Bacterial tracheitis
Foundations
Clinical features
Diagnostic testing
Management
Foreign Bodies
Airway foreign body
Foundations
Clinical features
Diagnostic testing
Management
Can’t Intubate, Can’t Ventilate Scenari
References
Chapter 163: Pediatric Lower Airway Obstruction
Asthma
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Clinical Features
History
Physical Examination
Differential Diagnoses
Diagnostic Testing
Management
Mild Exacerbation
Moderate Exacerbation
Severe Exacerbation
Foundations
Anatomy, Physiology, and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Prophylaxis
Disposition
References
Chapter 164: Pediatric Lung Disease
Specific Disorders
Pneumonia
Foundations
Clinical Features
Differential Diagnoses
Bacterial Pneumonia
Viral Pneumonia
Mycoplasma Pneumonia
Chlamydia Pneumonia
Aspiration Pneumonia
Pneumonia in the Immunocompromised Patient
Diagnostic Testing
Radiography
Ultrasound
Laboratory Studies
Management
Infants Younger Than 2 Months
Infants 2 to 3 Months of Age
Infants and Children Older Than 3 Months
Disposition
Pertussis
Cystic Fibrosis
Bronchopulmonary Dysplasia
References
Chapter 165: Pediatric Cardiac Disorders
Foundations
Fetal and Neonatal Circulation
Pathophysiology of Cardiovascular Compensatory Responses
Clinical Features
Pathophysiology of Cyanosis
Clinical Features of Cyanosis
History
Chest Pain
Physical Examination
General Appearance and Pulses
Vital Signs and Blood Pressures
Cardiac Auscultation
Diagnostic Testing
Hyperoxia Test
Laboratory Analysis
Chest Radiography
Electrocardiography
Biochemical Markers
Specific Disorders
Congenital Heart Disease
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Acyanotic Congenital Heart Defect
Foundations
Specific Disorders
Ventricular Septal Defect
Clinical Features
Diagnostic Testing
Management
Atrial Septal Defect
Clinical Features
Diagnostic Testing
Management
Eisenmenger Syndrome
Clinical Features
Coarctation of the Aorta
Foundations
Clinical Features
Diagnostic Testing
Management
Cyanotic Congenital Heart Diseases
Foundations
Tetralogy of Fallot
Foundations
Clinical Features
Diagnostic Testing
Management
Postoperative Complications of Congenital Heart Defects
Respiratory Syncytial Virus Infections in Infants and Children With Congenital Heart Defects
Congestive Heart Failure
Foundations
Clinical Features
Diagnostic Testing
Management
Pediatric Dysrhythmias
Foundations
Clinical Features
Management
Bradydysrhythmias
Sinus Bradycardia
Tachydysrhythmias
Supraventricular Tachycardia
Clinical Features and Diagnostic Testing
Management
Atrial Flutter and Atrial Fibrillation
Ventricular Tachycardia
Special Resuscitation Situations in Children
Bacterial Endocarditis
Foundations
Clinical Features
Diagnostic Studies
Management
Pericarditis
Foundations
Clinical Features
Diagnostic Studies
Management
Myocarditis
Foundations
Clinical Features
Diagnostic Testing
Management
Kawasaki Disease
Foundations
Clinical Features
Incomplete Kawasaki Disease
Differential Diagnoses
Management
Acute Rheumatic Fever
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Cardiac Causes of Sudden Death in Young Athletes
Specific Disorders
Congenital Coronary Artery Anomalies
Marfan Syndrome
Hypertrophic Cardiomyopathy
Clinical Features
Diagnostic Testing
Management
Long QT Syndrome
Clinical Features
Management
Commotio Cordis
References
Chapter 166: Pediatric Gastrointestinal Disorders
Foundations
Specific Disorders
Neonatal Jaundice
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Hypertrophic Pyloric Stenosis
Foundations
Clinical Features
Diagnostic Testing
Differential Diagnoses
Management
Disposition
Malrotation with Midgut Volvulus
Foundations
Clinical Features
Diagnostic Testing
Differential Diagnoses
Management
Disposition
Necrotizing Enterocolitis
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Gastroesophageal Reflux
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Intussusception
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Hirschsprung Disease
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Meckel Diverticulum
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Henoch-Schönlein Purpura
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Inflammatory Bowel Disease
Foundations
Clinical Features
Diagnostic Testing
Differential Diagnoses
Management
Disposition
Gastrointestinal Foreign Bodies
Foundations
Clinical Features
Diagnostic Testing
Differential Diagnoses
Management
Disposition
Appendicitis
Foundations
Clinical Features
Diagnostic Testing
Differential Diagnoses
Management
Disposition
Pancreatitis
Foundations
Clinical Features
Diagnostic Testing
Differential Diagnoses
Management
Disposition
Biliary Tract Disease
Foundations
Clinical Features
Diagnostic Testing
Differential Diagnoses
Management
Disposition
References
Chapter 167: Pediatric Infectious Diarrheal Disease and Dehydration
Diarrhea
Foundations
Background and Importance
Anatomy, Physiology, and Pathophysiology
Pathophysiology
Clinical Features
Specific Etiologies
Viruses
Human Caliciviruses (Norovirus and Sapovirus)
Bacteria
Protozoa
Complications
Diagnostic Strategies
Differential Diagnoses
Management
Disposition
Dehydration
Foundations
Anatomy and Physiology
Pathophysiology
Clinical Features
Diagnostic Strategies
Differential Diagnoses
Management
Oral Rehydration Therapy
Intravenous Therapy
Emergency Resuscitation Phase
Repletion Phase
Hospital-Acquired hyponatremia
Disposition
References
Chapter 168: Pediatric Genitourinary and Renal Tract Disorders
Foundations
Specific Disorders
Priapism
Foundations
Clinical Features
Differential Diagnoses
Management
Disposition
Phimosis
Foundations
Diagnostic Testing
Management
Disposition
Paraphimosis
Foundations
Clinical Features
Diagnostic Testing
Management
Disposition
Balanoposthitis
Foundations
Clinical Features and Diagnostic Testing
Management
Disposition
Complications of Circumcisions
Foundations
Management
Penile Entrapment and Tourniquet Injuries
Foundations
Clinical Features and Diagnostic Testing
Management
Disposition
Epididymitis and Orchitis
Foundations
Clinical Features
Diagnostic Testing
Management
Disposition
Testicular Torsion
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Varicocele and Hydrocele
Foundations
Clinical Features
Diagnostic Testing
Management and Disposition
Acute Idiopathic Scrotal Edema
Foundations
Clinical Features and Diagnostic Testing
Management
Inguinal Hernia
Foundations
Clinical Features
Differential Diagnoses
Management and Disposition
Testicular Carcinoma/Tumors
Foundations
Clinical Features
Diagnostic Testing and Management
Urinary Tract Infections
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing and Management
Hematuria
Foundations
Nephrolithiasis
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Renal Tumors
Foundations
Clinical Features
Diagnostic Testing
Management and Disposition
Proteinuria
Foundations
Clinical Features
Diagnostic Testing and Management
Disposition
Poststreptococcal Glomerulonephritis (PSGN)
Foundations
Clinical Features
Diagnostic Testing
Management
Nephrotic Syndrome
Foundations
Clinical Features
Diagnostic Testing
Differential Diagnoses
Management
Disposition
Acute Kidney Injury
Foundations
Clinical Features and Differential Diagnoses
Diagnostic Testing
Management
Disposition
Hypertension
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Henoch-Schönlein Purpura
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Hemolytic Uremic Syndrome
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Chapter 169: Pediatric Neurologic Disorders
Seizures
Foundations
Clinical Features
Generalized Seizures
Focal Onset
Differential Diagnoses
Management
Status Epilepticus
Febrile Seizures
Afebrile Seizures
Neonatal Seizures
Disposition
Anticonvulsant Therapy at Discharge
Altered Mental Status
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Headaches
Foundations
Clinical Features
Differential Diagnoses
Acute Headache
Chronic Progressive Headache
Migraine Headache
Chronic Nonprogressive Headache
Cluster Headache
Diagnostic Testing
Management
Disposition
Pediatric Ataxia
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Pediatric Vertigo
Foundations
Clinical Features
Diagnostic Testing
Differential Diagnoses
Management
Disposition
Motor Dysfunction
Stroke
Foundations
Clinical Features
Diagnostic Testing
Management
Disorders of the Spinal Cord
Foundations
Clinical Features
Diagnostic Testing
Management and Disposition
Guillain-Barré Syndrome
Foundations
Clinical Features
Diagnostic Testing
Management and Disposition
Infant Botulism
Foundations
Clinical Features
Diagnostic Testing
Management and Disposition
Myasthenia Gravis
Foundations
Clinical Features
Diagnostic Testing
Management and Disposition
References
Chapter 170: Pediatric Musculoskeletal Disorders
Foundations
Anatomy and Physiology
Fracture Patterns
Specific Disorders
Clavicle Fracture
Supracondylar Fractures of the Humerus
Monteggia and Galeazzi Fracture-Dislocations
Nursemaid’s Elbow
Toddler’s Fracture
Nonaccidental Trauma
Developmental Dysplasia of the Hip
Foundations
Clinical Features
Diagnostic Testing
Management
Pediatric Hip Pain
Transient Synovitis
Acute Septic Arthritis
Legg-Calvé-Perthes Disease
Slipped Capital Femoral Epiphysis
Lyme Arthritis
Apophyseal Injuries
Osgood-Schlatter Syndrome
Sever Disease
Little League Elbow
Apophysitis and Avulsion Fractures of the Hip
Gymnast Wrist
References
Chapter 171: Pediatric Drug Therapy
Foundations
Pharmacokinetic Considerations in Children
Absorption
Distribution
Metabolism
Elimination
Other Considerations
Drug Therapy in the Neonate
Use of Antipyretics in Children
Over-the-Counter Cough and Cold Medications
Opioid Analgesics
Medication Safety and Adverse Drug Events
References
Chapter 172: Child Abuse
Physical Abuse
Foundations
Role of the Emergency Clinician
Clinical Features
Social and Demographic Risk Factors
History
Physical Examination
Sentinel Injuries
Universal Screening
Differential Diagnoses
Diagnostic Testing
Skeletal Survey
Neuroimaging (Computed Tomography or Magnetic Resonance Imaging)
Retinal Examination
Abdominal Injury Testing
Toxicology Testing
Management
Household Contacts
Timing
Mandated Reporting
Disposition
Sexual Abuse
Foundations
Trafficking
Clinical Features
History
Physical Examination
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Section Two: The Pregnant Patient
Chapter 173: Complications of Pregnancy
Problems in Early Pregnancy
Miscarriage Foundations
Pathophysiology
Terminology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Threatened Miscarriage
Incomplete Miscarriage
Completed Miscarriage
Ectopic Pregnancy
Foundations
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Ultrasonography
Hormonal Assays
Other Studies
Management and Disposition
Unstable Patients
Stable Patients
Molar Pregnancy
Foundations
Clinical Findings
Diagnostic Tests
Management
Complications of Late Pregnancy
Vaginal Bleeding in Later Pregnancy
Foundations
Abruptio Placentae
Pathophysiology
Clinical Features
Differential Diagnoses
Placenta Previa
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Pregnancy-Induced Hypertension (Preeclampsia and Eclampsia)
Foundations
Pathophysiology
Clinical Features
Signs and Symptoms
Complications
Differential Diagnoses
Diagnostic Testing
Management
Mild Preeclampsia
Severe Preeclampsia
Amniotic Fluid Embolus
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Rh (Anti-D) Immunization in Pregnancy
Medical and Surgical Problems in the Pregnant Patient
Abdominal Pain
Appendicitis
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Gallbladder Disease
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
Liver Disorders
Foundations
Hepatitis
Acute Fatty Liver
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Intrahepatic Cholestasis
Pathophysiology
Clinical Features
Differential Diagnoses and Management
Nausea and Vomiting in Pregnancy
Normal Pregnancy
Hyperemesis Gravidarum
Pathophysiology
Diagnostic Testing
Management
Thromboembolic Disease
Foundations
Clinical Features
Diagnostic Testing
Deep Venous Thrombosis
Pulmonary Embolism
Management and Disposition
Genitourinary Infections
Urinary Tract Infection
Foundations
Clinical Features and Diagnostic Testing
Differential Diagnosis
Management
Vaginitis
Bacterial vaginosis
Candida Albicans Vaginitis
Trichomonas Vaginitis
Sexually Transmitted Disease
Chlamydia Trachomatis
Neisseria Gonorrhoeae
Herpes Simplex
Upper Genital Tract Infection
Pelvic Inflammatory Disease
Chorioamnionitis
Endocrine Disorders
Thyroid Disorders
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disorders of the Hypothalamic-Pituitary Axis
Foundations
Clinical Features
Diagnostic Testing
Management
Acknowledgment
References
Chapter 174: Medical Emergencies During Pregnancy
Foundations
Asthma
Cardiovascular Disorders
Foundations
Hypertension
Chronic Hypertension
Hypertensive Emergencies
Cardiac Disorders
Acute Coronary Syndromes
Valvular Heart Disease and Pulmonary Hypertension
Foundations
Pulmonary Hypertension
Mitral Stenosis
Aortic and Mitral Regurgitation
Aortic Stenosis
Prosthetic Heart Valves
Hematologic Disorders
Anemia
Dilutional Anemia
Iron Deficiency Anemia
Folate Deficiency
Sickle Cell Anemia
Neurologic Disorders
Epilepsy
Multiple Sclerosis
Spinal Cord Injury
Myasthenia Gravis
Renal Disorders
Metabolic and Endocrine Disorders
Diabetes
General Management
Hyperglycemic
Hypoglycemia
Fetal Effects
Obesity
Thyroid Disorders
Hyperthyroidism
Hypothyroidism
Adrenal Insufficiency
Electrolyte Abnormalities
Systemic Infections
Human Immunodeficiency Virus Infection
Tuberculosis
Syphilis
Viral Hepatitis
Hepatitis B
Hepatitis C
Inflammatory Disorders
Systemic Lupus Erythematosus
Psychiatric Disorders
Schizophrenia, Bipolar Disorder, and Depression
Eating Disorders
Substance Dependence/Use Disorder
Alcohol
Smoking
Cannabis
Cocaine and Methamphetamines
Opioids
References
Chapter 175: Drug Therapy in Pregnancy
Foundations
Classification of Teratogenic Risk
Drug Transfer Across the Placenta
Drug Transfer During Lactation
Drug Therapy During Pregnancy
Pharmacologic Therapy
Analgesic Agents
Acetaminophen
Nonsteroidal Antiinflammatory Drugs
Aspirin
Opiate Analgesics
Rapid Sequence Intubation Agents
Anticoagulants
Thrombolytic Agents
Antidotes
N-Acetylcysteine
Deferoxamine
Digoxin Immune Fragment
Dimercaprol
Flumazenil
Fomepizole
Hydroxycobalamin
Methylene Blue
Naloxone
Physostigmine
Pralidoxime
Pyridoxine
Dimercaptosuccinic Acid (Succimer)
Antiinfective Agents
Antibiotics
Aminoglycosides
Cephalosporins
Chloramphenicol
Clindamycin
Fluoroquinolones
Linezolid
Macrolides
Metronidazole
Nitrofurantoin
Penicillins
Sulfonamides
Tetracyclines
Vancomycin
Antifungals
Antituberculous Agents
Antiviral Agents
Antiherpetic Drugs
Antiinfluenza Drugs
Anti-HIV Drugs
Cardiovascular Agents
Antidysrhythmics
Adenosine
Amiodarone
Digoxin and Quinidine
Lidocaine
Procainamide
Flecainide
Ibutilide
Sotalol
Antihypertensives
Angiotensin-Converting Enzyme Inhibitors
Angiotensin II Receptor Antagonists
Beta Blockers
Calcium Channel Blockers
Diuretics
Nitrates
Clonidine
Hydralazine
Methyldopa
Vasopressors
Endocrine Agents
Diabetes Medications
Thyroid Medications
Gastrointestinal Agents
Antacids
H2 Receptor Antagonists
Proton Pump Inhibitors
Antiemetic Medications
Pyridoxine (Vitamin B6), Doxylamine-Pyridoxine Combination
Phenothiazines
Serotonin 5-HT3 Receptor Antagonists
Neurologic Agents
Anticonvulsants
Antipsychotics
Migraine Medications
Ergot Alkaloids
Triptans
Respiratory Agents
Antihistamines
Asthma Medications
Corticosteroids
Decongestants
References
Chapter 176: Labor and Delivery
Foundations
Limitations of the Emergency Department
Epidemiology of Emergency Delivery
Patient Transfer Considerations
Normal Delivery
Initial Presentation
Distinguishing False From True Labor
Bloody Show
Stages of Labor
First Stage of Labor
Second Stage of Labor
Antenatal Fetal Assessment
Electronic Fetal Monitoring
Baseline Heart Rate
Variability
Decelerations
Diagnostic Patterns
Ultrasonography
Delivery
Episiotomy
Third Stage of Labor
Fourth Stage of Labor
Third-Trimester Complications Associated With Delivery
Premature Labor
Clinical Features
Diagnostic Testing
Management
Premature Rupture of Membranes
Clinical Features
Diagnostic Testing
Management
Chorioamnionitis
Vertical Transmission of Human Immunodeficiency Virus
Complicated Delivery
Foundations
Dystocia and Malpresentation
Breech Delivery
Diagnostic Testing
Management
Shoulder Dystocia
Diagnostic Testing
Management
Face, Brow, and Compound Presentations
Multiple Gestations
Diagnostic Testing
Management
Umbilical Cord-Related Emergencies
Umbilical Cord Prolapse
Clinical Features
Diagnostic Testing
Management
Cord Entanglement
Maternal Complications of Labor and Delivery
Postpartum Hemorrhage
Clinical Features
Differential Diagnosis and Management
Uterine Atony
Maternal Birth Trauma
Retained Products of Conception
Coagulopathies
Uterine Exploration and Removal of the Placenta
Pelvic Vessel Embolization
Uterine Packing
Uterotonic Agents
Hysterectomy
Uterine Inversion
Foundations
Clinical Features
Management
Uterine Rupture
Foundations
Clinical Features
Diagnostic Testing
Management
Amniotic Fluid Embolism
Postpartum Venous Thromboembolism
Postpartum Endometritis
Postpartum Problems
Peripartum Cardiomyopathy
Postpartum Depression
Clinical Features
Management
References
Chapter 177: Trauma in Pregnancy
Foundations
Anatomic Changes in Pregnancy
Physiologic Changes
Cardiovascular
Pulmonary
Gastrointestinal
Specific Disorders
Blunt Trauma
Interpersonal Violence
Falls
Penetrating Trauma
Fetal Injury
Placental Injury
Uterine Injury
Diagnostic Testing
Changes in Laboratory Values with Pregnancy
Laboratory
Kleihauer-Betke Test and Fetomaternal Hemorrhage
Radiography
Ultrasonography
Computed Tomography and Magnetic Resonance Imaging Scans
Special Procedures
Diagnostic Peritoneal Lavage
Management
Maternal Resuscitation
Primary Survey
Airway and Breathing
Circulation
Secondary Survey
Fetal Evaluation
Mother Stable, Fetus Stable
Mother Stable, Fetus Unstable
Mother Unstable, Fetus Unstable
Defibrillation
Resuscitative Hysterotomy
Disposition
References
Section Three: The Geriatric Patient
Chapter 178: Care of the Geriatric Patient
Foundations
Specific Issues and Disorders
Comprehensive Geriatric Assessment
Cognitive Deficits: Delirium and Dementia
Delirium
Dementia
Functional Decline, Vulnerability, and Frailty
Frailty
Goals of Care, Transitions of Care, and Palliative Care
Transitions in Care
Goals of Care and Palliative Care
Nonspecific Complaints and Atypical Presentations
Acute Coronary Syndrome
Syncope
Abdominal Pain
Infections
References
Chapter 179: Geriatric Trauma
Foundations
Background and Importance
Specific Issues
Age as a Trauma Triage Criterion
Mechanisms of Injury
Pathophysiology of Aging Affects Both the Injuries Sustained and the Recovery
Comorbidities
Medications
ATLS Assessment
Airway
Breathing
Circulation
Disability
Exposure
Secondary Assessment
Laboratory Testing
Common Injuries in Older Adults
Traumatic Brain Injury (TBI)
Vertebral Fractures and Spinal Cord Injuries
Thoracic Trauma
Fragility Fractures
Disposition, End-of-Life Considerations, and Recovery
References
Chapter 180: Geriatric Drug Therapy
Foundations
Pharmacokinetics
Pharmacodynamics
Specific Disorders
Polypharmacy and Drug Interactions
Potentially Inappropriate Medications
Beers Criteria
STOPP and START Criteria
Anticoagulation and Bleeding
Neurologic Conditions
Analgesia
Clinical Pharmacy Services
References
Chapter 181: Geriatric Abuse and Neglect
Foundations
Background
Epidemiology and Scope of the Problem
Identifying Elder Abuse and Neglect in the Emergency Department
Clinical Features
Observation and Medical History
Physical Examination
Diagnostic Testing
Diagnostic Imaging
Screening
Management
Emergency Medical Services
Trauma-Informed Care
Documentation
Reporting
Collaboration with the Community
Resources
Specific Issues
Elder Mistreatment in Institutions
Self-Neglect
References
Section Four: Special Clinical Circumstances
Chapter 182: The Immunocompromised Patient
Foundations
Physiology
Immunity and Immune Deficiency
Non–Microbe-Specific Immunity
Physical Barriers
Initial Inflammatory Response and Innate Immunity
Reticuloendothelial System
Adaptive (Microbe-Specific) Immunity
Humoral Immunity
Antibodies
Immunoglobulins
Complement
Cell-Mediated Immunity
Granulocytic Phagocytes
Specific Disorders
Solid Organ Transplants
Cancer
Neutropenia
Background
Febrile Neutropenia Evaluation Pitfalls
Evaluation and Management
Antibiotic Therapy
Risk Assessment and Disposition
Children With Cancer and Febrile Neutropenia
Non-Neutropenic Conditions in the Cancer Patient
The Solid Organ Cancer Patient Without Neutropenia
Impaired Cell-Mediated Immunity
Bacterial Infections
Mycobacterial Infections
Fungal Infections
Parasitic Infections
Viral Infections
Humoral Immune (B-Cell) Defects
Disruption of Natural Barriers
Opportunistic Infections Mimicking Neoplasm
Diabetes
Alcohol Use Disorder and Cirrhosis
Renal Failure
Splenectomy, Hyposplenia, and Functional Asplenia
Immunosuppressive Therapy
Corticosteroids
Other Immunosuppressive Medications
References
Chapter 183: The Solid Organ Transplant Patient
Introduction
Pathophysiology
Anatomy
Infection
Early Period: 0 to 4 Weeks Post-Transplantation
Intermediate Period: 1 to 12 Months Post-Transplantation
Late Period: Beyond 1 Year Post-Transplantation
Rejection
Desensitization Regimens and Therapies for Antibody-Mediated Rejection
Induction Agents
Maintenance Immunosuppression
Calcineurin Inhibitors
Mammalian Target of Rapamycin Inhibitors
Antimetabolites
Corticosteroids
Other Agents: Belatacept, Rituximab, Eculizumab
Organ-Specific Considerations
Heart Transplantation
Anatomic Considerations
Infection
Rejection
Drug Toxicity
Kidney Transplantation
Anatomic Considerations
Infection
Rejection
Drug Toxicity
Liver Transplantation
Anatomic Considerations
Infection
Rejection
Drug Toxicity
Lung Transplantation
Anatomic Considerations
Infection
Rejection
Drug Toxicity
Pancreas Transplantation
Intestinal and Multivisceral Transplantation (IMVT)
Vascularized Composite Allografts
Other Considerations
Post-Transplantation Malignancy
Post-Transplantation Lymphoproliferative Disorder
Graft-versus-Host Disease in Solid Organ Transplantation
Viral Hepatitis in Solid Organ Transplantation
Human Immunodeficiency Virus in Solid Organ Transplantation
Trauma
Eligible Organ Donors
Pregnancy and Solid Organ Transplantation
Psychological Aspects
Disposition
Acknowledgements
References
Chapter 184: The Morbidly Obese Patient
Foundations
Pathophysiology
Changes to Respiratory Mechanics
Obstructive Sleep Apnea and Obesity Hypoventilation Syndrome
Changes in Pharmacokinetics
Antibiotics
Sedatives and Induction Agents
Neuromuscular Blocking Agents
Anticoagulation
Trauma Considerations
Bariatric Surgery
Overview
Laparoscopic Gastric Band
Sleeve Gastrectomy
Roux-en-Y Gastric Bypass
Procedural Difficulties
Lumbar Puncture
Venous Access
Cardiopulmonary Resuscitation
Endotracheal Intubation
Ventilator Management
Challenges with Hospital Equipment
Imaging Challenges
References
Chapter 185: The Combative and Difficult Patient
The Combative Patient
Foundations
Clinical Presentation
Patient Characteristics
Emergency Department Influences
Initial Patient Evaluation
Management
Verbal Management Techniques
Physical Restraints
Chemical Restraints
Benzodiazepines
Antipsychotics
Combined Use of Benzodiazepines and Antipsychotics
Ketamine
Post-Restraint Medical Evaluation
Disposition and Medical Clearance
Assault and Hostage Situations
The Difficult Patient
Foundations
Specific Disorders
Attention-Seeking Patients
Demanding Patients
Repeat Visitors
Self-Destructive Patients
References
Section Five: Underserved Populations
Chapter 186: Multiculturalism, Diversity, and Care Delivery
Foundations
Background and Importance
Rationale For Cultural Competence
Changing Demographics
Racial and Ethnic Disparities in Health Care Access and Outcomes
Tests and Treatments
Health Outcomes
Failure of Trust
Specific Issues
Communication and Use of Interpreters
Disability and Accommodations
Overview
The Hearing Impaired
The Homeless
Prisoners
The Undocumented
Cultural Competence
Appreciation of Different Beliefs, Values, and Experiences
Interpreting the Culture of Medicine for Patients From Diverse Backgrounds
Combining Cultural Competence and Patient-Centered Care
Recommendations
References
Chapter 187: Human Trafficking
Foundations
Background and Importance
Epidemiology
Trafficking Typologies
Global and US Prevalence
Demographics of Trafficked Persons
Recruitment and Control Tactics
Impact On Health
Substance Use
Mental Illness
Pregnancy
Specific Issues
Recognition and Assessment
Indicators and Red Flags
Trafficking Inquiry
Use of Professional Interpreters
Evaluation and Treatment
Trauma-Informed Approach to Care
Multidisciplinary Response
Disposition
Admission versus Discharge
Safety Planning
Resources
Special Considerations
Mandatory Reporting
Medical Record Documentation
Diagnostic Codification
Law Enforcement Considerations
Barriers to Identification and Care
References
Chapter 188: Sexual Minority Populations (LGBTQ)
Foundations
Background and Importance
Terminology and Concepts
Historical Context
Identity
Specific Issues
Factors Affecting Equitable Care
Legal Barriers
Sexual Minority Parental Barriers
Barriers to Health Care Access
Health Care Experience
Provider Education
Health Disparities
Transgender Health
Medical Gender Affirming Therapy and Complications
Transgender Female
Transgender Male
Surgical Gender Affirming Therapy and Complications
Transgender Women
Transgender Men
Physical Examination
Special Populations
Youth
Elders
People of Color
References
Chapter 189: Social Determinants
Foundations
Specific Issues
Patient and Provider Factors
Language
Health Literacy
Insurance and Access to Care
Employment, Income, and Financial Strain
Food Insecurity
Homelessness and Housing
Transportation
Immigration Status
Education
Legal Concerns
Justice Involvement
The Built Environment
Management
Overview
Health Care Access and Literacy
Health Care Coverage
Disability and Loss of Employment
Challenges with Employers
Finding Employment
Income Support
Management of Food Insecurity
Health Care Based Resources
Community-Based Resources
Public Programs
Housing and Homelessness
Transportation Challenges
Immigration Status
Adjustment of Status
Victims of Violence and Crime
Refugees and Asylees
Hospital Safe Spaces Initiatives
Immigration Status and Public Charge
Education-Related Challenges
Domestic Concerns and Social Isolation
Legal Concerns
Legal Assistance
Patients in Police Custody
Tickets and Outstanding Warrants
References
Chapter 190: Community Violence
Foundations
Population Characteristics and Violence
Community Violence
Specific Issues
Root Causes of Community Violence
Psychological and Mental Health
Disparities in Access to Mental Health Care Services and Treatment
Physical Trauma From Violent Injury and the Role of Hospitals, Emergency Departments, and Trauma Centers
Hospital-Based Violence Intervention Programs
Boston University HVIP Model
References
Chapter 191: Sexual Assault
Foundations
Clinical Features
Differential Diagnoses
Diagnostic Testing
Sexually Transmitted Infections
Drug-Facilitated Sexual Assault
Evaluating the Victim of Attempted Strangulation
Management
Medical Forensic Examination
General Principles of Evidence Collection
Special Techniques
Colposcopy
Toluidine Blue Dye
Alternate Light Source
Special Populations
Older Adult Sexual Assault
Male Sexual Assault
Definitive Treatment to Prevent Sexually Transmitted Infections and Pregnancy
Disposition
Testifying in Court
Acknowledgment
References
Chapter 192: Intimate Partner Violence and Abuse
Foundations
Background
Causes and Natural History of Intimate Partner Violence
Identification
Screening
Clinical Features
Injuries and Comorbidities
Questioning Injury Presentations
Specific Issues
Gynecologic-Related Presentations
Mental Health Presentations
Alcohol and Drug Use and Intimate Partner Violence
Chronic Medical Conditions
Pain Syndromes
Human Trafficking
Diagnostic Testing
Management
Physician-Delivered Messages
Documentation
Immigration Issues
Referral
Danger Assessment
Mental Health Screening
Privacy and Confidentiality Considerations
Involvement of Law Enforcement Agencies
Intimate Partner Violence Coding and Diagnosis
Disposition
References
Public Health and Humanitarian Emergencies
Chapter e1: Global Emergency Medicine
Foundations
The Academic Practice of Global Emergency Medicine
Specific Issues
History of Global Emergency Medicine
Global EM Organizations
Areas of Focus in Global Emergency Medicine
Education
Systems Development (Systems Strengthening)
Research
National Societies
Policy
Humanitarian Assistance
Direct Clinical Care
Clinical Rotations Abroad
Preparation of the Traveler
Safety and Security
Research Ethics in Global EM
References
Chapter e2: Humanitarian Aid in Disaster and Conflict
Foundations
Types of Humanitarian Emergencies
Natural Disasters
Disease Epidemics/Pandemics
Armed Conflict
Specific Issues
Standards in Humanitarian Response
International Law
Codes of Conduct
Sphere Standards
Priorities in Global Humanitarian Emergencies
Protection
Rapid Assessment
Food, Water, and Shelter
Health Care
Transition and Exit
International Actors in Humanitarian Response
Response Organizations
United Nations
Foreign Governments
Militaries
Individual Responders
Coordination of Humanitarian Response
Ongoing Coordination
The Emergency Clinician in Humanitarian Crises
Preparing for Humanitarian Response
Training for Humanitarian Response
Choosing a Deployment
Safety and Security
Ethical Dilemmas
Conclusion
References
The Practice of Emergency Medicine
Chapter e3: Emergency Ultrasound
Foundations
Specific Issues
Basic Ultrasound Information
Physics and Knobology
Transducer Selection
Focused Assessment with Sonography in Trauma
Image Acquisition
Pathology
Special Considerations
Biliary
Image Acquisition
Pathology
Urinary Tract Ultrasound
Image Acquisition
Pathology
Abdominal Aorta
Image Acquisition
Pathology
Cardiac/Hemodynamic Assessment
Image Acquisition
Pathology
Airway/Thoracic Ultrasound
Image Acquisition
Pathology
Ultrasound in Early Pregnancy
Image Acquisition
Pathology
Deep Venous Thrombosis
Image Acquisition
Pathology
Ocular Ultrasound
Image Acquisition
Pathology
Soft Tissue Ultrasound
Image Acquisition
Pathology
Musculoskeletal Ultrasound
Image Acquisition
Pathology
Bowel Ultrasound
Pediatric Emergency Ultrasound
Ultrasound for Procedural Guidance
Vascular Access Procedures
Drainage Procedures
Localization Procedures
References
Chapter e4: The Geriatric Emergency Department
Principles
Background/Foundations
Specific Disorders/Issues
Geriatric Emergency Department Guidelines
Staffing and Administration
Equipment and Supplies
Education
Policies, Procedures, and Protocols
Follow-Up and Transition of Care
Quality Improvement Measures
Geriatric Emergency Department Collaborative and Geriatric Emergency Department Accreditation
Conclusion
References
Chapter e5: End of Life
Foundations
Palliative Care
Overview
Palliative Care in the Emergency Department
Hospice Care
Overview
Hospice and the Emergency Department
Core Aspects of Palliative Care in the Emergency Department
End-of-Life Trajectories and Prognostication
Common Procedures and Interventions Faced at the End of Life
Intubation and Mechanical Ventilation
Cardiac Arrest
Advance Care Planning and Advance Directives
Overview
Goals-of-Care Discussions
Common Symptoms Requiring Palliation Near the End of Life
Pain
Dyspnea
Death in the ED
Death Notification and Breaking Bad News
Viewing the Body
Family Presence During Resuscitation
Field Death Pronouncement
References
Chapter e6: Bioethics
Foundations
Ethics and Emergency Medicine
Specific Issues
Bioethics and the Law
Rights and Duties
Values
Society’s Values
Patient Values and Ethical Decisions
Fundamental Bioethical Principles
Nonmaleficence and Autonomy
Beneficence
Justice
Truth-Telling
Confidentiality Versus Privacy
Medical and Moral Imperatives in Emergency Medicine
Professional Values
Safety: A Unique Value
Codifying Professional Values: Ethical Oaths and Codes
Organizational and Institutional Values
Professional Codes
Applying Bioethics
Emergency Clinician/Patient Relationship
Recognizing Ethical Problems
Prioritizing Conflicting Principles
Case Example: Conflicting Bioethical Principles
Medical Imperatives and Bioethical Dilemmas
Professional Value Conflicts
Rapid Ethical Decision-Making Model
Advance Directives
Consent, Decision-Making Capacity, and Surrogate Decision Makers
Consent
Decision-Making Capacity
Surrogates
Family
Surrogate Lists
Bioethics Committees and Consultants
Emergency Clinicians
Courts
Resuscitation Ethics
Futility
Withholding Versus Withdrawal of Treatments
Palliative Care
Notifying Survivors
Viewing Resuscitations
Postmortem Teaching
Resuscitation Research
Public Policy And Bioethics
Restricted Access to Emergency Medical Care
Morality of Triage Decisions
Physician Response to Risky Situations
“Proactive Ethics”: How Can Emergency Clinicians Change the Rules?
Audiovisual Recordings and Social Media Use
A Global Perspective
References
Chapter e7: Emergency Medical Treatment and Labor Act and Medicolegal Issues
Principles
Specific Issues—Emergency Medical Treatment and Labor Act
Medical Screening Examination
Emergency Medical Condition
Patients Brought by Emergency Medical Services to the Emergency Department
National Emergencies or Disasters
Sexual Assault Cases
Police-Requested Blood Alcohol Tests
Health Care Providers Qualified to Perform the Medical Screening Examination
Ancillary Services as Part of the Medical Screening Examination
Policies, Procedures, and Practice Guidelines
Registration Process, Collections or Insurance Information, and Authorization
Central Log
Medical Record
Stabilization Requirements
Disposition Issues Under Emergency Medical Treatment and Labor Act
Admission
“Discharge” or “Transfer” to Home
Discharge or Transfer from the Emergency Department to an On-Call Physician’s Office
Follow-Up Care After Discharge from the ED
Transfers to Other Acute Care Hospitals
Duty to Accept Appropriate Transfers from Other Hospitals
Duty to Report Transfer Violations
Consent For Medical Care
Informed Consent
Federal Versus State Laws
Reasonable Person Versus Professional Disclosure Standard
Emergency Clinician Role in the Consent Process
Implied Consent in Emergency Situations
Minors
Minors Accompanied by a Parent or Legal Guardian
Unaccompanied Minors
Incompetent or Incapacitated Adults
Other Special Populations of Patients
Prisoners
Alcohol-Intoxicated Patients
Patients Given Pain Medications
Refusal Of Medical Care
Informed Refusal
Determining Competence
Ensuring an Informed Decision
Involving Others
Documenting Appropriately
Federal Rules
Leaving Without Being Seen
Leaving Against Medical Advice
Parent or Guardian Who Refuses Care or Blood Transfusions for a Minor
Jehovah’s Witnesses
Adult Blood Transfusions
Competent Adult
Unconscious or Medically Incompetent Adult
Reporting Requirements
References
Chapter e8: Quality Improvement and Patient Safety
Principles
Background
Work Systems
Resilience
Sources of Failure in Emergency Care
Communication and Interruptions
Workspace Design
Crowding
Information Gaps
Performance-Shaping Factors
Violation-Producing Factors
Teamwork
Efficiency/Thoroughness Trade-Off
Authority Gradients
Cognitive Processes
Fatigue and Shift Work
Problem Areas in Emergency Care
Triage
Technical Procedures
Laboratory Tests
Radiology Studies
Transitions in Patient Care
Orphaned Patients
Medications
Summary
References
Chapter e9: Patient Experience in the Emergency Department
Foundations
Specific Issues
Challenges and Opportunities
Focusing on Communication
Wait Times and Expectation Setting
Discharge Instructions
Summary
References
Chapter e10: Wellness, Stress, and the Impaired Physician
Foundations
Wellness Strategies
Individual
Health Care Organizations
External Environment
References
Chapter e11: Forensic Emergency Medicine
Perspective
Forensic Aspects of Gunshot Wounds
Background
Ballistics
Forensic Evaluation of Handgun Injuries
The Weapon
Handgun Ammunition
Forensic Aspects of Rifles
Forensic Aspects of Shotguns
Forensic Aspects of Air Guns/Rifles
Epidemiology
Clinical Features
Errors of Interpretation and Terminology
Handgun Entrance Wounds
Contact Wounds
Close-Range Wounds
Intermediate-Range Wounds
Long-Range Wounds
Atypical Entrance Wounds
Handgun Exit Wounds
Atypical Exit Wounds
Centerfire Rifle Wounds
Shotgun Wounds
Clinical Features of Firearm Injuries
Diagnostic Testing
Differential Diagnosis
Management and Disposition
Head and Neck Injuries
Thoracic Injuries
Abdominal Injuries
Extremity Injuries
Soft Tissue Injuries
Evidence
Conclusions
Forensic Aspects of Physical Assault
Perspective
Blunt Force Pattern Injuries
Pattern Contusions
Pattern Abrasions and Lacerations
Sharp Force Pattern Injuries
Thermal Pattern Injuries
Chemical Injuries
Forensic Aspects of Motor Vehicle Trauma
Perspective
Motor Vehicle Collisions
Motorcycle Collisions
Evaluation of Motor Vehicle Collisions
Pattern Injuries
Trace Evidence
Evaluation of Pedestrian Collisions
Pattern Injuries
Interfacing with the Law
Law Enforcement Exemptions to the Health Insurance Portability and Accountability Act
Mandatory Reporting
Subpoenas and Court Depositions
Forced Blood Draws
References
Emergency Medical Services and Disaster Preparedness
Chapter e12: Emergency Medical Services: Overview and Ground Transport
Foundations
Development of Emergency Medical Services
Specific Issues
Emergency Medical Service Systems
Private and Public Agencies
Basic Life Support and Advanced Life Support Service
Single-Tiered, Multitiered, and First Responder Systems
Levels of Provider and Scope of Practice
Emergency Medical Responder
Emergency Medical Technician
Advanced Emergency Medical Technician
Paramedic
Material Resources
Medications
Equipment
Ambulances
Communications
Access
Emergency Medical Dispatch
Systems Status Management and Flexible Deployment
Field Communications
Oversight
Federal
State
Local
Medical Director
Indirect Medical Oversight
Direct Medical Oversight
Medical Care and Controversies in Management
Airway Support and Respiratory Emergencies
Interventions
Medications
Cardiovascular Emergencies
Interventions
Medications
Traumatic Emergencies
Interventions
Interfacility And Specialized Transports
Acknowledgments
References
Chapter e13: Air Medical Transport
Foundations
Background and Importance
Aviation Physiology
Gas Laws
Additional Stresses of Flight
Specific Issues in Air Medical Transport
Administrative Structure of Air Transport Systems
Types of Transports
Air Medical Aircraft
Helicopters (Rotor-Wing Aircraft)
Airplanes (Fixed-Wing Aircraft)
Air Medical Flight Crew
Medical Direction
Safety
Landing Zones
Integration of Air Medical Transport Within Emergency Medical Service Systems
Specific Disorders
Trauma
Burn Victims
Cardiac Disorders
Stroke
High-Risk Obstetrics Patients
Neonates and Children
Lives Saved, Efficacy, and Cost-Effectiveness
Future of Air Medical Transport
References
Chapter e14: Disaster Preparedness
Foundations
Surge Capacity
Definitions
Classic Terminology
Hazard Vulnerability Analysis
Specific Issues In Disaster Management
Triage
Routine Multiple-Casualty Triage
Catastrophic Casualty Management
Vulnerable Triage Populations
Special Triage Categories
Care of Populations with Functional or Access Needs
Out-of-Hospital Response
Emergency Medical Services System Protocols
Incident Management System
Organization of the Out-of-Hospital Disaster Scene
Planning and Hospital Response
Comprehensive Emergency Management
Hospital Disaster Response Plan
The First 72 Hours
Basic Components of a Hospital Comprehensive Disaster Response Planning Process
Interdepartmental Planning Group
Resource Management
Command Structure
Media
Communication
Personnel
Patient Management
Hospital Evacuation
Training Exercises
Toxic Disasters (Hazardous Material)
Chemical, Biologic, Radiologic, Nuclear, and Explosive Terrorism
Disaster Stress Management
Personal Preparedness
Disaster Management and Response Organizations within the United States Government
Department of Homeland Security
Urban Search and Rescue (ESF #9 of the National Response Framework)
Department of Health and Human Services
National Disaster Medical System
Centers for Disease Control and Prevention
Department of Veterans Affairs
Department of Defense
Future Directions
References
Chapter e15: Weapons of Mass Destruction
Foundations
Specific Disorders
Nuclear and Radiologic Devices
Foundations
Clinical Features
Management
Biologic Weapons
Foundations
Clinical Features
Management
Anthrax
Foundations
Clinical Features
Management
Plague
Fundamentals
Clinical Features
Differential Diagnosis
Management
Smallpox
Foundations
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Chemical Weapons
Nerve Agents (Sarin, Tabun, Soman, and VX)
Fundamentals
Clinical Features
Management
Vesicants (Mustard)
Foundations
Clinical Features
Management
Cyanides (Blood Agents)
Foundations
Clinical Features
Management
Pulmonary Intoxicants (Phosgene and Chlorine)
Foundations
Clinical Features
Management
Blast Injuries from Conventional Explosives
Foundations
Clinical Features
Management
Primary Blast Injury
Blast Lung
Secondary Blast Injury
Tertiary Blast Injury
Quaternary Blast Injury
References
Chapter e16: Tactical Emergency Medical Support and Urban Search and Rescue
Principles
Background
Organizational Principles and Objectives
Special Issues
Tactical Emergency Medical Support Providers and Scopes of Practice
Medical Oversight of Tactical Emergency Medical Support
Casualty Care
Care Under Fire
Tactical Field Care
Combat Casualty Evacuation Care
Committee for Tactical Emergency Casualty Care
Direct Threat Care
Indirect Threat Care
Evacuation Care
Tactical Team Health
Integration With Emergency Medical Services Infrastructure
Active Shooter Incidents
Future Directions
Urban Search And Rescue
Components and Structure of an Urban Search and Rescue Team
Medical Team Operations in Urban Search and Rescue
Medical Team Tasks
Predeployment
Deployment
Confined Space Rescue
Specific Medical Challenges
Crush Injury and Crush Syndrome
Environmental and Hazardous Materials Exposures
References