Rosen's Emergency Medicine: Concepts and Clinical Practice

Front Matter
Copyright Page
Acknowledgments
Contributors
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: Critical Management Principles
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: MOANS
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.
Pretreatment.
Paralysis With Induction.
Positioning.
Placement of Tube.
Postintubation Management.
Delayed Sequence Intubation
Blind Nasotracheal 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 Versus Video Laryngoscopy
Videolaryngoscopes
Fiberoptic and Video Intubating Stylets
Flexible Intubating Scopes
Extraglottic Devices
Laryngeal Mask Airways.
Other Extraglottic Devices.
Surgical Airway Management
Needle Cricothyrotomy With Transtracheal Jet Ventilation
Cricothyrotomy
Outcomes
References
Chapter 1: Questions & Answers
Chapter 2: Mechanical Ventilation and Noninvasive Ventilatory Support
Perspective
Principles of Mechanical Ventilation
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
Mechanical Ventilation of the Intubated Patient
Ongoing Management
Sedation and Analgesia of the Ventilated Patient
Complications
Troubleshooting the Ventilator
Special Clinical Circumstances
Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Status Asthmaticus
Acute Respiratory Distress Syndrome
Outcomes
References
Chapter 2: Questions & Answers
Chapter 3: Pain Management
Principles
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
Chronic Pain.
Recurrent Pain.
Chronic Pain of Malignancy.
Neuropathic Pain.
Acute Pain.
Pharmacologic Therapy
Opioid Analgesic Agents
Mechanism of Action and Toxic Effects.
Drug-Seeking Behavior.
Administration of Pain Control.
Specific Agents
Morphine.
Meperidine.
Hydromorphone.
Fentanyl.
Oxycodone.
Hydrocodone.
Codeine.
Methadone.
Naloxone.
Tramadol.
Tapentadol.
Opioid Agonist-Antagonist Analgesic Agents.
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 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
Hypnosis
Out-of-Hospital Analgesia
Outcomes: Treatment Endpoints
References
Chapter 3: Questions & Answers
Chapter 4: Procedural Sedation and Analgesia
Principles
Background
Terminology
Management
Decision Making
Patient Assessment.
Preprocedural Fasting.
Personnel.
Supplies and Equipment.
Monitoring Devices and Techniques.
Recovery.
Postprocedure Recovery and Discharge.
Pharmacologic Therapy
Routes of Administration.
Opioids.
Fentanyl.
Morphine.
Benzodiazepines.
Midazolam.
Barbiturates.
Ketamine.
Sedative-Hypnotics
Etomidate.
Propofol.
Ketamine Plus Propofol.
Ultra—Fast-Acting Agents.
Reversal and Rescue Agents.
Naloxone.
Flumazenil.
Drug Selection and Administration
References
Chapter 4: Questions & Answers
Chapter 5: Monitoring the Emergency Patient
Blood Pressure Measurement
Principles
Decision Making
Devices and Techniques
Pulse Oximetry
Principles
Decision Making
Devices and Techniques
End-Tidal Carbon Dioxide Monitoring
Principles
Anatomy and Pathophysiology
Management
Capnography in Spontaneously Breathing Patients
Rapid Assessment of Critically Ill Patients.
Assessment and Measurement of Response to Treatment in Patients With Acute Respiratory Distress.
During Procedural Sedation and Analgesia.
Rapid Assessment of Obtunded or Unconscious Patients.
Rapid Assessment of Patients With Severe Illness.
Cerebral Function Monitoring
Principles
Fetal Monitoring
Principles
Monitor Alarms and Limits
References
Chapter 5: Questions & Answers
Chapter 6: Shock
Principles
Background and Importance
Anatomy, Physiology, and Pathophysiology
Specific Causes
Hemorrhagic Shock
Septic Shock
Cardiogenic Shock
Neurogenic Shock
Management
Decision Making
Monitoring Perfusion Status
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
Intraaortic Balloon Pumps and Percutaneous Coronary Intervention
Pericardiocentesis and Thrombectomy
Outcomes
References
Chapter 6: Questions & Answers
Chapter 7: Brain Resuscitation
Principles
Background
Anatomy, Physiology, and Pathophysiology
Elevated Intracranial Pressure
Management
Decision Making
Pharmacology, Devices, and Techniques
Cardiopulmonary Resuscitation
Reperfusion
Optimizing Perfusion and Oxygenation.
Elevated Intracranial Pressure
Medical Treatment.
Surgical Treatment.
Maintenance of Body Temperature
Resuscitative Mild Hypothermia
Avoidance of Hyperglycemia
Seizure Management
Outcomes
Summary
References
Chapter 7: Questions and Answers
Chapter 8: Adult Resuscitation
Principles
Background
Anatomy, Physiology, and Pathophysiology
Management
Decision Making
History and Physical Examination
Monitoring
Arterial Blood Pressure and Coronary Perfusion Pressure
End-Tidal Carbon Dioxide
Central Venous Oxygen Saturation
Pharmacologic Therapy
Devices and Techniques
Echocardiography
Laboratory Testing
Resuscitation
Defibrillation
Pulseless Electrical Activity
Asystole
Extracorporeal Cardiopulmonary Resuscitation
Outcomes
Post–Cardiac Arrest Care
Hypothermic Targeted Temperature Management
Coronary Angiography and Primary Percutaneous Coronary Intervention
References
Chapter 8: Questions & Answers
Section Two: Signs, Symptoms, and Presentations
Chapter 9: Fever in the Adult Patient
Perspective
Epidemiology
Pathophysiology
Diagnostic Approach and Algorithm
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms
Signs
Ancillary Testing
Diagnostic Algorithm
Empirical Management
Disposition
References
Chapter 9: Questions and Answers
Chapter 10: Weakness
Perspective
Epidemiology
Pathophysiology
Diagnostic Approach and Algorithm
Differential Considerations
Diagnostic Algorithm
Critical Diagnoses
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.
One Limb Only (Monomelic 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 and Muscle of Expression.
Pivotal Findings
Management
Disposition
Reference
Chapter 10: Questions and Answers
Chapter 11: Cyanosis
Perspective
Epidemiology
Pathophysiology
Diagnostic Approach
Pivotal Findings
Symptoms
Signs
Laboratory and Ancillary Testing
Other Diagnostic Modalities
Imaging
Electrocardiography and Echocardiography
Differential Algorithms
Critical Diagnoses
Emergent Diagnoses
Empirical Management
Specific Strategies
Methemoglobinemia and Sulfhemoglobinemia
Other Causes of Cyanosis
Patient Disposition
Admission
Discharge
References
Chapter 11: Questions and Answers
Chapter 12: Syncope
Perspective
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms
Signs
Ancillary Studies
Diagnostic Algorithm
Empirical Management
References
Chapter 12: Questions and Answers
Chapter 13: Depressed Consciousness and Coma
Perspective
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms
Signs
Ancillary Testing
Diagnostic Algorithm
Empirical Management
References
Chapter 13: Questions & Answers
Chapter 14: Confusion
Perspective
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms
Signs
Ancillary Testing
Diagnostic Algorithm
Empirical Management
References
Chapter 14: Questions & Answers
Chapter 15: Seizures
Perspective
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms
Signs
Ancillary Testing
Laboratory Testing
Imaging Studies
Electroencephalography
Diagnostic Algorithm
Empirical Management
Prehospital Management
Emergency Department Management
Disposition
References
Chapter 15: Questions & Answers
Chapter 16: Dizziness and Vertigo
Perspective
Pathophysiology
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms
Physical Examination
Vital Signs.
Head and Neck.
Neurologic Examination.
Positional Testing.
HINTS.
Ancillary Testing
Radiologic Imaging.
Diagnostic Algorithm
Empirical Management
Disposition
References
Chapter 16: Questions & Answers
Chapter 17: Headache
Perspective
Pathophysiology
Diagnostic Approach
Differential Diagnosis Considerations
Pivotal Findings
Signs
Ancillary Testing
Diagnostic Algorithm
Empirical Management
Disposition
References
Chapter 17: Questions & Answers
Chapter 18: Diplopia
Perspective
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms
Monocular Cause.
Mechanical Orbitopathy.
Isolated Oculomotor Nerve Palsy.
Neuroaxial Process Involving the Brainstem and Related Cranial Nerves.
Neuromuscular Disorder.
Signs
Monocular Cause.
Mechanical Orbitopathy.
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: Questions & Answers
Chapter 19: Red and Painful Eye
Perspective
Epidemiology and Pathophysiology
Diagnostic Approach
Differential Diagnosis Considerations
Pivotal Findings
Symptoms
Signs
Visual Acuity
Visual Field Testing
External Examination
Extraocular Muscle Function
Pupillary Evaluation
Ancillary Testing
Swinging Flashlight Test
Pressure Determination
Slit-Lamp Examination
Direct Funduscopic Examination
Topical Anesthetics
Imaging
Laboratory Testing
Diagnostic Algorithm
Critical Diagnoses
Emergent Diagnoses
Urgent Diagnoses
Empirical Management
References
Chapter 19: Questions & Answers
Chapter 20: Sore Throat
Perspective
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms and Signs
Ancillary Testing
Imaging
Diagnostic Algorithm
Critical and Emergent Diagnoses
Empirical Management
References
Chapter 20: Questions & Answers
Chapter 21: Hemoptysis
Perspective
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Diagnosis Considerations
Pivotal Findings
Symptoms
Signs
Ancillary Testing
Diagnostic Algorithm
Critical Diagnoses
Bronchoscopy
Empirical Management
References
Chapter 21: Questions & Answers
Chapter 22: Dyspnea
Perspective
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Diagnosis Considerations
Pivotal Findings
Symptoms
Duration of Dyspnea.
Onset of Dyspnea.
Positional Changes.
Signs
Ancillary Testing
Diagnostic Algorithm
Critical Diagnoses
Emergent Diagnoses
Empirical Management
References
Chapter 22: Questions & Answers
Chapter 23: Chest Pain
Perspective
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Considerations
Rapid Stabilization and Assessment
Pivotal Findings
History
Physical Examination
Ancillary Studies
Diagnostic Table
Empirical Management
References
Chapter 23: Questions & Answers
Chapter 24: Abdominal Pain
Perspective
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Diagnosis Considerations
Rapid Assessment and Stabilization
Pivotal Findings
Symptoms
Signs
Ancillary Testing
Diagnostic Algorithm
Critical Diagnoses
Emergent Diagnoses
Empirical Management
Disposition
Bibliography
Chapter 24: Questions & Answers
Chapter 25: Jaundice
Perspective
Epidemiology
Pathophysiology
Normal Bilirubin Metabolism
Abnormalities in Bilirubin Metabolism
Diagnostic Approach
Differential Diagnosis Considerations
Pivotal Findings
Symptoms
Signs
Laboratory Tests
Imaging
Diagnostic Algorithm
Empirical Management
References
Chapter 25: Questions & Answers
Chapter 26: Nausea and Vomiting
Perspective
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Diagnosis Considerations
Pivotal Findings
Symptoms
Signs
Ancillary Studies
Diagnostic Algorithm
Empirical Management
Special Situations
Opioid-Induced Vomiting
Headache
Pregnancy
Chemotherapy
Cyclical Vomiting
Vertigo
Disposition
References
Chapter 26: Questions & Answers
Chapter 27: Gastrointestinal Bleeding
Perspective
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms
Relevant Medical History
Signs
Ancillary Testing
Occult Blood and Guaiac Bedside Testing
Laboratory Studies
Electrocardiography
Imaging
Diagnostic Algorithm
Management
Empirical Treatment
Resuscitation
Blood Product Transfusion
Nasogastric Aspiration and Lavage
Sengstaken-Blakemore Tube
Pharmacologic Agents
Definitive Management
Consultation
Endoscopy
Colonoscopy
Disposition
References
Chapter 27: Questions & Answers
Chapter 28: Diarrhea
Perspective
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Diagnosis Considerations
Pivotal Findings
Signs and Symptoms
Ancillary Testing
Blood Tests.
Lactate.
Hemoccult and Fecal Cell Count.
Assays for Fecal Calprotectin and Fecal Lactoferrin.
Clostridium difficile Toxin Assay.
Escherichia coli O157:H7 Toxin Assay.
Stool Culture for Bacteria.
Stool Examination for Ova and Parasites.
Giardia Antigen Assay and Serologic Testing for Amebiasis.
Radiographic Studies.
Gastrointestinal Referral.
Diagnostic Algorithm
Critical Diagnoses
Emergent Diagnoses
Empirical Management
References
Chapter 28: Questions & Answers
Chapter 29: Constipation
Principles
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Diagnosis Considerations
Pivotal Findings
Symptoms
Signs
Ancillary Testing
Diagnostic Algorithm
Empirical Management
References
Chapter 29: Questions & Answers
Chapter 30: Acute Pelvic Pain
Perspective
Epidemiology
Pathophysiology
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms
Signs
Ancillary Testing
Diagnostic Algorithm
Empirical Management
References
Chapter 30: Questions & Answers
Chapter 31: Vaginal Bleeding
Perspective
Epidemiology
Pathophysiology
Nonpregnant Patients
Pregnant Patients
Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms
Signs
Ancillary Testing
Diagnostic Algorithm
Empirical Management
Disposition
References
Chapter 31: Questions & Answers
Chapter 32: Back Pain
Perspective
Epidemiology
Pathophysiology
II. Diagnostic Approach
Differential Considerations
Pivotal Findings
Symptoms
Signs
Ancillary Testing
Laboratory Tests
Imaging
Diagnostic Algorithm
Critical Diagnoses
Empirical Management
Acknowledgments
References
Chapter 32: Questions & Answers
Part II: Trauma
Section One: General Concepts and System Injuries
Chapter 33: Multiple Trauma
Principles
Epidemiology
Anatomy and Physiology
Pathophysiology
Clinical Features
Primary Survey
Secondary Survey
Differential Diagnoses
Diagnostic Testing
Laboratory Evaluation
Radiographic Evaluation
Management
Out-of-Hospital Management
Emergency Department
Disposition
References
Chapter 33: Questions & Answers
Chapter 34: Head Trauma
Principles of Disease
Background and Importance
Anatomy and Pathophysiology
Scalp and Cranium
Brain and Cerebrospinal Fluid
Cerebral Hemodynamics and Increased Intracranial Pressure
Increased Intracranial Pressure
Cushing’s Reflex
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
Primary Brain Injury
Secondary Systemic Insults
Hypotension.
Hypoxia.
Hypocarbia and Hypercarbia.
Anemia.
Hyperpyrexia.
Altered Levels of Consciousness
Cerebral Herniation Syndromes
Uncal Herniation
Central Transtentorial Herniation
Cerebellotonsillar Herniation
Upward Transtentorial Herniation
Moderate and Severe Traumatic Brain Injury
Clinical Features and History
Common Presentations of Specific Lesions
Epidural Hematoma
Subdural Hematoma
Traumatic Subarachnoid Hemorrhage
Subdural Hygroma
Traumatic Axonal Injury
Cerebral Contusion
Intracerebral Hematoma
Traumatic Intracerebellar Hematoma
Physical Examination
Acute Neurologic Examination
General.
Glasgow Coma Scale.
Pupillary Examination.
Motor Examination.
Brainstem Function.
Differential Diagnosis
Diagnostic Testing
Laboratory Tests
Neuroimaging
Skull Radiography.
Computed Tomography.
Pneumocephalus.
Epidural Hematoma.
Subdural Hematoma.
Traumatic Subarachnoid Hemorrhage.
Subdural Hygroma.
Diffuse Axonal Injury/ Traumatic Axonal Injury.
Cerebral Contusions.
Intracerebral Hematoma.
Traumatic Intracerebellar Hematoma.
Cerebral Edema.
Rotterdam Computed Tomography Score.
Management
Out-of-Hospital Care
Airway.
Hypotension.
Agitation.
Emergency Department Management
General.
Airway.
Hypotension.
Brain-Directed Hyperosmolar Therapy.
Hyperventilation.
Cranial Decompression.
Hemostatic Agents.
Induced Hypothermia.
Seizure Prophylaxis.
Antibiotic Prophylaxis.
Other Therapies
Corticosteroids.
Barbiturates.
Monitoring of Intracranial Pressure and Cerebral Spinal Fluid Drainage.
Glucose Control and Nutrition.
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
Seizures
Central Nervous System Infections
Meningitis After Basilar Fractures.
Brain Abscess.
Cranial Osteomyelitis.
Medical Complications
Disseminated Intravascular Coagulation.
Neurogenic Pulmonary Edema.
Cardiac Dysfunction.
Disposition
Mild Traumatic Brain Injury
Clinical Features and History
Physical Examination
Differential Diagnosis
Diagnostic Testing
Neuroimaging in the Emergency Department With Computed Tomography
Other Neuroimaging Modalities
Structural MRI.
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 Concussion in Sports
Military Personnel and Blast Injury
Anticoagulated Patients
Patients on Anticoagulant Medications.
Patients With Inherent Bleeding Disorders.
Head Trauma in Older Adults
References
Chapter 34: Questions & Answers
Chapter 35: Facial Trauma
Principles
Background and Importance
Anatomy of the Face
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 Diagnosis Based on Anatomic Site
Soft Tissue Injuries and Lacerations
Mouth
Perioral Burns
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
General Measures
Disposition
References
Chapter 35: Questions & Answers
Chapter 36: Spinal Injuries
Principles
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 Diagnosis
Diagnostic Testing
Radiographic Evaluation
Indications
Cervical Plain Radiographs
Cross-Table Lateral View.
Odontoid View.
Anteroposterior View.
Flexion and Extension Views.
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: Questions & Answers
Chapter 37: Neck
Principles
Background
Anatomy
Pathophysiology
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Airway
Breathing
Circulation
Cervical Spine
Thoracotomy
Venous/Arterial Air Embolism
Nasogastric Tubes
Pharyngoesophageal Trauma
Principles
Epidemiology
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Laryngotracheal Trauma
Principles
Clinical Features
Diagnostic Testing
Management
Vascular Trauma
Principles
Penetrating Injury
Blunt Injury
Clinical Features
Penetrating Injury
Blunt Trauma
Diagnostic Testing
Penetrating Trauma
Blunt Trauma
Other Radiographic Options
Management
Penetrating Injury
Blunt Injury
Nervous System, Glandular, and Retropharyngeal Injuries
Near Hanging and Strangulation
Principles
Clinical Features
Diagnostic Testing
Management
Disposition
References
Chapter 37: Questions & Answers
Chapter 38: Thoracic Trauma
Chest Wall Injury
Rib Fracture
Principles
Background and Importance
Anatomy and Physiology
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Sternal Fracture
Principles
Background and Importance
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Nonpenetrating Ballistic Injury
Principles
Background and Importance
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Disposition
Pulmonary Injuries
Pulmonary Contusion and Laceration
Principles
Background and Importance
Pathophysiology
Clinical Features
Diagnostic Testing
Laboratory
Radiology
Management
Pneumothorax
Principles
Background and Importance
Pathophysiology
Simple Pneumothorax.
Communicating Pneumothorax.
Tension Pneumothorax.
Clinical Features
Diagnostic Testing
Occult Pneumothorax
Management
Simple Pneumothorax
Communicating Pneumothorax
Tension Pneumothorax
Hemothorax
Principles
Background and Importance
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Tracheobronchial Injury
Principles
Background and Importance
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Diaphragmatic Injury
Principles
Background and Importance
Pathophysiology
Diagnostic Testing
Management
Cardiovascular Trauma
Blunt Cardiac Trauma
Myocardial Concussion
Principles
Background and Importance
Pathophysiology
Clinical Features
Diagnostic Testing
Laboratory Tests and Electrocardiogram
Management
Disposition
Myocardial Contusion
Principles
Background and Importance
Pathophysiology
Clinical Features
Diagnostic Testing
Laboratory Tests and Electrocardiogram
Electrocardiogram.
Cardiac Biomarkers.
Imaging
Management
Disposition
Myocardial Rupture
Principles
Background and Importance
Anatomy and Physiology
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Penetrating Cardiac Trauma
Acute Pericardial Tamponade
Principles
Background and Importance
Pathophysiology
Clinical Features
Diagnostic Testing
Radiology
Ultrasound.
Radiography.
Electrocardiography
Management
Emergency Department Thoracotomy
Indications for Emergency Department Thoracotomy.
Blunt Aortic Injury
Principles
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
Principles
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: Questions & Answers
Chapter 39: Abdominal Trauma
Principles
Background
Penetrating Abdominal Trauma
Blunt Abdominal Trauma
Anatomy and Physiology
Pathophysiology
Penetrating Abdominal Trauma
Stab Wounds.
Gunshot Wounds: Ballistics.
High-Velocity Missiles.
Shotgun Wounds.
Blunt Abdominal Trauma
Seatbelt Injuries.
Iatrogenic Injuries.
Clinical Features
Penetrating Abdominal Trauma
Stab Wounds.
Gunshot Wounds.
Blunt Abdominal Trauma
Physical Examination
Penetrating Abdominal Trauma
Stab Wounds.
Gunshot Wounds.
Blunt Abdominal Trauma
Differential Diagnoses
Trauma Versus Medical Condition
Single Versus Multisystem Trauma
Single Versus Multiple Intraperitoneal Organ Injury
Intraperitoneal Injury Versus Necessary Laparotomy
Diagnostic Testing
Ultrasonography
Laboratory
Hematocrit
White Blood Cell Count
Chemistry
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
Penetrating Abdominal Trauma: Gunshot Wounds
Step I: Clinical Indications for Laparotomy
Step II: Peritoneal Violation
Thoracoabdominal
Flank and Back
Shotgun Wounds
Blunt Abdominal Trauma
Operative Versus Nonoperative Management
Pelvic Fracture
Multiple System Injury
Bedside Procedures
Diagnostic Peritoneal Lavage
Local Wound Exploration
Therapeutic Angioembolization
Disposition
Consultation
Transfer
References
Chapter 39: Questions & Answers
Chapter 40: Genitourinary System
Principles
Background and Importance
Anatomy and Physiology
Pathophysiology
Renal Trauma
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Ureteral Trauma
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Bladder Trauma
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Urethral Trauma
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Genital Trauma
Clinical Features
Differential Diagnoses
Diagnostic Testing
Imaging
Management
References
Chapter 40: Questions & Answers
Chapter 41: Peripheral Vascular Injury
Principles
Background and Importance
Anatomy and Physiology
Upper Extremity
Lower Extremity
Pathophysiology
Penetrating Trauma
Blunt Trauma
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
Chapter 41: Questions & Answers
Section Two: Orthopedic Lesions
Chapter 42: General Principles of Orthopedic Injuries
Management Principles
Fractures
Fracture Nomenclature
General Descriptors
Descriptive Modifiers
Fracture Eponyms
Fracture Healing
Diagnostic Modalities for Fractures
Plain Radiography
Special Imaging Techniques
Computed Tomography.
Magnetic Resonance Imaging.
Ultrasound Imaging.
Complications of Fractures
Infection (Osteomyelitis)
Hemorrhage
Vascular Injuries
Nerve Injuries
Compartment Syndrome
Pathophysiology.
Anatomic Considerations and Risk Factors.
Clinical Presentation.
Diagnostic Tests.
Treatment, Complications, and Disposition.
Avascular Necrosis
Fat Embolism Syndrome
Fracture Blisters
Complications of Immobilization
Damage Control Orthopedic Surgery
Subluxation and Dislocations
Nomenclature
Assessment
Treatment
Soft Tissue Injuries
Sprains
Nomenclature
Assessment
Treatment and Disposition
Strains
Nomenclature
Assessment
Treatment and Disposition
Tendinitis and Tendinosis
Bursitis
Treatment Modalities
Splinting and Bandaging
Field Care
Emergency Department Care
Upper Extremity
Sling-and-Swathe and Velpeau Bandages.
Clavicle Fractures.
Plaster and Fiberglass Splints.
Forearm and Wrist Splints.
Lower Extremity
Ankle.
Casts
Thermal Therapy
References
Chapter 42: Questions & Answers
Chapter 43: Hand
Principles
Anatomy
Muscles and Tendons
Intrinsic Musculature.
Extrinsic Musculature.
Extensor Tendons.
Flexor Tendons.
Synovial Spaces.
Blood Supply
Arterial System.
Venous and Lymphatic Systems.
Nerve Supply
Motor Innervation.
Sensory Distribution.
Fingertip
Nail
Clinical Features
Diagnostic Testing
Management of Specific Injuries
Traumatic Injuries
Fingertip Injuries
Acute Nail Bed Injuries
Subungual Hematoma.
Nail Bed Lacerations.
Foreign Bodies in the Hand
Hand Fractures
Principles
Clinical Features
Distal Phalanx Fractures.
Management.
Complications.
Middle and Proximal Phalangeal Fractures.
Management.
Complications.
Metacarpal Fractures.
Metacarpal Fractures of the Index, Middle, Ring, and Little Fingers.
Management.
Complications.
Metacarpal Fractures of the Thumb.
Soft Tissue Injuries
Dislocations and Ligamentous Injuries
Principles
Interphalangeal Joint Injuries
Distal Interphalangeal Joint
Proximal Interphalangeal Joint
Management.
Injury to the Interphalangeal Joint of the Thumb
Metacarpophalangeal Joint Injury
Management.
Injury to the Metacarpophalangeal Joint of the Thumb
Management.
Carpometacarpal Joint Injury
Management.
Injuries to the Carpometacarpal Joint of the Thumb.
Ulnar Collateral Ligament Injuries
Management.
Radial Collateral Ligament Injuries.
Tendon Injuries
Extensor Tendon Injuries
Principles.
Clinical Features and Management
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 and VIII Extensor Injuries.
Flexor Tendon Injuries
Principles.
Zone I.
Zone II.
Zone III.
Zones IV and V.
Clinical Features.
Management.
Complications.
Vascular Injuries
Management
Nerve Injuries
Management
Complications
Amputations
Principles
Management
Complications
Fingertip Amputations
Principles.
Classification.
Management.
Complications.
Ring Avulsion Injuries.
Mutilating Injuries.
High-Pressure Injection Injuries
Principles
Clinical Features
Management
Compartment Syndrome in the Hand
Principles
Clinical Features
Management
Infections of the Hand
Paronychia
Principles.
Management.
Felon
Principles.
Management.
Complications.
Herpetic Whitlow
Principles.
Clinical Features.
Diagnostic Testing.
Management.
Complications.
Tenosynovitis
Principles.
Clinical Features.
Management.
Deep Space Infections
Principles.
Clinical Features.
Management.
Septic Arthritis
Principles.
Clinical Features.
Management.
Osteomyelitis
Clinical Features.
Management.
Nontraumatic Disorders of the Hand
Stenosing Tenosynovitis
Ganglion
References
Chapter 43: Questions & Answers
Chapter 44: Wrist and Forearm
Wrist
Principles
Anatomy and Physiology
Clinical Features
Diagnostic Testing: Radiology
Management and Disposition
Carpal Injuries
Scaphoid Fractures
Lunate Fractures
Triquetral Fractures
Pisiform Fractures
Hamate Fractures
Trapezium Fractures
Capitate Fractures
Trapezoid Fractures
Carpal Instability
Radiocarpal Instability and Dislocation
Distal Radius and Ulna Injuries
Colles’ Fracture
Smith’s Fracture
Barton’s Fracture
Hutchinson’s Fracture
Distal Radioulnar Joint Disruption
Soft Tissue Injuries of the Wrist
Carpal Tunnel and Acute Carpal Tunnel Syndrome
de Quervain’s Disease and Intersection Syndrome
Forearm
Principles
Anatomy
Clinical Features
Diagnostic Testing: Radiology
Management and Disposition
Forearm Injuries
Shaft Fractures of Radius and Ulna
Ulna Shaft Fractures
Monteggia’s Fracture
Galeazzi’s Fracture
Essex-Lopresti Lesion
Acknowledgment
References
Chapter 44: Questions & Answers
Chapter 45: Humerus and Elbow
Principles
Clinical Features
Differential Diagnosis
Fractures
Shaft of the Humerus
Clinical Features.
Diagnostic Testing.
Management.
Disposition.
Distal Humerus
Suprarcondylar Fractures.
Extension Type Supracondylar Fractures
Clinical Features.
Diagnostic Testing.
Management and Disposition.
Flexion Type Supracondylar Fractures
Clinical Features.
Diagnostic Testing.
Management and Disposition.
Transcondylar Fractures
Clinical Features.
Diagnostic Testing.
Management and Disposition.
Intercondylar Fractures
Clincial Features.
Diagnostic Testing.
Management and Disposition.
Condylar Fractures
Clinical Features.
Diagnostic Testing.
Management and Disposition.
Capitellum and Trochlea Fractures
Clinical Features.
Diagnostic Testing.
Management and Disposition.
Epicondylar Fractures
Clinical Features.
Diagnostic Testing.
Management and Disposition.
Olecranon
Clinical Features.
Diagnostic Testing.
Management and Disposition.
Radial Head and Neck
Clinical Features.
Diagnostic Testing.
Management and Disposition.
Dislocations/Subluxations
Elbow
Clinical Features.
Diagnostic Testing.
Management and Disposition.
Radial Head Subluxation
Clinical Features.
Diagnostic Testing.
Management and Disposition.
Soft Tissue Disorders
Epicondylitis
Clinical Features.
Diagnostic Testing.
Management and Disposition.
Olecranon Bursitis
Clinical Features.
Diagnostic Testing.
Management and Disposition.
Biceps Tendon Rupture
Clinical Features.
Diagnostic Testing.
Management and Disposition.
References
Chapter 45: Questions & Answers
Chapter 46: Shoulder
Principles
Anatomy
Clinical Features
History
Physical Examination
Diagnostic Testing
Radiology
Specific Injuries
Fractures
Clavicle
Principles.
Clinical Features.
Diagnostic Testing.
Management.
Disposition.
Complications.
Scapula
Principles.
Clinical Features.
Diagnostic Testing
Radiology.
Management.
Complications.
Proximal Humerus
Principles.
Clinical Features.
Management.
Complications.
Proximal Humeral Epiphysis
Principles.
Clinical Features.
Management.
Complications.
Dislocations
Sternoclavicular
Principles.
Clinical Features.
Diagnostic Testing.
Management.
Complications.
Acromioclavicular Joint
Principles.
Clinical Features.
Diagnostic Testing
Radiology.
Management.
Complications.
Glenohumeral Dislocations
Principles.
Anterior Dislocations
Pathophysiology.
Clinical Features.
Diagnostic Testing
Radiology.
Management.
Complications.
Anterior Subluxation
Posterior Dislocation
Pathophysiology.
Clinical Features.
Diagnostic Testing
Radiology.
Management.
Complications.
Inferior Glenohumeral Dislocation (Luxatio Erecta)
Pathophysiology.
Clinical Features.
Diagnostic Testing
Radiology.
Management.
Complications.
Scapulothoracic Dissociation
Soft Tissue Conditions
Impingement Syndromes
Principles.
Clinical Features.
Management.
Rotator Cuff Tears
Principles.
Clinical Features.
Diagnostic Testing
Radiology.
Management.
Lesions of the Biceps Muscle
Bicipital Tendinitis
Pathophysiology.
Clinical Features.
Diagnostic Testing
Radiology.
Management.
Ruptures of the Biceps Tendon
Principles.
Clinical Features.
Diagnostic Testing
Radiology.
Management.
Subluxations and Dislocations of the Biceps Tendon
Calcific Tendinitis
Pathophysiology.
Clinical Features.
Diagnostic Testing
Radiology.
Management.
Adhesive Capsulitis
Principles.
Clinical Features.
Management.
Injection Therapy
References
Chapter 46: Questions & Answers
Chapter 47: Musculoskeletal Back Pain
Principles
Background
Epidemiology
Anatomy and Physiology
Pathophysiology
Uncomplicated Back Pain
Nerve Root Syndromes
Skeletal Causes
Clinical Features
History
Physical Examination
Differential Diagnoses
Diagnostic Testing
Laboratory Testing
Imaging Studies
Plain Radiographs
Computed Tomography
Magnetic Resonance Imaging
Computed Tomography Myelogram
Management
Uncomplicated Back Pain
Disk Herniation
Nerve Root Pain
Epidural Abscess and Spinal Osteomyelitis
Epidural Hematoma
Cauda Equina Syndrome
Malignancy
Fracture
Disposition
References
Chapter 47: Questions & Answers
Chapter 48: Pelvic Trauma
Perspective
Background
Epidemiology
Anatomy
Bony and Ligamentous Anatomy
Vascular Anatomy
Neurologic Anatomy
Pathophysiology and Key Patterns of Pelvic Fracture
Stable Injuries (Tile Type A)
Undisplaced 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
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
Acknowledgments
References
Chapter 48: Questions & Answers
Chapter 49: Femur and Hip
Principles
Anatomy of the Hip and Femur
Skeletal Anatomy
Musculature
Arterial Supply
Venous System
Nerves
Pathophysiology
Osteoporosis of the Femur
Fractures and Trauma of the Femur and Hip
Osteoarthritis of the Hip.
Avascular Necrosis
Myositis Ossificans
Calcific Bursitis and Calcifying Peritendinitis
Neoplastic Disease in the Hip
Clinical Features
History
Physical Examination
Differential Diagnosis
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
Hip Arthroplasty
Fractures of the Hip and Femur
Avulsion Fractures
Proximal Femoral Fractures
Femoral Neck Fractures
Classification.
Intertrochanteric Fractures
Isolated Fractures of the Greater or Lesser Trochanter
Subtrochanteric Fractures
Femoral Shaft Fractures
Stress Fractures
Pathophysiology.
Dislocations and Fracture-Dislocations of the Hip and Femur
Hip Dislocations
Fracture-Dislocation of the Femoral Head
Dislocation of Hip Prosthetics
Soft Tissue Injuries
Muscular Injuries
The Hamstrings.
The Quadriceps.
Iliopsoas Strain.
Hip Adductor Strain.
Gluteus Muscle Strain.
Tendon Injuries
Osteitis Pubis
Vascular Injuries
Neurologic Injuries
Acknowledgments
References
Chapter 49: Questions & Answers
Chapter 50: Knee and Lower Leg
Knee
Principles
Background and Importance
Anatomy and Physiology
Clinical Features
Physical Examination
Tests for Specific Injuries and Disturbances
Anterior Drawer Test.
Posterior Drawer Test.
Posterior Sag Sign Test.
Collateral Ligament Stress Test.
Assessing for Meniscal Tears.
Mcmurray’s Test.
Apley’s Test.
Diagnostic Testing
Radiologic Evaluation
Angiography
Duplex Ultrasonography
Radionuclide Bone Scan
Arthroscopy
Joint Injection
Arthrocentesis
Knee Injuries
Dislocation
Anatomy and Pathophysiology
Clinical Features and Differential Diagnosis
Diagnostic Testing
Management
Distal Femur Fractures
Anatomy and Pathophysiology
Clinical Features
Diagnostic Testing
Management and Disposition
Tibial Plateau Fractures
Anatomy and Pathophysiology
Clinical Features
Diagnostic Testing
Management and Disposition
Fractures of the Intercondylar Eminence (Tibial Spine)
Anatomy and Pathophysiology
Clinical Features
Diagnostic Testing
Management and Disposition
Osteochondritis Dissecans
Extensor Mechanism Injuries
Anatomy and Pathophysiology
Clinical Features
Diagnostic Testing
Management
Patellar Fractures
Anatomy and Pathophysiology
Clinical Features
Diagnostic Testing
Management
Patellar Dislocation
Anatomy and Pathophysiology
Clinical Features
Diagnostic Strategies
Management and Disposition
Cruciate and Collateral Ligament Injuries
Clinical Features
Cruciate Ligament Injuries.
Collateral Ligament Injuries.
Diagnostic Testing
Management and Disposition
Meniscal Injuries
Anatomy and Pathophysiology
Clinical Features
Diagnostic Testing
Management and Disposition
Overuse Syndromes
Patellofemoral Pain Syndrome
Anatomy and Pathophysiology
Clinical Features
Diagnostic Testing
Management
Iliotibial Band Syndrome
Clinical Features
Management and Disposition
Peripatellar Tendinitis
Plica Syndrome
Popliteus Tendinitis
Bursitis
Septic Arthritis
Baker’s Cyst
Leg
Principles
Anatomy and Pathophysiology
Clinical Features
Proximal Extraarticular Tibial Fractures
Subcondylar Tibial Fractures
Tibial Tubercle Fractures
Anatomy and Pathophysiology.
Clinical Features.
Diagnostic Testing.
Management.
Tibial Shaft Fractures
Anatomy and Pathophysiology
Clinical Features
Diagnostic Testing
Management and Disposition
Proximal Fibula Fractures
Anatomy and Pathophysiology
Clinical Features
Diagnostic Testing
Management and Disposition
Proximal Tibiofibular Joint Dislocations
Anatomy and Pathophysiology
Clinical Features
Diagnostic Testing
Management
Stress Fractures
Anatomy and Pathophysiology
Clinical Features
Diagnostic Testing
Management
Compartment Syndrome
Soft Tissue Injuries Involving the Lower Leg
Strains
Gastrocnemius Strain.
Plantaris Strain and Rupture.
Shin Splints
Foreign Bodies
References
Chapter 50: Questions & Answers
Chapter 51: Ankle and Foot
Ankle
Principles
Anatomy
Pathophysiology
Clinical Features
Physical Examination
Diagnostic Testing
Radiology
Other Imaging Techniques
Specific Pathologic Conditions
Ankle Fractures: General Considerations
Pathophysiology
Management
Disposition
Unimalleolar Fractures
Lateral Malleolar Fractures
Medial Malleolar Fractures
Posterior Malleolar Fractures
Bimalleolar Fractures
Trimalleolar Fractures
Open Fractures
Management
Complications
Pilon Fractures
Pathophysiology
Management
Complications
Soft Tissue Injuries
Ligament Injuries
Pathophysiology.
Clinical Features.
Diagnostic Tests and Differential Diagnosis.
Management.
Disposition.
Tendon Injuries
Achilles Tendon Rupture.
Peroneal Tendon Dislocation or Rupture.
Tibialis Posterior Tendon Rupture.
Other Tendon Injuries.
Ankle Dislocations
Foot
Principles of Disease
Anatomy
Clinical Features
Diagnostic Testing: Radiology
Specific Pathologic Conditions
Hindfoot Injuries
Talar Fractures
Principles of Disease: Anatomy.
Pathophysiology.
Minor Talar Fractures.
Major Talar Fractures.
Clinical Features.
Diagnostic Testing: Radiology.
Management.
Disposition.
Osteochondral Lesions
Subtalar Dislocations
Principles of Disease: Pathophysiology.
Clinical Features.
Diagnostic Testing: Radiology.
Management.
Disposition.
Total Talar Dislocation
Calcaneal Fractures
Principles of Disease: Anatomy.
Pathophysiology.
Intraarticular Calcaneal Fractures.
Extraarticular Calcaneal Fractures.
Clinical Features.
Diagnostic Testing: Radiology.
Management.
Disposition.
Midtarsal Joint Injuries
Midfoot Injuries
Navicular Fractures
Principles of Disease: Anatomy.
Pathophysiology.
Clinical Features.
Diagnostic Testing: Radiology.
Management.
Disposition.
Cuboid Fractures
Cuneiform Fractures
Dislocations of the Navicular, Cuboid, and Cuneiforms
Lisfranc (Tarsometatarsal) Fractures and Dislocations
Principles of Disease: Anatomy.
Pathophysiology.
Clinical Features.
Diagnostic Testing: Radiology.
Management.
Disposition.
Forefoot Injuries
Metatarsal Fractures
Metatarsal Shaft Fractures
Principles: Pathophysiology.
Clinical Features.
Diagnostic Testing: Radiology.
Management.
Disposition.
Metatarsal Head and Neck Fractures.
Metatarsal Base Fractures
Pathophysiology.
Fifth Metatarsal.
Clinical Features.
Diagnostic Testing: Radiology.
Management.
Disposition.
Phalangeal Fractures
Pathophysiology.
Clinical Features.
Diagnostic Testing: Radiology.
Management.
Disposition.
Sesamoid Fractures
Metatarsophalangeal Dislocations
Pathophysiology.
Clinical Features.
Diagnostic Testing: Radiology.
Management.
Disposition.
Interphalangeal Joint Dislocations
Foot Pain
Perspective.
Hindfoot Pain.
Midfoot Pain.
Forefoot Pain.
Special Considerations
Complex Regional Pain Syndrome
Stress Fractures
Pathophysiology
Clinical Features
Diagnostic Testing: Radiology
Management
Disposition
Tendon Injuries
Crush Injuries, Amputations, and Major Vascular Injuries
Compartment Syndrome
Principles of Disease: Pathophysiology
Clinical Features
Diagnostic Testing: Special Procedures
Management
Disposition
Acknowledgment
References
Chapter 51: Questions & Answers
Section Three: Soft Tissue Injuries
Chapter 52: Wound Management Principles
Principles
Anatomy of Skin and Fascia
Wound Biology
Biomechanical Properties of Skin
Clinical Features
History
Risk Factors
Physical Examination
Diagnostic Testing
Management
Anesthesia
Anesthetic Agents
Allergy
Skin Preparation
Wound Preparation
Débridement
Wound Cleansing
Irrigation
Wound Closure
Decision-Making
Wound Tension
Suture Technique
Basic and Advanced Techniques
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 52: Questions & Answers
Chapter 53: Foreign Bodies
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Eye
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Ear
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Nose
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Airway
Principles
Background and Importance
Anatomy and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Gastrointestinal Tract
Principles
Pharynx and Esophagus
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Stomach and Bowel
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Rectum
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Genitourinary Tract
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Soft Tissues
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Chapter 53: Questions & Answers
Chapter 54: Mammalian Bites
Principles
Background
Dog Bites
Principles
Clinical Features
Capnocytophaga Canimorsus
Differential Diagnoses
Diagnostic Testing
Management
Prophylactic Antibiotics
Disposition
Cat Bites
Principles
Clinical Features
Bacteriology
Pasteurella Multocida.
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Other Mammals
Monkeys
Principles
Clinical Features
Differential Diagnoses
Management
Disposition
Rodents
Principles
Clinical Features
Differential Diagnoses
Management
Disposition
Ferrets
Domestic Herbivores
Sheep, Cattle, and Pigs
Horses
Camels
Wild Animals
Bears
Wild Cats
Coyotes and Wolves
Management
Other Prophylaxis
Disposition
Human Bites
Principles
Clinical Features
Fight Bites (Clenched Fist Injury)
Other Human Bites
Bacteriology.
Differential Diagnoses
Diagnostic Testing
Management
Prophylactic Antibiotics
Disposition
References
Chapter 54: Questions & Answers
Chapter 55: Venomous Animal Injuries
Principles
Epidemiology
Venom Delivery
Venomous Reptiles
Snakes
Epidemiology
Classification and Characteristics
Identification
Other Reptiles
Toxins
Venom Delivery
Clinical Features
Pit Vipers
Coral Snakes
Gila Monster
Infection
Differential Diagnoses
Diagnostic Testing
Management
Out-of-Hospital Care
Emergency Department Care
Patient History.
Patient Examination.
Initial Medical Care.
Antivenom.
Administration of Antivenom.
Dosage and Precautions.
Coral and Exotic Snakes.
Wound Care.
Serum Sickness.
Other Envenomation.
Disposition
Venomous Arthropods
Hymenoptera
Clinical Features
“Killer Bees.”
Fire Ants.
Differential Diagnoses
Diagnostic Testing
Management
Prehospital Care.
Emergency Department Care.
Disposition
Spiders and Scorpions
Black Widow Spider
Clinical Features.
Differential Diagnoses.
Diagnostic Testing.
Management.
Latrodectus Antivenom.
Disposition
Brown Recluse Spider
Clinical Features.
Differential Diagnoses.
Diagnostic Testing.
Management.
Disposition.
Other Spiders
Scorpions
Clinical Features.
Differential Diagnoses.
Diagnostic Testing.
Management.
Disposition
Other Arthropods
Venomous Marine Animals
Principles
Venom Delivery
Bites
Nematocysts
Toxicity.
Clinical Features
Stings
Sea Urchins.
Cone Shells.
Stingray.
Bony Fishes.
Management
Nematocysts
Fish
Disposition
References
Chapter 55: Questions & Answers
Chapter 56: Thermal Burns
Principles
Background
Epidemiology
Anatomy and Physiology
Pathophysiology of Burns
Clinical Features
Classification and Diagnosis of Burns
Differential Diagnoses
Diagnostic Testing
Management
Initial First Aid
Airway Management
Breathing Management: Recognition and Management of Inhalation Injury
Circulation Management and Fluid Resuscitation
Escharotomy
Local Wound Therapies
Pain Management
Disposition
References
Chapter 56: Questions & Answers
Chapter 57: Chemical Injuries
Principles
Community Preparedness and HazMat Response
Contingency Plan
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Ocular Injuries
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Specific Toxins
Hydrofluoric Acid
Principles
Clinical Features
Inhalational Exposure
Gastrointestinal Exposure
Ocular Exposure
Dermal Exposure
Differential Diagnoses
Diagnostic Testing
Management
Infiltration Therapy
Subcutaneous.
Intravenous and Intra-Arterial.
Ocular Exposures
Systemic Toxicity
Disposition
Formic Acid
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Anhydrous Ammonia
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Cement
Phenol and Derivatives
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Polyethylene Glycol Therapy
Treatment of Systemic Toxicity
Disposition
Phosphorus
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Nitrates and Nitrites
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Hydrocarbons
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Tar
Principles
Clinical Features
Management
Disposition
Elemental Metals
Chromium
Miscellaneous Gases
Chlorine
Phosgene
Nitrogen Oxides
Chemical Terrorism
Principles
Response
Chemical Agents
Nerve Agents
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Vesicants
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Cyanide
Principles
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Chapter 57: Questions & Answers
Section Four: Violence and Abuse
Chapter 58: Sexual Assault
Principles
Clinical Features
Diagnostic Considerations
Differential Diagnosis
Diagnostic Testing
Sexually Transmitted Infections
Alcohol- or Drug-Facilitated Rape
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
Further Considerations
Definitive Treatment to Prevent Sexually Transmitted Infections and Pregnancy
Disposition
Testifying in Court
References
Chapter 58: Questions & Answers
Chapter 59: Intimate Partner Violence and Abuse
Principles
Background and Importance
Causes and Natural History of Intimate Partner Violence
Clinical Features
Injury Presentations
Gynecologic-Related Presentations
Mental Health Presentations
Alcohol and Drug Use and Intimate Partner Violence
Chronic Medical Conditions
Pain Syndromes
Diagnostic Considerations
Differential Diagnosis
Human Trafficking
Diagnostic Testing
Screening
Management
Intervention
Danger Assessment
Mental Health Screening
Privacy and Confidentiality Considerations
Documentation
Intimate Partner Violence Coding and Diagnosis
Disposition
References
Chapter 59: Questions & Answers
Part III: Medicine and Surgery
Section One: Head and Neck Disorders
Chapter 60: Oral Medicine
Introduction
Disorders of the Tooth
Principles
Anatomy
Pathophysiology
Clinical Features
Physical Examination
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Disorders of the Gingiva and Periodontium
Principles
Anatomy
Pathophysiology
Gingivitis and Periodontitis.
Pericoronitis.
Gingival Hyperplasia.
Clinical Features
Historical Features
Physical Examination
Differential Diagnosis
Diagnostic Testing
Management
Gingivitis and Periodontitis
Pericoronitis
Disposition
Disorders Involving Dental Procedures
Principles
Anatomy
Pathophysiology
Clinical Features
Historical Features
Physical Examination
Diagnostic Testing
Management
Disposition
Odontogenic and Deep Neck Infections
Principles
Anatomy
Pathophysiology
Clinical Features
Historical Features
Physical Examination
Diagnostic Testing
Management
Disposition
Dentoalveolar Trauma
Principles
Anatomy
Pathophysiology
Dental Fractures.
Concussion, Subluxation, Luxation, and Avulsion.
Clinical Features
Historical Features
Physical Examination
Diagnostic Testing
Management
Dental Fractures
Tooth Avulsion
Luxation and Alveolar Fractures
Soft Tissue Injuries
Disposition
Temporomandibular Joint Disorder and Dislocation
Principles
Anatomy
Pathophysiology
Temporomandibular Joint Disorder.
Temporomandibular Joint Dislocation.
Clinical Features
Historical Features
Temporomandibular Joint Disorder.
Temporomandibular Joint Dislocation.
Physical Examination
Temporomandibular Joint Disorder.
Temporomandibular Joint Dislocation.
Differential Diagnoses
Diagnostic Testing
Management
Temporomandibular Joint Disorder
Temporomandibular Joint Dislocation
Disposition
References
Chapter 60: Questions & Answers
Chapter 61: Ophthalmology
Traumatic Conditions
Principles
Periorbital Contusions and Eyelid Lacerations
Clinical Features and Differential Diagnosis
Diagnostic Testing
Management and Disposition
Conjunctival and Scleral Injuries: Subconjunctival Hemorrhage, Conjunctival Laceration, and Scleral Laceration
Clinical Features and Differential Diagnosis
Diagnostic Testing
Management and Disposition
Corneal Injuries: Corneal Abrasions, Foreign Bodies, and Lacerations
Clinical Features and Differential Diagnosis
Diagnostic Testing
Management and Disposition
Corneal Abrasions.
Corneal Foreign Bodies.
Corneal Lacerations.
Anterior Segment Injuries: Traumatic Hyphema, Iritis, Cyclodialysis, and Lens Dislocation
Clinical Features and Differential Diagnosis
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 and Differential Diagnosis
Diagnostic Evaluation
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 and Differential Diagnosis
Diagnostic Testing
Management and Disposition
Orbital Wall Fractures.
Retrobulbar Hemorrhage.
Optic Nerve Injury.
Chemical Exposures and Glues
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management and Disposition
Inflammatory Conditions
Principles
The Conjunctiva and Cornea: Keratitis, Pterygium and Pinguecula
Clinical Features and Differential Diagnosis
Diagnostic Evaluation
Management and Disposition
Superficial Punctate Keratitis and Radiation Keratitis.
Pterygium and Pinguecula.
The Globe: Uveitis, Scleritis, and Episcleritis
Clinical Features and Differential Diagnosis
Diagnostic Evaluation
Management and Disposition
The Orbit: Orbital Pseudotumor, Orbital Apex Syndrome, and Thyroid Orbitopathy
Clinical Features, Differential Diagnosis, and Diagnostic Evaluation
Management and Disposition
Infectious Conditions
Principles
The Conjunctiva: Allergic, Viral and Bacterial Conjunctivitis, and Ophthalmia Neonatorum
Clinical Features, Differential Diagnosis, and 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 and Differential Diagnosis
Diagnostic Testing
Management and Disposition
Corneal Ulcers and Infiltrates.
Herpes Simplex Keratitis.
Herpes Zoster Keratitis.
The Eyelids and Periorbital Area: Hordeolum, Chalazion, Dacryocystitis, Blepharitis, and Cellulitis
Clinical Features and Differential Diagnosis
Diagnostic Testing
Management and Disposition
Hordeolum and Chalazion.
Dacryocystitis.
Blepharitis.
Periorbital Cellulitis.
The Globe: Endophthalmitis
Clinical Features, Differential Diagnosis, and Diagnostic Testing
Management and Disposition
Acute Angle-Closure Glaucoma
Principles
Clinical Features, Differential Diagnosis, and Diagnostic Testing
Management and Disposition
Primary Disorders of Vision
Principles
Blurred Vision: Optic Neuritis, Toxic and Metabolic Disturbances, and Papilledema
Clinical Features and Differential Diagnosis
Diagnostic Testing, Management, and Disposition
Optic Neuritis.
Toxic and Metabolic Visual Disturbances.
Papilledema.
Visual Field Disturbances: Floaters, Flashes, and Field Deficits
Clinical Features and Differential Diagnosis
Diagnostic Testing, Management, and Disposition
Vitreous Hemorrhage and Detachment.
Retinal Detachment.
Chiasmal and Cortical Disturbances.
Sudden Vision Loss: Retinal Artery and Vein Occlusion, and Ischemic Optic Neuropathy
Clinical Features and Differential Diagnosis
Diagnostic Testing, Management, and Disposition
Central Retinal Artery Occlusion.
Central Retinal Vein Occlusion.
Ischemic Optic Neuropathy.
Functional Vision Loss
Clinical Features, Differential Diagnosis, Diagnostic Testing, Management, and Disposition
Diplopia
Anisocoria
Principles
Clinical Features and Differential Diagnosis
Adie’s and Argyll Robertson Pupils
Pharmacologic Mydriasis and Miosis
Third-Nerve Palsy
Horner’s Syndrome
Physiologic and Headache-Associated Anisocoria
Diagnostic Testing, Management, and Disposition
Nystagmus
Principles
Clinical Features, Differential Diagnosis, Diagnostic Evaluation, Management, and Disposition
Peripheral Nystagmus and Central Nystagmus
Toxic and Metabolic Nystagmus
References
Chapter 61: Questions & Answers
Chapter 62: Otolaryngology
Otitis Media
Principles
Anatomy and Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Otitis Externa
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Necrotizing (Malignant) External Otitis
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Mastoiditis
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Sudden Hearing Loss
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Epistaxis
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Sialolithiasis
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Neck Masses
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management and Disposition
References
Chapter 62: Questions & Answers
Section Two: Pulmonary System
Chapter 63: Asthma
Principles
Background and Importance
Anatomy and Physiology
Pathophysiology
Clinical Features
Symptoms
Differential Diagnoses
Diagnostic Testing
Pulmonary Function Studies
Blood Gas Analysis
Other Blood Testing
Future Monitoring Strategies
Management
Oxygen Administration
Adrenergic Medication
Nebulizer Versus Metered-Dose Inhaler and Valved Holding Chamber.
Intravenous Adrenergic Agonists.
Subcutaneous Adrenergic Agents.
Long-Acting Beta-2 Agonists.
Corticosteroids
Systemic Corticosteroids.
Inhaled Corticosteroids.
Corticosteroids and Discharged Patients.
Corticosteroid-Resistant Asthma.
Methylxanthines
Leukotriene Modifiers
Other and Future Therapies
Special Situations
Pregnancy
Aspirin-Exacerbated Respiratory Disease
Exercise-Induced Asthma
Perimenstrual Asthma
Critical Asthma Syndromes
Clinical Approach to the Critically Ill Asthmatic
Disposition
References
Chapter 63: Questions & Answers
Chapter 64: Chronic Obstructive Pulmonary Disease
Principles
Background
Pathophysiology
Clinical Features
Symptoms and Natural History
Severity of Airflow Limitation
Physical Examination
Differential Diagnoses
Diagnostic Testing
Pulse Oximetry, Blood Gas Analysis, and Capnography
Chest Radiography
Spirometry
Sputum Examination
Electrocardiogram and Cardiac Monitoring
Blood Tests
Management
Oxygenation and Ventilation
General Drug Therapy
Bronchodilators
Corticosteroids
Antibiotics
Other Therapeutic Agents
Mucokinetic Medications and Mucus Clearance Strategies.
Heliox.
Respiratory Stimulants.
Prevention of Chronic Obstructive Pulmonary Disease Exacerbations via Anti-Inflammatory Therapy.
Future Therapies for Chronic Obstructive Pulmonary Disease Exacerbations.
Disposition
References
Chapter 64: Questions & Answers
Chapter 65: Upper Respiratory Tract Infections
Pharyngitis (Tonsillopharyngitis)
Principles
Clinical Features
Diagnostic Considerations
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Lingual Tonsillitis
Principles
Clinical Features
Diagnostic Considerations
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Laryngitis
Principles
Clinical Features
Diagnostic Considerations
Differential Diagnoses
Management
Disposition
Adult Epiglottis
Principles
Clinical Features
Diagnostic Considerations
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Peritonsillitis (Peritonsillar Cellulitis and Peritonsillar Abscess)
Principles
Clinical Features
Diagnostic Considerations
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Ludwig’s Angina
Principles
Clinical Features
Diagnostic Considerations
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Retropharyngeal Abscess
Principles
Clinical Features
Diagnostic Considerations
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Parapharyngeal Abscess
Principles
Clinical Features
Diagnostic Considerations
Differential Diagnosis
Diagnostic Strategies
Management
Disposition
Rhinosinusitis
Principles
Clinical Features
Diagnostic Considerations
Differential Diagnosis
Diagnostic Testing
Management
Disposition
References
Chapter 65: Questions & Answers
Chapter 66: Pneumonia
Principles
Background and Importance
Anatomy and Physiology
Pathophysiology
Clinical Features
Diagnostic Considerations
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Chapter 66: Questions & Answers
Chapter 67: Pleural Disease
Spontaneous Pneumothorax
Principles
Background and Importance
Anatomy and Physiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Pleural Inflammation and Effusion
Principles
Background and Importance
Anatomy and Physiology
Pathophysiology
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
References
Chapter 67: Questions & Answers
Section Three: Cardiac System
Chapter 68: Acute Coronary Syndrome
Principles
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
Classic History.
Nontraditional (or Atypical) History.
Outcomes in Nontraditional Presentations
Physical Examination
Missed Diagnosis of Acute Coronary Syndrome
Early Complications of Acute Myocardial Infarction
Diagnostic Considerations
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
Troponins.
Other Serum Markers.
Multiple Marker Strategies.
Exercise Testing
Echocardiography
Myocardial Scintigraphy (Nuclear Imaging)
Coronary Computed Tomography Angiography
Observation Unit Evaluation
Management
Time-Sensitive Nature of Acute Coronary Syndrome Therapy
Pharmacologic Intervention
Oxygen
Nitroglycerin
Morphine and Other Opioid Analgesic Agents
β-Adrenergic Blockers
Angiotensin-Converting Enzyme Inhibitors
HMG–Coenzyme A Reductase Inhibitors (Statins)
Calcium Channel Blockade
Antiplatelet Therapy
Aspirin.
Glycoprotein IIb/IIIa Receptor Inhibitors.
PSY12 Receptor Inhibitor Agents.
Antithrombins
Heparins.
Other Antithrombins: Bivalirudin, Fondaparinux, and Hirudin.
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 Acute Coronary Syndrome
Management Summary: Potential Pharmacologic Management Approach
Disposition
Transfer of a Patient With Acute Coronary Syndrome
References
Chapter 68: Questions & Answers
Chapter 69: Dysrhythmias
Principles
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
Bretylium
Amiodarone
Ibutilide
Sotalol
Dofetilide
Dronedarone
Class IV Agents
Diltiazem
Verapamil
Miscellaneous Agents
Digoxin
Magnesium
Adenosine
Approach to Dysrhythmia: Recognition and Management
Clinical Features
Initial Assessment of Stable Patients
Diagnostic Considerations
Differential Diagnosis
Diagnostic Testing
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’s Syndrome
Disposition
References
Chapter 69: Questions & Answers
Chapter 70: Implantable Cardiac Devices
Principles
Clinical Features
Pacemaker Terminology
Pacemaker Components
History
Physical Examination
Differential Diagnosis
Complications of Implantation
Infection
Thrombophlebitis
The “Pacemaker Syndrome”
Pacemaker Malfunction
Failure to Capture
Inappropriate Sensing
Undersensing
Oversensing
Inappropriate Pacemaker Rate
Diagnostic Testing
Chest Radiograph
12-Lead Electrocardiogram
Management
Advanced Cardiac Life Support Interventions
Disposition
Implantable Cardioverter- Defibrillators
Principles
Clinical Features
Terminology and Components
Differential Diagnosis
Complications of Implantation
Malfunction
Diagnostic Testing
Management
Advanced Cardiac Life Support Interventions
Disposition
Biventricular Pacing
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Cardiac Assist Devices
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
References
Chapter 70: Questions & Answers
Chapter 71: Heart Failure
Principles
Background
Epidemiology
Anatomy and Physiology
Cellular Mechanisms
Cardiac Physiology
Physiologic Mechanisms
Increase in Stroke Volume
Increased Systemic Vascular Resistance
Development of Cardiac Hypertrophy
Neurohormonal Modulation
Cardiac Neurohormonal Response
Central and Autonomic Nervous System Neurohormonal Response
Renal Neurohormonal Response
Vascular Endothelial Neurohormonal Response
Pathophysiology
Maladaptive Changes in Heart Failure
Primary Disease Processes Resulting in Heart Failure
Coronary Artery Disease.
Cardiomyopathy and Myocarditis.
Valvular Heart Disease.
Pericardial Diseases.
Pulmonary Disease.
Classification of Heart Failure
Acute Versus Chronic Heart Failure.
Systolic Versus Diastolic Dysfunction.
Right-Sided Versus Left-Sided Heart Failure.
High-Output Versus Low-Output Failure.
Precipitating Causes of Heart Failure and Exacerbating Factors
Sodium and Volume Excesses
Systemic Hypertension
Myocardial Infarction and Ischemia
Systemic Infection
Dysrhythmias
Acute Hypoxia and Respiratory Problems
Anemia
Pregnancy
Thyroid Disorders
Acute Myocarditis
Acute Valvular Dysfunction
Pulmonary Embolus
Sympathomimetic or Alcohol Excess
Excessive Exertion or Trauma
Pharmacologic Complications
Clinical Features
History
Physical Examination
Differential Diagnoses
Diagnostic Testing
Management
Acute Heart Failure
Acute Heart Failure With Adequate Perfusion
Oxygen and Ventilation
Vasodilator Agents
Nitrates
Morphine Sulfate
Loop Diuretics
Other Therapies
Treatment of Acute Heart Failure in Hypotensive Patients
Inotropic or Vasopressor Therapy
Rate and Rhythm Controllers
Chronic Heart Failure
Common Therapeutic Agents in Chronic Heart Failure
Renin Angiotensin System Blocking Drugs.
Beta-Blocker and Combined Alpha- and Beta-Blocker Therapy.
Diuretics.
Nitrates.
Cardiac Glycosides.
Other Considerations in Chronic Heart Failure
Electrical Therapy.
Antidysrhythmic Therapy.
Calcium Channel Blockers.
Ultrafiltration and Renal Dialysis.
Coronary Artery Bypass Grafting and Angioplasty.
Phosphodiesterase Inhibitors.
Statins and Polyunsaturated Fatty Acids.
Anemia.
Sleep Apnea-Related Respiratory Support.
Exercise Programs.
Advanced Surgical Therapies.
Psychosocial Factors.
Disposition
Admission Criteria, Observation Units, and Predictors of Readmission
References
Chapter 71: Questions & Answers
Chapter 72: Pericardial and Myocardial Disease
Pericardial Disease (Pericarditis)
Principles
Pericardial Anatomy Physiology and Pathophysiology
Specific Disorders: Idiopathic Pericarditis
Principles and Clinical Features
Differential Diagnosis
Diagnostic Testing
Management and Disposition
Complications
Uremic Pericardial Disease
Principles
Clinical Features and Diagnostic Testing
Management and Disposition
Post–Myocardial Infarction Pericarditis
Postinjury Pericarditis
Principles
Clinical Features, Diagnostic Testing, Management, and Disposition
Neoplastic Pericardial Disease
Principles
Clinical Features and Diagnostic Strategies
Management and Disposition
Radiation-Induced Pericarditis
Pericardial Disease Related to Connective Tissue Disorders
Miscellaneous Infectious Causes of Pericarditis
Tuberculous Pericarditis
Other Causes of Pericarditis
Pericardial Effusion
Principles and Clinical Features
Diagnostic Testing
Management and Disposition
Cardiac Tamponade
Principles
Clinical Features and Diagnostic Testing
Management and Disposition
Purulent Pericarditis
Principles
Pathophysiology
Clinical Features and Diagnostic Testing
Management and Disposition
Pneumopericardium
Principles
Clinical Features and Diagnostic Testing
Management and Disposition
Constrictive Pericarditis
Principles and Pathophysiology
Clinical Features
Diagnostic Testing and Management
Myocardial Diseases
Myocarditis
Principles
Pathophysiology
Clinical Features
Diagnostic Testing
Differential Diagnosis
Management
Disposition
Chagas’ Disease
Principles and Clinical Features
Diagnostic Testing
Management
Trichinosis
Diphtheria
Lyme Disease
Epidemiology and Clinical Features
Other Causes of Myocarditis
Cocaine Cardiotoxicity
Cardiomyopathies and Specific Heart Muscle Disease
Principles
Pathophysiology
Dilated Cardiomyopathy
Principles
Pathophysiology
Clinical Features
Diagnostic Testing
Management and Disposition
Outcome
Hypertrophic Cardiomyopathy
Principles
Pathophysiology
Clinical Features
Diagnostic Testing
Differential Diagnosis
Management
Disposition
Restrictive Cardiomyopathy
Principles
Pathophysiology
Clinical Features and Diagnostic Testing
Management and Disposition
Arrhythmogenic Right Ventricular Cardiomyopathy
Peripartum Cardiomyopathy
Principles
Clinical Features and Diagnostic Testing
Management and Disposition
Takotsubo Cardiomyopathy
Principles
Clinical Features and Diagnostic Testing
Management and Disposition
Ion Channelopathies
Principles
Sudden Death
References
Chapter 72: Questions & Answers
Chapter 73: Infective Endocarditis, Rheumatic Fever, and Valvular Heart Disease
Infective Endocarditis
Principles
Background and Importance
Pathophysiology
Clinical Features and Differential Diagnosis
Diagnostic Testing
Management
Disposition
Prophylaxis
Rheumatic Fever
Principles
Background and Importance
Pathophysiology
Clinical Features and Differential Diagnosis
Diagnostic Testing
Management and Disposition
Valvular Heart Disease
Principles
Anatomy and Physiology
Mitral Stenosis
Pathophysiology
Clinical Features
Management
Mitral Regurgitation
Pathophysiology
Clinical Features
Management
Aortic Stenosis
Pathophysiology
Clinical Features
Management
Aortic Insufficiency
Pathophysiology
Clinical Features
Management
Mitral Valve Prolapse
Pathophysiology
Clinical Features
Management
Complications of Prosthetic Valves
Disposition
References
Chapter 73: Questions & Answers
Section Four: Vascular System
Chapter 74: Hypertension
Principles
Background
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
Blood Pressure Elevation
Acute Target Organ Damage in the Context of Systemic Illness
Absence of Target Organ Dysfunction
Diagnostic Considerations
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 74: Questions & Answers
Chapter 75: Aortic Dissection
Principles
Epidemiology
Anatomy and Physiology
Pathophysiology
Classification
Clinical Features
History
Physical Examination
Diagnostic Considerations
Differential Diagnoses
Diagnostic Testing
Electrocardiography
Chest Radiography
Echocardiography
Computed Tomography
Magnetic Resonance Imaging
Choice of Diagnostic Test
Management
Emergency Department
Recommended Therapy
Alternative Agents
Operative and Interventional Repair
Disposition
References
Chapter 75: Questions & Answers
Chapter 76: 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 76: Questions & Answers
Chapter 77: Peripheral Arteriovascular Disease
Principles
Principles of Disease
Arterial Anatomy
Pathophysiology
Atherosclerosis
Aneurysms
Arterial Embolism
Thromboembolism.
Atheroembolism.
Arterial Thrombosis
Inflammation
Trauma
Vasospasm
Arteriovenous Fistulae
Clinical Features
History
Acute Arterial Occlusion
Chronic Arterial Insufficiency
Physical Examination
Arterial Embolism
Arterial Thrombosis
Inflammation
Vasospasm
Arteriovenous Fistulae
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
Sympathectomy
Hyperbaric Therapy
Disposition
Specific Arteriovascular Diseases
Diseases of Chronic Arterial Insufficiency
Arteriosclerosis Obliterans
Clinical Features and Differential Diagnosis
Management
Buerger’s Disease (Thromboangiitis Obliterans)
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Diseases of Acute Arterial Occlusion
Arterial Embolism
Differential Diagnosis
Management
Atheroembolism (Blue Toe Syndrome)
Clinical Features
Differential Diagnosis
Management
Arterial Thrombosis
Management
Peripheral Arterial Aneurysms
Lower Extremity
Upper Extremity
Viscera
Splenic Artery Aneurysms
Hepatic Artery Aneurysms
Superior Mesenteric Artery Aneurysms
Infected Aneurysms
Mycotic Aneurysms
Atherosclerotic Arteries
Preexisting Aneurysms
Post-Traumatic Pseudoaneurysms
Traumatic Aneurysms
Vasospastic Disorders
Thoracic Outlet Syndrome
Principles
Clinical Features
Physical Examination
Ancillary Evaluation
Differential Diagnosis
Management
Disposition
Peripheral Arteriovenous Fistulae
Differential Diagnosis
Management
Vascular Abnormality Caused by Drug Abuse
Principles
Clinical Features
Management
References
Chapter 77: Questions & Answers
Chapter 78: Pulmonary Embolism and Deep Vein Thrombosis
Principles
Anatomy and Pathophysiology of Thrombosis
Clinical Features
Diagnosis
Differential Diagnosis
Diagnostic Testing
Laboratory Evaluation
Radiographic Evaluation
Management
Superficial Leg Thrombophlebitis
Isolated Calf Vein Thrombosis
Phlegmasia Cerulea Dolens (Painful Blue Leg)
Upper Extremity Venous Thromboses
Complications
Disposition
Pulmonary Embolism
Principles
Pathophysiology of Pulmonary Vascular Occlusion
Clinical Features
Differential Diagnosis
Diagnostic Testing
Pregnant Women
Management
Standard Anticoagulation
Fibrinolytic (Thrombolytic) Therapy
Surgical Embolectomy
Disposition
References
Chapter 78: Questions & Answers
Section Five: Gastrointestinal System
Chapter 79: Esophagus, Stomach, and Duodenum
Dysphagia
Principles
Background
Oropharyngeal Dysphagia.
Esophageal Dysphagia.
Pathophysiology
Clinical Features
Oropharyngeal Dysphagia
Esophageal Dysphagia
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Foreign Bodies
Principles
Background
Anatomy and Physiology
Pathophysiology
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Upper Esophagus
Lower Esophagus
Stomach
Disposition
Esophageal Perforation
Principles
Background
Anatomy and Physiology
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Esophagitis
Principles
Gastroesophageal Reflux Disease
Eosinophilic Esophagitis
Infectious Esophagitis
Pill Esophagitis
Radiation-Induced Esophagitis
Clinical Features
Gastroesophageal Reflux Disease
Eosinophilic Esophagitis
Infectious Esophagitis
Pill Esophagitis
Differential Diagnosis
Diagnostic Testing
Management
Gastric Reflux
Eosinophilic Esophagitis
Infectious Esophagitis
Pill Esophagitis
Disposition
Gastritis and Peptic Ulcer Disease
Principles
Background
Pathophysiology
Clinical Features
Complications
Differential Diagnosis
Diagnostic Testing
Management
Antacids
Histamine Blockers
Proton Pump Inhibitors
Prostaglandins
Other Agents
Disposition
Gastric Volvulus
Principles
Clinical Features
Complications
Differential Diagnosis
Diagnostic Testing
Management
Disposition
References
Chapter 79: Questions & Answers
Chapter 80: Disorders of the Liver and Biliary Tract
Hepatic Disorders
Hepatitis
Viral Hepatitis
Principles
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
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Cirrhosis
Principles
Clinical Features
Diagnostic Testing
Management
Ascites
Gastrointestinal Bleeding
Hepatorenal Syndrome
Hepatic Encephalopathy
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Spontaneous Bacterial Peritonitis
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Hepatic Abscesses
Pyogenic Abscess
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Amebic Abscess
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Miscellaneous Disorders and Conditions of the Liver
Liver Disease in Pregnancy
Benign Cholestasis
Acute Fatty Liver
Budd-Chiari Syndrome
Liver Transplantation
Biliary Tract Disorders
Cholelithiasis
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Special Considerations
Disposition
Cholecystitis
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Special Considerations
Acalculous Cholecystitis.
Emphysematous Cholecystitis.
Disposition
Cholangitis
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Sclerosing Cholangitis
AIDS Cholangiopathy
References
Chapter 80: Questions & Answers
Chapter 81: Pancreas
Acute Pancreatitis
Background
Causes
Anatomy and Physiology
Pathophysiology
Disease Classification
Clinical Features
Differential Diagnoses
Diagnostic Testing
Laboratory Results
Imaging
Predicting Disease Severity
Management
Disposition
Chronic Pancreatitis
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Pancreatic Cancer
Clinical Features
Diagnostic Testing
Management
References
Chapter 81: Questions & Answers
Chapter 82: Disorders of the Small Intestine*
Small Bowel Obstruction
Background
Anatomy and Physiology
Pathophysiology
Clinical Features
History
Physical Examination
Differential Diagnosis
Diagnostic Testing
Laboratory
Imaging
Management
Disposition
Acute Mesenteric Ischemia
Background
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
Disposition
References
Chapter 82: Questions & Answers
Chapter 83: Acute Appendicitis
Principles
Background
Anatomy and Physiology
Pathophysiology
Clinical Features
History
Physical Examination
Differential Diagnosis
Diagnostic Testing
Laboratory Data
White Blood Cell Count
C-Reactive Protein
Combined Inflammatory Markers
Urinalysis
Other Laboratory Tests
Imaging Tests
General Principles
Radiography
Graded-Compression Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Combined Imaging Pathways
Summary of Imaging Methods
Management
Supportive Care
Antibiotic Therapy
Definitive Treatment
Disposition
References
Chapter 83: Questions & Answers
Chapter 84: Gastroenteritis
Overview
Background
Pathophysiology
Clinical Features
History
Physical Examination
Differential Diagnosis
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
Enterohemorrhagic (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
Principles
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
Clinical Features
Diagnostic Testing
Management
References
Chapter 84: Questions & Answers
Chapter 85: Disorders of the Large Intestine
Irritable Bowel Syndrome
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Diverticular Disease
Principles
Clinical Features
Diverticulosis
Diverticulitis
Differential Diagnosis
Diagnostic Testing
Uncomplicated Diverticulitis
Complicated Diverticulitis
Abdominal Computed Tomography.
Barium Enema.
Water-Soluble Contrast Enema.
Ultrasonography.
Colonoscopy.
Plain Radiography Without Contrast.
Management
Diverticulosis
Uncomplicated Diverticulitis
Complicated Diverticulitis
Definitive Management
Disposition
Large Bowel Obstruction
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Laboratory Tests
Imaging Studies
Plain Radiography.
Computed Tomography.
Colonoscopy and Water-Soluble Contrast Enema.
Management
Disposition
Volvulus
Principles
Sigmoid Volvulus
Cecal Volvulus
Clinical Features
Sigmoid Volvulus
Cecal Volvulus
Differential Diagnosis
Diagnostic Testing
Sigmoid Volvulus
Cecal Volvulus
Management
Sigmoid Volvulus
Cecal Volvulus
Disposition
Intussusception
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Ultrasound Examination
Plain Radiography
Computed Tomography
Barium Enema
Colonoscopy
Management
Disposition
Inflammatory Bowel Disease
Principles
Ulcerative Colitis
Crohn’s Disease
Clinical Features
Toxic Megacolon
Extraintestinal Manifestations
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Colonic Ischemia
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Laboratory Tests
Imaging Studies
Plain Radiography.
Computed Tomography.
Barium Enema.
Colonoscopy.
Angiography.
Management
Disposition
Radiation Proctocolitis
Principles
Acute Radiation Proctocolitis
Chronic Radiation Proctocolitis
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Acute Radiation Proctocolitis
Chronic Radiation Proctocolitis
Disposition
References
Chapter 85: Questions & Answers
Chapter 86: Disorders of the Anorectum
Principles
Clinical Features
Specific Anorectal Problems
Hemorrhoids
Principles
Clinical Features
Management
Anal Fissures
Principles
Clinical Features
Management
Abscesses and Fistulae
Principles
Management
Perirectal and Perianal Abscesses.
Ischiorectal Abscess.
Intersphincteric Abscess.
Supralevator Abscess.
Postanal Abscess.
Horseshoe Abscess.
Necrotizing Infection.
Fistulae.
Pilonidal Disease
Principles
Management
Hidradenitis Suppurativa
Principles
Clinical Findings
Differential Diagnosis
Management
Proctalgia
Levator Ani Syndrome
Proctalgia Fugax
Fecal Incontinence
Principles
Clinical Features
Management
Pruritis Ani
Principles
Diagnostic Testing
Management
Sexually Transmitted Disease and Proctitis
Principles
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
Principles
Clinical Features
Diagnostic Testing
Management
References
Chapter 86: Questions & Answers
Section Six: Genitourinary and Gynecologic Systems
Chapter 87: Renal Failure
Acute Kidney Injury
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.
Analysis of Information
Management
Hyperkalemia and Other Metabolic Derangements
Hyperkalemia.
Hypocalcemia.
Hyperphosphatemia.
Hypermagnesemia.
Disturbances of Volume Regulation.
Disposition
Chronic Kidney Disease
Causes
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
Major Dialysis Modalities.
Hemodialysis.
Peritoneal Dialysis.
Indications for Dialysis.
Complications of Dialysis
Hemodialysis
Vascular Access–Related Complications
Non–Vascular Access–Related Complications
Hypotension.
Shortness of Breath.
Chest Pain.
Neurologic Dysfunction.
Peritoneal Dialysis
References
Chapter 87: Questions & Answers
Chapter 88: Sexually Transmitted Diseases
Principles
Disorders Characterized by Genital Ulcers
Herpes
Principles
Clinical Features
Diagnostic Testing
Management
Disposition
Syphilis
Principles
Clinical Features
Diagnostic Testing
Management
Disposition
Chancroid
Principles
Clinical Features
Diagnostic Testing
Management
Disorders Characterized by Genital Discharge
Gonorrhea
Principles
Clinical Features
Diagnostic Testing
Treatment
Disposition
Chlamydia
Principles
Clinical Features
Diagnostic Testing
Management
Disposition
Nongonococcal Urethritis
Trichomoniasis
Principles
Clinical Features
Diagnostic Testing
Management
Disposition
Pelvic Inflammatory Disease
Principles
Clinical Features
Diagnostic Testing
Management
Disposition
Bacterial Vaginosis
Principles
Clinical Features and Diagnostic Testing
Management
Vulvovaginal Candidiasis
Principles
Clinical Features and Diagnostic Testing
Management
Epithelial Cell Infections
Condyloma Acuminata (Genital Warts)
Principles
Clinical Findings
Diagnostic Testing
Management
Molluscum Contagiosum
Ectoparasites
Pediculosis Pubis
Scabies
References
Chapter 88: Questions & Answers
Chapter 89: Selected Urologic Disorders
Urinary Tract Infection in Adults
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
Clinical Features
Diagnostic Testing
Management
Renal Calculi
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
Clinical Features
Diagnostic Testing
Management
Acute Scrotal Pain
Specific Disorders
Testicular Torsion
Clinical Features.
Differential Diagnosis.
Diagnostic Testing
Urinalysis.
Imaging.
Management.
Disposition.
Torsion of Appendages of the Testis
Clinical Features.
Diagnostic Testing.
Management and Disposition.
Epididymitis
Clinical Features.
Diagnostic Testing.
Management.
Disposition.
Orchitis
Clinical Features.
Diagnostic Testing.
Management.
Testicular Tumors
Principles.
Clinical Features.
Diagnostic Testing.
Management and Disposition.
Testicular Trauma
Inguinal Hernia, Acute Hydrocele, Varicocele, and Spermatocele
Acute Urinary Retention
Epidemiology
Pathophysiology
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Hematuria
Clinical Features
Diagnostic Testing
Management and Disposition
References
Chapter 89: Questions & Answers
Chapter 90: Selected Gynecologic Disorders
Ovarian Torsion
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Laboratory Tests
Imaging
Ultrasonography.
Computed Tomography.
Magnetic Resonance Imaging.
Laparoscopy.
Management and Disposition
Ovarian Cysts and Masses
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Laboratory Tests
Imaging
Ultrasonography.
Computed Tomography.
Magnetic Resonance Imaging.
Management and Disposition
Abnormal Uterine Bleeding in the Nonpregnant Patient
Principles
Clinical Features
History
Physical Examination
Differential Diagnosis
Diagnostic Strategies
Laboratory Studies
Imaging
Management
Disposition
Emergency Contraception
References
Chapter 90: Questions & Answers
Section Seven: Neurology
Chapter 91: Stroke
Principles
Background
Epidemiology
Ischemic Stroke
Transient Ischemic Attack
Hemorrhagic Stroke
Pathophysiology
Anatomy and Physiology
Clinical Features
Ischemic Stroke
Hemorrhagic Stroke
Differential Diagnosis
Ischemic Stroke
Hemorrhagic Stroke
Diagnostic Testing
Ischemic Stroke
Transient Ischemic Attack
Hemorrhagic Stroke
Management
Ischemic Stroke
Blood Pressure Management
Thrombolytic Therapy
Endovascular Rescue Therapy
Anticoagulation
Intracerebral Hemorrhage
Disposition
Ischemic Stroke and Transient Ischemic Attacks
References
Chapter 91: Questions & Answers
Chapter 92: Seizures
Principles
Background and Classification
Epidemiology
Pathophysiology
Clinical Features
Clinical History
Physical Examination
Differential Diagnosis
Convulsive Syncope
Nonepileptic Attacks
Diagnostic Testing
Laboratory Studies
Electrocardiogram
Neuroimaging
Lumbar Puncture
Electroencephalogram
Management
Initiation of Antiepileptic Drugs
First-Time Seizures
Patients With a History of Seizures
Special Cases
Alcohol-Related Seizures
Toxins
Post-Traumatic Seizures
Pregnancy
Disposition
References
Chapter 92: Questions & Answers
Chapter 93: 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
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 Cranial Vasoconstriction Syndrome
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Chapter 93: Questions & Answers
Chapter 94: Delirium and Dementia
Overview
Delirium
Principles
Background
Pathophysiology
Clinical Features
Differential Diagnosis
Diagnostic Studies
Management
Disposition
Dementia
Principles
Background
Pathophysiology
Clinical Features
Differential Diagnosis
Senescent Forgetfulness
Delirium
Depression
Diagnostic Strategies
Cognitive Evaluation
Laboratory Tests and Imaging Studies
Summary
Management
Disposition
References
Chapter 94: Questions & Answers
Chapter 95: Brain and Cranial Nerve Disorders
Trigeminal Neuralgia (Cranial Nerve V)
Principles
Clinical Features
Differential Diagnosis
Diagnostic Strategies
Management
Disposition
Facial Nerve Paralysis (Cranial Nerve VII)
Principles
Clinical Features
Bell’s Palsy
Ramsey Hunt Syndrome
Lyme Disease
Bacterial Ear Infections
Differential Diagnosis
Diagnostic Strategies
Management
Bell’s Palsy
Ramsay Hunt Syndrome
Lyme Disease
Bacterial Infections
Disposition
Vestibular Schwannoma (Cranial Nerve VIII)
Principles
Clinical Features
Differential Diagnosis
Diagnostic Strategies
Management
Disposition
Diabetic Cranial Mononeuropathy
Principles
Clinical Features
Differential Diagnosis
Diagnostic Studies
Management
Cerebral Venous Thrombosis
Principles
Clinical Features
Differential Diagnosis
Diagnostic Strategies
Management
Disposition
Multiple Sclerosis
Principles
Clinical Features
Differential Diagnosis
Diagnostic Strategies
Management
Treatment of Disease Progression
Treatment of Acute Exacerbations
Treatment of Complications
Disposition
References
Chapter 95: Questions & Answers
Chapter 96: Spinal Cord Disorders
Principles
Anatomy
Classification of Spinal Cord Syndromes
Complete (Transverse) Spinal Cord Syndrome
Incomplete 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 Diagnosis
Diagnostic Testing
Management
Specific Disease Processes
Intrinsic Cord Lesions
Multiple Sclerosis
Transverse Myelitis
Principles.
Clinical Features.
Differential Diagnosis.
Diagnostic Strategies.
Management.
Spinal Subarachnoid Hemorrhage
Principles.
Clinical Features.
Differential Diagnosis.
Diagnostic Testing.
Management.
Syringomyelia
Principles.
Clinical Features.
Differential Diagnosis.
Diagnostic Testing.
Management.
Human Immunodeficiency Virus Myelopathy
Spinal Cord Infarction
Extrinsic Cord Lesions
Spinal Epidural Hematoma
Principles.
Clinical Features.
Differential Diagnosis.
Diagnostic Testing.
Management.
Spinal Epidural Abscess
Principles.
Clinical Features.
Differential Diagnosis.
Diagnostic Testing.
Management.
Diskitis
Principles.
Clinical Features.
Differential Diagnosis.
Diagnostic Testing.
Management.
Neoplasm
Principles.
Clinical Features.
Differential Diagnosis.
Diagnostic Testing.
Management.
References
Chapter 96: Questions & Answers
Chapter 97: Peripheral Nerve Disorders
Overview
Principles
Differential Diagnosis
Diagnostic Testing
Specific Types of Neuropathies
Type 1: Demyelinating Polyneuropathy (Guillian-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 97: Questions & Answers
Chapter 98: Neuromuscular Disorders
Principles
Clinical Features
History
Physical Examination
Differential Diagnosis
Myelopathies
Motor Neuron Disease
Neuropathies
Diseases of the Neuromuscular Junction
Myopathies
Diagnostic Testing
Laboratory Studies
Special Studies
Disorders of the Neuromuscular Junction
Myasthenia Gravis
Principles
Myasthenic Crisis.
Lambert-Eaton Syndrome.
Clinical Features
Diagnostic Testing
Management
Cholinesterase Inhibitors.
Immunosuppressant Drugs.
Thymectomy.
Immunomodulatory Therapy.
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 98: Questions & Answers
Chapter 99: Central Nervous System Infections
Principles
Overview
Bacterial Meningitis
Tuberculous Meningitis
Viral Meningitis and Encephalitis
Fungal Meningitis
Central Nervous System Abscess
Clinical Features
Meningitis
Viral Encephalitis
Central Nervous System Abscess
Differential Diagnosis
Diagnostic Testing
Laboratory Testing
Neuroimaging
Cerebrospinal Spinal Fluid Analysis
Opening Pressure
Cerebrospinal Spinal Fluid Collection
Cerebrospinal Spinal Fluid Cell Count
Gram’s Stain
Xanthochromia
Glucose
Protein
India Ink Preparation
Lactic Acid and Other Markers
Antigen Detection
Bacteriologic Cultures
Additional Investigations
Management
Bacterial Meningitis
Tuberculous Meningitis
Fungal Meningitis
Viral Meningitis
Viral Encephalitis
Central Nervous System Abscess
Chemoprophylaxis
Immunoprophylaxis
Disposition
References
Chapter 99: Questions & Answers
Section Eight: Psychiatric and Behavioral Disorders
Chapter 100: Thought Disorders
Principles
Clinical Features
Differential Diagnosis
Medical Disorders
Psychiatric Disorders
Diagnostic Testing
Management
Disposition
References
Chapter 100: Questions & Answers
Chapter 101: Mood Disorders
Principles
Epidemiology
Pathophysiology
Neurophysiology
Neuroanatomy
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
Postpartum 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 Diagnosis
Medical Disorders, Medications, and Substance Abuse or Withdrawal
Grief and Bereavement
Adjustment Disorders
Borderline Personality Disorder
Dementia
Diagnostic Testing
Management
Disposition
References
Chapter 101: Questions & Answers
Chapter 102: Anxiety Disorders
Principles
Background
Epidemiology
Pathophysiology
Clinical Features
Panic Disorder
Generalized Anxiety Disorder
Post-Traumatic Stress Disorder
Specific Phobias
Obsessive-Compulsive Disorder
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 102: Questions & Answers
Chapter 103: Somatoform Disorders
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
References
Chapter 103: Questions & Answers
Chapter 104: Factitious Disorders and Malingering
Principles
Clinical Features
Factitious Disorders
Factitious Disorders Imposed on Self
Psychological Symptoms.
Physical Symptoms.
Approach to Diagnosis.
Munchausen Syndrome.
Factitious Disorder Imposed on Another
Perpetrator Characteristics.
Victim Characteristics.
Approach to Diagnosis.
Malingering
Differential Diagnosis
Management
Factitious Disorders
Malingering
Disposition
References
Chapter 104: Questions & Answers
Chapter 105: Suicide
Principles
Background
Epidemiology
Risk Factors
Self-Harm
Mental Illness
Alcohol and Substance Abuse
Adolescence
Older Age
Chronic Illness
Other Risk Factors
Methods of Suicide
Pathophysiology
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Suicide Precautions
Use of Restraints
Pharmacologic Treatments
Risk Assessment
Documentation
Disposition
Psychiatric Hospitalization
Discharge
References
Chapter 105: Questions & Answers
Section Nine: Immunologic and Inflammatory
Chapter 106: Arthritis
Principles
Background
Pathophysiology
Clinical Features
History
Physical Examination
General Examination
Joints
Spine
Upper Extremities
Lower Extremities
Diagnostic Testing
Laboratory Tests
Radiologic Tests
Plain Radiography
Computed Tomography, Magnetic Resonance Imaging, and Sonography
Arthrocentesis
Indications and Contraindications.
Complications.
Technique.
Synovial Fluid Examination.
General Appearance.
Synovial Fluid Studies.
White Blood Cell Count.
Crystal Analysis.
Differential Diagnosis and Management
Acute Monoarticular Arthritis
Nongonococcal Bacterial Septic Arthritis
Principles
Epidemiology.
Pathophysiology.
Microbiology.
Clinical Features.
Diagnostic Testing.
Management.
Gonococcal Arthritis
Principles.
Clinical Features.
Management.
Gouty Arthritis
Principles
Epidemiology.
Pathophysiology.
Clinical Features.
Diagnostic Testing.
Laboratory Tests.
Radiologic Tests.
Management.
Nonsteroidal Antiinflammatory Drugs.
Colchicine.
Steroids.
Adrenocorticotropic Hormone (Corticotropin).
Other Agents.
Summary.
Calcium Pyrophosphate Dihydrate Deposition Disease (Pseudogout)
Principles.
Clinical Features.
Diagnostic Testing.
Management.
Basic Calcium Phosphate Hydroxyapatite Crystal Disease
Acute Calcific Periarthritis
Trauma and Hemarthrosis
Chronic Monoarticular Arthritis
Osteoarthritis (Degenerative Joint Disease)
Principles.
Clinical Features.
Management
Nonpharmacologic Therapy.
Pharmacologic Therapy.
Summary.
Acute Polyarticular Arthritis
Lyme Disease
Principles.
Clinical Features.
Diagnostic Testing.
Management.
Acute Rheumatic Fever
Principles.
Clinical Features.
Diagnostic Testing.
Management.
Chronic Polyarthritis
Rheumatoid Arthritis
Principles.
Clinical Features.
Diagnostic Testing.
Management.
Adult-Onset Still’s Disease
Relapsing Polychondritis
Seronegative Spondyloarthropathies
Ankylosing Spondylitis
Clinical Features.
Management.
Reactive Arthritis (Formerly Reiter’s Syndrome)
Clinical Features.
Management.
Enteropathic Arthritis.
Psoriatic Arthritis.
Fibromyalgia
Clinical Features.
Management.
Polymyalgia Rheumatica
Scleroderma (Systemic Sclerosis)
Disposition
References
Chapter 106: Questions & Answers
Chapter 107: Tendinopathy and Bursitis
Tendinopathy
Principles
Background
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 Diagnosis
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
Principles
Clinical Features
Olecranon and Prepatellar Bursitis
Subacromial Bursitis
Trochanteric Bursitis
Ischiogluteal Bursitis
Iliopsoas Bursitis
Pes Anserine Bursitis
Diagnostic Testing
Differential Diagnosis
Management
Septic Bursitis
Nonseptic Bursitis
Disposition
References
Chapter 107: Questions & Answers
Chapter 108: Systemic Lupus Erythematosus and the Vasculitides
Systemic Lupus Erythematosus
Principles
Background
Epidemiology
Etiology
Pathophysiology
Clinical Features
The Patient With Undiagnosed or Suspected Systemic Lupus Erythematosus
Acute Presentations in the Patient With Known Systemic Lupus Erythematosus
Systemic Lupus Erythematosus Exacerbation
Specific Symptoms and Presentations of Systemic Lupus Erythematosus
Fever.
Neuropsychiatric Presentations.
Headache.
Seizure.
Focal Neurologic Findings.
Psychiatric Symptoms.
Cardiorespiratory Presentations and Diseases.
Coronary Artery Disease.
Pericardial Disease.
Pulmonary Embolism.
Pleuritis.
Pneumonia.
Undifferentiated Dyspnea.
Musculoskeletal Presentations.
Gastrointestinal Presentations.
Dermatologic Presentations.
Renal Disease.
Complications Due to Medications
Diagnostic Testing
Laboratory Tests
Imaging Studies
Radiography.
Computed Tomography.
Echocardiography and Ultrasound.
Nuclear Imaging.
Differential Diagnosis
Management
Special Considerations
Antiphospholipid Syndrome
Principles.
Clinical Features.
Diagnostic Testing.
Management.
Drug-Induced Lupus
Disposition
Vasculitides
Principles
Clinical Features
Vasculitis Presenting With Large-Vessel Occlusive Symptoms
Giant Cell Arteritis
Principles.
Clinical Features.
Diagnostic Testing.
Management.
Takayasu’s Arteritis
Principles.
Clinical Features.
Diagnostic Testing.
Management.
Vasculitis Typified by Pulmonary-Renal Manifestations
Wegener’s Granulomatosis
Principles.
Clinical Features and Diagnostic Testing.
Management.
Goodpasture’s Syndrome
Principles.
Clinical Features and Diagnostic Testing.
Management.
Microscopic Polyangiitis
Principles.
Clinical Features and Diagnostic Testing.
Management.
Churg-Strauss Syndrome
Principles.
Clinical Features and Diagnostic Testing.
Management.
Vasculitis With Characteristic Cutaneous Manifestations
Erythema Nodosum
Principles.
Clinical Features.
Management.
Henoch-Schönlein Purpura
Principles.
Clinical Features and Diagnostic Testing.
Management.
Polyarteritis Nodosa
Principles.
Clinical Features.
Management.
Behçet’s Disease
Principles.
Clinical Features and Diagnostic Testing.
Management.
Vasculitis Associated With Environmental or Foreign Antigen Exposure
Vasculitis Caused by Cocaine Adulterated With Levamisole.
Cryoglobulinemic Vasculitis.
References
Chapter 108: Questions & Answers
Chapter 109: Allergy, Hypersensitivity, and Anaphylaxis
Allergy
Principles
Background and Terminology
Pathophysiology
Development of the Immune System and Mechanism of Immune-Mediated Injury.
T-Cell Development.
B-Cell Development and Immunoglobulins.
Classification of Reactions
Anaphylaxis
Principles
Epidemiology and Risk Factors
Common Triggers for Anaphylaxis
Foods.
Insect Stings.
Drugs.
Natural Rubber Latex.
Radiocontrast Media.
Exercise Induced Anaphylaxis.
Idiopathic Anaphylaxis.
Mediators of Anaphylaxis
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Overview
Positioning
Epinephrine
Airway
Volume Expansion
Antihistamines
Glucocorticoids
Patients Receiving Beta-Blockade
Disposition
Urticaria and Angioedema
Principles and Clinical Features
Diagnostic Strategies
Management
Angioedema With Urticaria
Angioedema Without Urticaria
Disposition
References
Chapter 109: Questions & Answers
Chapter 110: Dermatologic Presentations
Overview
Principles
Background
Anatomy and Physiology
Clinical Features
Diagnostic Testing
Management
Disposition
Infectious Disorders
Bacterial Infections
Impetigo
Folliculitis
Cellulitis
Abscess
Carbuncle
Methicillin-Resistant Staphylococcus Aureus
Erythema Migrans
Necrotizing Fasciitis
Meningococcal Infection
Scarlet Fever
Syphilis
Gonococcal Dermatitis
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.
Infestations
Scabies
Pediculosis
Bed Bugs
Allergic Reactions
Contact Dermatitis
Urticaria
Poison Ivy
Drug Reactions
Inflammatory Conditions
Atopic Dermatitis
Pityriasis Rosea
Kawasaki Disease (Mucocutaneous Lymph Node Syndrome)
Erythema Multiforme
Toxic Epidermal Necrolysis
Erythema Nodosum
Lichen Planus
Autoimmune Disorders
Bullous Pemphigoid
Pemphigus Vulgaris
Cutaneous Malignancies
Skin Conditions Associated With Systemic Disease
Management
Disposition
References
Chapter 110: Questions & Answers
Section Ten: Hematology and Oncology
Chapter 111: Blood and Blood Components
Principles
Background and Importance
Anatomy, Physiology, and Pathophysiology
Blood Banking
Blood Typing
Type and Screen.
Type and Crossmatch.
Management
Decision Making
Pharmacology
Devices and Techniques
Whole Blood
Packed Red Blood Cells
Fresh-Frozen Plasma
Outcomes
Safety and Effectiveness
Complications
Adverse Effects of Massive Transfusions
Adverse Effects of Nonmassive RBC Transfusion
References
Chapter 111: Questions & Answers
Chapter 112: Anemia and Polycythemia
Anemia
Principles
Background and Importance
Anatomy and Physiology
Pathophysiology
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Anemias Due to Decreased Red Blood Cell Production
Principles
Background and Importance
Iron Deficiency Anemia
Principles.
Clinical Features.
Diagnostic Testing.
Management.
Thalassemia
Principles.
Pathophysiology.
Clinical Features.
Diagnostic Testing.
Management.
Sideroblastic Anemia
Principles.
Clinical Features.
Differential Diagnosis.
Management.
Anemia of Chronic Disease
Principles.
Clinical Features.
Diagnostic Testing.
Management.
Macrocytic and Megaloblastic Anemias
Principles.
Clinical Features.
Differential Diagnoses.
Diagnostic Testing.
Management.
Normochromic and Normocytic Anemias
Principles.
Differential Diagnoses.
Aplastic Anemia
Principles.
Clinical Features.
Diagnostic Testing.
Management.
Increased Red Blood Cell Destruction
Principles
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
Principles.
Clinical Features.
Differential Diagnoses
Sickle Cell–β-Thalassemia.
Diagnostic Testing
Management
Disposition
Polycythemia
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
References
Chapter 112: Questions & Answers
Chapter 113: White Blood Cell Disorders
White Blood Cell Disorders
Principles
Background and Importance
Anatomy and Physiology
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Chronic Myeloid Leukemia
Principles
Anatomy and Physiology
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Lymphocytic Leukocytosis
Principles
Anatomy and Physiology
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Leukopenia
Principles
Pathophysiology
Clinical Features
Diagnostic Testing
Management
Disposition
References
Chapter 113: Questions & Answers
Chapter 114: Disorders of Hemostasis
Principles
Background and Importance
Anatomy and Physiology
Pathophysiology
Clinical Features
History and Physical Examination
Thrombocytopenia
Immune Thrombocytopenia.
Idiopathic Thrombocytopenic Purpura.
Nonimmune Thrombocytopenia.
Thrombotic Thrombocytopenic Purpura.
Dilutional Thrombocytopenia.
Thrombocytopathy
Adhesion Defects.
Release Defects.
Aggregation Defects.
Thrombocytosis
Disorders of the Coagulation Pathway
Abnormal Prothrombin Time and Other Test Results Normal
Abnormal Partial Thromboplastin Time and Other Test Results Normal
Hemophilia A.
von Willebrand’s Disease.
Hemophilia B (Christmas Disease).
Miscellaneous Coagulation Disorders
Disseminated Intravascular Coagulation.
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
Out-of-Hospital Treatment
Platelet Disorders
Platelet Transfusions.
Medication-Induced Thrombocytopenia
Post-Transfusion Thrombocytopenia
Heparin-Induced Thrombocytopenia
Idiopathic Thrombocytopenic Purpura
Thrombotic Thrombocytopenic Purpura
Hemophilia A
Management of Hemophilia A
Preparation.
Replacement Therapy.
Prophylaxis.
Hemophilia B
von Willebrand’s Disease
Medication-Induced Bleeding
Disseminated Intravascular Coagulation
Disposition
References
Chapter 114: Questions & Answers
Chapter 115: Selected Oncologic Emergencies
Introduction
Febrile Neutropenia
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Metastatic Spinal Cord Compression
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Malignant Pericardial Disease
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Hypercalcemia
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Tumor Lysis Syndrome
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Leukostasis
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Superior Vena Cava Syndrome
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Conclusion
References
Chapter 115: Questions & Answers
Section Eleven: Metabolism and Endocrinology
Chapter 116: Acid-Base Disorders
Principles
Specific Acid-Base Disorders
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Elevated Anion Gap Metabolic Acidosis
Lactic Acidosis.
Diabetic Ketoacidosis.
Alcoholic Ketoacidosis.
Methanol and Ethylene Glycol.
Renal Failure.
Isoniazid Toxicity.
Salicylate Toxicity.
Iron Ingestion.
Normal Anion Gap Metabolic Acidosis
Physiologic Compensation for Metabolic Acidosis
Metabolic Alkalosis
Diagnostic Testing and Mixed Disorders
Management
Acidosis
Alkalosis
References
Chapter 116: Questions & Answers
Chapter 117: Electrolyte Disorders
Hyperkalemia
Principles
Clinical Features
Diagnostic Strategies
Management
Hypokalemia
Principles
Clinical Features
Diagnostic Testing
Management
Hypernatremia
Principles
Clinical Features
Diagnostic Testing
Management
Hyponatremia
Principles
Pseudohyponatremia
Hypovolemic Hyponatremia
Hypervolemic Hyponatremia
Euvolemic Hyponatremia
Diagnostic Testing
Clinical Features
Management
Hypovolemic Hyponatremia
Hypervolemic Hyponatremia
Euvolemic Hyponatremia
Hypercalcemia
Principles
Clinical Features
Diagnostic Testing
Management
Hypocalcemia
Principles
Clinical Features
Diagnostic Strategies
Management
Hypermagnesemia
Principles
Clinical Features
Diagnostic Testing
Management
Hypomagnesemia
Principles
Patients Maintained on Diuretics
Malnourished and Alcoholic Patients
Patients With Hypokalemia
Patients With Acute Coronary Artery Disease and Ventricular Arrhythmias
Patients Receiving Specific Medications
Clinical Features
Diagnostic Testing
Management
Hyperphosphatemia
Principles
Clinical Features
Management
Hypophosphatemia
Principles
Clinical Features
Management
References
Chapter 117: Questions & Answers
Chapter 118: Diabetes Mellitus and Disorders of Glucose Homeostasis
Diabetes Mellitus
Principles
Background
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.
Epidemiology
Clinical Features
Type 1
Type 2
Diagnostic Testing
Serum Glucose Level
Glycosylated Hemoglobin
Urine Glucose Level
Urine Ketone Level
Dipstick Blood Glucose Level
Management
Approach to New-Onset Hyperglycemia in the Emergency Department
Management of Diabetes
Oral Hypoglycemic Agents.
Biguanides.
Sulfonylureas.
Thiazolidinediones.
α-Glucosidase Inhibitors.
Meglinitides.
Glucagon-Like Peptide Analogues and Agonists.
Dipeptidyl Peptidase-4 Inhibitors.
Amylin Analogue.
Sodium-Glucose Cotransporter 2 Inhibitors.
Insulin.
Pancreas Transplantation.
New Trends in Diabetes Management.
Diabetic Ketoacidosis
Principles
Pathophysiology
Causes
Clinical Features
Diagnostic Testing
Differential Diagnoses
Management
Insulin
Intravenous Fluids
Potassium
Magnesium
Acidosis
Complications
Disposition
Hyperglycemic Hyperosmolar State
Principles
Pathophysiology
Causes
Clinical Features
Diagnostic Testing
Differential Diagnoses
Management
Intravenous Fluids
Electrolytes
Insulin
Other Considerations
Acute Complications
Disposition
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 in Pregnancy
Hypoglycemia
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Chapter 118: Questions & Answers
Chapter 119: Rhabdomyolysis
Principles
Background
Physiology
Pathophysiology
Clinical Features
Complications
Early Complications
Compartment Syndrome.
Electrolyte Disorders and Acidosis.
Hypovolemia.
Hepatic Dysfunction.
Late Complications
Myoglobin-Induced Acute Kidney Injury.
Disseminated Intravascular Coagulation.
Diagnostic Testing
Serum Creatine Kinase
Serum and Urine Myoglobin
Urine Dipstick and Urinalysis
Other Laboratory Findings
Prognostic Tests in Rhabdomyolysis
Management
Fluid Replacement and Urine Alkalinization
Diuretics
Mannitol
Furosemide
Acetazolamide
Experimental Therapies
Renal Replacement Therapy
Disposition
Prognosis
References
Chapter 119: Questions & Answers
Chapter 120: Thyroid and Adrenal Disorders
Hyperthyroidism
Principles
Background
Anatomy and Physiology
Pathophysiology
Graves’ Disease.
Toxic Multinodular Goiter.
Toxic Adenoma.
Thyroiditis.
Silent Thyroiditis.
Postpartum Thyroiditis.
Subacute Thyroiditis.
Suppurative Thyroiditis.
Drug-Induced Thyroiditis.
Factitious Thyroiditis.
Subclinical Hyperthyroid.
Clinical Features
History and Physical Examination
Thyroid Storm
Diagnostic Testing
Differential Diagnosis
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
Principles
Background
Pathophysiology
Clinical Features
History and Physical Examination
Myxedema Coma
Diagnostic Testing
Differential Diagnosis
Management
Hypothyroidism
Myxedema Coma
Disposition
Adrenal Insufficiency
Principles
Background
Anatomy and Physiology
Pathophysiology
Clinical Features
Diagnostic Testing
Differential Diagnosis
Management
Disposition
References
Chapter 120: Questions & Answers
Section Twelve: Infectious Diseases
Chapter 121: Bacteria
Diphtheria
Principles
Background
Epidemiology
Etiology
Pathophysiology
Clinical Features
Symptoms and Signs
Complications
Diagnostic Strategies
Differential Diagnosis
Management
Disposition
Pertussis
Principles
Background
Epidemiology
Etiology
Pathophysiology
Clinical Features
Symptoms and Signs
Complications
Diagnostic Strategies
Differential Diagnosis
Management
Acute Treatment
Vaccination
Tetanus
Principles
Background
Epidemiology
Etiology
Pathophysiology
Clinical Features
Symptoms and Signs
Generalized Tetanus.
Localized Tetanus.
Cephalic Tetanus.
Neonatal Tetanus.
Complications
Diagnostic Strategies
Differential Diagnosis
Management
Acute Treatment
Supportive Care.
Elimination of Unbound Toxin and Active Immunization.
Prevention of Further Toxin Production.
Vaccination
Botulism
Principles
Background
Epidemiology
Etiology
Pathophysiology
Clinical Features
Symptoms and Signs
Complications
Diagnostic Strategies
Differential Diagnosis
Management
Disposition
Pneumococcemia
Principles
Background
Epidemiology
Etiology
Pathophysiology
Clinical Features
Symptoms and Signs
Complications
Diagnostic Strategies
Differential Diagnosis
Management
Acute Treatment
Vaccination
Disposition
Meningococcemia
Principles
Background
Epidemiology
Etiology
Pathophysiology
Clinical Features
Symptoms and Signs
Occult Bacteremia.
Meningococcal Meningitis.
Meningococcal Septicemia.
Fever and a Nonblanching Rash.
Chronic Meningococcemia.
Complications
Diagnostic Strategies
Differential Diagnosis
Management
Acute Treatment
Antibiotic Prophylaxis and Vaccination
Disposition
Toxic Shock Syndrome
Principles
Background
Epidemiology
Etiology
Pathophysiology
Clinical Features
Symptoms and Signs
Complications
Diagnostic Strategies
Differential Diagnosis
Management
Disposition
References
Chapter 121: Questions & Answers
Chapter 122: Viruses
Perspective
Vaccine-Preventable Infections of Childhood
Mumps
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management and Disposition
Measles (Rubeola)
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Rubella (German Measles)
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management and Disposition
Viral Infections With Vesicular Rash
Herpes Simplex
Principles
Clinical Features
Oral Infection.
Genital Herpes.
Central Nervous System Infection.
Other Infections.
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Varicella-Zoster Virus
Principles
Clinical Features
Varicella.
Zoster.
Differential Diagnosis
Diagnostic Testing
Management
Varicella.
Zoster.
Disposition
Viral Infections Causing Nonspecific Febrile Illness
Epstein-Barr Virus
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Cytomegalovirus
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Enteroviruses
Principles
Clinical Features
Poliovirus.
Non-Polio Enteroviruses.
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Viruses Associated With Respiratory Infections
Influenza
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Neuraminidase Inhibitors.
Adamantane Antivirals.
Disposition
Coronavirus
Principles
Clinical Features
Severe Acute Respiratory Syndrome.
Middle East Respiratory Syndrome.
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Rhinovirus
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management and Disposition
Adenovirus
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management and Disposition
Parainfluenza
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Respiratory Syncytial Virus
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Viruses Associated With Diarrheal Illness
Norovirus and Rotavirus
Principles
Clinical Features
Norovirus.
Rotavirus.
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Viral Infections With Neurologic Manifestations
Principles
Clinical Features
West Nile Virus
Eastern Equine Encephalitis Virus
St. Louis Encephalitis Virus
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Viral Hemorrhagic Fevers
Dengue Virus
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Chikungunya Virus
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management and Disposition
Yellow Fever Virus
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Ebola
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Marburg
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Lassa Fever
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
References
Chapter 122: Questions & Answers
Chapter 123: Rabies
Principles
Epidemiology
Pathophysiology
Encephalitic Rabies
Paralytic Rabies
Diagnostic Considerations
Differential Diagnoses
Diagnostic Testing
Prophylaxis and Vaccination
Preexposure Prophylaxis
Postexposure Prophylaxis and Vaccination
Wound Care
Management of Human Rabies Infection
References
Chapter 123: Questions & Answers
Chapter 124: HIV Infection and AIDS
Principles
Background and Epidemiology
Pathophysiology
Risk Factors for HIV Transmission
Clinical Features
Primary HIV Infection
Chronic HIV Infection
AIDS
Initial Evaluation
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
Diagnosticconsiderations
Differential Diagnosis
Diagnostic Testing
HIV Testing
Management
Postexposure Prophylaxis
Disposition
References
Chapter 124: Questions & Answers
Chapter 125: Parasites
Overview
Travel History
Therapy
Presentations
Fever
Malaria
Clinical Features.
Diagnostic Testing.
Management.
Babesiosis
Clinical Features.
Management.
Other Parasites
Neurologic Symptoms
Cerebral Malaria
Clinical Features.
Management.
Cysticercosis
Clinical Features.
Diagnostic Strategies and Management.
Echinococcosis
Principles and Clinical Features.
Diagnostic Strategies and Management.
African Trypanosomiasis
Clinical Features.
Diagnostic Strategies and Management.
Other Parasites
Anemia
Malaria
Whipworm and Hookworm
Tapeworm
Peripheral Edema
Elephantiasis
Clinical Features.
Diagnostic Strategies and Management.
Dermatologic Symptoms
Cutaneous Leishmaniasis
Clinical Features.
Diagnostic Strategies and Management.
Dracunculiasis
Principles and Clinical Features.
Management.
Other Parasites
Visual Symptoms
Onchocerciasis
Clinical Features.
Diagnostic Strategies and Management.
Loiasis
Clinical Features.
Diagnostic Strategies and Management.
Other Parasites
Pulmonary Symptoms
Cardiovascular Symptoms
Chagas’ Disease
Clinical Features.
Diagnostic Strategies.
Management.
Other Parasites
Gastrointestinal Symptoms
Diarrhea
Abdominal Pain
Pruritus Ani
Parasitic Co-Infections in Patients With HIV Infection and AIDS
Specific Parasites
References
Chapter 125: Questions & Answers
Chapter 126: 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 Diagnosis
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
Relapsing Fever
Clinical Features
Differential Diagnosis
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 Diagnosis
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 Diagnosis
Diagnostic Testing
Management
Tick Bite Prophylaxis With Insect Repellents
References
Chapter 126: Questions & Answers
Chapter 127: Tuberculosis
Principles
Background
Pathophysiology
Transmission
Pathogenesis
Stage 1
Stage 2
Stage 3
Stage 4
Clinical Features
History
Present Illness
Risk Factors
Physical Examination
Complications of Pulmonic Tuberculosis
Hemoptysis
Pneumothorax
Pleural Effusion
Empyema
Airway Tuberculosis
Superinfection With Fungi
Primary Tuberculous Pericarditis
Differential Diagnosis
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 127: Questions & Answers
Chapter 128: Bone and Joint Infections
Principles
Background
Anatomy and Physiology
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 Diagnosis
Diagnostic Testing
Laboratory Tests
Diagnostic Imaging
Conventional Radiography.
Radionuclide Bone Scanning.
Computed Tomography.
Magnetic Resonance Imaging.
Microbiologic Diagnosis
Management
Disposition
Septic Arthritis
Principles
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 Diagnosis
Diagnostic Testing
Serum and Urine Tests
Joint Fluid Analysis
Imaging
Management
Disposition
References
Chapter 128: Questions & Answers
Chapter 129: Skin Infections
Principles
Background and Importance
Anatomy and Physiology
Pathophysiology
Clinical Features
Differential Diagnosis and Diagnostic Testing
Wound Cultures
Blood Cultures
Radiographic Studies
Other Diagnostic Tests
Cellulitis
Principles and Clinical Features
Diabetic Foot Infections
Bite Wounds
Water-Borne Infections
Differential Diagnosis and Diagnostic Testing
Management
Disposition
Abscess
Principles and Clinical Features
Differential Diagnosis and Diagnostic Testing
Management
Disposition
Impetigo
Principles
Clinical Features and Differential Diagnosis
Management
Infections of the Pilosebaceous Follicle
Principles
Clinical Features and Management
Furuncles and Carbuncles
Acne
Hidradenitis Suppurativa (Acne Inversa)
Necrotizing Skin and Soft Tissue Infections
Principals and Clinical Features
Differential Diagnosis and Diagnostic Testing
Management and Disposition
Toxic Shock Syndromes
Principles and 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 129: Questions & Answers
Chapter 130: Sepsis Syndromes
Principles
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.
Microbiology.
Special Procedures
Radiology
Management
Respiratory Support
Cardiovascular Support
Fluid Resuscitation
Vasoactive Drug Therapy
Norepinephrine.
Dopamine.
Phenylephrine.
Epinephrine.
Vasopressin.
Dobutamine.
Bicarbonate
Antibiotics
Steroid Therapy
Disposition
References
Chapter 130: Questions & Answers
Part IV: Environment and Toxicology
Section One: Environment
Chapter 131: Frostbite and Nonfreezing Cold Injuries
Frostbite
Principles
Background
Physiology
Pathophysiology
Predisposing Factors
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Prehospital
Emergency Department
Prethaw.
Thaw.
Postthaw.
Disposition
Nonfreezing Cold Injuries
Principles
Clinical Features
Immersion Injury
Pernio
Differential Diagnosis
Diagnostic Testing
Management
Immersion Injury
Pernio
Disposition
References
Chapter 131: Questions & Answers
Chapter 132: Accidental Hypothermia
Principles
Background
Physiology of Temperature Regulation
Pathophysiology
Cardiovascular System
Central Nervous System
Renal System
Respiratory System
Predisposing Factors
Decreased Heat Production.
Increased Heat Loss.
Impaired Thermoregulation.
Traumatic Factors
Clinical Features
Diagnostic Considerations
Differential Diagnosis
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
References
Chapter 132: Questions & Answers
Chapter 133: Heat Illness
Principles
Background
Anatomy and Physiology
Heat Production
Conduction.
Convection.
Radiation.
Evaporation.
Heat Regulation
Thermosensors.
Central Integrative Area.
Thermoregulatory Effectors.
Acclimatization
Pathophysiology
Predisposing Factors
Fever Versus Hyperthermia
Minor Heat Illness
Prickly Heat
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management and Disposition
Heat Cramps
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management and Disposition
Heat Edema
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management and Disposition
Heat Syncope
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management and Disposition
Major Heat Illness
Heat Exhaustion
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Heatstroke
Principles
Clinical Features
Heatstroke Versus Heat Exhaustion.
Classic Heatstroke Versus Exertional Heatstroke.
Differential Diagnosis
Meningitis and Encephalitis.
Thyroid Storm.
Drug-Induced Heat Illness.
Neuroleptic Malignant Syndrome.
Serotonin Syndrome.
Diagnostic Testing
Management
Cooling.
Resuscitation.
Disposition
References
Chapter 133: Questions & Answers
Chapter 134: Lightning and Electrical Injuries
Principles
Background
Electrical Injury
Lightning
Physics of Electricity
Electrical Injury
Type of Circuit.
Current.
Resistance.
Voltage.
Duration of Contact.
Pathway.
Conducted Electrical Weapons.
Lightning Injury
Clinical Features
Electrical Injury
General Tissue Effects
Skin
Cardiovascular System
Head and Neck
Extremities
Nervous System
Other Viscera
Clinical Features After Discharge of a Conducted Electrical Weapon
Lightning Injury
Cardiovascular System
Nervous System
Skin
Ears
Eyes
Other Injuries
Differential Diagnoses
Electrical Injury
Lightning Injury
Diagnostic Testing
Electrical Injury
Lightning Injury
Management
Electrical Injury
Lightning Injury
Disposition
Electric Injury
Lightning Injury
References
Chapter 134: Questions & Answers
Chapter 135: Scuba Diving and Dysbarism
Principles
Background
Pathophysiology
Clinical Features
Disorders Related to Descent
Middle Ear Barotrauma
External Ear Barotrauma
Inner Ear Barotrauma
Barosinusitis
Facial Barotrauma
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 135: Questions & Answers
Chapter 136: High-Altitude Medicine
Principles
Background
Epidemiology
Definitions
Environmental Considerations
Acclimatization
Pathophysiology
Acute Mountain Sickness
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Oxygen Therapy
Analgesics and Antiemetics
Acetazolamide
Dexamethasone
Disposition
Prevention
High-Altitude Pulmonary Edema
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Ultrasonography
Chest Radiographs
Electrocardiogram and Echocardiogram
Management
Oxygen Therapy
Nifedipine
Other Medications
Disposition
Prevention
High-Altitude Cerebral Edema
Principles
Clinical Features
Differential Diagnosis
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
Acknowledgment
References
Chapter 136: Questions & Answers
Chapter 137: Drowning
Principles
Definitions
Epidemiology
Risk Factors
Pathophysiology
Clinical Features
History and Physical Examination
Prognostic Factors
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Preventive Efforts
References
Chapter 137: Questions & Answers
Chapter 138: Radiation Injuries
Principles
Radiation
Overview
Radiation Measurements
Radiation Protection
Radiation Sources
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
Chapter 138: Questions & Answers
Section Two: Toxicology
Chapter 139: Approach to 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 139: Questions & Answers
Chapter 140: Substance Abuse
Principles of Toxicity
Epidemiology
Pharmacology
Clinical Features
History
Physical Examination
Complications
Differential Diagnoses
Diagnostic Testing
Management
Agitation
Drug Seeker
Disposition
References
Chapter 140: Questions & Answers
Chapter 141: Toxic Alcohols
Methanol
Principles of Toxicology
Clinical Features
Diagnostic Considerations
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Ethylene Glycol
Principles of Toxicology
Clinical Features
Diagnostic Considerations
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Isopropyl Alcohol
Principles of Toxicology
Clinical Features
Diagnostic Considerations
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Other Alcohols of Clinical Significance
References
Chapter 141: Questions & Answers
Chapter 142: Alcohol-Related Disease
Principles of Toxicity
Metabolism of Alcohol
Clinical Features
Alcohol Withdrawal Syndrome
Alcohol-Related Seizures
Alcohol Withdrawal Seizures
Cardiovascular Effects
Pulmonary Effects
Gastrointestinal and Hepatic Effects
Esophagus and Stomach
Gastrointestinal Bleeding
Liver Damage
Alcoholic Hepatitis
Alcoholic Cirrhosis
Pancreatitis and Malabsorption
Neurologic Effects
Neuropathy
Wernicke-Korsakoff Syndrome
Movement Disorders
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
Alcohol Withdrawal Syndrome
Clinical Features
Differential Diagnoses
Diagnostic Testing
Laboratory Tests
Alcohol Screening Questionnaires
Management Considerations
Alcohol Withdrawal Syndrome
Pharmacologic Treatment
Benzodiazepines.
Butyrophenones.
Other Agents.
Neurologic Examination
Normal Examination
New-Onset Seizures.
Prior History of Seizures During Withdrawal.
Abnormal Neurologic Examination
New-Onset Partial Seizures.
Patients Taking Phenytoin Anticonvulsant
Disposition
Acute Intoxication
Alcohol Withdrawal
Seizures
Psychiatric and Social Problems
References
Chapter 142: Questions & Answers
Chapter 143: Acetaminophen
Principles of Toxicity
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
References
Chapter 143: Questions & Answers
Chapter 144: 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 144: Questions & Answers
Chapter 145: 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
Intensive Care Unit Admission
Consultations
References
Chapter 145: Questions & Answers
Chapter 146: 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
Miscellaneous Antidepressants
Bupropion
Trazodone
Nefazodone
Serotonin Syndrome
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Discontinuation Syndromes
References
Chapter 146: Questions & Answers
Chapter 147: Cardiovascular Drugs
Cardioactive Steroids (Digoxin)
Principles of Toxicity
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Fab Fragments (DigiFab)
Electrolyte Correction
Atropine
Pacing and Cardioversion
Phenytoin and Lidocaine
Pediatric Considerations
Disposition
Beta-Adrenergic Blockers
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
Principles of Toxicity
Pathophysiology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Hypotension and Bradycardia
Pediatric Considerations
Disposition
Clonidine
Principles of Toxicity
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Nitrates and Nitrites
Principles of Toxicity
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
References
Chapter 147: Questions & Answers
Chapter 148: Caustics
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Special Cases
Povidone-Iodine
Phenol and Formaldehyde
Hydrogen Peroxide
Button Batteries
References
Chapter 148: Questions & Answers
Chapter 149: Cocaine and Other Sympathomimetics
Principles of Toxicity
Cocaine Formulations
Pathophysiology of Cocaine
Clinical Features
Hyperthermia
Hypertensive Emergencies
Cardiac Dysrhythmias
Other Complications
Differential Diagnoses
Diagnostic Testing
Management
Pharmacologic Sedation for Agitation
Hyperthermia
Acute Hypertensive Emergencies
Dysrhythmias
Cocaine-Related Chest Pain
Cocaine Body Packers
Body Stuffers
Levamisole-Related Complications
Disposition
Other Stimulants
Amphetamines
Methylenedioxymethamphetamine
Methamphetamine
Ephedrine and Ephedra
Khat and Methcathinone
Bath Salts
References
Chapter 149: Questions & Answers
Chapter 150: 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
Marijuana 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 150: Questions & Answers
Chapter 151: Iron and Heavy Metals
Iron
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Decontamination
Enhanced Elimination
Antidotal Therapy
Disposition
Lead
Principles of Toxicity
Clincal Features
Differential Diagnoses
Diagnostic Testing
Management
Decontamination
Antidotal Therapy
Children
Adults
Disposition
Arsenic
Principles of Toxicity
Clinical Features
Acute Arsenic Toxicity
Chronic Arsenic Toxicity
Arsine Gas
Differential Diagnoses
Diagnostic Testing
Management
Decontamination and Enhanced Elimination
Antidotal Therapy
Acute Arsenic Poisoning
Chronic Arsenic Poisoning
Disposition
Mercury
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Chapter 151: Questions & Answers
Chapter 152: Hydrocarbons
Principles of Toxicology
Pathophysiology
Pulmonary Pathophysiology
Central Nervous System Pathophysiology
Cardiac Pathophysiology
Other Organ Systems
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Chapter 152: Questions & Answers
Chapter 153: Inhaled Toxins
Simple Asphyxiants
Principles of Toxicity
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Pulmonary Irritants
Principles of Toxicity
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Smoke Inhalation
Principles of Toxicity
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Cyanide and Hydrogen Sulfide
Principles of Toxicity
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Hydrogen Cyanide
Hydrogen Sulfide
Disposition
Carbon Monoxide
Principles of Toxicity
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Simultaneous Carbon Monoxide and Cyanide Poisoning (Fire Victims)
Disposition
References
Chapter 153: Questions & Answers
Chapter 154: Lithium
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Chapter 154: Questions & Answers
Chapter 155: Antipsychotics
Principles of Toxicity
Pathophysiology
Clinical Features
Acute Overdose
Acute Extrapyramidal Syndromes
Tardive Dyskinesia
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 155: Questions & Answers
Chapter 156: Opioids
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Stabilization and Supportive Care
Decontamination
Enhanced Elimination
Antidote Therapy
Disposition
Withdrawal
References
Chapter 156: Questions & Answers
Chapter 157: Pesticides
Organophosphate Insecticides
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Decontamination
Stabilization and Supportive Care
Enhanced Elimination
Antidote Therapy
Disposition
Carbamate Insecticides
Chlorinated Hydrocarbons Insecticides
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Decontamination
Stabilization and Supportive Care
Enhanced Elimination
Antidote Therapy
Disposition
Substituted Phenols
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Decontamination
Stabilization and Supportive Care
Enhanced Elimination
Antidote Therapy
Disposition
Chlorophenoxy Herbicides
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Decontamination
Stabilization and Supportive Care
Enhanced Elimination
Antidote Therapy
Disposition
Bipyridyl Herbicides
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Decontamination
Stabilization and Supportive Care
Enhanced Elimination
Antidote Therapy
Disposition
Pyrethrin and Pyrethroid Insecticides
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Decontamination
Stabilization and Supportive Care
Enhanced Elimination
Antidote Therapy
Disposition
Glyphosate
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Decontamination
Stabilization and Supportive Care
Enhanced Elimination
Antidote Therapy
Disposition
DEET
Principles of Toxicology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Decontamination
Stabilization and Supportive Care
Enhanced Elimination
Antidote Therapy
Disposition
Rodenticides
Principles of Toxicology
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Decontamination
Stabilization and Supportive Care
Enhanced Elimination
Antidote Therapy
Disposition
References
Chapter 157: Questions & Answers
Chapter 158: Plants, Mushrooms, and Herbal Medications
Plants
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Plant Categories
Anticholinergics
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Antimitotic Toxins
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Cardiac Glycosides
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
Principles of Toxicity
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 158: Questions & Answers
Chapter 159: Sedative Hypnotics
Barbiturates
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Gastrointestinal Decontamination
Enhanced Elimination
Disposition
Benzodiazepines
Principles of Toxicity
Pharmacokinetics
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
General
Antidote
Disposition
Benzodiazepine Withdrawal Syndrome
Special Considerations
Flunitrazepam
Buspirone
Zolpidem, Zaleplon, and Zopiclone
Eszopiclone
Chloral Hydrate
Principles of Toxicity
Clinical Features
Differential Diagnoses
Management
Disposition
Over-the-Counter Sleep Aids
Principles of Toxicity
Gamma-Hydroxybutyrate
Principles of Toxicity
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Withdrawal
Disposition
References
Chapter 159: Questions & Answers
Part V: Special Populations
Section One: The Pediatric Patient
Chapter 160: General Approach to the Pediatric Patient
Principles
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
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 160: Questions & Answers
Chapter 161: Airway Management for the Pediatric Patient
Principles
Anatomy
Physiology
Equipment
Management
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 161: Questions & Answers
Chapter 162: Procedural Sedation and Analgesia for the Pediatric Patient
Sedation
Principles
Definitions
Management
Preprocedural Fasting
Supplemental Oxygen and Capnography During PSA
Monitoring
Specific Medications
Propofol
Ketamine
Use of Ketamine in Head Injury Patients.
Recovery Agitation: Use of Benzodiazepines.
Use of Anticholinergics.
Use of Antiemetics.
Ketofol: Ketamine Plus Propofol
Outcomes
Pain Management
Principles
Management
Pain Assessment
Nonpharmacologic 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 162: Questions & Answers
Chapter 163: Pediatric Resuscitation
Cardiac Arrest
Principles
Pathophysiology
Clinical Features
Location to Perform Pulse Check
Recognizing Imminent Arrest
Management
Compressions-Airway-Breathing
Compressions.
Ventilation.
Compression-Only Cardiopulmonary Resuscitation
Defibrillation.
Medications for Cardiac Arrest.
Vascular Access.
Post-Arrest Care.
Disposition
Family Presence.
Termination of Resuscitation.
Septic Shock in the Pediatric Patient
Principles
Pathophysiology
Clinical Features
Management
Timely and Appropriate Antibiotics
Fluid Resuscitation
Vasoactive Agents
Hemodynamic Monitoring to Direct Therapy
Corticosteroids
Glucose
Impact of Bundled Sepsis Care
Acute Life-Threatening Events
Principles
Clinical Features
Diagnostic Testing
Disposition
References
Chapter 163: Questions & Answers
Chapter 164: Neonatal Resuscitation
Principles
Pathophysiology
Transition From Fetal to Extrauterine Life
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
Preparation
Management
Newborn Resuscitation Algorithm
Dry, Warm, Position, Suction, Stimulate, and Assess Need for Further Intervention
Ventilation, Oxygen, Intubation
Chest Compressions
Medications
Vascular Access
Types
Epinephrine.
Volume Expanders.
Antibiotics.
Glucose.
Dopamine.
Therapeutic Hypothermia
Disposition
Outcomes
Safety
Effectiveness
Complications
Further Considerations
References
Chapter 164: Questions & Answers
Chapter 165: Pediatric Trauma
Principles
Anatomy and Physiology
Clinical Features
Initial Assessment Priorities and Primary Survey
A—Airway and Cervical Spine Stabilization
B—Breathing and Ventilation
C—Circulation and Hemorrhage Control
D—Disability Assessment
E—Events, Exposure, and Thorough Examination
F—FAST and Family
Secondary Survey
Management and Diagnostic Testing
General Management Principles
Physical Examination
Pain Control
Diagnostic Testing
Laboratory Studies
Radiology
Specific Disorders and Injuries
Head Injury
Principles
Clinical Features
Differential Diagnoses
Concussion.
Scalp Injuries.
Skull Fractures.
Cerebral Contusions.
Epidural Hematoma.
Subdural Hematoma.
Diagnostic Testing and Management
Radiology
Skull Radiographs.
Computed Tomography of the Head.
Spinal Injury
Principles
Clinical Features
Diagnostic Testing
Management
Cardiothoracic Injury
Principles
Specific Disorders
Pneumothorax.
Open Pneumothorax.
Tension Pneumothorax.
Hemothorax.
Pulmonary Contusion.
Traumatic Diaphragmatic Hernia.
Cardiac and Vascular Injuries.
Commotio Cordis.
Abdominal Injury
Principles
Clinical Features
Diagnostic Testing and Management
Spleen Injury.
Liver Injury.
Renal Injury.
Penetrating Injury.
Radiology.
Disposition
References
Chapter 165: Questions & Answers
Chapter 166: Pediatric Fever
Principles
Background
Anatomy and Physiology
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
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
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 Acquired Immunodeficiency Syndrome
Sickle Cell Disease
Congenital Heart Disease
Ventriculoperitoneal Shunts
References
Chapter 166: Questions & Answers
Chapter 167: Pediatric Respiratory Emergencies: Upper Airway Obstruction and Infections
Principles
Clinical Features
Diagnostic Considerations
Diagnostic Testing and Management
Differential Diagnoses
Supraglottic Airway Diseases
Congenital Lesions
Choanal Atresia.
Macroglossia.
Micrognathia.
Retropharyngeal Abscess
Clinical Features.
Diagnostic Testing.
Management.
Peritonsillar Abscess
Mononucleosis
Ludwig’s Angina
Epiglottitis
Principles.
Clinical Features.
Diagnostic Strategies.
Management.
Trauma and Burns
Allergic Reactions
Diseases of the Larynx
Congenital Lesions.
Acquired Lesions
Laryngeal Papillomas.
Subglottic Tracheal Diseases.
Viral Croup
Principles of Disease.
Clinical Features.
Management.
Spasmodic or Atypical Croup
Diseases of the Trachea
Congenital Lesions.
Bacterial Tracheitis
Principles.
Clinical Features.
Diagnostic Strategies.
Management.
Foreign Bodies
Airway Foreign Body
Perspective.
Clinical Features.
Diagnostic Testing.
Management.
Can’t Intubate, Can’t Ventilate Scenario.
References
Chapter 167: Questions & Answers
Chapter 168: Pediatric Respiratory Emergencies: Lower Airway Obstruction
Asthma
Principles
Anatomy and Physiology
Clinical Features
History
Physical Examination
Diagnostic Considerations
Differential Diagnoses
Diagnostic Testing
Management
Mild Exacerbation
Moderate Exacerbation
Intermittent Versus Continuous Therapy.
Severe Exacerbation
Bronchiolitis
Principles
Clinical Features
Diagnostic Considerations
Differential Diagnoses
Diagnostic Testing
Management
Prophylaxis
Disposition
References
Chapter 168: Questions & Answers
Chapter 169: Pediatric Respiratory Emergencies: Diseases of the Lungs
Pneumonia
Principles
Pathophysiology
Clinical Features
Diagnostic Considerations
Differential Diagnoses
Diagnostic Testing
Radiology.
Laboratory Studies
Types of Pneumonia
Bacterial Pneumonia
Viral Pneumonia
Mycoplasma Pneumonia
Chlamydial Pneumonia
Aspiration Pneumonia
Pneumonia in an Immunocompromised Host
Complications
Management and Disposition
Infants Younger Than 2 Months
Infants 2 to 3 Months of Age
Infants and Children Older Than 3 Months
Other Respiratory Emergencies
Pertussis
Cystic Fibrosis
Bronchopulmonary Dysplasia
References
Chapter 169: Questions & Answers
Chapter 170: Cardiac Disorders
Principles
Fetal and Neonatal Circulation
Pathophysiology of Cardiovascular Compensatory Responses
Pathophysiology of Cyanosis
Clinical Features of Cyanosis
Clinical Features and Diagnostic Testing: the Cardiac Evaluation
History
Chest Pain
Physical Examination
General Appearance and Pulses
Vital Signs and Blood Pressures
Cardiac Auscultation
Hyperoxia Test
Arterial Blood Gas Analysis
Hemoglobin and Hematocrit Levels and Serum Electrolyte Values
Chest Radiography
Electrocardiography
Biochemical Markers
Specific Disorders
Congenital Heart Disease
Clinical Features
Diagnostic Testing
Management
Acyanotic Congenital Heart Defect
Ventricular Septal Defect.
Clinical Features.
Diagnostic Testing.
Management.
Atrial Septal Defect.
Clinical Features.
Diagnostic Testing.
Management.
Eisenmenger’s Syndrome.
Coarctation of the Aorta.
Clinical Features.
Diagnostic Testing.
Management.
Cyanotic Congenital Heart Diseases
Tetralogy of Fallot.
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
Perspective
Clinical Features
Diagnostic Testing
Management
Pediatric Dysrhythmias
Clinical Features
Management
Bradydysrhythmias
Sinus Bradycardia.
Tachydysrhythmias
Supraventricular Tachycardia.
Clinical Features and Diagnostic Testing.
Management.
Atrial Flutter and Atrial Fibrillation.
Ventricular Tachycardia.
Pulseless Rhythms
Ventricular Fibrillation and Pulseless Ventricular Tachycardia.
Asystole and Pulseless Electrical Activity.
Special Resuscitation Situations in Children
Bacterial Endocarditis
Perspective
Clinical Features and Diagnostic Strategies
Management
Myocarditis
Clinical Features
Diagnostic Testing and Management
Pericarditis
Clinical Features
Management
Kawasaki Disease
Clinical Features
Incomplete Kawasaki Disease
Differential Diagnoses
Clinical Course
Management
Acute Rheumatic Fever
Clinical Features and Diagnostic Testing
Differential Diagnoses
Management
Cardiac Causes of Sudden Death in Young Athletes
Specific Disorders
Congenital Coronary Artery Anomalies.
Marfan Syndrome.
Hypertrophic Cardiomyopathy.
Clinical Features.
Diagnostic Testing.
Management.
Prolonged QT Syndrome.
Clinical Features.
Management.
Commotio Cordis.
References
Chapter 170: Questions & Answers
Chapter 171: Gastrointestinal Disorders
Principles
Specific Disorders
Neonatal Jaundice
Principles of Disease
Clinical Features
Diagnostic Considerations
Differential Diagnoses.
Diagnostic Testing.
Management
Disposition
Hypertrophic Pyloric Stenosis
Principles of Disease
Clinical Features
Diagnostic Considerations
Diagnostic Testing.
Differential Considerations.
Management
Disposition
Malrotation With Midgut Volvulus
Principles of Disease
Clinical Features
Diagnostic Considerations
Diagnostic Testing.
Differential Diagnoses.
Management
Disposition
Necrotizing Enterocolitis
Principles of Disease
Clinical Features
Diagnostic Considerations
Differential Diagnoses.
Diagnostic Testing.
Management
Disposition
Gastroesophageal Reflux
Principles of Disease
Clinical Features
Diagnostic Considerations
Differential Diagnoses.
Diagnostic Testing.
Management
Disposition
Intussusception
Principles of Disease
Clinical Features
Diagnostic Considerations
Differential Diagnoses.
Diagnostic Testing.
Management
Disposition
Hirschsprung’s Disease
Principles of Disease
Clinical Features
Diagnostic Considerations
Differential Diagnoses.
Diagnostic Testing.
Management
Disposition
Meckel’s Diverticulum
Principles of Disease
Clinical Features
Diagnostic Considerations
Differential Diagnoses.
Diagnostic Testing.
Management
Disposition
Henoch-Schönlein Purpura
Principles of Disease
Clinical Features
Diagnostic Considerations
Differential Diagnoses.
Diagnostic Testing.
Management
Disposition
Inflammatory Bowel Disease
Principles of Disease
Clinical Features
Diagnostic Considerations
Diagnostic Testing.
Differential Diagnoses.
Management
Disposition
Gastrointestinal Foreign Bodies
Principles of Disease
Clinical Features
Diagnostic Considerations
Diagnostic Testing.
Differential Diagnoses.
Management
Disposition
Appendicitis
Principles of Disease
Clinical Features
Diagnostic Considerations
Diagnostic Testing.
Differential Diagnoses.
Management
Disposition
Pancreatitis
Principles of Disease
Clinical Features
Diagnostic Considerations
Diagnostic Testing.
Differential Diagnoses.
Management
Disposition
Biliary Tract Disease
Principles of Disease
Clinical Features
Diagnostic Considerations
Diagnostic Testing.
Differential Diagnoses.
Management
Disposition
References
Chapter 171: Questions & Answers
Chapter 172: Infectious Diarrheal Disease and Dehydration
Perspective
Principles of Disease
Pathophysiology
Clinical Features
Specific Etiologies
Viruses
Human Caliciviruses (Norovirus and Sapovirus).
Bacteria
Protozoa
Complications
Diagnostic Strategies
Consideration of Differential Diagnoses
Management
Disposition
Dehydration
Perspective
Principles of Disease
Anatomy and Physiology
Pathophysiology
Clinical Features
Diagnostic Strategies
Consideration of Differential Diagnoses
Management
Oral Rehydration Therapy
Intravenous Therapy
Emergency Resuscitation Phase.
Repletion Phase.
Hospital-Acquired Hyponatremia.
Disposition
References
Chapter 172: Questions & Answers
Chapter 173: Genitourinary and Renal Tract Disorders
Priapism
Principles
Clinical Features
Diagnostic Considerations
Diagnostic Testing
Differential Diagnoses
Management
Phimosis
Principles
Clinical Features
Management
Disposition
Paraphimosis
Principles
Clinical Features
Management
Disposition
Balanoposthitis
Principles
Clinical Features
Management
Disposition
Complications of Circumcision
Principles
Management
Penile Entrapment and Tourniquet Injuries
Epididymitis
Principles
Clinical Features
Diagnostic Considerations
Diagnostic Testing
Management
Disposition
Orchitis
Principles
Clinical Features
Diagnostic Considerations
Diagnostic Testing
Management and Disposition
Testicular Torsion
Principles
Clinical Features
Diagnostic Considerations
Diagnostic Testing
Management
Varicocele
Idiopathic Scrotal Edema
Hydrocele
Inguinal Hernia
Principles
Testicular Carcinoma
Principles
Clinical Features
Urinary Tract Infections
Principles
Clinical Features
Diagnostic Considerations
Diagnostic Testing
Differential Diagnoses
Management
Younger Than 2 Months
2 Months to 2 Years
Older Than 2 Years
Disposition
Hematuria
Principles
Clinical Features
Diagnostic Considerations
Differential Diagnoses
Diagnostic Testing
Management
Renal Stones
Principles
Clinical Features
Diagnostic Considerations
Diagnostic Strategies
Differential Diagnoses
Management
Renal Tumors
Principles
Clinical Features
Diagnostic Considerations
Diagnostic Testing
Differential Diagnoses
Disposition
Proteinuria
Principles
Clinical Features
Diagnostic Considerations
Differential Diagnoses
Diagnostic Testing
Disposition
Poststreptococcal Glomerulonephritis
Principles
Clinical Features
Diagnostic Considerations
Diagnostic Testing
Differential Diagnoses
Management
Disposition
Nephrotic Syndrome
Principles
Clinical Features
Diagnostic Considerations
Diagnostic Testing
Differential Diagnoses
Management
Disposition
Acute Kidney Injury
Principles
Clinical Features
Diagnostic Considerations
Diagnostic Testing
Differential Diagnoses
Management
Disposition
Hypertension
Principles
Clinical Features
Diagnostic Considerations
Diagnostic Testing
Differential Diagnoses
Management
Disposition
Henoch-Schönlein Purpura
Principles
Clinical Features
Diagnostic Considerations
Diagnostic Testing
Differential Diagnoses
Management
Disposition
Hemolytic-Uremic Syndrome
Principles
Clinical Features
Diagnostic Considerations
Diagnostic Testing
Differential Diagnoses
Management
Disposition
References
Chapter 173: Questions & Answers
Chapter 174: Neurologic Disorders
Altered Mental Status
Principles
Clinical Features
Diagnostic Considerations
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Seizures
Principles
Clinical Features
Categories of Seizures
Acute Symptomatic Seizures
Remote Symptomatic Seizures
Diagnostic Considerations
Differential Diagnoses
Management
Status Epilepticus
Febrile Seizures
Afebrile Seizures
Neonatal Seizures
Disposition
Anticonvulsant Therapy at Discharge
Headaches
Principles
Clinical Features
Diagnostic Considerations
Differential Diagnoses
Acute Headache.
Chronic Progressive Headache.
Migraine Headache.
Chronic Nonprogressive Headache.
Cluster Headache.
Diagnostic Testing
Management
Disposition
Disorders of Balance
Pediatric Ataxia
Principles
Clinical Features
Diagnostic Considerations
Differential Diagnoses
Diagnostic Testing
Management
Disposition
Pediatric Vertigo
Principles
Clinical Features
Diagnostic Considerations
Diagnostic Testing
Differential Diagnoses
Management
Disposition
Motor Dysfunction
Stroke
Principles
Clinical Features
Diagnostic Considerations: Diagnostic Testing
Management
Disorders of the Spinal Cord
Principles
Clinical Features
Diagnostic Considerations: Diagnostic Testing
Management and Disposition
Guillain-Barré Syndrome
Principles
Clinical Features
Diagnostic Considerations: Diagnostic Testing
Management and Disposition
Infant Botulism
Principles
Clinical Features
Diagnostic Considerations: Diagnostic Testing
Management and Disposition
Myasthenia Gravis
Principles
Clinical Features
Diagnostic Considerations: Diagnostic Testing
Management and Disposition
References
Chapter 174: Questions & Answers
Chapter 175: Musculoskeletal Disorders
Principles
Anatomy and Physiology
Fracture Patterns
Specific Disorders
Clavicle Fracture
Supracondylar Fractures of the Humerus
Monteggia’s Fracture-Dislocation
Nursemaid’s Elbow
Toddler’s Fracture
Developmental Dysplasia of the Hip
Principles
Clinical Features
Diagnostic Testing
Management
Pediatric Hip Pain
Principles
Specific Disorders and Injuries
Transient Synovitis.
Acute Septic Arthritis.
Legg-Calvé-Perthes Disease.
Slipped Capital Femoral Epiphysis.
Apophyseal Injuries
Principles
Specific Disorders
Osgood-Schlatter Syndrome.
Sever’s Disease.
Little League Elbow.
Apophysitis of the Hip.
Avulsion Fractures.
References
Chapter 175: Questions & Answers
Chapter 176: Drug Therapy for the Pediatric Patient
Principles
Background
Historical Perspective
Recent Legislative Efforts
Current Landscape
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
Phenothiazines
Opioid Analgesics
Medication Safety and Adverse Drug Events
References
Chapter 176: Questions & Answers
Chapter 177: Child Abuse
Physical Abuse
Principles
Role of the Emergency Clinician
Clinical Features
Social and Demographic Risk Factors
History
Physical Examination Findings
Red-Flag Injuries
Differential Diagnoses
Diagnostic Testing
Skeletal Survey
Neuroimaging (Computed Tomography or Magnetic Resonance Imaging)
Retinal Examination
Abdominal Injury Testing
Household Contacts
Timing
Management
Mandated Reporting
Disposition
Sexual Abuse
Principles
Clinical Features
Differential Diagnoses
Diagnostic Testing
Management
Disposition
References
Chapter 177: Questions & Answers
Section Two: The Pregnant Patient
Chapter 178: Acute Complications of Pregnancy
Problems in Early Pregnancy
Miscarriage
Pathophysiology
Terminology
Clinical Features
Diagnostic Testing
Differential Diagnosis
Management
Ectopic Pregnancy
Principles
Pathophysiology
Clinical Features
Diagnostic Testing
Ultrasonography.
Hormonal Assays.
Other Studies.
Differential Diagnosis
Management
Molar Pregnancy
Complications of Late Pregnancy
Vaginal Bleeding in Later Pregnancy
Abruptio Placentae
Clinical Features.
Differential Diagnosis.
Placenta Previa
Clinical Features.
Diagnostic Testing.
Management.
Pregnancy-Induced Hypertension (Preeclampsia and Eclampsia)
Pathophysiology
Clinical Features
Signs and Symptoms.
Complications
Diagnostic Testing
Differential Diagnosis
Management
Amniotic Fluid Embolus
Clinical Features
Diagnostic Testing
Differential Diagnosis
Management
Rh (Anti-D) Immunization in Pregnancy
Medical and Surgical Problems in the Pregnant Patient
Abdominal Pain
Appendicitis
Clinical Features.
Differential Diagnosis.
Diagnostic Testing.
Management.
Gallbladder Disease
Clinical Features
Diagnostic Testing
Differential Diagnosis
Management
Liver Disorders
Hepatitis
Acute Fatty Liver
Clinical Features.
Diagnostic Testing.
Differential Diagnosis.
Management.
Intrahepatic Cholestasis
Clinical Features.
Differential Diagnosis and Management.
Nausea and Vomiting
Normal Pregnancy
Hyperemesis Gravidarum
Diagnostic Testing.
Management.
Thromboembolic Disease
Clinical Features
Diagnostic Testing
Deep Venous Thrombosis.
Pulmonary Embolism.
Management
Genitourinary Infections
Urinary Tract Infection
Clinical Features and Diagnostic Testing.
Differential Diagnosis.
Management.
Vaginitis
Bacterial Vaginosis.
Candida albicans Vaginitis.
Trichomonas Vaginitis.
Sexually Transmitted Disease
Chlamydia trachomatis.
Herpes Simplex.
Neisseria gonorrhoeae.
Upper Genital Tract Infection
Pelvic Inflammatory Disease.
Chorioamnionitis.
Thyroid Disorders
Clinical Features
Diagnostic Testing
Differential Diagnosis
Management
Disorders of the Hypothalamic-Pituitary Axis
Clinical Features
Diagnostic Testing
Differential Diagnosis and Management
Acknowledgment
References
Chapter 178: Questions & Answers
Chapter 179: Comorbid Medical Emergencies During Pregnancy
Principles
Asthma
Cardiovascular Disorders
Principles
Chronic Hypertension and Hypertensive Emergencies
Cardiac Disorders
Acute Coronary Syndromes
Valvular Heart Disease and Pulmonary Hypertension
Principles.
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
Maternal Complications
Fetal Complications
Management
Obesity
Thyroid Disorders
Hyperthyroidism
Hypothyroidism
Systemic Infections
Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome
Tuberculosis
Syphilis
Viral Hepatitis
Hepatitis B
Hepatitis C
Inflammatory Disorders
Systemic Lupus Erythematosus
Rheumatoid Arthritis
Treatment
Psychiatric Disorders
Eating Disorders
Substance Abuse
Alcohol
Smoking
Cannabis
Cocaine and Methamphetamines
Opioids
References
Chapter 179: Questions & Answers
Chapter 180: Drug Therapy in Pregnancy
Principles
Background
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
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
Classic Anticonvulsants.
Newer Anticonvulsants.
Antipsychotics
Migraine Medications
Ergot Alkaloids
Triptans
Respiratory Agents
Antihistamines
Asthma Medications
Corticosteroids
Decongestants
References
Chapter 180: Questions and Answers
Chapter 181: Labor and Delivery and Their Complications
Principles
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
Background
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.
Uterine Packing.
Pelvic Vessel Embolization.
Uterotonic Agents.
Hysterectomy.
Uterine Inversion
Perspective
Clinical Features
Management
Uterine Rupture
Clinical Features
Diagnostic Testing
Management
Amniotic Fluid Embolism
Postpartum Endometritis
Postpartum Problems
Peripartum Cardiomyopathy
Postpartum Depression
Clinical Features
Management
References
Chapter 181: Questions & Answers
Chapter 182: Trauma in Pregnancy
Principles
Background
Anatomy and Physiology
Anatomic Changes in Pregnancy
Physiologic Changes
Cardiovascular
Pulmonary
Gastrointestinal
Specific Disorders
Blunt and Penetrating 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
Plain Radiographs
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
Perimortem Cesarean Section
Disposition
References
Chapter 182: Questions & Answers
Section Three: The Geriatric Patient
Chapter 183: Approach to the Geriatric Patient
Principles
Epidemiology and Demographics
Assessing the Older Patient
Adapting Fundamental Principles of Geriatrics to the Emergency Department
Transitions in Care
Goals of Care and Palliative Care
Specific Disorders and Chief Complaints
Acute Coronary Syndrome
Abdominal Pain
Generalized Weakness
Infections
References
Chapter 183: Questions & Answers
Chapter 184: Geriatric Trauma
Principles
Background and Importance
Demographics and Epidemiology
Age as a Trauma Triage Criterion
Mechanisms of Injury
Anatomy and Physiology
Pathophysiology
Comorbidities
Effect of Medications
Clinical Features
Modifications to the Trauma Assessment of Older Adults
Primary Assessment and Resuscitation
Airway
Breathing
Circulation
Disability
Exposure
Secondary Assessment
Laboratory Testing
Imaging
Specific Disorders
Traumatic Brain Injury
Differential Diagnosis
Management
Disposition
Vertebral Fractures and Spinal Cord Injuries
Differential Diagnosis
Central Cord Syndrome.
Cervical Extension-Distraction Injury.
Odontoid Fractures.
Thoracic Trauma
Differential Diagnosis
Diagnostic Testing
Management
Disposition
Abdominal Trauma
Differential Diagnosis
Diagnostic Testing
Management
Extremity Injuries
Differential Diagnosis
Diagnostic Testing
Management
Disposition: End-of-Life Considerations
References
Chapter 184: Questions & Answers
Chapter 185: Drug Therapy in the Geriatric Patient
Principles
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 185: Questions & Answers
Chapter 186: Abuse and Neglect of the Geriatric Patient
Principles
Background
Epidemiology and Scope of the Problem
Identifying Elder Abuse and Neglect in the Emergency Department
Clinical Features
Screening
Medical History
Physical Examination
Differential Diagnoses
Diagnostic Testing
Management
Documentation
Reporting Requirements
Specific Disorders
Elder Mistreatment in Institutions
Self-Neglect
Disposition
References
Chapter 186: Questions & Answers
Section Four: Special Clinical Circumstances
Chapter 187: The Immunocompromised Patient
Principles
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
Evaluation and Management
Antibiotic Therapy.
Cell Stimulation 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
Pulmonary Infections in the Immunocompromised Patient
Diabetes
Alcoholism and Cirrhosis
Renal Failure
Splenectomy, Hyposplenia, and Functional Asplenia
Immunosuppressive Therapy
Corticosteroids
Other Immunosuppressive Medications
References
Chapter 187: Questions & Answers
Chapter 188: The Solid Organ Transplant Patient
Principles
Pathophysiology
Anatomy
Rejection
Infection
First Month After Transplantation.
1 to 6 Months After Transplantation.
6 Months After Transplantation
Healthy Transplant.
Chronic Viral Infection.
Chronic Rejection.
Drug Toxicity
Induction Agents.
Calcineurin Inhibitors.
Cyclosporine.
Tacrolimus.
Mammalian Target of Rapamycin Inhibitors.
Antimetabolites
Azathioprine.
Mycophenolate Mofetil.
Corticosteroids.
Specific Disorders
Heart Transplant
Anatomic Considerations
Rejection
Drug Toxicity
Infection
Liver Transplant
Anatomic Considerations
Rejection
Drug Toxicity
Infection
Kidney Transplant
Anatomic Considerations
Infection
Rejection
Lung Transplant
Anatomic Considerations
Rejection
Infection
Pancreas Transplant
Anatomic Considerations
Rejection
Infection
Other Considerations
Trauma
Psychological Aspects
Disposition
References
Chapter 188: Questions & Answers
Chapter 189: The Combative and Difficult Patient
The Combative Patient
Principles
Presentation
Patient Characteristics
Emergency Department Influences
Initial Patient Evaluation
Therapeutics
Verbal Management Techniques
Physical Restraints
Chemical Restraints
Benzodiazepines.
Antipsychotics.
Ketamine.
Post-Restraint Medical Evaluation
Disposition and Medical Clearance
Assault and Hostage Situations
The Difficult Patient
Principles
Specific Disorders
The Dependent Clinger
The Entitled Demander
The Manipulative Help Rejecter
The Self-Destructive Denier
References
Chapter 189: Questions & Answers
Part VI: Emergency Medical Services and Disaster Preparedness
Chapter 190: Emergency Medical Services
Principles
Background and Importance
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
Future
Material Resources
Medications
Equipment
Ambulances
Communications
Access
Emergency Medical Dispatch
Systems Status Management and Flexible Deployment
Field Communications
Oversight
Federal
State
Local
Emergency Medical Services Medical Director
Indirect Medical Control
Direct Medical Control
Out-of-Hospital Medical Care and Controversies in Management
Airway Support and Respiratory Emergencies
Interventions
Medications
Cardiovascular Emergencies
Interventions
Medications
Traumatic Emergencies
Interventions
Interfacility and Specialized Transports
References
Chapter 190: Questions & Answers
Chapter 191: Air Medical Transport
Principles
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 Missions
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
Clinical Concepts and Patient Care
Trauma
Cardiac Disorders
Stroke
High-Risk Obstetric Patients
Neonates and Children
Efficacy and Cost-Effectiveness
Future of Air Medical Transport
References
Chapter 191: Questions & Answers
Chapter 192: Disaster Preparedness
Principles
Surge Capacity
Definitions
Classic Terminology
Potential Injury-Creating Event Nomenclature
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 Command System
Incident Command
Operations Section
Planning Section
Logistics Section
Finance Section
Organization of the Out-of-Hospital Disaster Scene
Planning and Hospital Response
Comprehensive Emergency Management
Hospital Disaster Response Plan
Basic Components of a Hospital Comprehensive Disaster Response Planning Process
Interdepartmental Planning Group
Resource Management
Command Structure
Media
Communication
Personnel
Patient Management
Training Exercises
Review of Hospital and Community Disaster Response Experience
Focal Disasters
Catastrophic Disasters
Need for Local Response
Toxic Disasters (Hazardous Material)
Chemical, Biologic, Radiologic, Nuclear, and Explosive Terrorism
Disaster Stress Management
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 192: Questions & Answers
Chapter 193: Weapons of Mass Destruction
Principles
Specific Disorders
Nuclear and Radiologic Devices
Principles
Clinical Features
Management
Biologic Weapons
Principles
Clinical Features
Management
Anthrax
Principles
Clinical Features
Management
Plague
Principles
Clinical Features
Differential Diagnosis
Management
Smallpox
Principles
Clinical Features
Differential Diagnosis
Diagnostic Testing
Management
Chemical Weapons
Nerve Agents (Sarin, Tabun, Soman, and VX)
Principles
Clinical Features
Management
Vesicants (Mustard)
Principles
Clinical Features
Management
Cyanides (Blood Agents)
Principles
Clinical Features
Management
Pulmonary Intoxicants (Phosgene and Chlorine)
References
Chapter 193: Questions & Answers
Online Content
Public Health and Humanitarian Emergencies
Chapter e1: Forensic Emergency Medicine
e1 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 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
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
Law Enforcement Exemptions to the Health Insurance Portability and Accountability Act
References
Chapter e1: Questions & Answers
Chapter e2: Injury Prevention and Control
e2 Injury Prevention and Control
Principles
History of Injury Prevention
Current State of Injury Prevention
Injury Epidemiology and Documentation
Risk Assessment
Motor Vehicle Collisions
Behavioral and Comorbid Risk Factors
Hospital-Based Violence Intervention Programs
Brief Emergency Department Interventions
Specific Issues and Disorders
Acute Care
Firearm-Related Injuries
Emergency Medicine Leadership: Advocacy of Public Policy
References
Chapter e2: Questions & Answers
Chapter e3: Global and Humanitarian Emergency Medicine
e3 Global and Humanitarian Emergency Medicine
Principles
Specific Types of Humanitarian Emergencies
Natural Disasters
Armed Conflict
Disease Epidemics
Standards in Humanitarian Response
International Law
Humanitarian Principles and 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 a Humanitarian Response
Response Organizations: The International Humanitarian Architecture
United Nations
Foreign Governments
Militaries
Individual Responders
Role of the Emergency Clinician
Coordination of Humanitarian Response
United Nations Cluster Approach
Ongoing Coordination
Emergency Clinician in Humanitarian Emergencies
Preparing for Humanitarian Response
Training for Humanitarian Response
Choosing a Deployment
Tips for the Field
Safety and Security
Ethical Dilemmas
What to Bring
References
Chapter e3: Questions & Answers
Chapter e4: Tactical Emergency Medical Support and Urban Search and Rescue
e4 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
Airway Management
Hazardous Materials and Exposures
References
Chapter e4: Questions & Answers
Chapter e5: Emergency Ultrasound
e5 Emergency Ultrasound
Principles
History
Training, Credentialing, and Accreditation
Applied Ultrasound Physics and Instrumentation
Equipment and Safety
Applications and Categorization
Specific Ultrasound Uses
Trauma Ultrasound
Identification of Appropriate Patients
Image Acquisition
Interpretation of the Acquired Images
Integration of Ultrasound Findings Into Patient Management
Pelvic Ultrasound
Identification of Appropriate Patients
Image Acquisition
Interpretation of the Acquired Images
Integration of Ultrasound Findings Into Patient Management
Cardiac Ultrasound
Identification of Appropriate Patients
Image Acquisition
Interpretation of the Acquired Images
Integration of Ultrasound Findings Into Patient Management
Abdominal Vascular Ultrasound
Identification of Appropriate Patients
Image Acquisition
Integration of Ultrasound Findings Into Patient Management
Integration of Ultrasound Findings Into Patient Management
Biliary Ultrasound
Identification of Appropriate Patients
Image Acquisition
Interpretation of the Acquired Images
Integration of Ultrasound Findings Into Patient Management
Urinary Tract Ultrasound
Identification of Appropriate Patients
Image Acquisition
Interpretation of the Acquired Images
Integration of Ultrasound Findings Into Patient Management
Deep Venous Thrombosis Ultrasound
Identification of Appropriate Patients
Image Acquisition
Interpretation of the Acquired Images
Integration of Ultrasound Findings Into Patient Management
Thoracic Ultrasound
Identification of Appropriate Patients
Image Acquisition
Interpretation of the Acquired Images
Integration of Ultrasound Findings Into Patient Management
Ocular Ultrasound
Identification of Appropriate Patients
Image Acquisition
Interpretation of the Acquired Images
Integration of Ultrasound Findings Into Patient Management
Soft Tissue Ultrasound
Identification of Appropriate Patients
Image Acquisition
Interpretation of the Acquired Images
Integration of Ultrasound Findings Into Patient Management
Musculoskeletal Ultrasound
Identification of Appropriate Patients
Image Acquisition
Interpretation of the Acquired Images
Integration of Ultrasound Findings Into Patient Management
Testicular Ultrasound
Identification of Appropriate Patients
Image Acquisition
Interpretation of the Acquired Images
Integration of Ultrasound Findings Into Patient Management
Bowel Ultrasound
Pediatric Emergency Ultrasound
Ultrasound for Procedural Guidance
Vascular Access Procedures
Torso Drainage Procedures
Soft Tissue and Musculoskeletal Procedures
Nerve Blocks
Lumbar Puncture
Out-of-Hospital Ultrasound: Disasters and Remote Settings
Integration Into Emergency Medicine Practice
References
Chapter e5: Questions & Answers
The Practice of Emergency Medicine
Chapter e6: Observation Medicine and Clinical Decision Units
e6 Observation Medicine and Clinical Decision Units
Principles of Observation Medicine
The Observation Approach
Clinical Conditions
Evaluation of Critical Diagnostic Syndromes
Abdominal Pain
Traditional Approach.
Problem With Traditional Approach.
Observational Approach.
Chest Pain
Traditional Approach.
Problem With Traditional Approach.
Observational Approach.
Deep Vein Thrombosis
Traditional Approach.
Problem With Traditional Approach.
Observational Approach.
Upper Gastrointestinal Bleeding
Traditional Approach.
Problem With Traditional Approach.
Observational Approach.
Syncope
Traditional Approach.
Problem With Traditional Approach.
Observational Approach.
Transient Ischemic Attack
Traditional Approach.
Problem With Traditional Approach.
Observational Approach.
Trauma
Blunt Abdominal Injury
Traditional Approach.
Problem With Traditional Approach.
Observational Approach.
Penetrating Abdominal Injury
Traditional Approach.
Problem With Traditional Approach.
Observational Approach.
Blunt Chest Trauma
Traditional Approach.
Problem With Traditional Approach.
Observational Approach.
Penetrating Chest Injury
Traditional Approach.
Problem With Traditional Approach.
Observational Approach.
Treatment of Emergency Conditions
Asthma
Traditional Approach.
Problems With Traditional Approach.
Observational Approach.
Atrial Fibrillation
Traditional Approach.
Problem With Traditional Approach.
Observational Approach.
Congestive Heart Failure
Traditional Approach.
Problem With Traditional Approach.
Observational Approach.
Dehydration
Traditional Approach.
Problem With Traditional Approach.
Observational Approach.
Infections
Pneumonia
Traditional Approach.
Problem With Traditional Approach.
Observational Approach.
Pyelonephritis
Traditional Approach.
Problem With Traditional Approach.
Observational Approach.
Summary
References
Chapter e6: Questions & Answers
Chapter e7: Multiculturalism and Care Delivery
e7 Multiculturalism and Care Delivery
Principles
Rationale for Cultural Competence
Changing Demographics: New Challenges for Emergency Clinicians
Racial and Ethnic Disparities in Health Care Access and Outcomes
Factors Contributing to Disparities in Health Outcomes
Test and Treatment Disparity
Discrimination and Health Outcomes
Race-Based Medical Decision Making
Failure of Trust
Language and Effective Medical Care
Culturally Competent Approach to Language Barriers
Multiculturalism, Culture Competence, and Health Disparities: Progress to Date
Using Cultural Competence to Cross the Barrier of Different Beliefs, Values, and Life Experiences
Interpreting the Culture of Medicine to Patients From Diverse Backgrounds
Care and Communication for Victims of Community Violence
Trauma-Informed Care
Role Expectations in Western Medicine: Opportunities for Misunderstanding
Cultural Competence and Patient-Centered Care: New Models
Education
Recommendations
Summary
References
Chapter e7: Questions & Answers
Chapter e8: The Geriatric Emergency Department
e8 The Geriatric Emergency Department
Principles
Background
Older Patients in the Emergency Department
Geriatric Emergency Department Guidelines
Staffing and Administration
Equipment and Supplies
Education
Policies, Procedures, and Protocols
Follow-Up and Transition of Care
Quality Improvement
References
Chapter e8: Questions & Answers
Chapter e9: End of Life
e9 End of Life
Principles
Palliative Care
Emergency Medicine and End-of-Life Care
End-of-Life Trajectories
Goals of Care as Central to Emergency Intervention and Care Planning
Specific Disorders and Concerns
Out-of-Hospital Considerations
Field Death Pronouncement
Honoring Advance Directives to Withhold Resuscitation
Death in the Emergency Department
Delivering Bad News
Step 1: Clinician Preparation.
Step 2: What Does the Patient Know?
Step 3: How Much Does the Patient Want to Know?
Step 4: Sharing the Information.
Step 5: Responding to Feelings.
Step 6: Planning and Follow-Up.
Death Notification
Telling in Person.
Telephone Notification.
Viewing the Body
Family Presence During Resuscitation
Goals of Care
Establishing Goals of Care.
Initiating a Conversation on Goals of Care.
Prognostication
Functional Status and the Value of the Surprise Question.
Functional Status in Relationship to Prognosis.
Treating Symptoms Requiring Palliation at the End of Life
Pain
Shortness of Breath
Imminent Death
Hospice Care and the Emergency Department
Hospice as a Care System
Evaluation and Management of the Patient Enrolled in Hospice Care
Hospice Referral From the Emergency Department
References
Chapter e9: Questions & Answers
Chapter e10: Bioethics
e10 Bioethics
Principles
Definitions
Ethics and Emergency Medicine
Bioethics and the Law
Basic Considerations
Rights and Duties
Values
Society’s Values
Good Versus Evil
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
Conflicting Principles
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 of 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?
A Global Perspective
References
Chapter e10: Questions & Answers
Chapter e11: Emergency Medical Treatment and Active Labor Act and Medicolegal Issues
e11 Emergency Medical Treatment and Active Labor Act and Medicolegal Issues
Principles
Specific Issues—Emergency Medical Treatment and Active Labor Act
Medical Screening Examination
Emergency Medical Condition
Screening Each Individual Patient
Request for Examination or Treatment of a Medical Condition
“Comes to the Emergency Department”
“Parking” of 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
Documentation
Central Log
Medical Record
Stabilization Requirements
Disposition Issues Under Emergency Medical Treatment and Active 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
Transfers to Other Acute Care Hospitals
Duty to Accept Appropriate Transfers From Other Hospitals
When Must a Receiving Hospital Accept a Patient in Transfer?
Who Accepts Patients on Behalf of the Hospital?
Does a Hospital Have to Accept Transfers of Inpatients From Other Hospitals?
When Can a Hospital Refuse to Accept a Patient in Transfer?
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 e11: Questions & Answers
Chapter e12: Process Improvement and Patient Safety
e12 Process Improvement and Patient Safety
Principles
Background
Socio-Technical Work Systems
Safety and Risk in Dynamic 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 e12: Questions & Answers
Chapter e13: Wellness, Stress, and the Impaired Physician
e13 Wellness, Stress, and the Impaired Physician
Principles
Specific Issues Related to Emergency Clinician Wellness
Stress
Burnout
Compassion Fatigue
Resilience
Consequences of Lack of Wellness and the Impaired Physician
Wellness Strategies
Professional
Personal
References