Emergency Medicine: A Comprehensive Study Guide 6th edition

2091 Pages·2003·62.99 MB·English

by  Judith E Tintinalli

CONTENTS (İÇİNDEKİLER) İçin Buraya Tıkla.
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EMERGENCY MEDICINE: A Comprehensive Study Guide
Copyright © 2004, 2000,1996, 1992, 1988, 1985 by The McGraw-Hill Companies, Inc.
Copyright © 1978 by the American College of Emergency Physicians. All rights reserved. Printed in the United States of America.
Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in
any form or by any means, or stored in a data base or rctrievai system, without the prior written permission of the publisher.
1234567890 DOW/DOW 09876543 ISBN: 0-07-138875-3
This book was set in Times New Roman by ATLIS Graphics, Inc.
The editors were Andrea Seils, Nicky Fernando, and Michelle Watt.
The production supervisor was Catherine H. Saggese.
The cover designer was Aimee Nordin.
The index was prepared by Jerry Ralya.
RR Donnelley was the printer and binder.
This book is printed on acid-free paper.
LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA
Emergency medicine : a comprehensive study guide / [edited by] Judith E. Tintinalli, Gabor D. Kelen, J. Stephan Stapczynski.—
6th ed.
p. ; cm.
Includes bibliographical references and index. ISBN: 0-07-138875-3
1. Emergency medicine. I. Tintinalli, Judith E. II. Kelen, Gabor D. III. Stapczynski, J. Stepban.
[DNLM: 1. Emergency Medicine. 2. Emergencies. WB 105 E552 2004] RC86.7 .E57828 2004 616.02'5—dc2I
INTERNATIONAL EDITION ISBN: 0-07-121930-7
Copyright © 2004. Exclusive rights by the McGraw-Hill Companies, Inc., for manufacture and export. This book cannot be
reexported from the country to which it is consigned by McGraw-Hill. The International Edition is not available in North America.
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To students and practitioners of Emergency Medicine around the world.

JET

To Laurie, Ardie and Mikey, whose love and support sustained me through this endeavor.

GDK

To those who have taught me, my gratitude for their patience and wisdom; to those I have

taught, my encouragement for life-long learning.

JSS

……………………………………………………………………………………………………………………………………………………………………………………………………………….
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CONTENTS
Contributors xv Preface xxxvii
Acknowledgments xxxix
Section One Prehospital Care 1

1 Emergency Medical Services G. Patrick Lilja 1
2 Prehospital Equipment and Adjuncts Daniel G. Hankins, Andy Boggust 5
3 Air Medical Transport C. Keith Stone, Stephen H. Thomas 11
4 Neonatal and Pediatric Transport Phillip V. Gordon, Carl Bose 15
5 Mass Gatherings Eric W. Ossmann, Arthur H. Yancey II 21
Section Two Disaster Preparedness 27

6 Disaster Medical Services Eric K. Noji, Gabor D. Kelen 27
7 Bioterrorism Response: Implications for the Emergency Clinician Anthony G. Maclntyre, Joseph A.
Barbera 35
8 Disaster Management for Chemical Agents of Mass Destruction Suzanne R. White, Kelly R.
Klein,Col. Edward M. Eitzen, Jr. 42
9 Blast and Crush Injuries John M. Wightman, Barry A. Wayne 46
10 Radiation Injuries Christina L. Catlett, Pamela L. Piggott 50
Section Three Resuscitative Problems and Techniques 61

11 Sudden Cardiac Death Joseph P. Ornato 61
12 Basic Cardiopulmonary Resuscitation in Adults Jon Mark Hirshon 66
13 Neonatal Resuscitation and Emergencies Eugene E. Cepeda, Mary P. Bedard 71
14 Pediatric Cardiopulmonary Resuscitation William E. Hauda II 78
15 Pediatric Airway Management Marcie Rubin, Nicholas Sadovnikoff 88
16 Resuscitation Issues in Pregnancy Elizabeth M. Datner, Susan B. Promes 94
17 Ethical Issues of Resuscitation Catherine A. Marco 99
18 Noninvasive Airway Management A. Michael Roman 102
19 Tracheal Intubation and Mechanical Ventilation Daniel F. Danzl, Robert J. Vissers 108
20 Surgical Airway Management David R. Gens 119
21 Vascular Access William A. Berk, Bharat Sutariya 124
22 Invasive Monitoring, Pacing Techniques, and Automatic and Implantable Defibrillators Edward S.
Bessman 132
23 Cerebral Resuscitation Gary S. Krause, Blaine C. White 138
24 Newer Resuscitative Techniques James E. Manning,Christopher W. Barton, Laurence M.Katz 141
25 Acid-Base Disorders David D. Nicolaou, Gabor D. Kelen 149
26 Blood Gases: Pathophysiology and Interpretation Kelly L. Grogan, Peter Pronovost 159
27 Fluid and Electrolyte Problems Michael Londner, Darcie Hammer, Gabor D. Kelen 167
28 Disturbances of Cardiac Rhythm and Conduction Edmund Bolton 179
29 Pharmacology of Antidysrhythmic and Vasoactive Medications Elizabeth A. Clements, Bryan R. Kuhn
202
Section Four Shock 219

30 Approach to the Patient in Shock Emanuel P. Rivers, Ronny M. Otero, H. Bryant Nguyen 219
31 Fluid and Blood Resuscitation James E. Manning 225
32 Septic Shock Jonathan Jui 231
33 Cardiogenic Shock W. Franklin Peacock IV, Jim Edward Weber 242
34 Anaphylaxis and Acute Allergic Reactions Brian H. Rowe, Stuart Carr 247
35 Neurogenic Shock Brian Euerle, Thomas M. Scalea 252
Section Five Analgesia, Anesthesia, and Sedation 257

36 Acute Pain Management in the Adult Patient Gary D. Zimmer 257
37 Local and Regional Anesthesia Eric Higginbotham, Robert J. Vissers 264
38 Procedural Sedation and Analgesia David D. Nicolaou 275
39 Management of Patients with Chronic Pain David M. Cline 280
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Vlll CONTENTS
Section Six Emergency Wound Management 287

40 Evaluation of Wounds Judd E. Hollander, Adam J. Singer 287
41 Wound Preparation Susan Stone, Wallace A. Carter 289
42 Methods for Wound Closure Adam J. Singer, Judd E. Hollander 292
43 Lacerations to the Face and Scalp Wendy C. Coates 298
44 Injuries to the Arm, Hand, Fingertip, and Nail Fiona E. Gallahue, Wallace A. Carter 305
45 Lacerations of the Leg and Foot EarlJ. Reisdorff 312
46 Soft Tissue Foreign Bodies Richard L. hammers 317
47 Puncture Wounds and Mammalian Bites Robert A. Schwab, Robert D. Powers 324
48 Postrepair Wound Care Adam J. Singer, Judd E. Hollander 328
Section Seven Cardiovascular Disease 333

49 Approach to Chest Pain Gaty B. Green, Peter M. Hill 333
50 Acute Coronary Syndromes: Acute Myocardial Infarction and Unstable Angina Judd E. Hollander 343
51 Intervention Strategies for Acute Coronary Syndromes Judd E. Hollander, Deborah B. Diercks 352
52 Syncope Barbara K. Blok, Tina M. Newman 359
53 Congestive Heart Failure and Acute Pulmonary Edema W. Franklin Peacock IV 364
54 Valvular Emergencies David M. Cline 373
55 The Cardomyopathies, Myocarditis, and Pericardial Disease James T. Niemann 378
56 Pulmonary Embolism Jeffrey A. Kline 386
57 Hypertension Melissa M. Wu, Arjun Chanmugam 394
58 Aortic Dissection and Aneurysms Louise A. Prince, Gary A. Johnson 404
59 Thrombophlebitis and Occlusive Arterial Disease Anil Chopra 409
60 Cardiac Transplantation Michael R. Mill, Michelle S. Mill 418
61 Noninvasive Myocardial Imaging David A. Bluemke, Bennett Chin, JoaoA.C. Lima, MalekTebache 424
Section Eight Pulmonary Emergencies 437

62 Respiratory Distress J. Stephan Stapczynski 437
63 Bronchitis, Pneumonia, and Pleural Empyema Donald A. Moffa, Jr., Charles L. Emerman 445
64 Aspiration Pneumonia and Lung Abscess Eric Anderson 453
65 Tuberculosis Janet M. Poponick 458
66 Spontaneous and Iatrogenic Pneumothorax William Franklin Young, Jr., Roger L. Humphries 462
67 Hemoptysis William Franklin Young, Jr., Michael Stava 465
68 Acute Asthma in Adults Rita K. Cydulka 467
69 Chronic Obstructive Pulmonary Disease Rita K. Cydulka, Mohak Dave 475
70 The Lung Transplant Patient Thomas P. Noeller 480
71 Pulmonary Imaging Janet M. Poponick 483
Section Nine Gastrointestinal Emergencies 487

72 Acute Abdominal Pain E. John Gallagher 487
73 Abdominal Pain in the Elderly Robert McNamara 501
74 Gastrointestinal Bleeding David T. Overton 505
75 Esophageal Emergencies Moss H. Mendelson 508
76 Swallowed Foreign Bodies Wade R. Gaasch, Robert A. Barish 513
77 Peptic Ulcer Disease and Gastritis Matthew C. Gratton, Howard A. Werman 516
78 Acute Appendicitis Denis J. FitzGerald, Arthur M. Pancioli 520
79 Intestinal Obstruction Salvator J. Vicario, Timothy G. Price 523
80 Hernia in Adults and Children Frank W. Lavoie, Mary Harkins Becker 527
81 Ileitis, Colitis, and Diverticulitis Howard A. Werman, Hagop S. Mekhjian, Douglas A. Rund 530
82 Anorectal Disorders Brian E. Burgess, James K. Bouzoukis 539
83 Vomiting, Diarrhea, and Constipation Annie T. Sadosty, Jennifer J. Hess 551
84 Jaundice Richard O. Shields, Jr. 560
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CONTENTS IX
85 Cholecystitis and Biliary Colic William J. Brady, Thomas P. Aufderheide, Judith E. Tintinalli 561
86 Hepatic Disorders and Hepatic Failure Joshua S. Broder, Rawden Evans 566
87 Acute and Chronic Pancreatitis Robert J.Vissers, Riyad B. Abu-Laban 573
88 Complications of General Surgical Procedures Edmond A. Hooker 577
89 Complications of Gastrointestinal Devices Edmond A. Hooker 583
90 The Liver Transplant Patient Steven Kronick 585
91 Gastrointestinal Imaging Michael J. Bono 590
Section Ten Renal and Genitourinary Disorders 593

92 Acute Renal Failure Richard Sinert, Peter R. Peacock, Jr. 593
93 Emergencies in Renal Failure and Dialysis Patients Richard Sinert, Mark Spektor 599
94 Urinary Tract Infections David S. Howes, Mark P. Bogner 606
95 Male Genital Problems Robert E. Schneider 613
96 Urologic Stone Disease Rakesh Engineer, W. Franklin Peacock IV 620
97 Hematuria and Hematospermia David S. Howes, Mark P. Bogner 625
98 Complications of Urologic Procedures and Devices Elaine B. Josephson, Jatinder Singh 629
99 The Renal Transplant Patient Richard Sinert, Mert Erogul 633
100 Renal Imaging Daniel E. Wiener, Emily H. Sheffer 640
Section Eleven Gynecology and Obstetrics 647

101 Vaginal Bleeding in the Nonpregnant Patient Laurie J. Morrison, Julie M. Spence 647
102 Abdominal and Pelvic Pain in the Nonpregnant Patient Reb Close 653
103 Ectopic Pregnancy Richard S. Krause, David M. Janicke 658
104 Normal Pregnancy Christina E. Hantsch, Donna L. Seger 664
105 Comorbid Diseases in Pregnancy Jessica L. Bienstock, Harold E. Fox 670
106 Emergencies During Pregnancy and the Postpartum Period Gloria J. Kuhn 676
107 Emergency Delivery Michael J. VanRooyen, Kimberly B. Fortner 684
108 Vulvovaginitis Gloria J. Kuhn 691
109 Pelvic Inflammatory Disease Amy J. Behrman, William H. Shoff, Suzanne M. Shepherd 697
110 Breast Disorders Janet Simmons Young 700
111 Urogynecologic Disorders and Gynecologic Oncology Michael Londner, Daniela Meshkat 705
112 Complications of Gynecologic Procedures Michael A. Silverman, Karen M. Hardart 710
113 Pelvic Ultrasonography Robert F. Reardon, Dietrich V.K. Jehle 715
Section Twelve Pediatrics 727

114 The Normal Child Peter Mellis 727
115 Fever Carol D. Berkowitz 731
116 Bacteremia, Sepsis, and Meningitis in Children Peter Mellis 735
117 Common Neonatal Problems Tonia J. Brousseau, Niranjan Kissoon 742
118 The NICU Graduate Daniel G. Button 752
119 SIDS (Sudden Infant Death Syndrome) and ALTE (Apparent Life-Threatening Event) Carol D. Berkowitz 755
120 Pediatric Heart Disease C. James Corrall 758
121 Otitis and Pharyngitis in Children Kimberly S. Quayle, Susan Fuchs, David M. Jaffe 769
122 Skin and Soft Tissue Infections Richard Malley 778
123 Viral and Bacterial Pneumonia in Children Kathleen Brown, Willie Gilford, Jr. 784
124 Pediatric Asthma and Bronchiolitis Maybelle Kou, Thorn Mayer 789
125 Seizures and Status Epilepticus in Children Michael A. Nigro 798
126 Vomiting and Diarrhea in Children Christopher M. Holmes, Summer A. Smith 808
127 Pediatric Abdominal Emergencies Robert W. Schafermeyer 813
128 Diabetic Ketoacidosis Frederick Place, Thorn Mayer 821
129 Hypoglycemia Randolph Cordle 825
130 Altered Mental Status and Headache in Children Nancy Pook, Natalie Cullen, Jonathan I. Singer 831
131 Syncope and Sudden Death William E. Hauda II, Thorn Mayer 838

X CONTENTS
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132 Fluid and Electrolyte Therapy William Ahrens 843
133 Upper Respiratory Emergencies Randolph Cordle 848
134 Acute Pain Management and Procedural Sedation in Children Michael N. Johnston, Erica L. Liebelt 858
135 Pediatric Exanthems Michael S. Weinstock, Alexander M. Rosenau 869
136 Musculoskeletal Disorders in Children Courtney Hopkins-Mann, David Leader,
Donna Moro-Sutherland, Richard A. Christoph 876
137 Sickle Cell Disease Peter J. Paganussi, Thorn Mayer, Maybelle Kou 890
138 Evaluating the Child with Special Health Care Needs Douglas R. Trocinski, Donna Moro-Sutherland 895
139 Urologic and Gynecologic Problems in Children Samy Saad, Oily Duckett 900
140 Pediatric Urinary Tract Infections Michael F. Altieri, Mary Camarca, Thorn Mayer 905
Section Thirteen Infectious Diseases 909

141 Sexually Transmitted Diseases Joel Kravitz, Susan B. Promes 909
142 Toxic Shock Syndrome and Streptococcal Toxic Shock Syndrome Shawna J. Perry, Ashley E. Booth 913
143 Common Viral Infections: Influenzaviruses and Herpesviruses Robert A. Brownstein 919
144 HIV Infection and AIDS Richard E. Rothman, Catherine A. Marco, Gabor D. Kelen 925
145 Infective Endocarditis Richard E. Rothman, Samuel Yang, Catherine A. Marco 937
146 Tetanus Donna L. Carden 943
147 Rabies David J. Weber, David A. Wohl, William A. Rutala 946
148 Malaria Jeffrey D. Band 953
149 Infections from Helminths Harold H. Osborn 959
150 Food-Borne and Water-Borne Diseases William T. Anderson 964
151 Zoonotic Infections John T. Meredith 969
152 Soft Tissue Infections Steven G. Folstad 979
153 Reportable Infectious Diseases Jane H. Brice, J. Brent Myers 987
154 Occupational Exposures, Infection Control, and Standard Precautions Kathy J. Rinnert 994
155 Pharmacology of Antimicrobials, Antifungals, and Antivirals Ralph H. Raasch 1006
Section Fourteen Toxicology and Pharmacology 1015

156 General Management of Poisoned Patients Jason B. Hack, Robert S. Hoffman 1015
157 Principles of Drug Interactions George Delgado, Jr., Jamie Pilarowski 1022
158 Tricyclic Antidepressants Kirk C. Mills 1025
159 Newer Antidepressants and Serotonin Syndrome Kirk C. Mills 1033
160 Monoamine Oxidase Inhibitors Kirk C. Mills 1039
161 Antipsychotics Richard A. Harrigan, William J. Brady 1044
162 Lithium Sandra M. Schneider, Daniel J. Cobaugh 1048
163 Barbiturates Raquel M. Schears 1051
164 Benzodiazepines George M. Bosse 1055
165 Nonbenzodiazepine Hypnosedatives Raquel M. Schears 1057
166 Alcohols William A. Berk, Wilma V Henderson 1064
167 Opioids Suzanne Doyon 1071
168 Cocaine, Amphetamines, Caffeine, and Nicotine Jeanmarie Perrone, Robert S. Hoffman 1075
169 Hallucinogens Karen N. Hansen, Katherine M. Prybys 1079
170 Salicylates Luke Yip 1085
171 Acetaminophen Oliver L. Hung, Lewis S. Nelson 1088
172 Nonsteroidal Anti-Inflammatory Drugs G. Richard Bruno, Wallace A. Carter 1094
173 Theophylline Heather Marshall, Charles L. Emerman 1098
174 Digitalis Glycosides William Dribben, Mark A. Kirk 1102
175 P-Blocker Toxicity Teresa M. Carlin 1105
176 Calcium Channel Blockers Kennon Heard, Jeffrey A. Kline 1108
177 Antihypertensive Agent Toxicity Arjun Chanmugam, Keith Thomasset 1112
178 Phenytoin and Fosphenytoin Toxicity Harold H. Osborn 1117
179 Iron Joseph G. Rella, Lewis S. Nelson 1121
180 Hydrocarbons and Volatile Substances Paul M. Wax, Michael B. Beuhler 1124
181 Caustics G. Richard Bruno, Wallace A. Carter 1130

CONTENTS XI
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182 Insecticides, Herbicides, Rodenticides Walter C. Robey III, William J. Meggs 1134
183 Anticholinergic Toxicity Paul M. Wax 1143
184 Metals and Metalloids Heather Long, Lewis S. Nelson 1146
185 Toxicology of Hazardous Chemicals Suzanne R. White, Col. Edward M. Eitzen, Jr., Kelly R. Klein 1153
186 Vitamins and Herbals G. Richard Braen 1160
187 Antimicrobials G. Richard Bruno, Wallace A. Carter 1164
188 Cyanide Larissa I. Velez, Kathleen A. Delaney 1165
189 Dyshemoglobinemias Sean M. Rees, Lewis S. Nelson 1169
190 Hypoglycemic Agents Joseph G. Rella, Lewis S. Nelson 1172
Section Fifteen Environmental Injuries 1175

191 Frostbite and Other Localized Cold-Related Injuries MarkB.Rabold 1175
192 Hypothermia Howard A. Bessen 1179
193 Heat Emergencies James S. Walker, David E. Hogan 1183
194 Arthropod Bites and Stings Richard F. Clark, Aaron B. Schneir 1190
195 Reptile Bites Richard C. Dart, Frank F. S. Daly 1200
196 Trauma and Envenomations from Marine Fauna Geoffrey K. Isbister, David G. Caldicott 1206
197 Dysbarism and Complications of Diving Brian Snyder, Tom Neuman 1213
198 Near-Drowning Alan L. Causey, Mark A. Nichter 1218
199 Thermal Burns Lawrence R. Schwartz, Chenicheri Balakrishnan 1220
200 Chemical Burns Fred P. Harchelroad, Jr., David M. Rottinghaus 1226
201 Electrical Injuries Raymond M. Fish 1231
202 Lightning Injuries Raymond M. Fish 1235
203 Carbon Monoxide Poisoning Keith W. Van Meter 1238
204 Mushroom Poisoning Anne F. Brayer, Sandra M. Schneider 1242
205 Poisonous Plants Mark A. Hostetler, Sandra M. Schneider 1246
Section Sixteen Emergency Medicine in Unique Environments 1251

206 World Travelers Michael J. VanRooyen, Chayan C. Dey Raghu Venugopal 1251
207 High-Altitude Medical Problems Peter H Hackett 1263
208 Antarctic Medicine Desmond J. Lugg 1271
209 Space Medicine David Williams 1275
Section Seventeen Endocrine Emergencies 1283

210 Hypoglycemia William J. Brady, Richard A. Harrigan 1283
211 Diabetic Ketoacidosis Michael E. Chansky, Cary L. Lubkin 1287
212 Diabetes Mellitus Michael D. Rush, Sonia Winslett, Kimberley Dawn Wisdom 1294
213 Alcoholic Ketoacidosis William A. Woods, Debra G. Perina 1304
214 Hyperosmolar Hyperglycemic State Charles S. Graffeo 1307
215 Hyperthyroidism and Thyroid Storm Horace K. Liang 1311
216 Hypothyroidism and Myxedema Coma Horace K. Liang 1313
217 Adrenal Insufficiency and Adrenal Crisis Charles N. Schoenfeld 1315
Section Eighteen Hematologic and Oncologic Emergencies 1319

218 Evaluation of Anemia and the Bleeding Patient Robin R. Hemphill 1319
219 Acquired Bleeding Disorders Mary A. Wittier, Robin R. Hemphill 1324
220 Hemophilias and Von Willebrand Disease Robin R. Hemphill 1330
221 Hereditary Hemolytic Anemias Robin R. Hemphill 1335
222 Acquired Hemolytic Anemia Patty Chu, Robin R. Hemphill 1341
223 Transfusion Therapy Sally A. Santen 1348
224 Anticoagulants, Antiplatelet Agents, and Fibrinolytics Jim Edward Weber, F. Michael Jaggi, Charles V.
Pollack, Jr. 1354
225 Emergency Complications of Malignancy Paul Blackburn 1363