Tintinalli’s Emergency Medicine Manual 00_Cydulka_FM.indd 1 03/05/17 2:16 pm Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the pub- lisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet in- cluded in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. 00_Cydulka_FM.indd 2 03/05/17 2:16 pm Tintinalli’s Emergency Medicine Manual 8th Edition Rita K. Cydulka, MD, MS Professor, Department of Emergency Medicine Associate Professor, Department of Biostatistics and Epidemiology Case Western Reserve University MetroHealth Medical Center Cleveland, Ohio Michael T. Fitch, MD, PhD Professor and Vice Chair for Academic Affairs Department of Emergency Medicine Wake Forest School of Medicine Winston-Salem, North Carolina Scott A. Joing, MD Associate Professor Department of Emergency Medicine University of Minnesota Medical School Faculty Physician Hennepin County Medical Center Minneapolis, Minnesota Vincent J. Wang, MD, MHA Professor of Clinical Pediatrics Keck School of Medicine of the University of Southern California Associate Division Head Division of Emergency Medicine Children’s Hospital Los Angeles Los Angeles, California David M. Cline, MD Professor and Director of Departmental Research Department of Emergency Medicine Wake Forest School of Medicine Winston-Salem, North Carolina O. John Ma, MD Professor and Chair Department of Emergency Medicine Oregon Health & Science University Portland, Oregon New York Chicago San Francisco Athens London Madrid Mexico City Milan New Delhi Singapore Sydney Toronto 00_Cydulka_FM.indd 3 03/05/17 2:16 pm Copyright © 2018 by McGraw-Hill Education. All rights reserved. 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Under no circumstances shall McGraw- Hill Education and/or its licensors be liable for any indirect, incidental, special, puni- tive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. Contents Contributors xi Preface xix Section 1 Resuscitation Techniques 1 1 Advanced Airway Support Darren Braude 1 2 Management of Cardiac Rhythm Disturbances James K. Takayesu 10 3 Resuscitation of Children and Neonates Marc F. Collin 29 4 Fluids, Electrolytes, and Acid-Base Disorders Benjamin W. Wachira 37 5 Therapeutic Approach to The Hypotensive Patient Saurin P. Bhatt 60 6 Anaphylaxis, Acute Allergic Reactions, and Angioedema Alix L. Mitchell 64 Section 2 Analgesia, Anesthesia, and Sedation 67 7 Acute Pain Management and Procedural Sedation Michael S. Mitchell 67 8 Chronic Pain David M. Cline 77 Section 3 Emergency Wound Management 81 9 Evaluating and Preparing Wounds Timothy J. Reeder 81 10 Methods for Wound Closure Corey R. Heitz 85 11 Lacerations to The Face and Scalp J. Hayes Calvert 96 12 Injuries to the Arm, Hand, Fingertip, and Nail John Pettey Sandifer 101 13 Lacerations to the Leg and Foot Moira Davenport 108 14 Soft Tissue Foreign Bodies Michael T. Fitch 112 15 Puncture Wounds and Bites Michael T. Fitch 115 16 Postrepair Wound Care Eugenia B. Quackenbush 121 Section 4 Cardiovascular Diseases 125 17 Chest Pain: Cardiac or Not Andrew Nyce 125 18 Acute Coronary Syndromes: Myocardial Infarction and Unstable Angina Maame Yaa A. B. Yiadom 131 19 Cardiogenic Shock Brian Hiestand 138 20 Low-Probability Acute Coronary Syndrome David A. Wald 141 21 Syncope Jo Anna Leuck 146 22 Acute Heart Failure Lori J. Whelan 149 23 Valvular Emergencies Boyd Burns 152 24 The Cardiomyopathies, Myocarditis, and Pericardial Disease Lorraine Thibodeau 160 25 Venous Thromboembolism Christopher Kabrhel 167 26 Systemic and Pulmonary Hypertension Michael Cassara 175 27 Aortic Aneurysms and Aortic Dissection David E. Manthey 181 28 Arterial Occlusion Carolyn K. Synovitz 187 Section 5 Pulmonary Emergencies 191 29 Respiratory Distress Baruch S. Fertel 191 30 Bronchitis, Pneumonia, and Novel Respiratory Infections Jeffrey M. Goodloe 199 31 Tuberculosis Amy J. Behrman 204 32 Spontaneous and Iatrogenic Pneumothorax Mike Cadogan 208 33 Hemoptysis Nilesh Patel 211 34 Asthma and Chronic Obstructive Pulmonary Disease Stacey L. Poznanski 213 v 00_Cydulka_FM.indd 5 03/05/17 2:16 pm vi Contents Section 6 Gastrointestinal Emergencies 217 35 Acute Abdominal Pain Bryan E. Baskin 217 36 Nausea and Vomiting Jonathan A. Maisel 222 37 Disorders Presenting Primarily with Diarrhea Jonathan A. Maisel 225 38 Acute and Chronic Constipation Thomas E. Carter 233 39 Gastrointestinal Bleeding Mitchell C. Sokolosky 237 40 Esophageal Emergencies Mitchell C. Sokolosky 239 41 Peptic Ulcer Disease and Gastritis Teresa Bowen-Spinelli 244 42 Pancreatitis and Cholecystitis Rita K. Cydulka 247 43 Acute Appendicitis Charles E. Stewart 252 44 Diverticulitis James O’Neill 256 45 Intestinal Obstruction and Volvulus Olumayowa U. Kolade 259 46 Hernia in Adults and Children Louise Finnel 262 47 Anorectal Disorders Chad E. Branecki 265 48 Jaundice, Hepatic Disorders, and Hepatic Failure Cem Oktay 273 49 Complications of General Surgical Procedures Daniel J. Egan 282 Section 7 Renal and Genitourinary Disorders 287 50 Acute Kidney Injury Sum Ambur 287 51 Rhabdomyolysis Annet Alenyo Ngabirano 292 52 Emergencies in Renal Failure and Dialysis Patients Jonathan A. Maisel 296 53 Urinary Tract Infections and Hematuria David R. Lane 299 54 Acute Urinary Retention Casey Glass 303 55 Male Genital Problems Gavin R. Budhram 306 56 Urologic Stone Disease Geetika Gupta 312 57 Complications of Urologic Procedures and Devices Steven Go 316 Section 8 Gynecology and Obstetrics 319 58 Vaginal Bleeding and Pelvic Pain in the Nonpregnant Patient Joelle Borhart 319 59 Ectopic Pregnancy and Emergencies in The First 20 Weeks of Pregnancy Robert Jones 323 60 Comorbid Diseases in Pregnancy Abigail D. Hankin 328 61 Emergencies After 20 Weeks of Pregnancy and The Postpartum Period Kathleen Kerrigan 335 62 Emergency Delivery Stacie Zelman 340 63 Vulvovaginitis Robert R. Cooney 344 64 Pelvic Inflammatory Disease Abigail D. Hankin 347 65 Complications of Gynecologic Procedures Robert R. Cooney 350 Section 9 Pediatrics 353 66 Fever and Serious Bacterial Illness in Children Todd P. Chang 353 67 Common Neonatal Problems Lance Brown 361 68 Common Infections of the Ears, Nose, Neck, and Throat Yu-Tsun Cheng 366 69 Upper Respiratory Emergencies—Stridor and Drooling Christopher S. Cavagnaro 372 70 Wheezing in Infants and Children Richard J. Scarfone 379 71 Pneumonia in Infants and Children Ameer P. Mody 385 72 Pediatric Heart Disease Garth D. Meckler 388 73 Vomiting and Diarrhea in Infants and Children Stephen B. Freedman 395 74 Pediatric Abdominal Emergencies Janet Semple-Hess 400 75 Pediatric Urinary Tract Infections Marie Waterhouse 407 76 Seizures and Status Epilepticus in Children Ara Festekjian 409 77 Altered Mental Status and Headache in Children Carlo Reyes 412 78 Syncope and Sudden Death in Children and Adolescents Derya Caglar 417 00_Cydulka_FM.indd 6 03/05/17 2:16 pm Contents vii 79 Hypoglycemia and Metabolic Emergencies in Infants and Children Teresa J. Riech 420 80 Diabetes in Children Adam Vella 425 81 Fluid and Electrolyte Therapy in Infants and Children Ron L. Kaplan 428 82 Musculoskeletal Disorders in Children Mark X. Cicero 432 83 Rashes in Children Lance Brown 443 84 Sickle Cell Anemia in Children Ilene Claudius 455 85 Hematologic-Oncologic Emergencies in Children Ilene Claudius 461 86 Renal Emergencies in Infants and Children Saranya Srinivasan 468 Section 10 Infectious and Immunologic Diseases 473 87 Sexually Transmitted Infections Jennifer L. Hannum 473 88 Toxic Shock Syndromes Sorabh Khandelwal 480 89 Sepsis John E. Gough 484 90 Soft Tissue Infections Jon Femling 491 91 Serious Viral Infections Matthew J. Scholer 497 92 HIV Infection and AIDS Sarah Battistich 505 93 Infective Endocarditis Kristin M. Berona 513 94 Tetanus and Rabies Michael T. Fitch 517 95 Malaria Jennifer L. Hannum 523 96 Foodborne and Waterborne Diseases Benjamin Weston 527 97 Zoonotic Infections David Gordon 531 98 World Travelers Bret A. Nicks 540 99 The Transplant Patient Sarah E. Unterman 546 Section 11 Toxicology and Pharmacology 555 100 General Management of the Poisoned Patient L. Keith French 555 101 Anticholinergic Toxicity O. John Ma 564 102 Psychopharmacologic Agents Shan Yin 566 103 Sedatives and Hypnotics Shan Yin 574 104 Alcohols Michael Levine 580 105 Drugs of Abuse D. Adam Algren 584 106 Analgesics Joshua N. Nogar 591 107 Xanthines and Nicotine Robert J. Hoffman 598 108 Cardiac Medications Michael Levine 602 109 Anticonvulsants Robert J. Hoffman 613 110 Iron O. John Ma 617 111 Hydrocarbons and Volatile Substances Allyson A. Kreshak 621 112 Caustics Jennifer Cullen 624 113 Pesticides Charles W. O’Connell 626 114 Metals and Metalloids D. Adam Algren 631 115 Industrial Toxins Landen Rentmeester 637 116 Vitamins and Herbals Janna H. Villano 643 117 Dyshemoglobinemias Chulathida Chomchai 646 Section 12 Environmental Injuries 649 118 Cold Injuries Gerald (Wook) Beltran 649 119 Heat Emergencies Eric Kraska 655 120 Bites and Stings Michael Levine 658 121 Trauma and Envenomation from Marine Fauna Christian A. Tomaszewski 666 122 High-Altitude Disorders Shaun D. Carstairs 670 123 Dysbarism and Complications of Diving Christian A. Tomaszewski 673 124 Near Drowning Richard A. Walker 675 125 Thermal and Chemical Burns Sandra L. Werner 678 126 Electrical and Lightning Injuries Norberto Navarrete 686 00_Cydulka_FM.indd 7 03/05/17 2:16 pm viii Contents 127 Carbon Monoxide Jon B. Cole 692 128 Mushroom and Plant Poisoning Chulathida Chomchai 695 Section 13 Endocrine Emergencies 701 129 Diabetic Emergencies Michael P. Kefer 701 130 Alcoholic Ketoacidosis Michael P. Kefer 709 131 Thyroid Disease Emergencies Aziz Darawsha 711 132 Adrenal Insufficiency Michael P. Kefer 715 Section 14 Hematologic and Oncologic Emergencies 719 133 Evaluation of Anemia and the Bleeding Patient Rita K. Cydulka 719 134 Acquired Bleeding Disorders Alisheba Hurwitz 726 135 Hemophilias and von Willebrand Disease Colin G. Kaide 729 136 Sickle Cell Disease and Other Hereditary Hemolytic Anemias Colleen Fant 734 137 Transfusion Therapy Özlem Köksal 739 138 Anticoagulants, Antiplatelet Agents, and Fibrinolytics Jessica L. Smith 745 139 Emergency Complications of Malignancy Ross J. Fleischman 751 Section 15 Neurology 759 140 Headache Steven Go 759 141 Stroke Syndromes and Spontaneous Subarachnoid Hemorrhage Steven Go 765 142 Altered Mental Status and Coma C. Crawford Mechem 775 143 Ataxia and Gait Disturbances Ross J. Fleischman 781 144 Acute Vertigo Steven Go 784 145 Seizures and Status Epilepticus in Adults C. Crawford Mechem 792 146 Acute Peripheral Neurologic Lesions Nicholas E. Kman 796 147 Chronic Neurologic Disorders Michael T. Fitch 800 148 Central Nervous System and Spinal Infections Michael T. Fitch 806 Section 16 Eye, Ear, Nose, Throat, and Oral Emergencies 813 149 Eye Emergencies Steven Go 813 150 Face and Jaw Emergencies Jeffrey G. Norvell 826 151 Ear, Nose, and Sinus Emergencies Michael E. Vrablik 831 152 Oral and Dental Emergencies Steven Go 838 153 Neck and Upper Airway Disorders Rebecca Kornas 845 Section 17 Disorders of the Skin 851 154 Dermatologic Emergencies Jason P. Stopyra 851 155 Other Dermatologic Disorders Jason P. Stopyra 856 Section 18 Trauma 865 156 Trauma in Adults Rita K. Cydulka 865 157 Trauma in Children Matthew Hansen 869 158 Trauma in the Elderly O. John Ma 873 159 Trauma in Pregnancy John Ashurst 877 160 Head Trauma O. John Ma 880 161 Spine Trauma Jeffrey Dan 886 162 Facial Injuries Gerald (Wook) Beltran 892 163 Neck Injuries Steven Go 897 164 Cardiothoracic Injuries Paul Nystrom 903 165 Abdominal Injuries O. John Ma 909 166 Penetrating Trauma to The Flank and Buttocks Sum Ambur 914 167 Genitourinary Injuries Thomas Dalton 916 00_Cydulka_FM.indd 8 03/05/17 2:16 pm Contents ix 168 Trauma to The Extremities Amy M. Stubbs 920 Section 19 Injuries to the Bones, Joints, and Soft Tissue 923 169 Initial Evaluation and Management of Orthopedic Injuries Gregory M. Johnston 923 170 Hand and Wrist Injuries Robert R. Cooney 929 171 Forearm and Elbow Injuries Sandra L. Najarian 934 172 Shoulder and Humerus Injuries Sandra L. Najarian 942 173 Pelvis, Hip, and Femur Injuries Jeffrey G. Norvell 949 174 Knee and Leg Injuries Sandra L. Najarian 956 175 Ankle and Foot Injuries Sarah Elisabeth Frasure 961 176 Compartment Syndrome Sandra L. Najarian 966 Section 20 Nontraumatic Musculoskeletal Disorders 969 177 Neck and Back Pain Amy M. Stubbs 969 178 Shoulder Pain Andrew D. Perron 975 179 Hip and Knee Pain Augusta Czysz 979 180 Acute Disorders of The Joints and Bursae Andrew D. Perron 983 181 Emergencies in Systemic Rheumatic Diseases Nicholas Genes 988 182 Nontraumatic Disorders of The Hand Michael P. Kefer 995 183 Soft Tissue Problems of The Foot Gavin R. Budhram 998 Section 21 Psychosocial Disorders 1003 184 Clinical Features of Behavioral Disorders Leslie S. Zun 1003 185 Emergency Assessment and Stabilization of Behavioral Disorders Leslie S. Zun 1007 186 Panic and Conversion Disorders Kimberly Nordstrom 1010 Section 22 Abuse and Assault 1013 187 Child and Elderly Abuse Jonathan Glauser 1013 188 Sexual Assault and Intimate Partner Violence and Abuse Mary Hancock 1016 Section 23 Special Situations 1021 189 Palliative Care Kate Aberger 1021 Index 1025 00_Cydulka_FM.indd 9 03/05/17 2:16 pm