Schwartz - Principles and Practice of Emergency Medicine 4th
1710
Principles and Practice of Emergency Medicine 4th edition (January 15, 1999)by George R. Schwartz (Editor), Paul B. Roth (Editor), James S. Cohen (Editor) By Lippincott, Williams & Wilkins By OkDoKeY
Schwartz - Principles and Practice of Emergency Medicine 4th
Principles and Practice of Emergency Medicine 4th edition (January
15, 1999) by George R. Schwartz (Editor), Paul B. Roth
(Editor), James S. Cohen (Editor) By Lippincott, Williams &
Wilkins
By OkDoKeY
CONTENTS
Preface
Acknowledgments
1–1 Pathophysiology of Dying and Reanimation George R.
Schwartz
1–2 Post Intubation: Airway and Ventilator Management
CHAPTER 2 CARDIOVASCULAR SYSTEM FAILURE AND SHOCK
2–1 Shock Max Harry Weil, Eric C. Rackow
2–2 Shock: Clinical Treatment George R. Schwartz
CHAPTER 3 SUDDEN DEATH AND RESUSCITATION
3–1 Sudden Death Barbara K. Hanke, George R. Schwartz
3–2 Cardiopulmonary-Cerebral Resuscitation Peter Safar, Norman S.
Abramson
3–3 Advanced Cerebral Resuscitation: The Cutting Edge of ACLS
Aiming at Maximal Functional Recovery Peter Safar
CHAPTER 4 BRAIN DEATH AND ORGAN RETRIEVAL James L. Bernat, George
R. Schwartz
CHAPTER 5 ETHICAL ISSUES IN RESUSCITATION George R. Schwartz,
Kenneth V. Iserson
PART II: TECHNIQUES AND TIPS
CHAPTER 6 PAIN MANAGEMENT James R. Ungar, Daniel Brandes, Bruce M.
Reinoehl, George R. Schwartz, Al Ritter
CHAPTER 7 WOUND MANAGEMENT Barbara K. Hanke
CHAPTER 8 ENT TECHNIQUES
8–1 Cricothyrotomy and Tracheotomy William W. Montgomery, David M.
Bowling, George R. Schwartz
8–2 Transtracheal Ventilation Peter Safar, George R.
Schwartz
8–3 Myringotomy and Tympanocentesis
8–4 Epistaxis (Nosebleed) and Post-tonsillectomy Hemorrhage Donald
R. Paugh, Michael J. Sullivan
8–5 Dislocation of the Jaw Cherie A. Hargis
8–6 Dysphonia Andrew Blitzer
8–7 Sudden Hearing Loss
CHAPTER 9 FOREIGN BODY REMOVAL
9–1 External Auditory Canal Stuart R. Fritz, Gabor D. Kelen
9–2 Nose Howard A. Werman
9–3 Skin Robert A. Rusnak
9–4 Ocular Foreign Bodies Stephen F. Larson
9–5 Swallowed Objects Marsha D. Rappley, Sid M. Shah
9–6 Food and Foreign Body Asphyxiation Michael P. Poirier, George
R. Schwartz
9–7 Coin Ingestion George R. Schwartz
CHAPTER 10 ROUTES FOR DRUGS AND FLUIDS
11–1 Overview of Imaging Modalities Robin Gaupp, Gloria
Birkholz
11–2 Imaging Techniques for Specific Conditions James R. Ungar,
George R. Schwartz
11–3 What Test for Blunt Abdominal Trauma—CT, DPL, or Ultrasound?
Craig A. Meek, Stephen A. Colucciello, John A. Marx
CHAPTER 12 GENITOURINARY TECHNIQUES
12–2 Suprapubic Bladder Drainage Nanakram Agarwal, Ellen E.
Anderson
CHAPTER 13 GASTROINTESTINAL TECHNIQUES: NASOGASTRIC TUBE INSERTION
Nanakram Agarwal, Ellen E. Anderson
CHAPTER 14 PRACTICE PARAMETERS, CLINICAL POLICIES, PRACTICE
GUIDELINES John Dale Dunn
PART III: TRAUMA
15–1 Kinematics Norman E. McSwain, Jr.
15–2 Injury Control
Arthur L. Kellermann, Knox Todd
15–3 Forensic Emergency Medicine John E. Smialek, George R.
Schwartz
CHAPTER 16 PREHOSPITAL MANAGEMENT OF TRAUMA Paul E. Pepe
CHAPTER 17 EMERGENCY MANAGEMENT OF TRAUMA
17–1 Initial Trauma Evaluation Peter Stewart, Frank Ehrlich
17–2 Tips for Evaluation of Trauma: Injury Patterns
18–1 General Considerations Thomas A. Gennarelli
18–2 Head Injuries: Specific Emergency Department Management Issues
George R. Schwartz, Thom A. Mayer, H. Warren Goldman
18–3 Spinal Injuries
John R. Mangiardi, George R. Schwartz
18–4 Trauma to the Face Thom A. Mayer, Errikos Constant
CHAPTER 19 TRAUMA TO THE NECK: GENERAL CONSIDERATIONS
Prakashchandra M. Rao, Rao R. Ivatury, George R.
Schwartz
CHAPTER 20 THORACIC TRAUMA
20–1 General Considerations and Technique of Tube Thoracostomy
George R. Schwartz, Paul Pepe
20–2 Emergency Department Patient Management of Chest Trauma
Panagiotis N. Symbas
CHAPTER 21 ABDOMINAL TRAUMA C. Gene Cayten
CHAPTER 22 INJURIES OF THE GENITOURINARY TRACT E. James Seidmon, A.
Richard Kendall
CHAPTER 23 TRAUMA TO THE PERIPHERAL VASCULAR SYSTEM David V.
Feliciano
CHAPTER 24 TRAUMA TO THE HAND AND NAIL
24–1 Trauma to the Hand Mark T. Jobe, E. Jeff Justis, Jr.
24–2 Nail Evaluation and Procedures Richard K. Scher, Karin H.
Satra
CHAPTER 25 SPECIAL CONSIDERATIONS
25–1 Trauma in Pregnancy Cloyd B. Gatrell, George R.
Schwartz
25–2 Trauma in the Elderly Gerald B. Demarest, George R. Schwartz,
Clark Chipman
25–3 Pediatric Trauma George R. Schwartz
25–4 Burns Alan R. Dimick, Russell G. Wagner
25–5 Fat Embolism Syndrome
CHAPTER 26 CARDIOVASCULAR EMERGENCIES
26–1 Evaluation of Chest Pain George R. Schwartz, James R. Ungar,
Marvin A. Wayne, Rosanne Carrero
26–2 Diagnosis and Treatment of Arrhythmias Ruth Ann Greenfield,
Raymond N. Vitullo, Martin E. Bacon, J. Marcus Wharton, Joseph C.
Howton
Appendix/ECG Illustrative Tracings
CHAPTER 27 CARDIOVASCULAR PROCEDURES
27–1 Synchronized and Unsynchronized Cardioversion of Arrhythmias
Grant La Farge
27–2 Pericardiocentesis Grant La Farge
27–3 Emergency Pacemaker Use and Evaluation James C. Blankenship,
T. Duncan Sellers
27–4 Use of Flow-Directed, Balloon-Tipped Catheters Grant La Farge,
Steven G. Rothrock, George I. Litman
27–5 Emergency Physician’s Use of Echocardiography Joseph
Rosenblum, James V. Talano
CHAPTER 28 CARDIAC EMERGENCIES
28–1 Acute Myocardial Infarction and Unstable Angina James S.
Cohen, George R. Schwartz
28–2 Thrombolytic Therapy for Acute Myocardial Infarction James S.
Cohen
28–3 Cardiogenic Shock Mark Mandell
28–4 Congestive Heart Failure and Pulmonary Edema
28–5 Myocarditis, Cardiomyopathies, and Pericardial Disease Joseph
Rosenblum, James V. Talano
28–6 Infective Endocarditis Philip L. Henneman
28–7 Valvular Heart Disease Morton J. Kern, Lawrence M. Lewis
28–8 Prosthetic Heart Valves: Identification, Function, and
Failure
CHAPTER 29 VASCULAR EMERGENCIES
29–1 Hypertensive Emergencies Abdul M. Memon, Kathleen S.
Schrank
29–2 Aortic Aneurysms and Peripheral Arterial Diseases James S.
Cohen, Steven G. Rothrock, Nicholas Balsano, C. Gene Cayten, Steven
Sornsin
29–3 Carotid Artery Disease Charles L. Emerman, John E.
Duldner
29–4 Venous Diseases Earl J. Reisdorff, David E. Pawsat
B. Adul t Respiratory
CHAPTER 31 DYSPNEA
31–1 Evaluation of Dyspnea Robert H. Dailey
31–2 Acute Upper Airway Obstruction Gerard R. Cox, Suzanne M.
Shepherd
31–3 Mediastinal Emergencies Sheldon Jacobson
CHAPTER 32 EVALUATION OF PULMONARY FUNCTION IN THE EMERGENCY
DEPARTMENT Georges S. Yacoub, Basim A. Dubaybo
CHAPTER 33 SPECIFIC RESPIRATORY CONDITIONS
33–1 Pulmonary Embolism
Terence D. Valenzuela
33–2 Acute Asthma in Adults Steven E. Gentry, Sandra M. Schneider,
Joseph C. Howton
33–3 Hemoptysis Francis L. Counselman
33–4 Pneumothorax Jonathan Vargas
33–5 Aspiration
C. Gastrointes tinal
CHAPTER 35 ABDOMINAL PAIN: EVALUATION George R. Schwartz, Steven G.
Rothrock, Daniel J. Shea, Paul I. Bulat
CHAPTER 36 GASTROINTESTINAL BLEEDING
Eddy D. Palmer
36–2 Upper Gastrointestinal Bleeding Frederic E. Eckhauser, Steven
E. Raper, James A. Knol
36–3 Lower Gastrointestinal Bleeding Gail V. Anderson, Paul F.
Cunningham
CHAPTER 37 ESOPHAGEAL EMERGENCIES AND DYSPHAGIA Sid M. Shah,
Vincent Pflug, Gregory P. Hess
CHAPTER 38 ACUTE GASTROENTERITIS Louis J. Wilson, Christopher
Truss
CHAPTER 39 APPENDICITIS John R. Clarke, John M. Schoffstall, Steven
G. Rothrock, George R. Schwartz
CHAPTER 40 PERFORATED VISCUS James K. Bouzoukis
CHAPTER 41 INTRA-ABDOMINAL INFECTIONS Henry W. Murray
CHAPTER 42 GASTRITIS AND PEPTIC ULCER DISEASE Michael W.
Mulholland, Frederic E. Eckhauser
CHAPTER 43 CROHN DISEASE AND ULCERATIVE COLITIS Mark A.
Peppercorn
CHAPTER 44 DIVERTICULITIS AND DIVERTICULOSIS C. Gene Cayten, George
R. Schwartz
CHAPTER 45 ACUTE GALLBLADDER AND BILIARY TRACT DISEASE Richard E.
Burney
CHAPTER 46 LIVER DISEASE AND HEPATITIS
46–1 Liver Disease Daniel G. Murphy
46–2 Viral Hepatitis Daniel G. Murphy, George R.
Schwartz
CHAPTER 47 PANCREATIC DISEASE Bernard M. Schuman
CHAPTER 48 ANORECTAL DISORDERS George R. Schwartz, Steven G.
Rothrock, Monica Ann Rosenthal
D. Renal and Genitourin ary
CHAPTER 49 RENAL FAILURE Demetrius Ellis, Ellis D. Avner, John C.
Maino, II, George R. Schwartz
CHAPTER 50 URINARY TRACT INFECTIONS, CYSTITIS, PYELONEPHRITIS Mike
Kozminski, George R. Schwartz
CHAPTER 51 HEMATURIA Patricia L. Lamb
CHAPTER 52 MALE GENITAL PROBLEMS Scott B. Freeman
CHAPTER 53 ACUTE URINARY RETENTION AND BLADDER DRAINAGE Lester
Karafin, A. Richard Kendall
CHAPTER 54 NEUROGENIC BLADDER: CAUSES AND EVALUATION Scott B.
Freeman
CHAPTER 55 RENAL CALCULI (KIDNEY STONES) John J. Pahira
E. Obstetr ics and Gynecology
CHAPTER 56 OBSTETRIC EMERGENCIES
56–1 Emergency Delivery
56–2 Ectopic Pregnancy Russell J. Carlisle, Barbara Hanke
56–3 Hypertensive Disorders of Pregnancy and Preeclampsia Russell
J. Carlisle
56–4 Medical Disorders of Pregnancy Van H. Miller
56–5 Medication Use in Pregnancy
56–7 Postpartum Infections Mark D. Westfall
CHAPTER 57 GYNECOLOGIC EMERGENCIES
57–1 Pelvic Pain in Women: Evaluation Stephen J.
Wheeler
57–2 Vaginal Infections
Christopher K. Wuerker, Joseph C. Howton
57–3 Vaginal Bleeding Arthur Shapiro
CHAPTER 58 THE SEXUALLY ASSAULTED PATIENT Stephen D. Higgins,
George R. Schwartz
F. Infectiou s Disease
59–2 Vaccines and Immunoprophylaxis: Measles, Mumps, Rubella,
Diphtheria, Pertussis, Varicella, Rabies, Tetanus, and Other
Communicable Diseases David N. Zull
CHAPTER 60 INFECTIOUS DISEASE
60–1 Patients at Higher Risk for Infection George R.
Schwartz
60–2 Fever and Sepsis Sid M. Shah, James J. Gordon, M. Jevitz
Patterson, Steven G. Rothrock, George R. Schwartz
60–3 Antibiotic Choices Mary Anne Mangelsen, Kenneth A. Murphy,
Jr.
CHAPTER 61 SPECIFIC INFECTIONS
61–2 Sinusitis Arnold M. Cohn, John R. Jacobs
61–3 Ear Infections Donald R. Paugh, Steven A. Telian
61–4 Infections Causing Obstruction of the Upper Airway
Suzanne M. Shepherd, Gerard R. Cox
61–5 Community-acquired Pneumonia Ghiath Bayasi, Georges S. Yacoub,
Basim A. Dubaybo
61–6 Meningitis and Meningoencephalitis Mary Anne Mangelsen
61–7 Herpes Simplex Meningoencephalitis George R.
Schwartz
61–8 Other Infections: Osteomyelitis, Tetanus, Miliary
Tuberculosis, Coccidioides, Histoplasmosis, Blastomyces
George R. Schwartz
61–9 Diarrhea W. McDowell Anderson, Robert R. Brinson, George R.
Schwartz
CHAPTER 62 ABSCESSES
62–1 Abscesses of the Head and Neck John R. Jacobs, Arthur W.
Weaver
62–2 Cutaneous Abscesses, Necrotizing Fasciitis, and Gas Gangrene
John I. Ellis, George R. Schwartz, Patrick Connell
CHAPTER 63 SEXUALLY TRANSMITTED DISEASES
63–1 Sexually Transmitted Diseases Sumner E. Thompson, George
R.Schwartz, Ralph K. Della Ratta
63–2 HIV-Related Illness in the Emergency Department Gregory J.
Moran
G. Endocr ine and Metabol ic Balance
CHAPTER 64 DIABETES AND COMPLICATIONS
64–1 Diabetic Ketoacidosis David K. English, Joseph C. Howton
64–2 Hypoglycemia R. Carter Clements
64–3 Nonketotic Hypertonicity in Diabetes Mellitus Kristi Koenig,
Eric Stirling, Joseph C. Howton
64–4 Lactic Acidosis Douglas M. Salyards, Joseph C. Howton
CHAPTER 65 ADRENAL INSUFFICIENCY AND ADRENAL CRISIS David Baldwin,
Jr.
CHAPTER 66 INAPPROPRIATE SECRETION OF ANTIDIURETIC HORMONE David L.
Vesely
CHAPTER 67 THYROID DISORDERS
67–1 Hypothyroidism and Myxedema Coma Joseph C. Howton
67–2 Hyperthyroidism and Thyroid Storm Joseph C. Howton
CHAPTER 68 PHEOCHROMOCYTOMA Mukarem A. Siddiqui, Sushma Reddy,
James R. Sowers
CHAPTER 69 THE PORPHYRIAS Barbara H. Greene
CHAPTER 71 ACQUIRED HEMORRHAGIC DISORDERS Rajalaxmi McKenna
CHAPTER 72 EMERGENCY MANAGEMENT OF COMMON CONGENITAL BLEEDING
SYNDROMES: HEMOPHILIA AND ALLIED DISORDERS Wadie F. Bahou
CHAPTER 73 BLOOD CELL DISORDERS
73–1 Thrombocytopenic Disorders Steve Hulsey, Joseph C.
Howton
73–2 Leukocyte Dysfunction and Neutropenia Martin R. Klemperer,
Joseph C. Howton
73–3 Polycythemias Eric Stirling
CHAPTER 74 SICKLE CELL DISEASE William Reed, Elliott
Vichinsky
CHAPTER 75 SPLENOMEGALY Lawrence Dall, Lori Eakin
CHAPTER 76 TRANSFUSION THERAPY IN EMERGENCY MEDICINE Steven J.
Davidson, Ilya M.Chern
CHAPTER 77 ONCOLOGIC EMERGENCIES George R. Schwartz, Timothy G.
Janz, James Ungar
I . Neurolog ic
CHAPTER 78 NEUROLOGICAL PROCEDURES Venkat Narayan, William F.
Bouzarth
CHAPTER 79 EMERGENCY EVALUATION OF NEUROLOGIC DISORDERS J. Stephen
Huff, Thomas P. Bleck, Aron S. Buchman
CHAPTER 80 HEADACHE AND FACIAL PAIN
80–1 General Approach George R. Schwartz
80–2 Migraine
Joel R. Saper
80–3 Facial Pain, Trigeminal Neuralgia, and Tics George R.
Schwartz
CHAPTER 81 SYNCOPE
81–1 Evaluation and General Considerations Stephen L. Adams, Gary
J. Martin
81–2 Selected ED Presentations of Syncope Milton N. Luria, George
R. Schwartz
CHAPTER 82 CONFUSION Arthur P. Safran, Thomas D. Sabin
CHAPTER 83 THE COMATOSE PATIENT Michael C. Smith, George
Katsamakis
CHAPTER 84 SEIZURES Kevin M. Kelly, James P. Valeriano
CHAPTER 85 DIZZINESS OR VERTIGO Kevin M. Kelly, Steven A. Telian,
Thomas M. Stein
CHAPTER 86 STROKE AND TRANSIENT ISCHEMIC ATTACKS Stephen J. Marks,
Alan J. Tuchman
CHAPTER 87 NONTRAUMATIC SPINAL CORD SYNDROMES Philippe D.
Vaillancourt, George R. Schwartz
CHAPTER 88 NEUROMUSCULAR EMERGENCIES James W. Albers, Mark B.
Bromberg
CHAPTER 89 INCREASED INTRACRANIAL PRESSURE Thomas P.
Bleck
CHAPTER 90 HYDROCEPHALUS SHUNTS IN THE EMERGENCY DEPARTMENT Robert
C. Dauser
CHAPTER 91 NEUROLEPTIC MALIGNANT SYNDROME Barbara S.
Koppel
J. Ophthalmology
CHAPTER 92 OCULAR EVALUATION AND PROCEDURES: GENERAL CONSIDERATIONS
George L. Spaeth, John Purcell, Jr., John B. Jeffers, John A.
Milton
CHAPTER 93 OCULAR TRAUMA John J. Purcell, George L. Spaeth, John A.
Milton
CHAPTER 94 ACUTE VISUAL LOSS Douglas D. Brunette, Steven R.
Bennett
CHAPTER 95 THE ACUTE PAINFUL EYE Michael E. Whiting
CHAPTER 96 COMMON EYE INFECTIONS Theodore Rabinovitch, Scott S.
Weissman, Robert A. Nozik
CHAPTER 97 NEURO-OPHTHALMOLOGIC EMERGENCIES Douglas D. Brunette,
Steven R. Bennett
CHAPTER 98 THE EYE AND SYSTEMIC DISEASE
CHAPTER 99 OPHTHALMOLOGIC PHARMACOTHERAPY IN EMERGENCIES Scott S.
Weissman, Theodore Rabinovitch, Robert A. Nozik
K. Dermatology
CHAPTER 100 DERMATOLOGIC EXAMINATION Philip D. Shenefelt, Neil A.
Fenske
CHAPTER 101 PRURITUS George R. Schwartz, Howard M. Simons
CHAPTER 102 CUTANEOUS SIGNS OF SYSTEMIC DISEASE Eric
Stirling
CHAPTER 103 LIFE-THREATENING DERMATOSES Jeffrey P. Callen, Carol L.
Kulp-Shorten
CHAPTER 104 DERMATITIS Joseph F. Fowler, Jr.
CHAPTER 105 PURPURA George R. Schwartz, Howard M. Simons
CHAPTER 106 SKIN INFECTIONS George R. Schwartz, Howard M.
Simons
CHAPTER 107 VESICULOBULLOUS ERUPTIONS George R. Schwartz, Howard M.
Simons
CHAPTER 108 DRUG ERUPTIONS Jeffrey P. Callen, Carol L.
Kulp-Shorten
CHAPTER 109 URITICARIA Marc D. Brown
L. Orthopedics
CHAPTER 111 MUSCULOSKELETAL INJURIES
111–1 Trauma to the Extremities and Soft Tissues James R. Ungar,
William R. MacAusland, Leo Capobianco, Barbara K. Hanke
111–2 Salter Classification of Growth Plate Injuries
James R. Ungar
CHAPTER 112 ACUTE LOW-BACK PAIN Charles M. Grudem, George R.
Schwartz
CHAPTER 113 EMERGENCIES IN SPORTS James G. Garrick, James R. Ungar,
Marie D. Schafle, George R. Schwartz
CHAPTER 114 EMERGENCY RHEUMATOLOGY
114–1 Systemic Rheumatic Diseases Rita K. Cydulka, Steven B.
Sorin
114–2 The Swollen Joint
114–2.1 Monoarticular Arthritis Rita K. Cydulka, Steven B.
Sorin
114–2.2 Polyarticular Arthritis Rita K. Cydulka, Steven B.
Sorin
M. Dental and Periodon tal
CHAPTER 115 INTRAORAL LOCAL ANESTHESIA Craig S. Miller, Donald
Falace
CHAPTER 116 TOOTHACHE AND PAIN OF DENTAL ORIGIN
CHAPTER 117 GINGIVA
117–2 Gingival and Periodontal Abscesses James T. Amsterdam
N. Psychiatric and Behavio ral Emergencies
CHAPTER 118 TRIAGE Stephanie von Ammon Cavanaugh, William S.
Gilmer
CHAPTER 119 TIPS FOR INITIAL EVALUATION OF THE NEUROPSYCHIATRIC
PATIENT Craig A. Taylor, Barbara C. Good
CHAPTER 120 EMERGENCY DEPARTMENT PSYCHIATRIC EMERGENCIES Stephanie
von Ammon Cavanaugh, William S. Gilmer
CHAPTER 121 PSYCHIATRIC MEDICAL LEGAL CONSIDERATIONS: CODES,
RESTRAINTS, COMMITMENTS, TRANSFERS, AND COBRA REGULATIONS Stephanie
von Ammon Cavanaugh, William S. Gilmer
CHAPTER 122 ORGANIC BRAIN SYNDROMES AND DISORDERS Stephanie von
Ammon Cavanaugh
CHAPTER 123 ANXIETY OR PANIC DISORDERS Wayne J. Katon
CHAPTER 124 SOMATOFORM DISORDERS
Beverly Fauman
CHAPTER 125 DOMESTIC ABUSE, ELDER ABUSE, AND THE ABUSED, ASSAULTED
ADULT Susan V. McLeer, Margo J. Krasnoff
PART V: SPECIAL POPULATIONS
126–2 Altered Mental Status in Children Daniel J. Isaacman
CHAPTER 127 RESUSCITATION
127–1 Neonatal Resuscitation and Selected Neonatal Emergencies Kent
F. Argubright, Kristi Watterberg
127–2 Pediatric Cardiopulmonary Resuscitation Paula C.
Fink
CHAPTER 128 AIRWAYS
128–1 Management of the Pediatric Airway Thom A. Mayer
128–2 Pediatric Asthma Robert G. Bolte
CHAPTER 129 INFECTIONS
129–1 Infection and Bacteremia: Management of the Febrile Child
Under Two Years Daniel J. Isaacman, Paul N. Seward
129–2 Acute Respiratory Emergencies in Children: Croup,
Epiglottitis, Bronchiolitis, Pneumonia Michael F. Altieri, Thom A.
Mayer
129–3 Pediatric Viral Infections: Measles, Mumps, Rubella “Fifth”
Disease, Roseola, Chicken Pox, Herpes Virus, Cytomegalovirus,
Infectious Mononucleosis, Rotavirus, Adenovirus, Polio,
Conjunctivitis, Gingivostomatitis, Rabies Michael R. Sayre, George
R. Schwartz
CHAPTER 130 SYSTEMS
130–2 Dehydration, Gastrointestinal Emergencies, Pediatric
Appendicitis, Urinary Tract Infections, Hematologic Emergencies,
and Neurologic Emergencies (including Meningitis) George R.
Schwartz, Thom A. Mayer, Garrett E. Bergman, Ellen B. Bishop
130–3 Sudden Infant Death Syndrome and Apparent Life-Threatening
Events Michele R. Wadsworth, George R. Schwartz
130–4 Evaluation and Management of Child Abuse George R. Schwartz,
Steve Lesser, Garrett E. Bergman
P. Geriatrics
CHAPTER 131 GERIATRIC EMERGENCY MEDICINE: OVERVIEW George R.
Schwartz, Gideon Bosker
CHAPTER 132 ACUTE MENTAL STATUS CHANGE IN THE ELDERLY Curt E. Dill,
Dennis P. Price, George R. Schwartz
CHAPTER 133 SEPSIS IN THE ELDERLY George R. Schwartz
PART VI: ENVIRONMENTAL AND TOXICOLOGY EMERGENCIES
Q. Environmental
CHAPTER 135 ENVIRONMENTAL PRESSURE
135–1 Diving and Altitude Emergencies George R. Schwartz, Jeffrey
Sipsy, Barbara K. Hanke
135–2 Hyperbaric Medicine Barbara K. Hanke
CHAPTER 136 NEAR-DROWNING Barbara K. Hanke, George R. Schwartz,
James E. Gerace
CHAPTER 137 BITES
137–2 Diagnosis and Treatment of Snakebite James R. Roberts
137–3 Toxic Bites and Stings Loren Johnson
137–4 Tick-Borne Diseases Mary Anne Mangelsen
CHAPTER 138 LIGHTNING AND ELECTRICAL INJURIES
138–1 Lightning Injuries Edgar B. Billowitz
138–2 Electrical Injuries Edgar B. Billowitz
138–3 Laser and Microwave Injuries
138–4 Radiation Injury George L. Voelz
CHAPTER 139 SMOKE INHALATION Dennis P. Price, Harvey Silverman,
George R. Schwartz
CHAPTER 140 TRAVEL MEDICINE
140–2 Wilderness Medicine Kenneth V. Iserson
140–3 Wilderness Infectious Diseases Sharon Kolber
140–4 Sun-Induced Disorders David A. Kramer, Philip Shayne
140–5 Hypothermia Loren Johnson
140–6 Frostbite and Other Cold Injuries
Loren Johnson
140–7 Heat Stress Diseases Audrey Urbano-Brown, Robert P.
Proulx, George R. Schwartz
R. Toxicology
CHAPTER 141 POISON CONTROL CENTERS Randall J. Berlin, Martin J.
Smilkstein
CHAPTER 142 PREHOSPITAL AND INTERHOSPITAL CARE OF THE POISONED OR
OVERDOSED PATIENT Theodore I. Benzer, Neal Flomenbaum
CHAPTER 143 THE POISONED PATIENT: OVERVIEW George R.
Schwartz
CHAPTER 144 CRITICAL CARE MEDICAL TOXICOLOGY Howard C. Mofenson,
Thomas R. Caraccio, Joseph Greensher, G. Brady
APPENDIX 144A_INDEX OF SUBSTANCES Howard C. Mofenson, Thomas R.
Caraccio, Joseph Greensher, G. Brady
CHAPTER 145 DRUG ABUSE AND TOXICITY James R. Ungar, George R.
Schwartz, David G. Levine
CHAPTER 146 ALCOHOL
146–1 Alcohol Toxicodynamics and Forensic Considerations Harold
Osborn, James Celentano, John Munyak
146–2 Alcohol Substitutes: Treatment of Poisonings by Methanol,
Ethylene Glycol, and Isopropyl Alcohol Harold Osborn
146–3 Alcohol Withdrawal: Differential Diagnosis and Emergency
Treatment David B. McMicken
146–4 Alcohol-Related Diseases: Emergency Department Management
John I. Ellis, Michael Whiting, Martha Roper
CHAPTER 147 OCCUPATIONAL EXPOSURES AND ART HAZARDS Steven H.
Lesser, Steven J. Weiss
CHAPTER 148 FOOD POISONING George R. Schwartz
PART VII: MISCELLANEOUS
S. Emergency Med ical Services (EMS) Systems
CHAPTER 149 EMS SYSTEMS DEVELOPMENT IN THE UNITED STATES
Alexander Kuehl
CHAPTER 150 EMS SYSTEMS FACTORS AND SURVIVAL OF CARDIAC ARREST
Mickey S. Eisenberg
CHAPTER 151 THE EFFECT OF EMS SYSTEMS FACTORS ON TRAUMA SURVIVAL
George R. Schwartz
CHAPTER 152 GROUND AND AIR EMERGENCY TRANSPORT Gregory W.
Hendey
CHAPTER 153 DISASTER PLANNING AND OPERATION IN THE EMERGENCY
DEPARTMENT Theresa M. Schwab, Eric K. Noji
CHAPTER 154 INTERNATIONAL PERSPECTIVE OF EMS SYSTEMS
DEVELOPMENT
154–1 Germany Markus D.W. Lipp, Andreas R. Thierbach
154–2 Emergency Care “Skoraya” in Russia Michail V.
Grinev
154–3 Australia Harry F. Oxer
154–4 Terrorism: EMS Issues and Management John E. Prescott, Thom
A. Mayer
T. Emergenc y Department Management
CHAPTER 155 INTRODUCTION TO MANAGEMENT: DEFINITIONS, UTILIZATION,
AND WORKFORCE ISSUES James S. Cohen
CHAPTER 156 THE WORK ENVIRONMENT IN EMERGENCY MEDICINE: STRESS,
SHIFT WORK, AND AVOIDING BURNOUT George R. Schwartz
CHAPTER 157 THE ROLE OF THE EMERGENCY DEPARTMENT DIRECTOR
CHAPTER 158 TIPS FOR CONTINUOUS QUALITY IMPROVEMENT Thom A.
Mayer
CHAPTER 159 FAST-TRACK CARE AND OCCUPATIONAL MEDICINE David
Brooke
CHAPTER 160 TIPS FOR CONTRACTING WITH MANAGED CARE ORGANIZATIONS
Thom A. Mayer
CHAPTER 161 FINANCIAL ASPECTS OF EMERGENCY MEDICINE James S.
Cohen
CHAPTER 162 EDUCATION IN EMERGENCY DEPARTMENTS: FOCUS ON DECISION
MAKING Sheldon Jacobson, George R. Schwartz
CHAPTER 163 COMPUTERS AND EMERGENCY MEDICINE Mark Mandell, Ashraf
Nashed, John Horning
U. Medicolegal Aspects o f Emergency Care
CHAPTER 164 MEDICOLEGAL ISSUES IN EMERGENCY MEDICINE John D.
Dunn
APPENDIX A: NORMAL REFERENCE VALUES Dennis R. Ehrhardt
APPENDIX B: USEFUL TABLES
CONTRIBUTORS
Norman S. Abramson, M.D. Professor of Emergency Medicine Ohio State
University Columbus, Ohio
Jose A. Acosta, M.D., F.A.C.S. Attending Surgeon Department
of General Surgery and Critical Care National Naval Medical
Center Bethesda, Maryland
Stephen L. Adams, M.D., F.A.C.P., F.A.C.E.P. Associate
Professor of Medicine Northwestern University Medical
School
Associate Chief, Division of Emergency Medicine Department of
Medicine Clinical Practice Director, Emergency Medicine
Northwestern Medical Faculty Foundation
Associate Medical Director, Emergency Medical Services
Northwestern Memorial Hospital Chicago, Illinois
Nanakram Agarwal, M.D. New York Medical College Our Lady of Mercy
Medical Center Bronx, New York
James W. Albers, M.D., Ph.D. Professor of Neurology Director,
Neuromuscular Program Department of Neurology University of
Michigan Medical Center
Ann Arbor, Michigan
James T. Amsterdam, D.M.D., M.D. Professor of Emergency Medicine
Department of Emergency Medicine Northeastern Ohio Universities
College of Medicine Rootstown, Ohio
Ellen E. Anderson, M.D. Currently Missionary Physician in
Africa
Gail V. Anderson, Jr., M.D., M.B.A., F.A.C.E.P. Associate
Professor Department of Surgery (Emergency Medicine) Emory
University School of Medicine Senior Vice President
Department of Medical Affairs Grady Health System
Atlanta, Georgia
W. McDowell Anderson, M.D. Associate Professor of Medicine
Division of Pulmonary and Critical Care Medicine University of
Southern Florida College of Medicine Tampa, Florida
Kent F. Argubright, M.D. Albuquerque, New Mexico
University Hospital and Medical Center Stony Brook, New
York
David Baldwin, Jr., M.D. Assistant Professor of Medicine
Department of Internal Medicine Rush Medical College Chicago,
Illinois
Nicholas Balsano, M.D. Bronx, New York
Ghiath Bayasi, M. D. Genesee Lung Associates Burton, Michigan
Steven R. Bennett, M.D. Clinical Assistant Professor
Department of Ophthalmology University of Minnesota
Minnesota, Minnesota
Theodore I. Benzer, M.D., Ph.D. Lecturer in Medicine Harvard
Medical School Emergency Department Massachusetts
General Hospital Boston, Massachusetts
Garrett E. Bergman, M.D. Clinical Professor of Pediatrics
Department of Pediatrics
Allegheny University of the Health Sciences Philadelphia,
Pennsylvania
Randall J. Berlin, M.D., D.A.C.E.P. Clinical Instructor
Department of Emergency Medicine Oregon Health Sciences
University Portland, Oregon
James L. Bernat, M.D. Professor of Neurology Dartmouth
Medical School Hanover, New Hampshire Neurology Service
Dartmouth-Hitchcock Medical Center Lebanon, New
Hampshire
Edgar B. Billowitz, M.D., F.A.C.E.P. Staff Physician Department of
Emergency Medicine St. Vincent Hospital Santa Fe, New
Mexico
Gloria Birkholz, R.N., J.D. Professor of Nursing College of
Nursing University of New Mexico
Albuquerque, New Mexico
Ellen B. Bishop, M.D., F.A.A.P. Department of Pediatrics Lehigh
Valley Hospital
Allentown, Pennsylvania
James C. Blankenship, M.D., F.A.C.C., F.S.C.A.I. Director, Cardiac
Catheterization Laboratories Department of Cardiology, Geisinger
Medical Center Pennsylvania State Geisinger Health System
Danville, Pennsylvania
Thomas P. Bleck, M.D. Assistant Professor Health and
Science Center Department of Neurology University of
Virginia Medical Center Charlottesville, Virginia
Andrew Blitzer, M.D., D.D.S. Professor of Clinical
Otolaryngology Columbia University Director, New York
Center for Voice and Swallowing Disorders New York, New
York
James K. Bouzoukis, M.D., F.A.C.S., F.A.A.E.M. Program
Director Department of Emergency Medicine Medical Center of
Delaware Newark, Delaware
David M. Bowling, M.D., F.A.C.S. Clinical Instructor in Otology
& Laryngology Harvard Medical School Department of
Otolaryngology-Head and Neck Surgery Massachusetts Eye and
Ear Infirmary Boston, Massachusetts
G. Brady, M.D.
Robert R. Brinson, M.D. Montgomery, Alabama
Mark B. Bromberg, M.D., Ph.D. Associate Professor
Department of Neurology University of Utah Medical
Center Salt Lake City, Utah
David Brooke, M.D., F.A.C.E.P. Medical Director Department of
Emergency Services Lakeland Regional Medical Center Lakeland,
Florida
Marc D. Brown, M.D. Associate Professor of Dermatology
Department of Dermatology University of Rochester
Strong Memorial Hospital Rochester, New York
Douglas D. Brunette, M.D. Department of Emergency Medicine Hennepin
County Medical Center Minneapolis, Minnesota
Aron S. Buchman, M.D. Associate Professor Department of
Neurology Rush-Presbyterian St. Luke’s Medical Center
Chicago, Illinois
Paul I. Bulat, M.D., F.A.C.E.P. Instructor in Medicine Division of
Emergency Medicine The University of Massachusetts Medical
School Director of Emergency Services St. Luke’s Hospital of
New Bedford, Inc. New Bedford, Massachusetts
Richard E. Burney, M.D., F.A.C.S. Professor of Surgery
University of Michigan
Ann Arbor, Michigan
Jeffrey P. Callen, M.D. Professor and Chief Department of
Medicine Division of Dermatology University of Louisville
School of Medicine Louisville, Kentucky
Leo J. Capobianco, D.O. Morristown Memorial Hospital
Emergency Medicine/Travel Medicine Emergency Medical Associates
Livingston, New Jersey
Assistant Professor of Emergency Medicine University
Hospital State University of New York at Stony Brook
Stony Brook, New York
Russell J. Carlisle, M.D., F.A.C.E.P. Medical Director
Emergency Department Providence Seattle Medical Center
Clinical Instructor Department of Internal Medicine
University of Washington Seattle, Washington
Rosanne Carrero, M.D. St. Joseph Hospital Bellingham,
Washington Ketchikan General Hospital Ketchikan, Alaska
C. Gene Cayten, M.D., M.P.H., F.A.C.S. Professor of Surgery and
Preventive and Community Medicine Director, Institute for Trauma
and Emergency Care Director, Department of Surgery, Our Lady of
Mercy Medical Center New York Medical College Valhalla, New
York
James J. Celentano, M.D., Ph.D. Attending Physician
Department of Emergency Medicine Lincoln Medical and Mental Health
Center Bronx, New York
Ilya M. Chern, M.D., F.A.C.E.P. Chief Department of Emergency
Medicine Plantation General Hospital Plantation,
Florida
Clark Chipman, M.D. Emergency Physician Emanuel Hospital and Health
Center Clinical Associate Professor of Emergency Medicine
Department of Emergency Medicine Oregon Health Sciences
University Portland, Oregon
John R. Clarke, M.D., F.A.C.S. Professor of Surgery
Allegheny University of the Health Sciences Philadelphia,
Pennsylvania
R. Carter Clements, M.D., F.A.C.E.P. Clinical Instructor in
Medicine Department of Internal Medicine Division of Emergency
Medicine University of California, San Francisco San Francisco,
California
Assistant Chief/CQI Coordinator Department of Emergency
Medicine
ACMC Highland Hospital Oakland, California
James S. Cohen, M.D., D.A.B.E.M., D.A.B.I.M., F.A.A.E.M.
Attending Physician Saratoga Emergency Physicians Saratoga
Springs, New York
Arnold M. Cohn, M.D. Professor Department of
Otolaryngology-Head and Neck Surgery Wayne State University
Medical School Detroit, Michigan
Stephen A. Colucciello, M.D., F.A.C.E.P. Director, Clinical
Services Trauma Coordinator Department of Emergency Medicine
Carolinas Medical Center Charlotte, North Carolina
Francis L. Counselman, M.D., F.A.C.E.P. Associate Professor
and Chairman Department of Emergency Medicine Eastern Virginia
Medical School Norfolk, Virginia
Gerard R. Cox, M.D., M.H.A., F.A.C.E.P. Commander Medical Corps,
U.S. Navy Clinical Assistant Professor Department of
Military and Emergency Medicine Uniformed Services University of
the Health Sciences Bethesda, Maryland Clinical Assistant
Professor Department of Emergency Medicine University of
South Alabama School of Medicine Mobile, Alabama
Paul A. Cunningham, M.B., B.S., F.A.C.E.M. Emergency Physician
Emergency Department Concord Hospital Sydney,
Australia
Rita K. Cydulka, M.D., F.A.C.E.P. Residency Director
Department of Emergency Medicine Metro Health Medical
Center
Assistant Professor Department of Surgery Case
Western Reserve University Cleveland, Ohio
Robert H. Dailey, M.D., F.A.C.E.P. Clinical Professor
Department of Medicine University of California, San Francisco San
Francisco, California
Lawrence Dall, M.D. Professor of Medicine Chief, Section of
Infectious Diseases University of Missouri-Kansas City School of
Medicine Kansas City, Missouri
Jamie Dananberg, M.D. Clinical Research Physician Diabetes Care and
Endocrinology Lilly Research Laboratories Indianapolis,
Indiana
Robert C. Dauser, M.D. Assistant Professor University
of Michigan
Ann Arbor, Michigan
Steven J. Davidson, M.D., M.B.A. Chairman Department of Emergency
Medicine Maimonides Medical Center Professor of Clinical
Emergency Medicine Department of Emergency Medicine State
University of New York Health Sciences Center Brooklyn, New
York
Ralph K. Della Ratta, M.D. Mineola, New York
Gerald B. Demarest, M.D. Director, Burn and Trauma Service
University of New Mexico Medical Center
Albuquerque, New Mexico
Jeffrey B. Dembo, D.D.S., M.S. Professor of Oral and Maxillofacial
Surgery Department of Oral Health Practice University of
Kentucky College of Dentistry Lexington, Kentucky
Curt E. Dill, M.D.
Stephen J. Dresnick, M.D., F.A.C.E.P. Clinical Professor
Department of Emergency Medicine University of North Carolina
Chapel Hill, North Carolina President Sterling Health Care
Group Miami, Florida
Basim A. Dubaybo, M.D. Associate Professor of Medicine
Department of Internal Medicine Wayne State University School of
Medicine Detroit, Michigan
John E. Duldner, M.D. Clinical Research Fellow Department of
Emergency Medicine MetroHealth Medical Center Cleveland,
Ohio
John Dale Dunn, M.D., J.D., F.A.C.E.P., F.A.C.L.M., F.A.A.F.P.
Director Emergency Services and Physician Advisor Brownwood
Regional Medical Center Brownwood, Texas
Lori Eakin, M.D. Instructor, Clinical Pediatrics University of
Missouri-Kansas City School of Medicine Kansas City,
Missouri
Frederic E. Eckhauser, M.D. Professor of Surgery Department
of Surgery Chief, Division of Gastrointestinal Surgery
University of Michigan Medical Center
Ann Arbor, Michigan
Dennis R. Ehrhardt, M.D. St. Vincent Hospital Santa Fe, New
Mexico
Frank Ehrlich, M.D., F.A.C.S. Chairman, Department of Surgery
St. Joseph’s Hospital and Medical Center Paterson, New
Jersey
Mickey S. Eisenberg, M.D., Ph.D. Professor of Medicine Director of
Emergency Medicine Service University of Washington Medical
Center Seattle, Washington
Demetrius Ellis, M.D. Professor of Pediatrics and Nephrology
Director of Pediatric Nephrology University of Pittsburgh
School of Medicine Children’s Hospital of Pittsburgh Pittsburgh,
Pennsylvania
John I. Ellis, M.D. Assistant Clinical Professor
Department of Medicine Division of Emergency Medicine University of
California San Francisco San Francisco, California Doctor’s Medical
Center San Pablo, California
Charles L. Emerman, M.D. Chairman Department of Emergency Medicine
MetroHealth Medical Center Cleveland, Ohio
David K. English, M.D. Medical Student Director Department of
Emergency Medicine
Alameda County Medical Center Oakland, California
Assistant Clinical Professor of Medicine Department of
Medicine University of California San Francisco San Francisco,
California
Lexington, Kentucky
Beverly J. Fauman, M.D., F.A.P.A, F.A.C.Psych. Associate
Professor of Psychiatry University of Maryland School of
Medicine Senior Psychiatrist Walter P. Carter Center
University of Maryland Medical Systems Baltimore,
Maryland
David V. Feliciano, M.D., F.A.C.S. Professor of Surgery Emory
University School of Medicine Chief of Trauma and Tumor Services
Grady Memorial Hospital
Atlanta, Georgia
Neil A. Fenske, M.D., F.A.C.P. Professor and Director
Department of Cutaneous Surgery University of South Florida
College of Medicine Tampa, Florida
Paula C. Fink, M.D., F.A.A.P. Clinical Assistant Professor of
Pediatrics Department of Pediatrics University of Minnesota,
Childrens Health Care Minneapolis, Minnesota
Neal Flomenbaum, M.D. Professor of Clinical Medicine Cornell
University Medical College Chief, Emergency Medicine The New York
Hospital New York, New York
Joseph F. Fowler, Jr., M.D. Associate Clinical Professor of
Dermatology Director, Occupational Dermatology and Patch Test
Clinic University of Louisville School of Medicine
Louisville, Kentucky
Scott B. Freeman, M.D., F.A.C.E.P. Residency Director and Assistant
Professor Section of Emergency Medicine Wayne State
University Detroit Receiving Hospital and University Health
Center Emergency Department Detroit, Michigan
Stuart R. Fritz, M.D., F.A.C.E.P. Emergency Physicians Professional
Association Minneapolis, Minnesota
James G. Garrick, M.D. Director, Center for Sports Medicine St.
Francis Memorial Hospital San Francisco, California
Cloyd B. Gatrell, M.D., F.A.C.E.P. Colonel, Medical Corps
Commander Munson Army Community Hospital Fort
Leavenworth, Kansas
Robin J. Gaupp, M.D., D.A.B.R. Attending Radiologist
Santa Fe Radiology St. Vincent Hospital Santa Fe, New
Mexico
Thomas A. Gennarelli, M.D., F.A.C.S. Professor and Chair
Department of Neurosurgery
Allegheny University of the Health Sciences Philadelphia,
Pennsylvania
Steven E. Gentry, M.D. Assistant Professor of Medicine
Department of Internal Medicine Eastern Virginia Medical
School Norfolk, Virginia
James E. Gerace, M.D. Medical Director USA MCO Chief of Staff
Phoenix Memorial Hospital Phoenix, Arizona
William S. Gilmer, M.D. Assistant Professor
Asher Center for Study & Treatment of Depressive
Disorders Chicago, Illinois
H. Warren Goldman, Ph.D., M.D. Clinical Professor and Vice Chairman
Department of Neurosurgery Jefferson Medical College
Director, Center for Minimally Invasive Brain Surgery Wills
Neurosensory Institute Thomas Jefferson University Hospital
Philadelphia, Pennsylvania
Barbara C. Good, Ph.D. Senior Medical Writer Neurosciences
Research Center
Allegheny University of the Health Sciences Pittsburgh,
Pennsylvania
James G. Gordon, M.D., F.A.C.P. Assistant Clinical Professor
of Medicine Department of Medicine Wayne State University
Detroit, Michigan
Barbara H. Greene, M.D. Associate Professor of Medicine
Division of General Medicine Emory University
Atlanta, Georgia
Ruth Ann Greenfield, M.D. Assistant Professor of Medicine
Division of Cardiology Duke University Medical Center
Durham, North Carolina
Joseph Greensher, M.D. Medical Director and Associate Chairman
Department of Pediatrics
Associate Director Long Island Regional Poison Control
Center Winthrop University Hospital Mineola, New
York Professor of Pediatrics University of New York at Stony
Brook Stony Brook, New York
David Gregory, M.D. Captain, United States Public Health Service
Senior Consultant in Infectious Disease Indian Health Service Santa
Fe Indian Hospital Santa Fe, New Mexico
Michail V. Grinev, M.D., Ph.D. Professor Director of
Institute of Emergency Care Djanelidze Research Institute of
Emergency Care St. Petersburg, Russia
Charles M. Grudem, M.D., D.A.B.E.M., F.N.A.S.S., F.A.A.D.E.P.
Medical Director Managed Disability UNICARE
Atlanta, Georgia
Barbara K. Hanke, M.D., F.A.C.E.P. Staff Emergency Physician St.
Vincent Hospital Santa Fe, New Mexico Clinical Assistant
Professor of Family and Community Medicine University of New Mexico
School of Medicine
Albuquerque, New Mexico
Cherie A. Hargis, M.D. Attending Physician Department of
Emergency Medicine
Alameda County Medical Center, Highland Campus Oakland,
California
Gregory W. Hendey, M.D. Assistant Clinical Professor of
Medicine University of California San Francisco University Medical
Center Fresno, California
Torrance, California Associate Professor of Medicine
University of California Los Angeles School of Medicine Los
Angeles, California
Gregory P. Hess, M.D. Georgetown Medical Center Washington,
D.C.
Stephen D. Higgins, M.D. Medical Director Department of
Emergency Services St. Francis Medical Center Lynwood,
California
John Horning, M.D. Staff Physician Department of Emergency Medicine
Elliot Hospital Manchester, New Hampshire
Joseph C. Howton, M.D. Assistant Clinical Professor of
Medicine Department of Medicine University of California School of
Medicine San Francisco, California
Attending Physician Department of Emergency Medicine Good
Samaritan Hospital Puyallup, Washington
J. Stephen Huff, M.D. Associate Professor of Emergency
Medicine and Neurology Department of Emergency Medicine
University of Virginia Health Sciences Center
Charlottesville, Virginia
Steve Hulsey, M.D. Assistant Professor Department of
Surgery University of Vermont Burlington,
Vermont
Daniel J. Isaacman, M.D., F.A.A.P. Division Director
Pediatric Emergency Medicine Children’s Hospital of the King’s
Daughters
Associate Professor of Pediatrics Eastern Virginia Medicine
School Norfolk, Virginia
Kenneth V. Iserson, M.D., M.B.A., F.A.C.E.P. Professor of
Surgery Director, Arizona Bioethics Program University of
Arizona College of Medicine Tucson, Arizona
Rao R. Ivatury, M.D., F.A.C.S. Associate Professor of
Surgery New York Medical College Chief of Trauma Co-Director
of SICU Lincoln Hospital Bronx, New York
John R. Jacobs, M.D. Professor Otolaryngology-Head and Neck
Surgery Wayne State University Medical School Director,
Head and Neck Cancer Program Karmanos Cancer Institute Detroit,
Michigan
Sheldon Jacobson, M.D. Professor and Chairman Department of
Emergency Medicine Mount Sinai School of Medicine New York, New
York
Timothy G. Janz, M.D. Associate Professor Department of
Emergency Medicine and Pulmonary/Critical Care Division Department
of Medicine Wright State University School of Medicine Dayton,
Ohio
Mark T. Jobe, M.D. Assistant Professor Department of
Orthopaedic Surgery University of Tennessee-Campbell
Clinic Memphis, Tennessee
Loren A. Johnson, M.D., F.A.C.E.P. Medical Director Emergency
Department Sutter Davis Hospital Davis,
California
E. Jeff Justis, Jr., M.D. Clinical Associate Professor
Department of Orthopedics University of Tennessee-Campbell
Foundation Memphis, Tennessee
Lester J. Karafin, M.D. Professor Emeritus Department of
Urology Temple University Professor Emeritus Department
of Urology Medical College of Pennsylvania Philadelphia,
Pennsylvania
Wayne Katon, M.D. Professor and Chief Division of
Consultation-Liaison Department of Psychiatry and Behavioral
Sciences University of Washington School of Medicine Seattle,
Washington
George Katsamakis, M.D. Department of Neurological Sciences
Rush-Presbyterian-St. Luke’s Medical Center Chicago,
Illinois
Gabor D. Kelen, M.D. Professor and Chair Johns Hopkins
University Emergency Physician-in-Chief Johns Hopkins
Hospital Department of Emergency Medicine Baltimore,
Maryland
Arthur L. Kellermann, M.D., M.P.H., F.A.C.E.P. Professor of
Emergency Medicine Director, Center for Injury Control
Rollins School of Public Health of Emory University
Atlanta, Georgia
Kevin M. Kelly, M.D., Ph.D. Associate Professor
Department of Neurology
Allegheny University of the Health Sciences Pittsburgh,
Pennsylvania
A. Richard Kendall, M.D. Professor of Urology Temple
University Hospital Department of Urology Philadelphia,
Pennsylvania
Morton J. Kern, M.D. Cardiac Catheterization Laboratory St.
Louis, Missouri
Martin R. Klemperer, M.D. Professor of Pediatrics University of
South Florida Medical Director, Bone Marrow Transplantation
Services Department of Pediatrics
All Children’s Hospital St. Petersburg, Florida
James A. Knol, M.D. Associate Professor of Surgery
University of Michigan Medical School
Ann Arbor, Michigan
Kristi Koenig, M.D. Associate Professor of Medicine
University of California San Francisco Department of Emergency
Medicine
Alameda County Medical Center/Highland General Hospital
Oakland, California
Sharon S. Kolber, M.D. Staff Physician Emergency Department
Lovelace Medical Center Clinical Assistant Professor
University of New Mexico School of Medicine Department of Emergency
Medicine
Albuquerque, New Mexico
Barbara S. Koppel, M.D. Professor of Clinical Neurology
Department of Neurology New York Medical College New York,
New York
Mike Kozminski, M.D., F.A.C.S. Private Practice Urologist
Phoenix Urology of St. Joseph, Inc. St. Joseph,
Missouri
David A. Kramer, M.D., F.A.C.E.P. Associate Professor
Department of Emergency Medicine Emory University School of
Medicine
Atlanta, Georgia
Margo J. Krasnoff, M.D. Associate Professor of Clinical
Medicine Department of Internal Medicine State University of New
York at Buffalo Millard Fillmore Health System Buffalo, New
York
Alexander Kuehl, M.D., M.P.H., F.A.C.E.P., F.A.C.S. Associate
Professor of Surgery and Public Health Cornell University Medical
College New York, New York Emergency Physician-in-Chief
Champlain Valley Physicians Hospital Plattsburgh, New
York
Carol L. Kulp-Shorten, M.D. Assistant Professor of Medicine
(Dermatology) Department of Medicine Division of Dermatology
University of Louisville Louisville, Kentucky
C. Grant LaFarge, M.D., F.A.C.C., F.A.C.P., F.A.P.S. Pediatric
Cardiologist Department of Pediatrics, Cardiology Santa
Fe Pediatric Cardiology, PC Santa Fe, New Mexico Clinical
Professor of Internal Medicine and Pediatrics University of New
Mexico
Albuquerque, New Mexico
Patricia L. Lamb, M.D. Attending Staff Physician W.A. Foote
Memorial Hospital Jackson, Michigan Clinical Instructor,
University of Michigan Emergency Services
Ann Arbor, Michigan
Alta Bates Medical Center Berkeley, California
Steven H. Lesser, M.D., F.A.C.E.P. Associate Professor
Medicine Section of Emergency Medicine Charity Hospital of New
Orleans Louisiana State University New Orleans,
Louisiana
David G. Levine, M.D., F.A.P.A. Associate Clinical
Professor Department of Psychiatry University of
California Medical Center San Francisco, California
Lawrence M. Lewis, M.D., F.A.C.E.P. St. Louis University
Hospital St. Louis, Missouri
Clinic of Anesthesiology University of Mainz Mainz,
Germany
George I. Litman, M.D., F.A.C.C. Professor of Medicine Chief of
Cardiology
Akron General Medical Center Northeastern Ohio
Universities College of Medicine
Akron, Ohio
Milton N. Luria, M.D., F.A.C.P. Professor Emeritus of Medicine
Department of Medicine University of Rochester School of Medicine
and Dentistry Rochester, New York
Robert C. Luten, M.D. Professor, Pediatric Emergency Services
University of Florida Health Science Center Jacksonville,
Florida
William MacAusland, M.D. Faulkner Hospital Jamaica Plain,
Massachusetts
John C. Maino II, M.D., F.A.C.E.P. Associate Medical
Director Department of Emergency Medicine W.A. Foote Memorial
Hospital University of Michigan School of Medicine Jackson,
Michigan
Mark Mandell, M.D., F.A.C.E.P. Chairman and Program Director
Department of Emergency Medicine Morristown Memorial Hospital
Morristown, New Jersey
Mary Anne Mangelsen, Ph.D., M.D. Clinical Assistant Professor of
Emergency Medicine Department of Emergency Medicine University of
Michigan
Ann Arbor, Michigan
John R. Mangiardi, M.D. Chief of Neurosurgery Lenox Hill
Hospital Chairman Foundation for Neurosurgical Research New
York, New York
Stephen J. Marks, M.D. Associate Professor of Clinical
Medicine Department of Neurology New York Medical College
Valhalla, New York Director Department of
Neurology Saint Agnes Hospital White Plains, New
York
Gary J. Martin, M.D., F.A.C.C. Professor of Medicine Chief,
Division of General Internal Medicine Department of Medicine
Northwestern University Medical School Northwestern Medical
Faculty Foundation Chicago, Illinois
Jean T. Martin, M.D., F.A.C.E.P. Medical Director Emergency
Department Centennial Healthcare Plaza Englewood,
Colorado
John A. Marx, M.D. Chairman Department of Emergency Medicine
Carolinas Medical Center Charlotte, North Carolina
Rajalaxmi McKenna, M.D. Associate Professor Department
of Medicine and Pharmacology Former Director Venous
Thrombosis, Radiohematology and Platelet Function Laboratories
Hinsdale, Illinois
Susan V. McLeer, M.D. Professor and Chairman Department of
Psychiatry State University of New York at Buffalo Buffalo,
New York
David McMicken, M.D., F.A.C.E.P. Clinical Assistant Professor of
Family and Preventive Medicine Emory University School of Medicine
President, Acute Care Express Columbus, Georgia
Norman E. McSwain, Jr., M.D. Professor of Surgery Department
of Surgery Tulane Medical School New Orleans,
Louisiana
Craig A. Meek, M.D., F.A.C.E.P. Attending Physician
Department of Emergency Medicine Brackenridge Hospital
Austin, Texas
Abdul M. Memon, M.D., F.A.C.P., F.A.C.E.P. Associate
Professor Division of Emergency Medicine Department of
Medicine University of Miami School of Medicine Miami,
Florida
Craig S. Miller, D.M.D. Associate Professor of Oral Medicine
Oral Health Science University of Kentucky College of
Dentistry Lexington, Kentucky
Van H. Miller, M.D. Chairman Department of Emergency Medicine St.
Francis Medical Center Lynwood, California
John A. Milton, M.D. Wills Eye Hospital Philadelphia,
Pennsylvania
Howard C. Mofenson M.D., D.A.B.M.T., F.A.A.P., F.H.A.C.T. Medical
Director Long Island Regional Poison Control Center
Winthrop University Hospital Professor of Pediatrics and
Emergency Medicine University Hospital Medical School State
University of New York at Stony Brook Mineola, New
York
William W. Montgomery, M.D. , F.A.C.S. John M. Merriam Professor of
Otolaryngology Harvard Medical School Department of
Otolaryngology Massachusetts Eye and Ear Infirmary
Boston, Massachusetts
Gregory J. Moran, M.D., F.A.C.E.P. Assistant Professor of
Medicine University of California Los Angeles School of Medicine
Department of Emergency Medicine Division of Infectious Diseases
Olive View-University of California Los Angeles Medical
Center Sylmar, California
Michael W. Mulholland, M.D., Ph.D. Professor Department of
Surgery University of Michigan
Ann Arbor, Michigan
Daniel G. Murphy, M.D., F.A.C.E.P. Medical Director
Department of Emergency Medicine Maimonides Medical Center
Brooklyn, New York
Kenneth A. Murphy, Jr., Pharm.D., B.C.P.S. Clinical Manager
Department of Pharmacy W.A. Foote Memorial Hospital
Jackson, Michigan
Adjunct Assistant Professor of Clinical Pharmacy Ferris
State University Big Rapids, Michigan
Henry W. Murray, M.D. Professor and Associate Chairman Department
of Medicine Cornell University Medical Center New York, New
York
Venkat Narayan, M.D., F.A.C.S., F.I.C.S. Staff Neurosurgeon St.
Vincent Hospital Santa Fe, New Mexico
Ashraf Nashed, M.D. Assistant Program Director
Residency in Emergency Medicine Department of Emergency Medicine
Morristown Memorial Hospital Morristown, New
Jersey
Edward Newton, M.D. Vice Chairman Department of Emergency Medicine
LAC and University of Southern California Medical Center Los
Angeles, California
Eric Noji, M.D. World Health Organization Geneva,
Switzerland
Robert A. Nozik, M.D. Clinical Professor of Ophthalmology
Department of Ophthalmology University of California San
Francisco Research Ophthalmologist Proctor Foundation San
Francisco, California
Harold Osborn, M.D. Professor and Chairman Department of Emergency
Medicine New York Medical College Valhalla, New York
Harry F. Oxer, M.A., M.B., B.Chir., F.R.C.A. Medical Director
Western Australian Ambulance Service St. John Ambulance, WA Perth,
Western Australia
John H. Pahira, M.D. Professor of Urology Director, Center
for Kidney Stone Disease Department of Surgery Georgetown
University Medical Center Washington, D.C.
Eddy D. Palmer, M.D., M.A.C.P. Private Practice Schooley’s Mt., New
Jersey
M. Jevitz Patterson, M.D. Professor, Microbiology and Pediatrics
Michigan State University East Lansing, Michigan
Donald R. Paugh, M.D. Department of Otolaryngology-Head and Neck
Surgery Wenatchee Valley Clinic Wenatchee,
Washington
Paul E. Pepe, M.D., M.P.H., F.A.C.E.P., F.C.C.M. Professor and
Chairman Department of Emergency Medicine
Allegheny University of the Health Sciences Director,
Emergency Services
Allegheny General Hospital Pittsburgh,
Pennsylvania
Mark A. Peppercorn, M.D. Professor of Medicine Harvard Medical
School Director, Center for Inflammatory Bowel Disease
Division of Gastroenterology Beth Israel Deaconess Medical
Center Boston, Massachusetts
Vincent Pflug, M.D.
Michael P. Poirier, M.D. Assistant Professor of Pediatrics
Children’s Hospital of The King’s Daughters Eastern Virginia
Medical School Norfolk, Virginia
John E. Prescott, M.D., F.A.C.E.P. Professor and Chair
Department of Emergency Medicine West Virginia University School of
Medicine Morgantown, West Virginia
Dennis P. Price, M.D. Attending Physician Emergency
Department Bellevue Hospital Center Emergency Medical
Services New York, New York
Robert P. Proulx, M.D., F.A.C.E.P. Department of Emergency Medicine
St. Joseph Medical Center Burbank, California
John J. Purcell, Jr., M.D. Associate Clinical Professor of
Ophthalmology St. Louis University School of Medicine St.
Louis, Missouri
Les M. Puretz, D.O. Assistant Professor College of
Human Medicine Michigan State University Lansing,
Michigan
Theodore Rabinovitch, M.D., F.R.C.S.C. Lecturer University of
Toronto Department of Ophthalmology Toronto, Ontario,
Canada
Eric C. Rackow, M.D. Professor and Vice Chairman Department of
Medicine New York Medical College Chairman, Department of Medicine
St. Vincent’s Hospital and Medical Center New York, New
York
East Lansing, Michigan
Sushma Reddy, M.D. Assistant Professor of Medicine Division
of Endocrinology and Hypertension Harper and Grace Hospitals Wayne
State University School of Medicine Detroit, Michigan
William Reed, M.D. Fellow in Hematology and Transfusion Medicine
Department of Hematology/Oncology Children’s Hospital of
Oakland Oakland, California
Bruce M. Reinoehl, M.D. Associate Professor of Medicine
Michigan State University
Assistant Chairman, Emergency Department Sparrow
Hospital Lansing, Michigan
Earl J. Reisdorff, M.D., F.A.C.E.P. Program Director Michigan
State University, Emergency Medicine Residency Michigan
Capital Medical Center, Sparrow Hospital Lansing,
Michigan
Karen Rheuban, M.D. Professor of Pediatrics Department of
Pediatrics University of Virginia Charlottesville, Virginia
Ronald L. Rhule, D.O., F.A.C.O.E.P. Medical Director and Chairman
Department of Emergency Medicine Sparrow Hospital Lansing,
Michigan
Albert W. Ritter, M.D. Emergency Medicine Staff Physician
Department of Emergency Medicine Mountainside Hospital
Montclair, New Jersey
James R. Roberts, M.D., F.A.A.E.M., F.A.C.M.T. Professor and Vice
Chair Department of Emergency Medicine Director, Division of
Toxicology
Allegheny University of the Health Sciences Mercy Health
Systems Director, Institute for the Treatment of Bites and Stings
Mercy Hospital of Philadelphia Philadelphia, Pennsylvania
Donald A. Romig, M.D. Associate Clinical Professor
Department of Internal Medicine University of New Mexico Medical
School
Albuquerque, New Mexico
Monica Ann Rosenthal, M.D., F.A.C.E.P. Assistant Chief,
Emergency Medicine Highland General Hospital
Assistant Clinical Professor of Medicine University of
California at San Francisco Oakland, California
Richard Eric Rothman, M.D., Ph.D. Instructor Department of
Emergency Medicine The Johns Hopkins University School of Medicine
Baltimore, Maryland
Steven G. Rothrock, M.D., F.A.A.E.M., F.A.A.P., F.A.C.E.P.
Department of Emergency Medicine Orlando Regional Medical
Center Orlando, Florida Clinical Adjunct Assistant
Professor Division of Emergency Medicine
University of Florida Gainesville, Florida Department of Emergency
Medicine Loma Linda University School of Medicine Loma Linda,
California
Bruce R. Rothwell, D.M.D., M.S.D. Director, Hospital
Dentistry University of Washington Department of Restorative
Dentistry Seattle, Washington
George J. Rubeiz, M.D. Assistant Professor of Medicine Wayne
State University Detroit, Michigan
Wallace Rubin, M.D. Clinical Professor Department of
Otolaryngology & Bio-Communications Louisiana State University
School of Medicine New Orleans, Louisiana
Brent E. Ruoff, M.D., F.A.C.E.P. Associate Chief
Emergency Medicine Division Washington University School of
Medicine St. Louis, Missouri
Robert A. Rusnak, M.D. Associate Physician Department of
Emergency Medicine Hennepin County Medical Center
Minneapolis, Minnesota
Thomas D. Sabin, M.D. Clinical Professor Department of
Neurology Tufts University School of Medicine Boston,
Massachusetts
Peter Safar, M.D., Dr .h.c., F.C.C.M., F.C.C.P. Distinguished
Professor of Resuscitation Medicine Safar Center for Resuscitation
Research Pittsburgh, Pennsylvania
Arthur P. Safran, M.D. Department of Neurology
Columbia-MetroWest Medical Center Framingham,
Massachusetts
Douglas M. Salyards, M.D. Emergency Department W.A. Foote
Memorial Hospital Jackson, Michigan
Joel R. Saper, M.D. Director, Michigan Head-Pain &
Neurological Institute
Ann Arbor, Michigan
Karin H. Satra, M.D. Associate in Clinical Dermatology
Department of Dermatology Columbia Presbyterian Medical
Center New York, New York
Michael R. Sayre, M.D. Assistant Professor Department
of Emergency Medicine University of Cincinnati Cincinnati,
Ohio
Marie D. Schafle, M.D. Director, Sports and Performing Arts
Clinic Student Health Service San Francisco State
University San Francisco, California
Richard K. Scher, M.D. Professor of Clinical Dermatology
Department of Dermatology College of Physicians and Surgeons
Columbia University New York, New York
John M. Schoffstall, M.D. Assistant Professor
Department of Emergency Medicine
Allegheny University of the Health Sciences Philadelphia,
Pennsylvania
Kathleen S. Schrank, M.D., F.A.C.E.P., F.A.C.P. Professor of
Medicine Division of Emergency Medicine University of Miami School
of Medicine Miami, Florida
Bernard M. Schuman, M.D., F.A.C.P., M.A.G.G. Professor of Medicine
Department of Medicine Director, Special Procedures and Endoscopy
Unit Section of Gastroenterology and Hepatology Medical
College of Georgia
Augusta, Georgia
Theresa M. Schwab, M.D. Associate Professor of Medicine
Department of Emergency Medicine University of California San
Francisco University Medical Center Fresno, California
George R. Schwartz, M.D. Director Emergency Medicine of the
Southwest Santa Fe, New Mexico
Adjunct Associate Professor of Emergency Medicine
Allegheny University of the Health Sciences Philadelphia,
Pennsylvania
T. Duncan Sellers, Jr., M.D., F.A.C.C. Electrophysiologist
Department of Cardiology Memorial Hospital Colorado
Springs, Colorado
Paul N. Seward, M.D., F.A.C.E.P., F.A.A.P. Clinical Assistant
Professor of Emergency Medicine Medical College of Georgia
Emergency Department University Hospital
Augusta, Georgia
Sid M. Shah, M.D., F.A.C.E.P. Assistant Clinical
Professor College of Human Medicine Michigan State
University Michigan Capital Medical Center Lansing,
Michigan
Arthur G. Shapiro, M.D., F.A.C.O.G., F.A.C.E. Department of
Obstetrics and Gynecology University of Florida School of
Medicine Miami, Florida
Philip Shayne, M.D., F.A.C.E.P. Assistant Professor
Division of Emergency Medicine Emory University School of
Medicine
Atlanta, Georgia
Daniel J. Shea, M.D., F.A.C.E.P. Assistant Professor of
Emergency Medicine University of Massachusetts Medical
School
Associate Director, Emergency Services St. Luke’s
Hospital New Bedford, Massachusetts
Philip D. Shenefelt, M.D., M.S. Associate Professor
Division of Dermatology and Cutaneous Surgery Department of
Internal Medicine University of South Florida Tampa, Florida
Suzanne Moore Shepherd, M.D., F.A.C.E.P. Associate Professor
and Program Director Department of Emergency Medicine
University of Pennsylvania Medical Center Philadelphia,
Pennsylvania
Mukarem A. Siddiqui, M.D. Harvey Silverman, M.D.
Adjunct Assistant Professor of Clinical Medicine
Dartmouth Medical School Emergency Physician Catholic Medical
Center Manchester, New Hampshire
Jeffrey Sipsey, M.D. Los Angeles County Department of Health
Sciences Emergency Medical Services Medical Alert Center Los
Angeles, California
Morton S. Skorodin, M.D. Staff Physician
Ambulatory Care Service Muskogee VA Medical Center
Muskogee, Oklahoma Professor of Medicine Department of Medicine
University of Oklahoma Tulsa Medical College Tulsa, Oklahoma
Nathan C. Skorodin, Pharm.D. Clinical Pharmacist Heartland
Home Infusions Hinsdale, Illinois
John E. Smialek, M.D. Professor and Head Division of Forensic
Pathology Department of Pathology University of
Maryland School of Medicine Baltimore, Maryland
Martin Smilkstein, M.D., A.C.M.T. Associate Professor of
Emergency Medicine Department of Emergency Medicine Oregon Health
Sciences University Portland, Oregon
Michael C. Smith, M.D. Director, Rush Epilepsy Center
Department of Neurological Sciences Rush-Presbyterian-St. Luke’s
Medical Center
Associate Professor Department of Neurological Sciences
Rush Medical College Chicago, Illinois
Ronald K. Smith, D.O., F.A.C.E.P. Quality Improvement
Coordinator Department of Emergency Medicine Westmoreland
Regional Hospital Greensburg, Pennsylvania
Steven B. Sorin, M.D. Assistant Professor of Medicine Case
Western Reserve University Chief of Rheumatology Mt.
Sinai Medical Center Cleveland, Ohio
Steven M. Sornsin, M.D., F.A.C.E.P. Highland General Hospital
Oakland, California
James R. Sowers, M.D. Professor of Medicine and Physiology
Director, Division of Endocrinology, Metabolism and Hypertension
Department of Internal Medicine Wayne State University School of
Medicine Detroit, Michigan
George L. Spaeth, M.D., F.A.C.S. Professor of Ophthalmology
Jefferson Medical College Director, William Anna Goldberg Glaucoma
Service Wills Eye Hospital Philadelphia, Pennsylvania
Thomas M. Stein, M.D., F.A.C.E.P. Director, Emergency Medical
Support Services Medical Director Life Flight Department of
Emergency Medicine
Allegheny University of the Health Sciences Allegheny
Campus Pittsburgh, Pennsylvania
Michael J. Sullivan, M.D. W.A. Foote Memorial Hospital
Ann Arbor, Michigan
Panagiotis N. Symbas, M.D. Professor of Cardiothoracic
Surgery Department of Cardiothoracic Surgery Emory
University School of Medicine Director Department of
Cardiothoracic Surgery Grady Memorial Hospital
Atlanta, Georgia
James V. Talano, M.D., M.M., F.A.C.C. Chief, Division of
Cardiovascular Medicine Department of Medicine Tulane University
Medical School New Orleans, Louisiana
Satyanarayana Tatineni, M.D., F.A.C.C., F.A.C.P. Department of
Cardiology The Heart Group Evansville, Indiana
Craig A. Taylor, M.D. Community Neuropsychiatric Services, Inc.
Leetsdale, Pennsylvania
Steven A. Telian, M.D. University of Michigan W.A. Foote Memorial
Hospital
Ann Arbor, Michigan
Knox Todd, M.D., M.P.H. Associate Professor Department
of Emergency Medicine Emory University School of Medicine
Atlanta, Georgia
Christopher Truss, M.D. Professor of Medicine Department of
Medicine University of Alabama at Birmingham Birmingham,
Alabama
James R. Tryon, M.D., F.A.C.E.P. New Mexico Family Practice
Associates, Inc.
Albuquerque, New Mexico
Alan J. Tuchman, M.D. Professor of Neurology New York Medical
College Valhalla, New York
James R. Ungar, M.D., F.A.C.E.P. Co-Director Center for
Emergency Medicine
Assistant Medical Director Air Med Team Redding
Medical Center Redding, California
Audrey Urbano-Brown, M.D., F.A.C.E.P. Assistant
Professor Department of Emergency Medicine University of New
Mexico School of Medicine
Albuquerque, New Mexico
James P. Valeriano, M.D. Associate Professor Department
of Neurology
Allegheny University of the Health Sciences Pittsburgh,
Pennsylvania
Michel Vandormael, M.D. Hôpital de la Citadelle Liege,
Belgium
Jonathan Vargas, M.D., F.A.C.E.P. Clinical Associate Professor of
Emergency Medicine Wright State University Dayton, Ohio
David L. Vesely, M.D., Ph.D., F.A.C.P., F.A.C.E. Professor of
Medicine, Physiology and Biophysics Department of Internal Medicine
Chief of Endocrinology and Metabolism University of South Florida
for Health Sciences Tampa Veterans Administration Hospital
Tampa, Florida
Elliott P. Vichinsky, M.D. Director Department of
Hematology/Oncology Children’s Hospital of Oakland
Oakland, California
Raymond N. Vitullo, M.D. Duke University Medical Center
Durham, North Carolina
George L. Voelz, M.D. Occupational Health Specialist
Occupational Medical Group Los Alamos National Laboratory Los
Alamos, New Mexico
Stephanie von Ammon Cavanaugh, M.D. Professor and Chief, Section of
Psychiatry and Medicine Department of Psychiatry Rush
Presbyterian St. Luke’s Medical Center Chicago,
Illinois
Michele R. Wadsworth, M.D. Assistant Professor of Pediatrics
Eastern Virginia Medical School Norfolk, Virginia
Russel G. Wagner, M.D. Assistant Professor Department
of Emergency Medicine University of Alabama at Birmingham
Birmingham, Alabama
Kristi Watterberg, M.D. Associate Professor Department
of Pediatrics, Division of Newborn Medicine Pennsylvania State
University College of Medicine Hershey, Pennsylvania
Marvin A. Wayne, M.D., F.A.C.E.P. Clinical Associate
Professor University of Washington Clinical Assistant
Professor Yale University Medical Director of Emergency
Medical Services Bellingham, Washington Senior Attending
Emergency Department St. Joseph Hospital Bellingham,
Washington
Arthur W. Weaver, M.D. University Health Center Detroit,
Michigan
Nashville, Tennessee
Scott S. Weissman, M.D. Associate Director Department
of Ophthalmology New York Eye and Ear Infirmary New
York, New York
Howard A. Werman, M.D. Associate Professor of Clinical
Emergency Medicine The Ohio State University College of Medicine
and Public Health Columbus, Ohio
Mark Westfall, M.D. Department of Emergency Medicine Mercy
Hospital Dubuque, Iowa
J. Marcus Wharton, M.D. Duke University Medical Center
Durham, North Carolina
Stephen J. Wheeler, M.D. Department of Emergency Medicine Royal
Jubilee Hospital Victoria, Canada
Robert R. Whipkey, M.D., F.A.C.E.P. Director, Department of
Emergency Medicine Westmoreland Regional Hospital Greensburg,
Pennsylvania
Michael E. Whiting, M.D. Staff Physician Emergency Department
St. Vincent Hospital Santa Fe, New Mexico
Louis J. Wilson, M.D. Fellow in Gastroenterology Department
of Medicine University of Alabama Birmingham Birmingham,
Alabama
Christopher K. Wuerker, M.D., F.A.C.E.P. Assistant Clinical
Professor of Emergency Medicine George Washington University
Medical Center Medical Director MedSTAR Transport
Washington Hospital Center Washington, D.C.
Georges S. Yacoub, M.D. Chief Fellow, Pulmonary and Critical Care
Medicine Department of Internal Medicine Wayne State
University Detroit, Michigan
Robert J. Zimmerman, M.D. Department of Emergency Medicine
MetroHealth Medical Center Cleveland, Ohio
David N. Zull, M.D., F.A.C.E.P. Associate Professor of
Medicine Northwestern University
Associate Firm Chief (Medicine) Northwestern Memorial
Hospital Chicago, Illinois
Dedication
This work is dedicated to the men and women who have worked
ardently to make this edition happen; to the editors, secretaries,
typesetters, production people, and in particular Joyce
Murphy and Helen Powers. To shorten, refine, and distill the
textbook has been a difficult assignment, and one needed by the
practitioners of
emergency medicine. This work also is dedicated to the men and
women who practice emergency medicine—those who labor joyfully to
help their patients and advance their chosen field.
Theodore Roosevelt said:
George R. Schwartz, M.D. Director, Emergency Medicine of the
Southwest
Santa Fe, New Mexico Partner, Brain Resuscitation Research,
LLC
Sewickley, Pennsylvania Adjunct Associate Professor of
Emergency Medicine
Allegheny University of the Health Sciences Philadelphia,
Pennsylvania
Associate Editors
Barbara K. Hanke, M.D. Staff Emergency Physician St. Vincent
Hospital Santa Fe, New Mexico Clinical Assistant Professor of
Family and Community Medicine University of New Mexico School of
Medicine
Albuquerque, New Mexico
Thomas A. Mayer, M.D. Professor of Emergency Medicine and
Pediatrics Georgetown University School of Medicine George
Washington University School of Medicine Washington, D.C. Chairman
Department of Emergency Medicine, Fairfax Hospital Falls Church,
Virginia
James S. Cohen, M.D. Attending Physician Saratoga Emergency
Physicians Saratoga Springs, New York
John Dale Dunn, M.D., J.D. Director Emergency Services and
Physician Advisor Brownwood Regional Medical Center
Brownwood, Texas
Joseph C. Howton, M.D. Assistant Clinical Professor of
Medicine Department of Medicine University of California School of
Medicine San Francisco, California
Attending Physician Department of Emergency Medicine Good
Samaritan Hospital Puyallup, Washington
Daniel J. Isaacman, M.D. Division Director Pediatric
Emergency Medicine Children’s Hospital of the King’s
Daughters
Associate Professor of Pediatrics Eastern Virginia Medicine
School Norfolk, Virginia
Paul B. Roth, M.D. Dean, University of New Mexico, School of
Medicine
Associate Vice President for Clinical Affairs, Health
Sciences Center Professor of Emergency Medicine Director,
Center for Disaster Medicine Department of Emergency Medicine
University of New Mexico Medical Center
Albuquerque, New Mexico
Steven G. Rothrock, M.D. Department of Emergency Medicine Orlando
Regional Medical Center Orlando, Florida Clinical Adjunct
Assistant Professor Division of Emergency Medicine University
of Florida Gainesville, Florida Department of Emergency Medicine
Loma Linda University School of Medicine Loma Linda,
California
James R. Ungar, M.D. Co-Director Center for Emergency
Medicine
PREFACE
The Fourth Edition of Principles and Practice of Emergency Medicine
breaks new ground with a refined and streamlined edition.
Clinical usefulness has been the touchstone. We have maintained the
encyclopedic and authoritative nature of the previous editions, but
have aimed for a single, user-friendly volume, which brings the
essential knowledge, time orientation, and procedures required for
emergency medicine. To help achieve our goals we have expanded our
use of tables, guidelines, charts, radiographs and
photographs.
We have listened to our readers who require “cutting-edge”
accessible information in a single volume rather than ponderous
presentations in a multivolume format. The use of capsules, heads,
and subheads allows easier indexing and rapid availability of
needed information. Clinical pitfalls have been highlighted as have
medical-legal pearls. Whenever possible, we have offered access to
ways to network, including databases, national contact telephone
numbers, and Internet addresses. The field of emergency medicine
has changed to include many experienced and board-certified
practitioners who do not need the extensive pathophysiology found
in prior editions.
This edition of Principles and Practice of Emergency Medicine
has a new section on “tips and techniques” that organizes
information on common emergency conditions, such as foreign bodies
in the skin, eyes, ears, esophagus, airway, and nose and a new
chapter dealing with the most common ingestion—that of coins, in an
accessible format. Aspirated foreign bodies are an important focus
(e.g., balloons in children), and a chapter is devoted to this
life-threatening event. Common techniques such as reduction of jaw
dislocation and epistaxis are presented in easy-to-use formats. At
the beginning of each chapter the usual emergency procedures (e.g.,
emergency delivery leads the obstetrics/gynecology section,
emergency burr-holes leads the neurology/neurosurgery section) are
presented to allow the reader rapid access to that
information.
The emergency medicine services (EMS) section has changed to a
focussed format that shows what can be done in the field to aid
survival in acute illness and injury based on scientific data—with
all of the “bells and whistles” we are now looking at what actually
works.
Nine additional associate editors who are active practitioners as
well as scholars have contributed to this edition. All of the
editors understand the reality of being faced with myriad
emergencies in a busy emergency department (ED) where the emergency
physician is alone and is the “trauma center” instead of being in
an academic environment where multiple specialists are seconds
away. As a result, the tendency to be “academic” and not practical
has been avoided.
Time and critical decision making have been an important focus.
What is the time of appendiceal perforation, how much time is there
for a successful outcome from a leaking abdominal aortic aneurysm,
how much time for successful thrombolytic therapy in myocardial
infarction and stroke? How long is the time period to treat
meningitis to avoid complications? The flowering of the art of the
emergency physician has always been that of understanding the added
dimension of time and the need for rapid diagnosis and
action.
Changes in health care have been rapid. To this end we have
completely revised and updated the sections related to management
and added new sections on practice parameters, guidelines, and
standards as well as the various regulations with which we must
live.
On this twentieth anniversary year of our first edition, we hark
back to the original reviews that hailed the publication of the
first textbook defining clinical standards in emergency medicine.
Now, in the fourth edition, Principles and Practice of Emergency
Medicine is still the book for the clinical practitioner who
wants rapid, authoritative standard-of-care answers. We have
created a lean and ready work. With its comprehensive and
encyclopedic coverage, the fourth edition of Principles and
Practice of Emergency Medicine will be the book used in the
emergency department — open on the desk, coffee stained, cover
frayed, but ready for action—ready for the man or woman “in the
arena.”
ACKNOWLEDGMENTS
To shorten, consolidate, and focus an expansive textbook such as
the Principles and Practice of Emergency Medicine was a
formidable task as we were going into the fourth edition. There are
many books published, and we were acutely aware that most don’t
survive into multiple editions, but Principles and Practice of
Emergency Medicine had weathered some storms since the first
edition in 1978. As the original comprehensive text in emergency
medicine, our task was to adjust to the changing need for rapid and
focused access to pertinent material in the most convenient form,
rather than continue with a two-, three -, or even four-volume
unwieldy format.
Kathleen Schwartz, my indomitable wife, kept the work on course and
Corie Conwell used her formidable computer skills to allow a
worldwide search in new areas. Family is all important, and our
many children helped in the ways they could. As we had changed
publisher (to Williams and Wilkins) there were many adjustments to
be made. Katey Millet, editor, took the project on with energy and
stamina, and when she needed a leave, Joyce Murphy, managing
editor, filled the breach and worked to keep the book on a
reasonable schedule and edited, coordinated, and stepped in
wherever there was a need. Keith Murphy ably assisted Joyce (no
relation) as she and Katey encouraged, cajoled, and ordered
essential cutting and shortening. For this I am very grateful, and
they did it all with charm, grace, and continued good humor.
As to the many accomplished contributors who took the time to
update or develop their chapters, these thanks are a humble
tribute. The associate editors listed on the cover helped to bring
forgotten areas to light and entered in at important stages. Drs.
James Ungar, Joseph Howton, and James S. Cohen took time out of
their busy schedules and came to Santa Fe to help steer the fourth
edition.
Certainly the previous editors and associates brought us to where
we are today. It is a competitive world of books and Principles and
Practice of Emergency Medicine throughout its three editions
was able to garner superior reviews and, most important, reader
feedback that confirmed the usefulness of the text. Drs. Peter
Safar, Dave Wagner, Jim Roberts, and many others have helped to
support these endeavors, and I take my hat off to them.
I would like to offer particular thanks to Saul Cohen, friend and
attorney, who helped with legal issues and scheduling, working with
Susan Gay and Ted Hutton, senior executives who took over when
George Stamathis left to pursue other interests. George’s early
work set the stage, and I wish to acknowledge his fervent
approach.
ASSOCIATE EDITOR ACKNOWLEDGMENTS
Barbara Kate Hanke, M.D.: To my wonderful family: Rod, Austin and
Will, who continue to put up with the odd hours. To all the
hard-working front-line emergency physicians who find the personal
motivation to work compassionately and expertly, taking care of the
tides of humanity at their most vulnerable.
Thomas A. Mayer, M.D.: To my wife, Maureen, and our sons, Josh,
Kevin and Gregory, whose love and support sustain me in all
things.
James S. Cohen, M.D.: To Major W. Bradshaw, M.D. and Richard B.
Pesikoff, M.D. “Minds are like parachutes: they work best when
opened.” Thanks for being good skydivers. To Joseph Braver, M.D.:
You don’t play golf or tie toe tags but your sense of ethics and
clinical acumen exceeds that of any emergency physician I have ever
known. To Joel R. Gernsheimer, M.D.: Your dedication to emergency
medicine is an inspiration to us all. Thank you for being my
residency director.
John Dale Dunn, M.D., J.D.: To Dale E. Dunn, M.D., gone now, but
still my inspiration, and thanks to my love, Patty, for advice and
support.
Daniel J. Isaacman, M.D.: For Fran, Alissa, and Michael. You make
life wonderful. I am forever grateful for your love and
support.
Steven G. Rothrock, M.D.: To Angela, for her love, support,
patience, and encouragement. To the students, residents,
colleagues, and mentors who are the source of my professional
inspiration and growth.
Principles and Practice of Emergency Medicine
CHAPTER 1 MECHANISMS OF DYING AND TECHNIQUES OF RESUSCITATION
George R. Schwartz
Resuscitation and the Postresuscitation Syndrome Fundamental
Mechanisms of Rapid Dying and Resuscitation Alternatives to
Tracheal Intubation Other Airway Control Procedures Use of
Open-Chest CPR
INTRODUCTION
The clinical practice of cardiopulmonary resuscitation (CPR) has
been expanded to cardiopulmonary cerebral resuscitation (CPCR) (
1). Its scientific basis, “resuscitology” (2) or “reanimatology”
(3), has also expanded to encompass a variety of acute dying
processes, including the derangements of the entire organism.
Resuscitation potentials have also expanded beyond emergency
resuscitation into prolonged life support, which is sometimes
necessary with multiorgan system failure from postresuscitation
disease. The derangements after cardiac arrest, in order of acute
importance, involve the microcirculation, brain,
cardiovascular-pulmonary system, kidneys, and the gastrointestinal,
hematologic, immune, and endocrine systems. This order of
importance seems different after prolonged shock-trauma states, a
condition in which the brain is less likely to suffer ischemic
damage but kidneys and lungs frequently fail and endocrine
derangements are important. Sepsis has also gained recognition as a
final common pathway in dying processes.
The scientific importance of resuscitology lies in its ability to
establish the pathophysiologic mechanisms of the postresuscitation
syndrome ( 4,5). This helps define the ultimate potentials and
limitations of resuscitation for the treatment of cardiac
arrest.
When CPR attempts inside or outside the hospital have succeeded in
restoring some cerebral oxygenation within about 4 minutes of
arrest, and adequate spontaneous circulation was accomplished
within minutes thereafter, one-half to two-thirds of patients so
treated have recovered, with central nervous system (CNS) function
grossly equivalent to the prearrest state ( 6,7,8 and 9). Most
of the remaining patients died before leaving the hospital from
complications secondary to coma or from underlying disease. Among
the long-term survivors of all CPR attempts, including the delayed
attempts, about 5 to 20% seem to have a permanent major neurologic
deficit ( 6,7 and 8,10), depending on the type and quality of
post-CPR life support. The use of selective hypothermia will likely
alter the neurologic status. Young, healthy people who suffer
accidental deep hypothermia and circulatory arrest have shown
little neurologic deficit even after prolonged time ( 10A).
CARDIAC ARREST
Death in the terminal stages of incurable disease does not result
from sudden cardiac arrest. We define sudden cardiac arrest as “the
clinical picture of abrupt cessation of circulation in a person who
was not expected to die at that time” ( 1). Cardiac arrest is
clinically diagnosed when the following four conditions
coexist:
1. Unconsciousness (Fig. 1–1.1, Fig. 1–1.2, Fig. 1–1.3 and
Fig. 1–1.4).
Figure 1–1.1. Phases and steps of cardiopulmonary-cerebral
resuscitation. (See protocols for ACLS details ) (Reprinted with
permission from Safar P. Cardiopulmonary cerebral resuscitation.
Stavanger, Norway: Asmund S. Laerdal, 1981.)
Figure 1–1.3. Positioning of the unconscious patient.
Supported supine-aligned position—for resuscitation or for an
injured person. Hold the head, neck, and chest aligned with slight
traction. With both hands at the sides of the face, provide a jaw
thrust, open the patient's mouth, and moderate backward tilt of the
head. Prevent flexion and rotation of the head. (Reprinted with
permission from Safar P. Cardiopulmonary cerebral resuscitation.
Stavanger, Norway: Asmund S. Laerdal, 1981.)
Figure 1&