Rosen’s Emergency Medicine Concepts and Clinical Practice

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Cleaned version with corrected pagination, page orientation and bookmarks. Cover Rosen’s Emergency Medicine Concepts and Clinical Practice Copyright Acknowledgments Contributors Preface to the Tenth Edition Preface to the Ninth Edition How This Medical Textbook Should Be Viewed by the Practicing Clinician and Judicial System Part I: Fundamental Clinical Concepts Section One: Resuscitation and Analgesia Chapter 1: Airway Principles Background Anatomy, Physiology, and Pathophysiology Failure to Maintain or Protect the Airway Failure of Ventilation or Oxygenation Anticipated Clinical Course Identification of the Difficult Airway Difficult Direct Laryngoscopy: LEMON L—look externally E—evaluate 3-3-2 M—Mallampati scale O—obstruction or obesity N—neck mobility Difficult Bag-Mask Ventilation: ROMAN Difficult Extraglottic Device Placement: RODS Difficult Cricothyrotomy: SMART Measurement and Incidence of Intubation Difficulty Confirmation of Endotracheal Tube Placement Management Decision Making Difficult Airway Failed Airway Methods of Intubation Rapid Sequence Intubation Preparation Preoxygenation Preintubation optimization Paralysis with induction Positioning Placement of tube Postintubation management Delayed Sequence Intubation Awake Oral Intubation Oral Intubation Without Pharmacologic Agents Pharmacologic Agents Neuromuscular Blocking Agents Succinylcholine Uses and dosing Cardiovascular effects Fasciculations Hyperkalemia Masseter spasm Malignant hyperthermia Competitive agents Rocuronium Paralysis after intubation Induction Agents Etomidate Ketamine Propofol Other induction agents Special Clinical Circumstances Status Asthmaticus Hemodynamic Consequences of Intubation Elevated Intracranial Pressure Hypotension and Shock Potential Cervical Spine Injury Airway Devices and Techniques Direct Laryngoscopy Versus Videolaryngoscopy Videolaryngoscopes Flexible Intubating Scopes Extraglottic Devices Laryngeal mask airways Other extraglottic devices Surgical Airway Management Needle Cricothyrotomy with Transtracheal Jet Ventilation Cricothyrotomy Outcomes References Chapter 2: Mechanical Ventilation and Noninvasive Ventilatory Support Foundations Physiology of Positive-Pressure Breathing Invasive Mechanical Ventilation: Control Variable and Ventilator Mode Positive End-Expiratory Pressure Noninvasive Techniques Management Decision Making: Noninvasive Versus Invasive Ventilation Approach to Initial Ventilator Settings Noninvasive Ventilation High-Flow Nasal Cannula Mechanical Ventilation of the Intubated Patient Ongoing Management Pharmacology: Analgesia and Sedation of the Ventilated Patient Ventilator-Associated Pneumonia Prevention Troubleshooting the Ventilator Special Clinical Circumstances Acute Exacerbation of Chronic Obstructive Pulmonary Disease Status Asthmaticus Acute Respiratory Distress Syndrome Outcomes Complications References Chapter 3: Shock Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Specific Causes Hemorrhagic Shock Septic Shock Cardiogenic Shock Neurogenic Shock Management Decision Making Quantitative Resuscitation Pharmacology Volume Replacement Crystalloids Colloids and hypertonic saline Blood products Vasopressors Inotropes Antimicrobial Therapy Corticosteroids Special Cases Devices and Procedures Ventilation Source Control Mechanical Circulatory Support and Percutaneous Coronary Intervention Pericardiocentesis and Thrombectomy Outcomes References Chapter 4: Brain Resuscitation Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Elevated Intracranial Pressure Management Decision Making Pharmacology Intracranial Pressure Management Seizure Management Devices and Techniques Cardiopulmonary Resuscitation Reperfusion Optimizing perfusion and oxygenation Elevated Intracranial Pressure Medical treatment Surgical treatment Maintenance of Body Temperature Targeted Temperature Management Outcomes References Chapter 5: Adult Resuscitation Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Management Decision Making Prehospital History and Physical Examination Resuscitation Ventricular Fibrillation and Pulseless Ventricular Tachycardia Pulseless Electrical Activity Asystole Pharmacology Devices and Techniques Monitoring End-Tidal Carbon Dioxide Central Venous Oxygen Saturation Echocardiography Extracorporeal Cardiopulmonary Resuscitation Laboratory Testing Arterial Blood Pressure and Coronary Perfusion Pressure Outcomes Post–Cardiac Arrest Care Hypothermic Targeted Temperature Management Coronary Angiography and Primary Percutaneous Coronary Intervention Antidysrhythmic Therapy Oxygen Debt and Hemodynamic Management References Chapter 6: Pain Management Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Pain Conduction Pathways Pain Detection Information Transmission Peripheral nerve fibers Pain Transmission Dorsal horn Visceral pain Ascending tracts associated with pain Pain Modulation Central Sensitization Pain Expression Reflex Responses to Pain Endorphin System Acute Versus Chronic Pain Management Decision Making Pain Assessment Oligoanalgesia Pain Measurement Treatment Groups Acute pain Chronic pain Recurrent pain Chronic pain of malignancy Neuropathic pain Pharmacologic Therapy Opioids Mechanism of action and toxic effects Drug-seeking behavior Administration of pain control Specific agents Morphine Meperidine Hydromorphone Fentanyl Sufentanil Buprenorphine Oxycodone Hydrocodone Codeine Methadone Naloxone Tramadol Tapentadol Opioid use for acute abdominal pain Nonopioid Analgesic Agents Acetaminophen Nonsteroidal Antiinflammatory Drugs Drug interactions with nonsteroidal antiinflammatory drugs Aspirin Oral anticoagulants Angiotensin-converting enzyme inhibitors Diuretics Glucocorticoids Lithium Nonselective cyclooxygenase inhibitor selection Ketorolac tromethamine Ibuprofen Skeletal muscle relaxants Nitrous oxide–oxygen mixtures Ketamine Local/Regional Anesthesia Mechanism of action Classes of local anesthetic agents Allergic reactions Local and systemic toxicity Local toxicity Systemic toxicity Reducing the pain of local anesthetic injection Topical Anesthesia Topical anesthetics applied to intact skin Eutectic mixture of local anesthetics Ethyl chloride and fluoromethane sprays Agents applied to mucosal surfaces Cocaine Lidocaine Tetracaine Benzocaine Agents applied to open skin: lidocaine, epinephrine, and tetracaine Nonpharmacologic Interventions Transcutaneous Electrical Nerve Stimulation Out-of-Hospital Analgesia Outcomes: Treatment Endpoints References Chapter 7: Procedural Sedation and Analgesia Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Management Decision Making Patient Assessment Preprocedural Fasting Personnel Devices and Techniques Supplies and Equipment Recovery Post-procedure Recovery and Discharge Pharmacology Routes of Administration Opioids Fentanyl Morphine Benzodiazepines Midazolam Ketamine Sedative-Hypnotics Etomidate Propofol Ketamine plus propofol Ultra–fast-acting agents Reversal and Rescue Agents Naloxone Flumazenil Drug Selection and Administration References Section Two: Signs, Symptoms, and Presentations Chapter 8: Fever in the Adult Patient Foundations Epidemiology Pathophysiology Diagnostic Approach Differential Considerations Pivotal Findings Symptoms Signs Ancillary Testing Diagnostic Algorithm Empirical Management Disposition References Chapter 9: Weakness Foundations Epidemiology Pathophysiology Diagnostic Approach Differential Considerations Diagnostic Algorithm Critical and Emergent Diagnoses Specific Presentations of Neuromuscular Disorders Unilateral Weakness Combination of arm, hand, or leg with ipsilateral facial involvement Combination of arm, hand, or leg with contralateral facial involvement Combination of arm, hand, or leg without facial involvement Isolated extremity weakness (monoparesis or monoplegia) Bilateral Weakness Lower extremities only (paraparesis or paraplegia) Upper extremities only All four extremities without facial involvement (quadriparesis or quadriplegia) Proximal portions of extremities only Distal portions of extremities only Facial Weakness Without Extremity Involvement Unilateral facial droop Facial weakness not limited to cranial nerve VII Empiric Management Disposition References Chapter 10: Cyanosis Foundations Epidemiology Pathophysiology Diagnostic Approach Pivotal Findings Presentation and Symptoms Signs Ancillary Testing Imaging Electrocardiography and Echocardiography Diagnostic Algorithm Critical Diagnoses Emergent Diagnoses Empiric Management Methemoglobinemia and Sulfhemoglobinemia Other Causes of Cyanosis Patient Disposition Admission Discharge References Chapter 11: Syncope Foundations Epidemiology Pathophysiology Diagnostic Approach Differential Considerations Pivotal Findings Symptoms Signs Ancillary Testing Electrocardiogram Laboratory Testing Urine Testing Imaging Chest Imaging Neuroimaging Echocardiography Diagnostic and Management Algorithm Risk-Stratification Empiric Management References Chapter 12: Depressed Consciousness and Coma Foundations Epidemiology Pathophysiology Diagnostic Approach Differential Considerations Pivotal Findings Symptoms Signs Ancillary Testing Diagnostic Algorithm Empirical Management References Chapter 13: Confusion Foundations Epidemiology Pathophysiology Diagnostic Approach Differential Considerations Pivotal Findings Symptoms Signs Ancillary Testing Diagnostic Algorithm Empirical Management References Chapter 14: Seizures Foundations Epidemiology Pathophysiology Diagnostic Approach Pivotal Findings History Taking and Physical Exam Ancillary Testing Laboratory Testing Imaging Studies Electroencephalography Cardiac Monitoring Differential diagnoses Diagnostic Algorithm Empiric Management Disposition References Chapter 15: Dizziness and Vertigo Foundations Epidemiology Pathophysiology Diagnostic Approach Differential Considerations Pivotal Findings Symptoms Physical Examination Vital signs Head and neck Neurologic examination Positional testing Head Impulse Test, Nystagmus, Test of Skew Ancillary Testing Radiologic imaging Diagnostic Algorithm Empirical Management Disposition References Chapter 16: Headache Foundations Background and Importance Pathophysiology Diagnostic Approach Differential Considerations Pivotal Findings Symptoms Signs Ancillary Testing Diagnostic Algorithm Empirical Management References Chapter 17: Diplopia Foundations Pathophysiology Diagnostic Approach Differential Considerations Pivotal Findings History Physical Exam The external eye exam Pupil exam Extraocular muscle exam Funduscopic exam (posterior chamber exam) Slit lamp exam (anterior chamber exam) Signs and Symptoms Monocular diplopia Binocular diplopia Structural orbitopathy or myositis Isolated oculomotor nerve palsy Neuroaxial process involving the brainstem and related cranial nerves Neuromuscular disorder Ancillary Testing Diagnostic Algorithm Empirical Management Management Algorithm References Chapter 18: Red and Painful Eye Foundations Epidemiology and Pathophysiology Diagnostic Approach Differential Considerations Pivotal Findings Symptoms Signs Visual Acuity Visual Field Testing External Examination Extraocular Muscle Function Pupillary Evaluation Pressure Determination Ancillary Testing Swinging Flashlight Test Slit-Lamp Examination Direct Funduscopic Examination Topical Anesthetics Imaging Laboratory Testing Diagnostic Algorithm Critical Diagnoses Emergent Diagnoses Urgent Diagnoses Empiric Management References Chapter 19: Sore Throat Foundations Epidemiology Pathophysiology Diagnostic Approach Differential Considerations Pivotal Findings Symptoms and Signs Ancillary Testing Imaging Diagnostic Algorithm Critical and Emergent Diagnoses Empiric Management References Chapter 20: Hemoptysis Foundations Epidemiology Pathophysiology Diagnostic Approach Differential Considerations Pivotal Findings Symptoms Signs Ancillary Testing Diagnostic Algorithm Critical Diagnoses Bronchoscopy Empirical Management References Chapter 21: Dyspnea Foundations Epidemiology Pathophysiology Diagnostic Approach Differential Diagnosis Considerations Pivotal Findings Symptoms Quality of symptoms Duration and onset of dyspnea Positional changes Associated symptoms Signs Ancillary Testing Diagnostic Algorithm Critical Diagnoses Emergent Diagnoses Empirical Management References Chapter 22: Chest Pain Foundations Epidemiology Pathophysiology Diagnostic Approach Differential Considerations Pivotal Findings History Physical Examination Ultrasound Ancillary Studies Diagnostic Algorithm Empirical Management References Chapter 23: Abdominal Pain Foundations Epidemiology Pathophysiology Diagnostic Approach Differential Considerations Pivotal Findings Symptoms Signs Ancillary Testing Laboratory Tests Imaging Studies Diagnostic Algorithm Critical Diagnoses Emergent Diagnoses Empiric Management References Chapter 24: Jaundice Epidemiology Pathophysiology Normal Bilirubin Metabolism Abnormalities in Bilirubin Metabolism Diagnostic Approach Differential Considerations Pivotal Findings Symptoms Signs Laboratory Tests Imaging Diagnostic Algorithm Empirical Management References Chapter 25: Nausea and Vomiting Foundations Epidemiology Pathophysiology Diagnostic Approach Differential Diagnosis Considerations Pivotal Findings Symptoms Signs Ancillary Studies Diagnostic Algorithm Empirical Management Adults Pediatrics Special Situations Opioid-Induced Vomiting Headache Pregnancy Chemotherapy Cyclical Vomiting Syndrome and Cannabinoid Hyperemesis Syndrome Vertigo Gastroparesis Disposition References Chapter 26: Gastrointestinal Bleeding Foundations Diagnostic Approach Differential Considerations Pivotal Findings Symptoms Signs Ancillary Testing Laboratory Testing Electrocardiogram Nasogastric Aspirate Testing Imaging Diagnostic Algorithm Management Empiric Treatment Resuscitation Blood Product Transfusion Pharmacologic Therapy Balloon Tamponade Definitive Treatment References Chapter 27: Diarrhea Foundations Introduction Epidemiology Pathophysiology Diagnostic Approach Differential Considerations Pivotal Findings Signs and Symptoms Ancillary Testing Blood tests Stool studies Testing for specific pathogens Testing for bacterial infection Clostridioides difficile assay Escherichia coli O157:H7 toxin assay (Shiga toxin) Stool examination for ova and parasites Giardia antigen assay and serologic testing for amebiasis Radiographic studies Gastrointestinal Referral Diagnostic Algorithm Critical Diagnoses Emergent Diagnoses Empiric Management Rehydration Antibiotics Antimotility Agents Probiotics Disposition References Chapter 28: Constipation Foundations Pathophysiology Diagnostic Approach Differential Considerations Pivotal Findings Ancillary Testing Critical Diagnoses Emergent Diagnoses Empirical Management References Chapter 29: Acute Pelvic Pain Foundations Epidemiology Pathophysiology Diagnostic Approach Differential Considerations Pivotal Findings Symptoms Signs Ancillary Testing Laboratory Tests Imaging Diagnostic Algorithm Empirical Management References Chapter 30: Vaginal Bleeding Foundations Background and Importance Pathophysiology Nonpregnant Patients Pregnant Patients Diagnostic Approach Differential Considerations Nonpregnant Patients Pregnant Patients Pivotal Findings Symptoms Signs Ancillary Testing Diagnostic Algorithm Empiric Management Disposition References Chapter 31: Back Pain Foundations Background and Importance Pathophysiology Diagnostic Approach Differential Considerations Myelopathy Radiculopathy Spondylosis Disc Herniation Spinal Infections Spinal Tumors Cauda Equina Syndrome Acute Transverse Myelitis Mechanical Back Pain Chronic Back Pain Pivotal Findings Symptoms Signs Ancillary Testing Laboratory Tests Imaging Studies Abdominal Ultrasound Plain Film Radiographs Computed Tomography Scan Magnetic Resonance Imaging Diagnostic and Management Algorithms Critical Diagnoses Emergent Diagnoses Empiric Management Mild to Moderate Back Pain Severe Back Pain Chronic Back Pain Disposition Acknowledgments References Part II: Trauma Section One: General Concepts and System Injuries Chapter 32: Multiple Trauma Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Clinical Features Primary Survey Secondary Survey Differential Diagnoses Diagnostic Testing Laboratory Evaluation Radiographic Evaluation Management Out-of-Hospital Management Emergency Department Management Disposition References Chapter 33: Head Trauma Foundations Background and Importance Anatomy and Pathophysiology Anatomy Scalp and cranium Brain and cerebrospinal fluid Pathophysiology Cerebral hemodynamics and increased intracranial pressure Increased intracranial pressure Cushing reflex Altered Levels of Consciousness Definitions and Patterns of Injury Traumatic Brain Injuries: Severe, Moderate, and Mild Direct and Indirect Injuries Direct injury Indirect injury Neurochemical Cascade Penetrating Head Trauma Scalp Wounds Skull Fractures Linear Fractures Depressed Fractures Basilar Fractures Extra-Axial and Intra-Axial Intracranial Injuries Extra-Axial Injury Epidural hematoma Subdural hematoma Traumatic subarachnoid hemorrhage Subdural hygroma Intra-Axial Injury Diffuse axonal injury and traumatic axonal injury Cerebral contusions Intracerebral hematoma Intracerebellar hematoma Primary and Secondary Brain Injuries Secondary Systemic Insults Hypotension Hypoxia Hypocarbia and hypercarbia Anemia Hyperpyrexia Cerebral Herniation Syndromes Uncal Herniation Central Transtentorial Herniation Cerebellotonsillar Herniation Upward Transtentorial Herniation Moderate and Severe Traumatic Brain Injury Clinical Features Physical Examination Acute Neurologic Examination General Glasgow Coma Scale Pupillary examination Motor examination Brainstem function Common Presentations of Specific Lesions Epidural Hematoma Subdural Hematoma Traumatic Subarachnoid Hemorrhage Subdural Hygroma Traumatic Axonal Injury Cerebral Contusion Intracerebral Hematoma Traumatic Intracerebellar Hematoma Differential Diagnoses Diagnostic Testing Laboratory Tests Neuroimaging Skull radiography Computed tomography Pneumocephalus Epidural hematoma Subdural hematoma Traumatic subarachnoid hemorrhage Subdural hygroma Traumatic axonal injury Cerebral contusions Intracerebral hematoma Traumatic intracerebellar hematoma Cerebral edema Management Out-of-Hospital Care Airway Hypotension Agitation Emergency Department Management General Airway Hypotension Brain-directed hyperosmolar therapy Hyperventilation Cranial decompression Reversal of anticoagulation Hemostatic agents Induced hypothermia Seizure prophylaxis Antibiotic prophylaxis Other therapies Corticosteroids Barbiturates Monitoring of intracranial pressure and cerebral spinal fluid drainage Erythropoietin Progesterone Hyperbaric oxygen therapy Management of Specific Injuries Scalp wounds Skull fractures Linear fractures Depressed fractures Basilar skull fractures Extra-axial lesions Epidural hematoma Subdural hematoma Traumatic subarachnoid hemorrhage Subdural hygroma Intra-axial lesions Cerebral contusion Intracerebral hematoma Intracerebellar hematoma Complications and Outcome Central Nervous System Infections Meningitis after basilar fractures Brain abscess Cranial osteomyelitis Medical Complications Disseminated intravascular coagulation Respiratory complications Cardiac dysfunction Disposition Mild Traumatic Brain Injury (Also Known as Concussion) Clinical Features Physical Examination Head and Neck Mental Status and Alertness Cranial Nerves Cognitive Function (Attention, Memory, Concentration) Vestibular Function (Balance, Gait, and Eye Movements) Differential Diagnoses Diagnostic Testing Neuroimaging in the Emergency Department with Computed Tomography Other Neuroimaging Modalities Structural magnetic resonance imaging Susceptibility-weighted imaging Diffusion tensor imaging Computed tomography angiography and magnetic resonance angiography Ancillary Studies Laboratory testing Neuropsychological testing Disposition Complications Postconcussive Syndrome Seizures Posttraumatic Transient Cortical Blindness Special Populations with Mild Traumatic Brain Injury Mild Traumatic Brain Injury and Sports-­Related Concussion Military Personnel and Blast Injury Anticoagulated Patients Patients on anticoagulant medications Patients with inherent bleeding disorders Head Trauma in Older Adults References Chapter 34: Facial Trauma Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Bones Nerve Supply Ears Eyes Nose Mouth Temporomandibular Joint Soft Tissue, Vasculature, and Specialized Glands Pathophysiology Clinical Features History Physical Examination Eyes and orbits Oropharynx Ears Nose Neurologic Examination Differential Diagnoses Based on Anatomic Sites Soft Tissue Injuries and Lacerations Mouth Cheeks Nose Ears Eyes Fractures and Dislocations Forehead Orbit Midface Zygoma Mandible Dental and Alveolar Trauma Temporomandibular Joint Diagnostic Testing Imaging Management Out-of-Hospital Care Emergency Department Treatment Disposition References Chapter 35: Spinal Trauma Foundations Background and Importance Anatomy and Physiology Pathophysiology Classification of Spinal Column Injuries Flexion Shear injury Flexion-rotation Extension Vertical compression Classification of Spinal Cord Injuries Primary spinal cord injury Secondary spinal cord injury Classification of Cervical Soft Tissue Injuries Clinical Features Neurologic Evaluation Spinal Cord Lesions Complete Spinal Cord Lesions Incomplete Spinal Cord Lesions Differential Diagnoses Diagnostic Testing Radiographic Evaluation Indications Cervical Plain Radiographs Thoracolumbar Plain Radiographs Interpretation of spinal plain radiographs Advanced Imaging: Computed Tomography and Magnetic Resonance Management Spinal Column Stabilization Out-of-Hospital Care Emergency Department Airway Management Spinal Shock Pharmacologic Treatment for Incomplete Cord Injury Associated Injuries Cardiopulmonary Gastrointestinal and Genitourinary Skin Definitive Treatment and Prognosis Disposition Cervical Soft Tissue Injuries Minor Fractures References Chapter 36: Neck Trauma Foundations Background and Importance Anatomy and Physiology Pathophysiology Vascular Injuries Pharyngoesophageal Injuries Laryngotracheal Injuries Hanging Clinical Features Vascular Injuries Pharyngoesophageal Injuries Penetrating injury Blunt Injury Laryngotracheal Injuries Penetrating injury Blunt injury Hanging Miscellaneous Differential Diagnoses Diagnostic Testing Vascular Injuries Penetrating Injury Blunt injury Pharyngoesophageal Injuries Penetrating injury Blunt Injury Laryngotracheal Injuries Penetrating injury Blunt Injury Hanging Management Vascular Injuries Penetrating injury Blunt injury Pharyngoesophageal Injuries Penetrating injury Blunt Injury Laryngotracheal Injuries Hanging Miscellaneous Disposition Penetrating Injury Blunt Injury References Chapter 37: Thoracic Trauma Chest Wall Injury Rib Fracture Foundations Background and Importance Anatomy and Physiology Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Sternal Fracture Foundations Background and Importance Pathophysiology Clinical Features Diagnostic Testing Management Nonpenetrating Ballistic Injury Foundations Background and Importance Pathophysiology Clinical Features Diagnostic Testing Management Disposition Pulmonary Injuries Pulmonary Contusion and Laceration Foundations Background and Importance Pathophysiology Clinical Features Diagnostic Testing Laboratory Radiology Management Pneumothorax Foundations Background and Importance Pathophysiology Simple pneumothorax Communicating pneumothorax Tension pneumothorax Clinical Features Diagnostic Testing Occult Pneumothorax Management Simple Pneumothorax Communicating Pneumothorax Tension Pneumothorax Hemothorax Foundations Background and Importance Pathophysiology Clinical Features Diagnostic Testing Management Tracheobronchial Injury Foundations Background and Importance Pathophysiology Clinical Features Diagnostic Testing Management Diaphragmatic Injury Foundations Background and Importance Pathophysiology Clinical Features Diagnostic Testing Management Cardiovascular Trauma Blunt Cardiac Trauma Myocardial Concussion Foundations Background and Importance Pathophysiology Clinical Features Diagnostic Testing Laboratory Tests and Electrocardiogram Management Disposition Myocardial Contusion Foundations Background and Importance Pathophysiology Clinical Features Diagnostic Testing Laboratory Tests and Electrocardiogram Electrocardiogram Cardiac biomarkers Imaging Management Disposition Myocardial Rupture Foundations Background and Importance Anatomy and Physiology Pathophysiology Clinical Features Diagnostic Testing Management Penetrating Cardiac Trauma Acute Pericardial Tamponade Foundations Background and Importance Pathophysiology Clinical Features Diagnostic Testing Radiology Ultrasound Radiography Electrocardiography Management Emergency Department Thoracotomy Indications for emergency department thoracotomy Blunt Aortic Injury Foundation Background and Importance Pathophysiology Clinical Features Diagnostic Testing Chest Radiography Chest Computed Tomography Scan Management Stabilization and Empirical Therapy Definitive Management Endovascular repair Esophageal Perforation Foundations Background and Importance Pathophysiology Clinical Features Iatrogenic Foreign Bodies Caustic Burns Penetrating and Blunt Trauma Spontaneous Rupture Diagnostic Testing Radiology Endoscopy Management References Chapter 38: Abdominal Trauma Foundations Background and Importance Penetrating Abdominal Trauma Blunt Abdominal Trauma Anatomy and Physiology Pathophysiology Penetrating Abdominal Trauma Stab wounds Gunshot wounds Blunt Abdominal Trauma Seatbelt injuries Iatrogenic injuries Clinical Features Specific Clinical Presentations Penetrating Abdominal Trauma Stab wounds Gunshot wounds Blunt Abdominal Trauma Physical Examination Penetrating Abdominal Trauma Stab wounds Gunshot wounds Blunt Abdominal Trauma Differential Diagnoses Diagnostic Testing Ultrasonography Laboratory Testing Radiology Plain Radiographs Computed Tomography Magnetic Resonance Imaging Management Penetrating Abdominal Trauma Stab Wounds Anterior abdomen Step I: Clinical indications for emergent laparotomy Step II: Peritoneal violation Step III: Injury requiring laparotomy Thoracoabdominal penetration Flank and back Gunshot Wounds Anterior abdomen Thoracoabdominal Flank and back Blunt Abdominal Trauma Operative Versus Nonoperative Management Pelvic Fracture Multiple System Injury Bedside Procedures Diagnostic Peritoneal Lavage Local Wound Exploration Resuscitative Endovascular Balloon Occlusion of the Aorta Therapeutic Angioembolization Disposition Consultation Transfer References Chapter 39: Genitourinary Trauma Foundations Background and Importance Anatomy and Physiology Pathophysiology Renal Trauma Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Ureteral Trauma Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Bladder Trauma Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Urethral Trauma Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Genital Trauma Clinical Features Differential Diagnoses Diagnostic Testing Imaging Management Disposition References Chapter 40: Peripheral Vascular Trauma Foundations Background and Importance Anatomy and Physiology Upper Extremity Lower Extremity Pathophysiology Penetrating Trauma Blunt Trauma Vascular Injuries Complete occlusive injury Transection Thrombosis Reversible arterial spasm Nonocclusive injuries Intimal flap Pseudoaneurysm Arteriovenous fistula Compartment Syndrome Clinical Features Hard Findings of Vascular Injury Soft Findings of Vascular Injury Asymptomatic High-­Risk Wounds History Physical Examination Differential Diagnoses Diagnostic Testing Plain Radiography Pulse Oximetry and Near-Infrared Spectroscopy Handheld Doppler Arterial Pressure Index and Ankle-Brachial Index Ultrasound Computed Tomography and Magnetic Resonance Imaging Arteriography Diagnosis of Specific Vascular Injuries Management Major Vascular Injuries Upper Extremity Arterial Injuries Lower Extremity Arterial Injuries Late Complications of Arterial Injury Venous Injuries Minor Vascular Injuries Arterial Spasm Antibiotics Disposition References Section Two: Orthopedic Injuries Chapter 41: General Principles of Orthopedic Injuries Overall Foundations Background and Importance Fractures Foundations Anatomic Location of a Fracture: Nomenclature Anatomic Descriptors Descriptive Modifiers Fracture Eponyms and Mechanistic Names Epiphyseal Fractures Clinical Features of Fractures Fracture Healing Complications of Fractures Infection (Osteomyelitis) Hemorrhage Vascular Injuries Nerve Injuries Compartment Syndrome Pathophysiology Anatomic considerations and risk factors Clinical presentation Diagnostic testing Treatment, complications, and disposition of compartment syndrome Avascular Necrosis Fat Embolism Syndrome Fracture Blisters Complications of Immobilization and Hospitalization Damage Control Orthopedic Surgery Differential Diagnoses Diagnostic Testing Plain Radiography Special Imaging Techniques Computed tomography Magnetic resonance imaging Ultrasound imaging Laboratory Testing Management Field Care Splinting and bandaging Emergency Department Care Upper Extremity Sling-and- swathe bandages Clavicle fractures Plaster and fiberglass splints Casts Forearm and Wrist Splints Lower Extremity Ankle Thermal Therapy Disposition Subluxation and Dislocations Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Soft Tissue Injuries Sprains Foundations Clinical Features Differential Diagnoses Diagnostic Testing Plain radiography Magnetic resonance imaging Management Disposition Strains Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Tendinitis and Tendinosis Foundations Clinical Features Differential Diagnosis Diagnostic testing Management Disposition Bursitis Foundations Clinical Features Diagnostic Modalities Management Disposition Other Soft Tissue Conditions References Chapter 42: Hand Injuries Foundations: A General Approach to Hand Injuries Anatomy Surface Anatomy and Skin Fingertip and Nail Skeletal Anatomy and Ligaments Musculature and Tendons Intrinsic Musculature Extrinsic Musculature Extensor Muscles and Tendons Flexor Muscles and Tendons Digital Flexor Sheath Blood Supply Arterial Supply Venous and Lymphatic System Innervation and Sensory Systems Regional Blocks Digital Block Metacarpal and Transthecal Blocks Wrist Blocks Radial Nerve Block Median Nerve Block Ulnar Nerve Block Splinting Ring Removal Specific Hand Injuries Phalanx and Metacarpal Fractures Clinical Features Differential Diagnoses Diagnostic Testing Management Phalanx Fractures Distal Phalanx Fractures Clinical Features Differential Diagnoses Diagnostic Testing Management Middle Phalanx Fractures Clinical Features Differential Diagnoses Diagnostic Testing Management Proximal Phalanx Fractures Clinical Features Differential Diagnoses Diagnostic Testing Management Metacarpal Fractures Clinical Features Differential Diagnosis Diagnostic Imaging Management Thumb Fractures Clinical Features Differential Diagnoses Diagnostic Testing Management Joint Injuries Clinical Features Differential Diagnoses Diagnostic Testing Management Interphalangeal Joint Injuries Clinical Features Differential Diagnoses Diagnostic Testing Management Metacarpophalangeal Joint Injuries Clinical Features Differential Diagnoses Diagnostic Testing Management Carpometacarpal Joint Injuries Clinical Features Differential Diagnoses Diagnostic Testing Management Thumb Dislocations and Ligamentous Injuries Clinical Features Differential Diagnoses Diagnostic Testing Management Tendon Injuries Extensor Tendon Injuries Clinical Features Zone I Extensor Injuries Zone II Extensor Injuries Zone III Extensor Injuries Zone IV Extensor Injuries Zone V Extensor Injuries Zone VI Extensor Injuries Zone VII Extensor Injuries Differential Diagnoses Diagnostic Testing Management Zone I Extensor Injuries Management Zone II Extensor Injuries Management Zone III Extensor Injuries Management Zone IV Extensor Injuries Management Zone V Extensor Injuries Management Zone VI Extensor Injuries Management Zone VII Extensor Injuries Management Disposition Flexor Tendon Injuries Clinical Features Differential Diagnoses Diagnostic Studies Management Disposition Trigger Finger Clinical Features Differential Diagnoses Diagnostic Testing Management Finger and Nail Bed Injuries Nail Bed Injuries Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Amputations Fingertip Amputations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Degloving Injuries Mutilating Hand Injuries Skin and Soft Tissue Injuries Clinical Features Diagnostic Testing Management Laceration of the Extensor Tendon Disposition Clenched Fist Injuries Infectious Disorders of the Hand General Hand Infections Paronychia Onychomycosis Felon Herpetic Whitlow Clinical Features Differential Diagnoses Diagnostic Testing Management Purulent Flexor Tenosynovitis Clinical Features Differential Diagnoses Diagnostic Testing Management Deep Space Infections Clinical Features Differential Diagnoses Diagnostic Testing Management Skin and Soft Tissue Disorders Onycholysis High-Pressure Injury Ganglion Cysts Dupuytren Contracture Acknowledgments References Chapter 43: Wrist and Forearm Injuries Wrist Foundations Anatomy, Physiology, and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management and Disposition Carpal Injuries Scaphoid Fractures Foundations Clinical features Diagnostic testing Management and disposition Lunate fractures Foundations Clinical features Diagnostic testing Management and disposition Triquetral Fractures Foundations Clinical features Diagnostic testing Management and disposition Pisiform Fractures Foundations Clinical features Diagnostic testing Management and disposition Hamate Fractures Foundations Clinical features Diagnostic testing Management and disposition Trapezium Fractures Foundations. Clinical features Diagnostic testing Management and disposition Capitate Fractures Foundations Clinical features Diagnostic testing Management and disposition Trapezoid Fractures Foundations Clinical features Diagnostic testing Management and disposition Carpal Instability Foundations Clinical features Diagnostic testing Management and disposition Radiocarpal Dislocation Foundations Clinical features Diagnostic testing Management and disposition Distal Radius and Ulna Injuries Colles Fracture Foundations Clinical features Diagnostic testing Management and disposition Smith Fracture Foundations Clinical features Diagnostic testing Management and disposition Barton Fracture Foundations Clinical features Diagnostic testing Management and disposition Hutchinson Fracture Foundations Clinical features Diagnostic testing Management and disposition Distal Radioulnar Joint Disruption Foundations Clinical features Diagnostic testing Management and disposition Soft Tissue Injuries of the Wrist Carpal Tunnel and Acute Carpal Tunnel Syndrome Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management and Disposition De Quervain Disease Foundations Clinical Features Diagnostic Testing Management and Disposition Intersection Syndrome Foundations Clinical Features Diagnostic Testing Management and Disposition Forearm Foundations Anatomy, Physiology, and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing: Radiology Shaft Fractures of Radius and Ulna Foundations Clinical Features Diagnostic Testing Management and Disposition Ulna Shaft Fractures Foundations Clinical Features Diagnostic Testing Management and Disposition Monteggia Fracture Foundations Clinical Features Diagnostic Testing Management and Disposition Galeazzi Fracture Foundations Clinical Features Diagnostic Testing Management and Disposition Essex-Lopresti Lesion Foundations Clinical Features Diagnostic Testing Management and Disposition Acknowledgment References Chapter 44: Humerus and Elbow Injuries Foundations Background and Importance Anatomy, Physiology, and Pathophysiology General Clinical Features General Differential Diagnoses General Diagnostic Testing General Management General Disposition Specific Fractures Shaft of the Humerus Clinical features of humeral shaft fractures Diagnostic testing for humeral shaft fractures Management of humeral shaft fractures Disposition of humeral shaft fractures Distal Humerus Supracondylar fractures Extension type supracondylar fractures Clinical features of extension type supracondylar fractures Diagnostic testing of extension-type supracondylar fractures Management and disposition of extension type supracondylar fractures Flexion type supracondylar fractures Clinical features of flexion type supracondylar fractures Diagnostic of flexion type supracondylar fractures Management of flexion type supracondylar fractures Transcondylar Fractures Clinical features of intercondylar fractures Diagnostic testing of intercondylar fractures Management and disposition of intercondylar fractures Intercondylar Fractures Clinical features of intercondylar fractures Diagnostic testing of intercondylar fractures Management and disposition of intercondylar fractures Condylar Fractures Clinical Features of condylar fractures Diagnostic testing of condylar fractures Management and disposition of condylar fractures Capitellum and Trochlea Fractures Clinical features of capitellum and trochlea fractures Diagnostic testing of capitellum and trochlea fractures Management and disposition of capitellum and trochlea fractures Epicondylar Fractures Clinical features of epicondylar fractures Diagnostic testing of epicondylar fractures Management and disposition of epicondylar fractures Olecranon Clinical features of olecranon fractures Diagnostic testing of olecranon fractures Management and disposition of olecranon fractures Radial Head and Neck Clinical features of radial head and neck fractures Diagnostic testing of radial head and neck fractures Management and disposition of radial head and neck fractures Dislocations/Subluxations Elbow Clinical features of elbow dislocations/subluxations Diagnostic testing of elbow dislocations/subluxations Management and disposition of elbow dislocations/subluxations Radial Head Subluxation Clinical features of radial head subluxation Diagnostic testing of radial head subluxation Management and disposition of radial head subluxation Soft Tissue Disorders Epicondylitis Clinical features of epicondylitis Diagnostic testing of epicondylitis Management and disposition of epicondylitis Olecranon Bursitis Clinical features of olecranon bursitis Diagnostic testing of olecranon bursitis Management and disposition of olecranon bursitis Biceps Tendon Rupture Clinical features of biceps tendon rupture Diagnostic testing for biceps tendon rupture Management and disposition of biceps tendon rupture Acknowledgments References Chapter 45: Shoulder Injuries Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Clinical Features History Physical Examination Differential Diagnoses Diagnostic Testing Radiology Specific Injuries Fractures Clavicle Foundations Clinical features Differential diagnoses Diagnostic testing Management Disposition Scapula Foundations Clinical features Differential diagnoses Diagnostic testing Radiology Management Proximal Humerus Foundations Clinical features Differential diagnoses Diagnostic testing Management Pediatric Proximal Humeral Fracture Foundations Clinical features Differential diagnoses Diagnostic testing Management Dislocations Sternoclavicular Foundations Clinical features Differential diagnoses Diagnostic testing Management Acromioclavicular Joint Foundations Clinical features Differential diagnoses Diagnostic testing Radiology Management Glenohumeral Dislocations Foundations Anterior Dislocations Pathophysiology Clinical features Differential diagnoses Diagnostic testing Radiology Management Posterior Dislocation Pathophysiology Clinical features Differential diagnoses Diagnostic testing Radiology Management Inferior Glenohumeral Dislocation (Luxatio Erecta) Pathophysiology Clinical features Differential diagnoses Diagnostic testing Radiology Management Scapulothoracic Dissociation Foundations Clinical features Differential diagnoses Diagnostic testing Management Soft Tissue Conditions Impingement Syndrome Foundations Clinical features Differential diagnoses Diagnostic testing Management Rotator Cuff Tears Foundations Clinical features Differential diagnoses Diagnostic testing Radiology Management Lesions of the Biceps Muscle Bicipital Tendinitis Pathophysiology Clinical features Differential diagnoses Diagnostic testing Radiology Management Ruptures of the Biceps Tendon Foundations Clinical features Differential diagnoses Diagnostic testing Radiology Management Calcific Tendinitis Foundations. Clinical features Differential diagnoses Diagnostic testing Radiology Management Adhesive Capsulitis Foundations Clinical features Differential diagnoses Diagnostic testing Management Injection Therapy References Chapter 46: Pelvic Injuries Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Bony and Ligamentous Anatomy Vascular Anatomy Neurologic Anatomy Pathophysiology and Key Patterns of Pelvic Fracture Stable Injuries (Tile Type A) Nondisplaced or minimally displaced fractures of the pelvic ring Transverse fractures of the sacrum Avulsion fractures Stress fractures Pathologic and insufficiency fractures Partially Stable and Unstable Injuries (Tile Types B and C) Anteroposterior compression Lateral compression Vertical shear Vertical sacral fractures Open Pelvic Fractures Penetrating Pelvic Trauma Associated Pelvic Injuries Urologic Injury Neurologic Injury Gynecologic Injury Associated Non-­Pelvic Injuries Acetabular Fractures Coccyx Fractures Clinical Features History Physical Examination Deep Venous Thrombosis Differential Diagnosis Diagnostic Testing Radiology Plain Radiography Computed Tomography Evaluation of Hemorrhage Diagnostic Peritoneal Lavage Ultrasound Computed Tomography Management Resuscitation Control of Hemorrhage Stabilizing the Pelvis Noninvasive techniques Formal external fixation Angiography and Embolization Hemodynamically Unstable Patients With Pelvic and Intra-Abdominal Hemorrhage Disposition References Chapter 47: Femur and Hip Injuries General Information Foundations Anatomy of the Hip and Femur Skeletal Anatomy Musculature Arterial Supply Venous System Nerves Pathophysiology and Key Patterns of Injury Fractures and Trauma of the Femur and Hip Osteoporosis of the Femur Osteoarthritis of the hip Avascular Necrosis Myositis Ossificans Calcific Bursitis and Calcifying Peritendinitis Neoplastic Disease in the Hip Clinical Features of Hip and Femur Pathology History Physical Examination Differential Diagnoses Diagnostic Testing Radiographic Evaluation Occult Hip Fracture Management Traction and Immobilization Open Fracture Care Compartment Syndrome Pain Management Systemic Analgesia Pharmacologic Approaches Femoral Nerve Block Specific Fractures of the Hip and Femur Avulsion Fractures Foundations Clinical features Differential diagnoses Management Proximal Femur Fracture Femoral Neck Fractures Foundations Clinical presentation Diagnostic testing Management Disposition Intertrochanteric Fractures Foundation Clinical presentation Diagnostic testing Management Disposition Isolated Fractures of the Greater or Lesser Trochanter Foundations Clinical presentation Diagnostic testing Management Disposition Subtrochanteric Fractures Foundation Diagnostic testing Management Disposition Femoral Shaft Fractures Foundation Clinical presentation Diagnostic testing Management Disposition Stress Fractures Foundation Clinical presentation Diagnostic testing Management Disposition Dislocations and Fracture-­Dislocations of the Hip and Femur Hip Dislocations Foundations Clinical presentation Diagnostic testing Management Disposition Fracture-Dislocation of the Femoral Head Foundations Clinical presentation Diagnostic studies Management Disposition Dislocation of Hip Prosthetics Foundations Clinical presentation Diagnostic studies Management Disposition Soft Tissue Injuries Muscular Injuries Foundations Clinical features Differential diagnoses Diagnostic testing Management Disposition Tendon Injuries Foundations Clinical features Differential diagnoses Diagnostic studies Management Disposition Osteitis Pubis Foundation Clinical features Differential diagnoses Diagnostic testing Management Disposition Vascular Injuries Foundations Clinical features Differential diagnoses Diagnostic testing Management Disposition Neurologic Injuries Foundation Clinical features Diagnostic testing Management Disposition References Chapter 48: Knee and Lower Leg Injuries Knee Injuries—Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Femur The Tibia Cruciate Ligaments (ACL and PCL) Collateral Ligaments (MCL and LCL) Knee Compartments Fabella Popliteal Fossa Popliteal Artery Tibial Nerve Extensor Mechanism Meniscus The Iliotibial band The Popliteus Bursae Knee Injuries—Clinical Features Physical Examination Knee Injuries—Differential Diagnoses Dislocation Effusion Anterior Knee Pain Medial and Lateral Pain Posterior Knee Pain Knee Injuries—Examination Maneuvers Anterior Drawer/Lachman Test Posterior Drawer Test Posterior Sag Sign Test Collateral Ligament Stress Test Assessing for Meniscal Tears McMurray Test Apley Test Knee Injuries—Diagnostic Testing Radiologic Evaluation Vascular Imaging Arthroscopy Joint Injection Arthrocentesis Specific Knee Injuries Knee Dislocations—Foundations Knee Dislocations—Clinical Features Knee Dislocations—Diagnostic Testing Knee Dislocations—Management and Disposition Distal Femur Fractures—Foundations Distal Femur Fractures—Clinical Features Distal Femur Fracture—Diagnostic Testing Distal Femur Fractures—Management and Disposition Tibial Plateau Fractures—Foundations Tibial Plateau Fractures—Clinical Features Tibial Plateau Fractures—Diagnostic Testing Tibial Plateau Fractures—Management and Disposition Tibial Spine Fractures—Clinical Features Tibial Spine Fractures—Diagnostic Testing Tibial Spine Fractures—Management and Disposition Osteochondritis Dissecans—Foundations Osteochondritis Dissecans—Clinical Features Osteochondritis Dissecans—Diagnostic Testing Osteochondritis Dissecans—Management and Disposition Extensor Mechanism Injuries: Quadriceps and Patellar Tendon Ruptures—Foundations Quadriceps and Patellar Tendon Ruptures—Clinical Features Quadriceps and Patellar Tendon Ruptures—Diagnostic Testing Quadriceps and Patellar Tendon Ruptures—Management and Disposition Patellar Fractures—Foundations Patellar Fractures—Clinical Features Patellar Fractures—Diagnostic Testing Patellar Fractures—Management and Disposition Patellar Dislocation—Foundations Patellar Dislocation—Clinical Features Patellar Dislocation—Diagnostic Testing Patellar Dislocation—Management and Disposition Cruciate and Collateral Ligament Injuries—Foundations Cruciate and Collateral Ligament Injuries—Clinical Features Cruciate and Collateral Ligament Injuries—Diagnostic Testing Cruciate and Collateral Ligament Injuries—Management and Disposition Meniscal Injuries—Foundations Meniscal Injuries—Clinical Features Meniscal Injuries—Diagnostic Testing Meniscal Injuries—Management and Disposition Overuse Syndromes Patellofemoral Pain Syndrome—Foundations Patellofemoral Pain Syndrome—Clinical Features Patellofemoral Pain Syndrome—Diagnostic Testing Patellofemoral Pain Syndrome—Management and Disposition Iliotibial Band Syndrome—Foundations Iliotibial Band Syndrome—Clinical Features Iliotibial Band Syndrome—Diagnostic Testing Iliotibial Band Syndrome—Management and Disposition Patellar Tendinopathy—Foundations Patellar Tendinopathy—Clinical Features Patellar Tendinopathy—Diagnostic Testing Patellar Tendinopathy—Management and Disposition Plica Syndrome—Foundations Plica Syndrome—Clinical Presentation Plica Syndrome—Diagnostic Testing Plica Syndrome—Management and Disposition Popliteus Tendinopathy—Foundations Popliteus Tendinopathy—Clinical Presentation Popliteus Tendinopathy—Diagnostic Testing Popliteus Tendinopathy—Management and Disposition Bursitis—Foundations Bursitis—Clinical Features Bursitis—Diagnostic Testing Bursitis—Management and Disposition Arthritis Osteoarthritis—Foundations Osteoarthritis—Clinical Features Osteoarthritis—Diagnostic Testing Osteoarthritis—Management and Disposition Septic Arthritis—Foundations Septic Arthritis—Clinical Features Septic Arthritis—Diagnostic Testing Septic Arthritis—Management and Disposition Baker Cyst Baker Cyst—Foundations Baker Cyst—Clinical Features Baker Cyst—Diagnostic Testing Baker Cyst—Management and Disposition Leg Foundations Anatomy, Physiology, Pathophysiology Tibia and Fibula Vascular Supply Fascial Compartments Leg Injuries Differential Diagnoses Specific Leg Injuries Proximal Extra-articular Tibial Fractures Subcondylar Tibial Fractures—Foundations Subcondylar Tibial Fractures—Clinical Features Subcondylar Tibial Fractures—Diagnostic Testing Subcondylar Tibial Fractures—Management and Disposition Tibial Tubercle Fractures—Foundations Tibial Tubercle Fractures—Clinical Features Tibial Tubercle Fractures—Diagnostic Testing Tibial Tubercle Fractures—Management and Disposition Tibial Shaft Fractures—Foundations Tibial Shaft Fractures—Clinical Features Tibial Shaft Fractures—Diagnostic Testing Tibial Shaft Fractures—Management and Disposition Proximal Fibula Fractures—Foundations Proximal Fibula Fractures—Clinical Features Proximal Fibula Fractures—Diagnostic Testing Proximal Fibula Fractures—Management and Disposition Proximal Tibiofibular Joint Dislocations—Foundations Proximal Tibiofibular Joint Dislocations—Clinical Features Proximal Tibiofibular Joint Dislocations—Diagnostic Testing Proximal Tibiofibular Joint Dislocations—Management and Disposition Stress Fractures—Foundations Stress Fractures—Clinical Features Stress Fractures—Diagnostic Testing Stress Fractures—Management and Disposition Medial Tibial Stress Syndrome—Foundations Medial Tibial Stress Syndrome—Clinical Features Medial Tibial Stress Syndrome—Diagnostic Testing Medial Tibial Stress Syndrome—Disposition and Management Compartment Syndrome Soft Tissue Injuries Involving the Lower Leg Gastrocnemius and plantaris injury—foundations Gastrocnemius and plantaris injury—clinical features Gastrocnemius and plantaris injury—diagnostic testing Gastrocnemius and plantaris injury—management and disposition Foreign bodies References Chapter 49: Ankle and Foot Injuries Ankle Foundations Background and Importance Anatomy Physiology and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Radiology Other Imaging Techniques Ankle Fractures and Dislocations General Considerations Unimalleolar Fractures Lateral Malleolar Fractures Medial Malleolar Fractures Posterior Malleolar Fractures Bimalleolar Fractures Trimalleolar Fractures Open Fractures Pilon Fractures Clinical Features Differential Diagnoses Diagnostic Testing Management Dislocations Anatomy, Physiology, and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Ligamentous Injuries Foundations Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Tendon Injuries Differential Diagnoses Achilles Tendon Rupture Background and Importance, Physiology, and Pathophysiology Clinical Features Diagnostic Testing Management Peroneal Tendon Dislocation or Rupture Foundations and Clinical Features Diagnostic Testing Management Tibialis Posterior Tendon Rupture Foundations and Clinical Features Diagnostic Testing Management Other Tendon Injuries Foot Foundations Anatomy, Physiology, and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Specific Pathologic Conditions Hindfoot Injuries Differential Diagnoses Talar Fractures Anatomy, Physiology, and Pathophysiology Clinical Features Talar Neck Fractures Talar Head Fractures Talar Body Fractures Diagnostic Testing: Radiology Management. Disposition Osteochondral Lesions Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management and Disposition Subtalar Dislocations Pathophysiology Clinical Features Diagnostic Testing Management Disposition Pantalar Dislocation Calcaneal Fractures Anatomy and Pathophysiology Intraarticular Calcaneal Fractures Extraarticular Calcaneal Fractures Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Midtarsal Joint Injuries Foundations and Clinical Features Differential Diagnoses Diagnostic Testing Management and Disposition Nontraumatic Hindfoot Pain Clinical Features Differential Diagnoses Diagnostic Testing Management Midfoot Injuries Differential Diagnoses Navicular Fractures Anatomy Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing: Radiology Management Disposition Cuboid Fractures Cuneiform Fractures Dislocations of the Navicular, Cuboid, and Cuneiforms Lisfranc (Tarsometatarsal) Fractures and Dislocations Anatomy Physiology and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing: Radiology Management Disposition Nontraumatic Midfoot Pain Forefoot Injuries Differential Diagnoses Diagnostic Testing Metatarsal Fractures Foundations Fractures of the First Metatarsal Fractures of the Middle Metatarsals (Two to Four) Clinical Features Differential Diagnoses Diagnostic Testing Management and Disposition Fractures of the Fifth Metatarsal Fifth Metatarsal Shaft Fractures Fifth Metatarsal Base Fractures Differential Diagnoses Diagnostic Testing Management and Disposition Phalangeal Fractures Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Sesamoid Fractures Metatarsophalangeal Dislocations Foundations and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing: Radiology Management Disposition Interphalangeal Joint Dislocations Nontraumatic Forefoot Pain Clinical Features Differential Diagnoses Diagnostic Testing Management Special Considerations Complex Regional Pain Syndrome Stress Fractures Foundations and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Tendon Injuries Compartment Syndrome of the Foot and Ankle Foundations Clinical Features Differential Diagnoses Diagnostic Testing: Special Procedures Management and Disposition References Section Three: Soft Tissue Injuries Chapter 50: Wound Management Principles Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Clinical Features History Physical Examination Differential Diagnoses Diagnostic Testing Management Anesthesia Anesthetic Agents Allergy Skin Preparation Wound Preparation Debridement Wound Cleansing Irrigation Wound Closure Decision-Making Wound Tension Suture Technique Simple sutures Procedure Intradermal (buried) sutures Procedure Scalp laceration repair Procedure Skin tears Vertical mattress sutures Procedure Horizontal mattress sutures Procedure Dog-ear deformity repair Procedure Corner stitch (half-buried horizontal mattress sutures) Procedure V-Y wound closure Procedure Materials Suture Needles Tape Staples Tissue adhesives Antibiotic Prophylaxis Contamination, crush, and host factors Open fractures, joint wounds, and gunshot wounds Bites and puncture wounds Cat bites Dog bites Hand bites Intraoral lacerations Puncture wounds of the foot Drains, Dressings, and Immobilization Drains Dressings Immobilization Disposition Wound Care Instructions Tetanus Immunization References Chapter 51: Foreign Bodies Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Specific Disorders Eye Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Ear Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Nose Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Airway Foundations Background and Importance Anatomy and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Gastrointestinal Tract Foundations Pharynx and Esophagus Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Stomach and Bowel Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Rectum Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Genitourinary Tract Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Soft Tissues Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition References Chapter 52: Mammalian Bites Foundations Background and Importance Dog Bites Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Clinical Features Capnocytophaga canimorsus Diagnostic Testing Differential Diagnoses Management Prophylactic antibiotics Disposition Cat Bites Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Clinical Features Pasteurella multocida Differential Diagnoses Diagnostic Testing Management Disposition Other Mammals Monkeys Foundations Background and Importance Anatomy, physiology, and pathophysiology Clinical features Differential diagnoses Management Disposition Rodents Foundations Background and importance Anatomy, physiology, and pathophysiology Clinical features Differential diagnoses Management Disposition Uncommon Animal Bites Ferrets Domestic Herbivores Sheep, Cattle, and Pigs Horses Camels Wild Animals Bears Wild Cats Coyotes and Wolves Management Human Bites Foundations Background and importance Anatomy, physiology, and pathophysiology Clinical features Other human bites Differential diagnoses Diagnostic testing Management Prophylactic Antibiotics Disposition References Chapter 53: Venomous Animal Injuries Foundations Venom Delivery Venomous Reptiles Snakes Foundations Classification and Characteristics Anatomy and Identification Other Reptiles Pathophysiology and Toxins Venom Delivery Clinical Features Crotalids (Pit Vipers) Coral Snakes Infection Differential Diagnoses Diagnostic Testing Management Out-of-Hospital Care Emergency Department Care Patient History Patient Examination Initial Medical Care Pit Viper Envenomation Classification Antivenom Dosage and Precautions Coral and Exotic Snakes Wound Care Serum Sickness Heloderma Envenomation Disposition Venomous Arthropods Foundations Hymenoptera Spiders and Scorpions Black Widow Spider Brown Recluse Spider Scorpions Clinical Features Hymenoptera Africanized Bees Fire Ants Black Widow Spider Brown Recluse Spider Scorpions Differential Diagnoses Hymenoptera Black Widow Spider Brown Recluse Spider Scorpions Diagnostic Testing Hymenoptera Black Widow Spider Brown Recluse Spider Scorpions Management Prehospital Care Hymenoptera Black Widow Spider Brown Recluse Spider Scorpions Emergency Department Care Hymenoptera Black Widow Spider Latrodectus Antivenom Brown Recluse Spider Scorpions Disposition Hymenoptera Black Widow Spider Brown Recluse Spider Scorpions Other Arthropods Venomous Marine Animals Foundations Pathophysiology and Venom Delivery Bites Nematocyst Toxicity Clinical Features Stings Sea Urchins Cone Shells Stingrays Bony Fishes Differential Diagnoses Diagnostic Testing Management Bites Nematocysts Stings Disposition Acknowledgments References Chapter 54: Thermal Injuries Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Pathophysiology of Burns Cutaneous Injury Inhalation Injury Clinical Features Classification and Diagnosis of Burns Depth Size Inhalation Injury Differential Diagnoses Diagnostic Testing Management Initial First Aid Airway Management Breathing Management Circulation Management and Fluid Resuscitation Escharotomy Local Wound Therapies Pain Management Disposition References Chapter 55: Chemical Injuries General Approach to a Hazmat Event Foundations Background and Importance Community Preparedness and HazMat Response Contingency Plan Anatomy, Physiology, and Pathophysiology Clinical Features and Differential Diagnoses Diagnostic Testing Management Disposition Ocular Injuries Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Specific Toxins Hydrofluoric Acid Foundations Background and importance Anatomy, physiology, and pathophysiology Clinical Features Inhalational Exposure Gastrointestinal Exposure Ocular Exposure Dermal Exposure Differential Diagnoses Diagnostic Testing Management Infiltration Therapy Subcutaneous Intravenous and intra-arterial Respiratory Exposures Ocular Exposures Systemic Toxicity Disposition Formic Acid Foundations Background and importance Anatomy, physiology, and pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Anhydrous Ammonia Foundation Background and importance Anatomy, physiology, and pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Cement Phenol and Derivatives Foundations Background and importance Anatomy, physiology, and pathophysiology Clinical features Differential Diagnoses Diagnostic Testing Management Treatment of Systemic Toxicity Disposition Phosphorus Foundations Background and importance Anatomy, physiology, and pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Nitrates and Nitrites Foundations Background and importance Anatomy, physiology, and pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Hydrocarbons Foundations Background and importance Anatomy, physiology, and pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Tar Foundations Background and importance Clinical Features Management Disposition Elemental Metals Chromium Miscellaneous Chlorine, Chloramine, Phosgene, Nitrogen Oxide and Phosphide Foundations Background and importance Anatomy, physiology, and pathophysiology Clinical Features Management Disposition Chemical Terrorism Response During a Chemical Attack Chemical Agents Nerve Agents Foundations Background and importance Anatomy, physiology, and pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Vesicants Foundations Background and importance Anatomy, physiology, and pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Cyanide Foundations Background and importance Anatomy, physiology, and pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition References Part III: Emergency Medicine by System Section One: Head and Neck Chapter 56: Oral Medicine Introduction Disorders of the Tooth Foundations Anatomy, Physiology, and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management and Disposition Disorders of the Gingiva and Periodontium Foundations Anatomy, Physiology, and Pathophysiology Gingivitis and Periodontitis Pericoronitis Gingival Hyperplasia Clinical Features Differential Diagnoses Diagnostic Testing Gingivitis and Periodontitis Pericoronitis Management Gingivitis and Periodontitis Pericoronitis Disposition Gingivitis and Periodontitis Pericoronitis Disorders Involing Dental Procedures Foundations Anatomy, Physiology, and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Odontogenic and Deep Neck Infections Foundations Anatomy, Physiology, and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Dentoalveolar Trauma Foundations Anatomy, Physiology, and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management and Disposition Dental Fractures Tooth Avulsion Luxation and Alveolar Fractures Soft Tissue Injuries Disposition Temporomandibular Joint Disorder and Dislocation Foundations Anatomy, Physiology, and Pathophysiology Temporomandibular Joint Disorder Temporomandibular Joint Dislocation Clinical Features Temporomandibular Joint Disorder Temporomandibular Joint Dislocation Differential Diagnoses Diagnostic Testing Management Temporomandibular Joint Disorder Temporomandibular Joint Dislocation Disposition References Chapter 57: Ophthalmology Overview Traumatic Conditions Foundations Periorbital Contusions and Eyelid Lacerations Clinical Features and Differential Diagnoses Diagnostic Testing Management and Disposition Conjunctival and Scleral Injuries: Subconjunctival Hemorrhage, Conjunctival Laceration, and Scleral Laceration Clinical Features Differential Diagnoses Diagnostic Testing Management and Disposition Corneal Injuries: Corneal Abrasions, Foreign Bodies, and Lacerations Clinical Features Differential Diagnoses Diagnostic Testing Management and Disposition Corneal abrasions Corneal foreign bodies Corneal lacerations Anterior Segment Injuries: Traumatic Hyphema, Iritis, Cyclodialysis, and Lens Dislocation Clinical Features Differential Diagnoses Diagnostic Testing Management and Disposition Traumatic iritis, hyphema, and cyclodialysis Lens subluxation and dislocation Posterior Segment/Ocular Injuries: Commotio Retinae, Retinal Detachment, Intraocular Foreign Body, and Perforated Globe Clinical Features Differential Diagnoses Diagnostic Testing Management and Disposition Retinal injuries Intraocular foreign bodies and globe rupture Retrobulbar and Peribulbar Injuries: Orbital Wall Fracture, Retrobulbar Hemorrhage, and Optic Nerve Injury Clinical Features Differential Diagnoses Diagnostic Testing Management and Disposition Orbital wall fractures Retrobulbar hemorrhage Optic nerve injury Chemical Exposures and Glues Clinical Features and Differential Diagnoses Diagnostic Testing Management and Disposition Inflammatory Conditions Foundations The Conjunctiva and Cornea: Keratitis, Pterygium, and Pinguecula Clinical Features Differential Diagnoses Diagnostic Testing Management Superficial punctate keratitis and radiation keratitis Pterygium and pinguecula Disposition The Globe: Uveitis, Scleritis, and Episcleritis Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition The Orbit: Orbital Pseudotumor, Orbital Apex Syndrome, and Thyroid Orbitopathy Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Infectious Conditions Foundations The Conjunctiva: Allergic, Viral and Bacterial Conjunctivitis, and Ophthalmia Neonatorum Clinical Features and Differential Diagnoses Diagnostic Testing Management and Disposition Allergic and viral conjunctivitis Bacterial conjunctivitis Ophthalmia neonatorum The Cornea: Corneal Ulcers, Herpes Simplex Keratitis, and Herpes Zoster Keratitis Clinical Features Differential Diagnoses Diagnostic Testing Management Corneal ulcers and infiltrates Herpes simplex keratitis Herpes zoster keratitis Disposition The Eyelids and Periorbital Area: Hordeolum, Chalazion, Dacryocystitis, Blepharitis, and Cellulitis Clinical Features Differential Diagnoses Diagnostic Testing Management Hordeolum and chalazion Dacryocystitis Blepharitis Periorbital cellulitis Disposition The Globe: Endophthalmitis Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Acute Angle-Closure Glaucoma Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Primary Disorders of Vision Foundations Blurred Vision: Optic Neuritis, Toxic and Metabolic Disturbances, and Papilledema Clinical Features Differential Diagnoses Diagnostic Testing Optic neuritis Toxic and metabolic visual disturbances Papilledema Management Disposition Floaters, Flashes, and Field Deficits: Vitreous and Retinal Disorders Clinical Features Differential Diagnoses Diagnostic Testing Vitreous hemorrhage and detachment Retinal detachment Chiasmal and cortical disturbances Management Disposition Sudden Monocular Vision Loss: Retinal Artery and Vein Occlusion, and Ischemic Optic Neuropathy Clinical Features Differential Diagnoses Diagnostic Testing Management Central retinal artery occlusion Central retinal vein occlusion Ischemic optic neuropathy Disposition Functional Vision Loss Diplopia Anisocoria Foundations Clinical Features Adie’s and Argyll Robertson Pupils Pharmacologic Mydriasis and Miosis Third-Nerve Palsy Horner Syndrome Physiologic and Headache-Associated Anisocoria Diagnostic Testing, Management, and Disposition Nystagmus Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management References Chapter 58: Otolaryngology Otitis Media Foundations Background and Importance Anatomy and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Otitis Externa Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Necrotizing (Malignant) External Otitis Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management and Disposition Mastoiditis Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management and Disposition Sudden Hearing Loss Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management and Disposition Epistaxis Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Sialolithiasis Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management and Disposition Neck Masses Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management and Disposition Disclaimer References Section Two: Pulmonary System Chapter 59: Asthma Foundations Background and Importance Anatomy and Physiology Pathophysiology Clinical Features Signs and Symptoms Risk Factors Specific Contexts Cough Variant Cigarette Smokers Athletes Perimenstrual Asthma Elderly Obesity Aspirin-Exacerbated Respiratory Disease Differential Diagnoses Diagnostic Testing Peak Expiratory Flow Pulse Oximetry Capnography Blood Gas Other Blood Testing Radiology Point of Care Ultrasound Electrocardiogram Management Oxygen Administration Adrenergic Medications Inhaled Beta2 Agonists Long-Acting Beta-2 Agonists Intravenous Beta2 Agonists Subcutaneous Beta2 Agents Epinephrine Corticosteroids Systemic Corticosteroids Inhaled Corticosteroids Corticosteroids and Discharged Patients Anticholinergic Medications Magnesium Methylxanthines Leukotriene Modifiers Antibiotics Sedatives Ketamine Heliox High-Flow Nasal Canula Noninvasive Ventilation Mechanical Ventilation Extracorporeal Membrane Oxygenation Other and Future Therapies Special Situations Pregnancy Near Fatal Asthma Clinical Approach to Acute Severe Asthma Disposition References Chapter 60: Chronic Obstructive Pulmonary Disease Foundations Background Anatomy/Physiology/Pathophysiology Clinical Features Acute Exacerbations Respiratory Failure Differential Diagnosis for the Emergency Presentation Diagnostic Testing Chest Radiography Pulse Oximetry Blood Gas Analysis Electrocardiogram Laboratory Tests Management Short-Acting Beta Agonists Glucocorticoids Antibiotics Adjunctive Treatments Respiratory Support Oxygenation Non-Invasive Ventilation High-Flow Nasal Cannula Invasive Ventilation Disposition References Chapter 61: Upper Respiratory Tract Infections Pharyngitis Foundations Clinical Features Differential Diagnosis for Emergency Presentation Diagnostic Testing Management Disposition Laryngitis Foundations Clinical Features Differential Diagnosis for Emergency Presentation Diagnostic Testing Management Disposition Epiglottitis Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Peritonsillitis: Peritonsillar Cellulitis and Abscess Foundations Clinical Features Differential Diagnosis for Emergency Presentation Diagnostic Testing Management Disposition Ludwig Angina Foundations Clinical Features Differential Diagnosis for Emergency Presentation Diagnostic Testing Management Disposition Retropharyngeal Abscess Foundations Clinical Features Differential Diagnosis for Emergency Presentation Diagnostic Testing Management Disposition Parapharyngeal Abscess Foundations Clinical Features Differential Diagnosis for Emergency Presentation Diagnostic Testing Management Disposition Rhinosinusitis Foundations Clinical Features Differential Diagnosis for Emergency Presentation Diagnostic Testing Management Disposition References Chapter 62: Pneumonia Principles Background and Importance Anatomy and Physiology Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition References Chapter 63: Pleural Disease Introduction Spontaneous Pneumothorax Foundations Background and Importance Anatomy and Physiology Clinical Features Differential Diagnosis Diagnostic Testing Point of Care Ultrasound Management Primary Spontaneous Pneumothorax Secondary Spontaneous Pneumothorax Tension Pneumothorax Disposition Pleural Effusion Foundations Background and Importance Anatomy and Physiology Pathophysiology Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition References Section Three: Cardiac System Chapter 64: Acute Coronary Syndromes Foundations Epidemiology Spectrum of Illness: Coronary Artery Disease and Acute Coronary Syndrome Stable Angina Unstable Angina Acute Myocardial Infarction Pathophysiology Clinical Features Prehospital Evaluation Emergency Department Evaluation History Nontraditional History Physical Examination of the ACS Patient Early Complications of Acute Myocardial Infarction Differential Diagnoses Diagnostic Testing Electrocardiography Electrocardiographic Abnormalities in Acute Coronary Syndromes Anatomic Location of Acute Myocardial Infarction Electrocardiographic Differential Diagnosis of ST Segment Elevation Non–ST Segment Elevation Myocardial Infarction Electrocardiographic Adjuncts in the Diagnosis of Acute Coronary Syndrome Limitations of Electrocardiography in Acute Coronary Syndrome Chest Radiography Serum Markers Troponin Testing Other Serum Markers Exercise Stress Testing Echocardiography Myocardial Scintigraphy (Nuclear Imaging) Coronary Computed Tomography Angiography Risk Stratification Instruments ED Evaluation of the Chest Pain Patient with Suspected ACS Management Pharmacologic Intervention Oxygen Nitroglycerin Morphine and Other Opioid Analgesic Agents Beta-Adrenergic Blockers Angiotensin-Converting Enzyme Inhibitors HMG–Coenzyme A Reductase Inhibitors Calcium Channel Blockers Antiplatelet Therapy Aspirin P2Y12 Receptor Inhibitor Agents Glycoprotein IIb/IIIa Receptor Inhibitors Antithrombins Heparins Other Antithrombins: Bivalirudin and Fondaparinux Reperfusion Therapies Fibrinolytic Therapy Fibrinolytic Agent Selection Eligibility Criteria for Fibrinolytic Agent Therapy 12-Lead Electrocardiogram Patient Age Time from Symptom Onset Blood Pressure Extremes Retinopathy Cardiac Arrest Requiring Cardiopulmonary Resuscitation Previous Stroke or Transient Ischemic Attack Previous Myocardial Infarction or Coronary Artery Bypass Graft Recent Surgery or Trauma Menstruation Percutaneous Coronary Intervention Rescue Percutaneous Coronary Intervention Facilitated Percutaneous Coronary Intervention Choice of Reperfusion Therapy Reperfusion Therapy in Cardiogenic Shock Resuscitated Cardiac Arrest with Suspected ACS Management Summary: Potential Pharmacologic Management Approach Disposition Transfer of a Patient with Acute Coronary Syndrome Missed Diagnosis of Acute Coronary Syndrome References Chapter 65: Dysrhythmias Foundations Cardiac Cellular Electrophysiology Anatomy and Conduction Mechanisms of Dysrhythmia Formation Classification of Antidysrhythmic Drugs Class IA Agents Procainamide Class IB Agents Lidocaine Class IC Agents Flecainide Propafenone Class II Agents Esmolol Metoprolol Class III Agents Amiodarone Ibutilide Sotalol Dofetilide Dronedarone Class IV Agents Diltiazem Verapamil Miscellaneous Agents Adenosine Digoxin Magnesium Isoproterenol Clinical Features Initial Assessment of Stable Patients Differential Diagnosis Management Sinus Bradycardia and Sinoatrial and Atrioventricular Block Sinus Bradycardia Sinus Dysrhythmia Sinus Arrest and Sinoatrial Exit Block Sick Sinus Syndrome Atrioventricular Block First-Degree Atrioventricular Block Second-Degree Atrioventricular Block Type I Second-Degree Atrioventricular Block Type II Second-Degree Atrioventricular Block Third-Degree Atrioventricular Block Extrasystoles Premature Atrial Contractions Premature Ventricular Contractions Narrow-Complex Tachycardia Sinus Tachycardia Atrial Tachycardia Atrial Fibrillation Atrial Flutter Atrioventricular Nodal Reentrant Tachycardia Junctional Tachycardia Preexcitation and Accessory Pathway Syndromes Wide-Complex Tachycardia Ventricular Tachycardia Torsades de Pointes Brugada Syndrome Disposition References Chapter 66: Implantable Cardiac Devices Permanent Pacemakers Principles Clinical Features Pacemaker Terminology Pacemaker Components History Physical Examination 12-Lead Electrocardiogram Differential Diagnosis Complications of Implantation Infection Venous Thrombosis and Stenosis Complications of Existing Pacemakers The “Pacemaker Syndrome” Complications Unique to Biventricular Pacing Pacemaker Malfunction Failure to Capture Inappropriate Sensing Inappropriate Pacemaker Rate Diagnostic Testing Chest Radiograph 12-Lead Electrocardiogram Pacemaker Interrogation Magnetic Resonance Imaging in Patients with a Pacemaker Management Resuscitation Disposition Implantable Cardioverter-Defibrillators Principles Clinical Features Terminology and Components Differential Diagnosis Complications of Implantation Malfunction Diagnostic Testing Management ICD Defibrillation Resuscitation Disposition Mechanical Circulatory Support Devices Principles Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition References Chapter 67: Heart Failure Foundations Background and Importance Epidemiology Myocardial Physiology and the Cardiac Cycle in Heart Failure Abnormal Loading Conditions and Elevated Filling Pressures Congestion and Preload Afterload Disorganized Contraction Right Ventricular Dysfunction and Pulmonary Hypertension Myocardial Infarction Versus Injury Cardiorenal Syndrome Other Factors Clinical Features History and Physical Exam Precipitants Differential Diagnosis Diagnostic Testing Electrocardiogram Chest Radiography Laboratory Testing Lung Ultrasound Echocardiography Management Initial Evaluation Blood Pressure Considerations Vascular Phenotype Cardiac Phenotype Disposition References Chapter 68: Pericardial and Myocardial Disease Myocardial Disease Dilated Cardiomyopathy Foundations Clinical Features Diagnostic Testing Differential Diagnosis Management and Disposition Disposition Hypertrophic Cardiomyopathy Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Restrictive Cardiomyopathy Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Peripartum Cardiomyopathy Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Takotsubo Syndrome Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Arrhythmogenic Right Ventricular Cardiomyopathy Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Channelopathies Myocarditis Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Chagas Disease Cocaine Cardiotoxicity Sudden Death Pericardial Disease Pericarditis Foundations Clinical Findings Differential Diagnosis Diagnostic Testing Management Disposition Uremic Pericardial Disease Post–Myocardial Infarction Pericarditis Postinjury Pericarditis Neoplastic Pericardial Disease Radiation-Induced Pericarditis Miscellaneous Causes of Pericarditis Pericardial Effusion Purulent Pericarditis Constrictive Pericarditis Cardiac Tamponade Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Pneumopericardium References Chapter 69: Infective Endocarditis and Valvular Heart Disease Infective Endocarditis Foundations Background and Importance Pathophysiology and Microbiology Clinical Features and Differential Diagnosis Diagnostic Testing Management Disposition Prophylaxis Rheumatic Fever Foundations Background and Importance Pathophysiology Clinical Features and Differential Diagnosis Diagnostic Testing Management and Disposition Valvular Heart Disease Foundations Anatomy and Physiology Mitral Stenosis Pathophysiology Clinical Features Management Mitral Regurgitation Pathophysiology Clinical Features Acute Mitral Regurgitation Chronic Mitral Regurgitation Management Mitral Valve Prolapse Pathophysiology Clinical Features Management Aortic Stenosis Pathophysiology Clinical Features Management Aortic Regurgitation Pathophysiology Clinical Features Acute Aortic Regurgitation Chronic Aortic Regurgitation Management Complications of Prosthetic Valves Structural Failure Valve Thrombosis Systemic Embolization Hemolysis Endocarditis Disposition References Section Four: Vascular System Chapter 70: Hypertension Foundations Background and Importance Importance Definition of Hypertension and Relevant Terminology Physiology of Hypertension Neurohormonal Dysregulation Vascular Modulation Sodium Intake Psychosocial Stress Obesity Pathophysiology of Target-Organ Damage Clinical Features Hypertensive Emergency Hypertensive Encephalopathy Other Hypertension-Related Emergencies Acute Target Organ Damage in the Context of Systemic Illness Absence of Target Organ Dysfunction Differential Diagnoses Diagnostic Testing Management Acute Blood Pressure Control Antihypertensive Therapy Blood Pressure Goals Acute Coronary Syndrome and Acute Heart Failure Aortic Dissection Acute Ischemic Stroke Spontaneous Intracranial Hemorrhage Hypertensive Encephalopathy Acute Kidney Injury Preeclampsia and Eclampsia Sympathetic Crises Chronic Antihypertensive Therapy Disposition References Chapter 71: Aortic Dissection Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition References Chapter 72: Abdominal Aortic Aneurysm Principles Epidemiology Pathophysiology Natural History Clinical Features Unruptured Aneurysms Ruptured Aneurysms Pain-Hypotension-Mass Triad Aortoenteric Fistula Arteriovenous (Aortocaval) Fistula Differential Diagnoses Diagnostic Testing Abdominal Radiography Ultrasonography Computed Tomography Other Diagnostic Modalities Management Ruptured Aneurysms Fluid Resuscitation Diagnostic Confirmation Surgery and Mortality Intact Asymptomatic Aneurysms Traditional Repair Endovascular Repair Survival Late Complications of Repair Graft Infection Aortoenteric Fistula Pseudoaneurysm (Anastomotic Aneurysm) Complications of Endovascular Aneurysm Repair Disposition References Chapter 73: Peripheral Arteriovascular Disease Foundations Background Arterial Anatomy Pathophysiology Atherosclerosis Arterial Embolism Thromboembolism Atheroembolism Arterial Thrombosis Aneurysms Inflammation Trauma Vasospasm Arteriovenous Fistulae Clinical Features History Physical Examination Inflammation Vasospasm Differential Diagnosis Diagnostic Testing Noninvasive Assessment Contrast Arteriography Computed Tomography and Magnetic Resonance Imaging Management Noninvasive Therapy Acute Anticoagulation with Heparin Fibrinolytic Therapy Invasive Therapy Fogarty Catheter Thrombectomy Peripheral Percutaneous Transluminal Angioplasty Grafting Hyperbaric Therapy Disposition Specific Arteriovascular Diseases Diseases of Chronic Arterial Insufficiency Arteriosclerosis Obliterans Clinical Features History Physical Exam Differential Diagnosis Management Buerger Disease (Thromboangiitis Obliterans) Principles Clinical Features Differential Diagnosis Diagnostic Testing Management Diseases of Acute Arterial Occlusion Arterial Embolism Clinical Features History Physical Examination Differential Diagnosis Management Atheroembolism (Blue Toe Syndrome) Clinical Features Differential Diagnosis Management Arterial Thrombosis Physical Exam Management Peripheral Arterial Aneurysms Lower Extremity Upper Extremity Viscera Splenic Artery Aneurysms Hepatic Artery Aneurysms Superior Mesenteric Artery Aneurysms Traumatic Aneurysms Infected Aneurysms Mycotic Aneurysms Atherosclerotic Arteries Preexisting Aneurysms Post-Traumatic Pseudoaneurysms Vasospastic Disorders Thoracic Outlet Syndrome Clinical Features Physical Examination Ancillary Evaluation Differential Diagnosis Management Disposition Peripheral Arteriovenous Fistulae Physical Exam Differential Diagnosis Management Vascular Abnormality Caused by Drug Abuse Principles Clinical Features Management References Chapter 74: Pulmonary Embolism and Deep Vein Thrombosis Foundations Background and Importance Anatomy, Pathology, and Pathophysiology of VTE Deep Vein Thrombosis Clinical Features Differential Diagnosis Diagnostic Testing Pretest Probability Estimation Laboratory Evaluation Radiographic Evaluation Management Assessing Bleeding Risk Superficial Vein Thrombophlebitis Isolated Calf Vein Thrombosis Phlegmasia Cerulean and Alba Dolens Upper Extremity Venous Thromboses Complications Disposition Pulmonary Embolism Clinical Features Symptoms Vital Signs Physical Examination Differential Diagnosis Diagnostic Testing Bedside Assessment Pretest Probability Assessment Pulmonary Embolism Rule-Out Criteria D-Dimer Testing Computed Tomography Pulmonary Angiography Ventilation/Perfusion Scan Pregnant Women Clinical Course Management Airway, Oxygenation, and Ventilation Hemodynamic Resuscitation Pulmonary Vasodilators Standard Anticoagulation Reversal of Anticoagulation Thrombolytic (Fibrinolytic) Therapy Catheter-Directed Interventions Surgical Embolectomy Inferior Vena Cava Filters Pulmonary Embolism Response Teams (PERT) Mortality and Morbidity Disposition References Chapter 75: Esophagus, Stomach, and Duodenum Dysphagia Foundations Anatomy and Pathophysiology Oropharyngeal Dysphagia Neuromuscular Disorders Structural Disorders Esophageal Dysphagia Mechanical Disorders Motor Disorders Clinical Features Oropharyngeal Dysphagia Esophageal Dysphagia Differential Diagnoses Diagnostic Testing Management Disposition Foreign Bodies Foundations Background Anatomy and Physiology Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Overview Upper Esophagus Lower Esophagus Stomach Disposition Esophageal Perforation Foundations Background Anatomy and Physiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Esophagitis Foundations Gastroesophageal Reflux Disease Eosinophilic Esophagitis Infectious Esophagitis Pill Esophagitis Radiation-Induced Esophagitis Clinical Features Gastroesophageal Reflux Disease Eosinophilic Esophagitis Infectious Esophagitis Pill Esophagitis Differential Diagnoses Diagnostic Testing Management Gastric Reflux Eosinophilic Esophagitis Infectious Esophagitis Pill Esophagitis Disposition Gastritis and Peptic Ulcer Disease Foundations Background Pathophysiology Clinical Features Complications Differential Diagnoses Diagnostic Testing Management Antacids Histamine Blockers Proton Pump Inhibitors Prostaglandins Other Agents Disposition Gastric Volvulus Foundations Clinical Features Complications Differential Diagnoses Diagnostic Testing Management Disposition References Chapter 76: Liver and Biliary Tract Disorders Hepatic Disorders Hepatitis Viral Hepatitis Foundations Hepatitis A Hepatitis B Hepatitis C and E Hepatitis D Hepatitis E and G Clinical Features Differential Diagnosis Diagnostic Testing Management Prevention and Postexposure Management Disposition Alcoholic Hepatitis Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Autoimmune Hepatitis Foundations Diagnosis Management Disposition Cirrhosis Foundations Clinical Features Diagnostic Testing Management Ascites Gastrointestinal Bleeding Hepatorenal Syndrome Hepatic Encephalopathy Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Spontaneous Bacterial Peritonitis Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Hepatic Abscesses Pyogenic Abscess Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Amebic Abscess Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Miscellaneous Disorders and Conditions of the Liver Liver Disease of Pregnancy Benign Cholestasis Acute Fatty Liver Budd-Chiari Syndrome Liver Transplantation Biliary Tract Disorders Cholelithiasis Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Special Considerations Disposition Cholecystitis Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Special Considerations Acalculous Cholecystitis Emphysematous Cholecystitis Disposition Cholangitis Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Sclerosing Cholangitis Aids Cholangiopathy References Section Five: Gastrointestinal System Chapter 77: Pancreas Pancreatitis Anatomy, Physiology, and Pathophysiology Acute Pancreatitis Foundations Clinical Features Differential Diagnoses Diagnostic Testing Laboratory Tests Radiologic Tests Predicting Disease Severity Management Disposition Chronic Pancreatitis Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Pancreatic Cancer Foundations Clinical Features Diagnostic Testing Management References Chapter 78: Small Intestine Small Bowel Obstruction Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Pathophysiology Clinical Features History Physical Examination Differential Diagnosis Diagnostic Testing Laboratory Imaging Management Disposition Acute Mesenteric Ischemia Foundations Background and Importance Anatomy and Physiology Pathophysiology Mesenteric Arterial Embolism Mesenteric Arterial Thrombosis Nonocclusive Mesenteric Ischemia Mesenteric Venous Thrombosis Unusual Causes of Mesenteric Ischemia Clinical Features History Physical Examination Differential Diagnosis Diagnostic Testing Laboratory Tests Imaging Management Complications Disposition References Chapter 79: Acute Appendicitis Principles Background Anatomy and Physiology Pathophysiology Clinical Features History Physical Examination Differential Diagnosis Diagnostic Testing General Principles Laboratory Testing White Blood Cell Count C-Reactive Protein Urinalysis Other Laboratory Tests Combined Laboratory Tests Clinical Decision Instruments Imaging General Principles Plain Radiographs Graded Compression Ultrasound Computed Tomography Magnetic Resonance Imaging Summary of Imaging Methods Nonpregnant Patients Pregnant Patients Management Supportive Care Antibiotic Therapy Definitive Treatment Uncomplicated Appendicitis Complicated Appendicitis Disposition References Chapter 80: Gastroenteritis Overview Foundations Background and Importance Pathophysiology Clinical Features Patient History Physical Examination Differential Diagnoses Diagnostic Testing Management Disposition Bacterial Gastroenteritis Invasive Bacteria Campylobacter Enteritis Epidemiology Pathophysiology Clinical Features Diagnostic Testing Management Salmonellosis Epidemiology Pathophysiology Clinical Features Diagnostic Testing Management Shigellosis Epidemiology Pathophysiology Clinical Features Diagnostic Testing Management Yersinia enterocolitica Gastroenteritis Epidemiology Pathophysiology Clinical Features Diagnostic Testing Management Vibrio parahaemolyticus Gastroenteritis Epidemiology Pathophysiology Clinical Features Diagnostic Testing Management Shiga Toxin–Producing Escherichia coli Epidemiology Pathophysiology Clinical Features Diagnostic Testing Management Noninvasive Toxin-Forming Bacteria Staphylococcus spp. Epidemiology Pathophysiology Clinical Features Management Clostridium perfringens Epidemiology Pathophysiology Clinical Features Management Bacillus cereus Epidemiology Pathophysiology Clinical Features Diagnostic Testing Management Cholera and Noncholera Vibrio Species Epidemiology Pathophysiology Clinical Features Diagnostic Testing Management Enterotoxigenic Escherichia coli Epidemiology Pathophysiology Clinical Features Diagnostic Testing Management Clostridium difficile Colitis Epidemiology Pathophysiology Clinical Features Diagnostic Testing Management Viral Gastroenteritis Norovirus Epidemiology Pathophysiology Clinical Features Diagnostic Testing Management Rotavirus Epidemiology Pathophysiology Clinical Features Diagnostic Testing Management Parasites Giardia Epidemiology Pathophysiology Clinical Features Diagnostic Testing Management Amebiasis Epidemiology Pathophysiology Clinical Features Diagnostic Testing Management Food Poisoning Foundations Clinical Features Diagnostic Testing Management Scombroid Fish Poisoning Epidemiology Pathophysiology Clinical Features Management Ciguatera Fish Poisoning Epidemiology Pathophysiology Clinical Features Management Specific Groups With Gastroenteritis Traveler’s Diarrhea Epidemiology Pathophysiology Clinical Features Diagnostic Testing Management Gastroenteritis in the Immunocompromised Host with HIV/AIDS Epidemiology and Pathophysiology Clinical Features Diagnostic Testing Management References Chapter 81: Large Intestine Irritable Bowel Syndrome Foundations Background Anatomy, Physiology, and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Diverticular Disease Foundations Background Anatomy, Physiology, and Pathophysiology Clinical Features Diverticulosis Diverticulitis Differential Diagnoses Diagnostic Testing Management Diverticulosis Uncomplicated Diverticulitis Complicated Diverticulitis Disposition Large Bowel Obstruction Foundations Background Anatomy, Physiology, and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Laboratory Tests Imaging Studies Plain Radiography Computed Tomography Colonoscopy and Water-Soluble Contrast Enema Management Disposition Volvulus Foundations Background Anatomy, Physiology, and Pathophysiology Sigmoid Volvulus Cecal Volvulus Clinical Features Sigmoid Volvulus Cecal Volvulus Differential Diagnoses Diagnostic Testing Sigmoid Volvulus Cecal Volvulus Management Sigmoid Volvulus Cecal Volvulus Disposition Intussusception Foundation Background Anatomy, Physiology, and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Ultrasound Examination Plain Radiography Computed Tomography Colonoscopy Management Disposition Inflammatory Bowel Disease Foundations Background Anatomy, Physiology, and Pathophysiology Crohn Disease Ulcerative Colitis Clinical Features Toxic Megacolon Extraintestinal Manifestations Differential Diagnoses Diagnosis Management Crohn Disease Mild to Moderate Disease Moderate to Severe Disease Severe to Fulminant Disease Ulcerative Colitis Mild to Moderate Disease Moderate to Severe Disease Managing Special Populations With Irritable Bowel Syndrome Toxic Megacolon Disposition Colonic Ischemia Foundations Background Anatomy, Physiology, and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Laboratory Tests Imaging Studies Plain Radiography Computed Tomography Colonoscopy Angiography Management Disposition Stercoral Colitis Foundations Background Anatomy, Physiology, and Pathophysiology Clinical Features Differential Diagnoses Diagnosis Management Disposition Radiation Proctocolitis Foundations Background Anatomy, Physiology, and Pathophysiology Acute Radiation Proctocolitis Chronic Radiation Proctocolitis Clinical Features Differential Diagnosis Diagnostic Testing Management Acute Radiation Proctocolitis Chronic Radiation Proctocolitis Disposition Neutropenic Enterocolitis Foundations Background Anatomy, Pathology, and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Laboratory Tests Radiologic Tests Management Disposition References Chapter 82: Anorectum Foundations Clinical Features Specific Anorectal Problems Hemorrhoids Foundations Clinical Features Management Anal Fissures Foundations Clinical Features Management Abscesses and Fistulae Foundations Management Perirectal and Perianal Abscesses Ischiorectal Abscess Intersphincteric Abscess Supralevator Abscess Postanal Abscess Horseshoe Abscess Necrotizing Infection Fistulae Pilonidal Disease Foundations Management Hidradenitis Suppurativa Foundations Clinical Findings Differential Diagnosis Management Proctalgia Levator Ani Syndrome Proctalgia Fugax Fecal Incontinence Foundations Clinical Features Management Pruritis Ani Foundations Diagnostic Testing Management Sexually Transmitted Disease and Proctitis Foundations Gonorrhea Chlamydial Infection and Lymphogranuloma Venereum Herpes Simplex Virus Infection Syphilis Chancroid Condyloma Acuminatum Ulcerative Lesions in HIV-Infected Patients Management Radiation Proctitis Rectal Prolapse Rectal Foreign Bodies Foundations Clinical Features Diagnostic Testing Management References Section Six: Genitourinary and Gynecologic Systems Chapter 83: Renal Failure Renal Failure Acute Kidney Injury Foundations Clinical Features Differential Diagnosis Prerenal Azotemia Postrenal (Obstructive) Acute Kidney Injury Intrinsic Acute Kidney Injury Acute Glomerulonephritis Acute Interstitial Nephritis Intrarenal Vascular Disease of the Kidney Acute Tubular Necrosis Diagnostic Testing Urine Volume Urinalysis Heme Protein Serum and Urine Chemical Analysis Creatinine and Blood Urea Nitrogen Urine Sodium and Fractional Excretion of Sodium Renal Imaging Computed Tomography Ultrasonography Diagnosis Management Hyperkalemia and Other Metabolic Derangements Hyperkalemia Hypocalcemia Hyperphosphatemia Hypermagnesemia Disturbances of Volume Regulation Disposition Chronic Kidney Disease Foundations Pathophysiology Clinical Features Cardiovascular System Pulmonary Effects Neurologic Features Gastrointestinal System Dermatologic Features Musculoskeletal System Immunologic Considerations Hematologic Effects Differential Diagnosis Diagnostic Testing Management Hyperkalemia Pulmonary Edema Infection Dialysis Hemodialysis Peritoneal Dialysis Indications for Dialysis Complications of Dialysis Hemodialysis Vascular Access–Related Complications Non–Vascular Access–Related Complications of Dialysis Hypotension Shortness of Breath Chest Pain. Neurologic Dysfunction Peritoneal Dialysis References Chapter 84: Sexually Transmitted Infections Disorders Characterized by Genital Ulcers Herpes Background and Importance Clinical Features Diagnostic Testing Management Disposition Syphilis Background and Importance Clinical Features Diagnostic Testing Management Disposition Chancroid Background and Importance Clinical Features Diagnostic Testing Management Disorders Characterized by Genital Discharge Foundations Gonorrhea Background and Importance Clinical Features Diagnostic Testing Treatment Disposition Chlamydia Background and Importance Clinical Features Diagnostic Testing Management Disposition Nongonococcal Urethritis Trichomoniasis Background and Importance Clinical Features Diagnostic Testing Management Disposition Pelvic Inflammatory Disease Background and Importance Clinical Features Diagnostic Testing Management Disposition Bacterial Vaginosis Background and Importance Clinical Features and Diagnostic Testing Management Vulvovaginal Candidiasis Background and Importance Clinical Features and Diagnostic Testing Management Epithelial Cell Infections Condyloma Acuminata (Genital Warts) Background and Importance Clinical Findings Diagnostic Testing Management Molluscum Contagiosum Ectoparasites Pediculosis Pubis Scabies References Chapter 85: Urologic Disorders Urinary Tract Infection in Adults Background Anatomy and Physiology Pathophysiology Clinical Features Differential Diagnosis Diagnostic Testing Urinalysis and Urine Culture Imaging Management Simple Urinary Tract Infection Complex Urinary Tract Infection Disposition Complicated Urinary Tract Infection in High-Risk Populations Pregnancy Indwelling and Temporary Urinary Catheters Prostatitis Background Clinical Features Diagnostic Testing Management Renal Calculi Background Pathophysiology Clinical Features Differential Diagnosis Diagnostic Testing Urinalysis and Culture Other Laboratory Tests Imaging Radiography of the Kidney, Ureter, and Bladder Intravenous Pyelography Computed Tomography Ultrasonography Management Disposition Indications for Admission Outpatient Management Bladder (Vesical) Calculus Background Clinical Features Diagnostic Testing Management Acute Scrotal Pain Background Specific Disorders Testicular Torsion Background Clinical Features Differential Diagnosis Diagnostic Testing Urinalysis Imaging Management Disposition Torsion of Appendages of the Testis Background Clinical Features Diagnostic Testing Management and Disposition Epididymitis Background Clinical Features Diagnostic Testing Management Disposition Orchitis Background Clinical Features Diagnostic Testing Management Testicular Tumors Background Clinical Features Diagnostic Testing Management and Disposition Testicular Trauma Inguinal Hernia, Acute Hydrocele, Varicocele, and Spermatocele Acute Urinary Retention Background Physiology and Pathophysiology Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Hematuria Background Clinical Features Diagnostic Testing Management and Disposition References Chapter 86: Gynecologic Disorders Gynecologic Disorders Adnexal Torsion Foundations Clinical Features Differential Diagnoses Diagnostic Testing Laboratory Tests Imaging Tests Ultrasonography Computed tomography Magnetic resonance imaging Laparoscopy Management and Disposition Ovarian Cysts and Masses Foundations Clinical Features Differential Diagnoses Diagnostic Testing Laboratory Tests Imaging Tests Ultrasonography Computed tomography Magnetic resonance imaging Management and Disposition Abnormal Uterine Bleeding in the Nonpregnant Patient Foundations Clinical Features History Physical Examination Differential Diagnoses Diagnostic Strategies Laboratory Tests Imaging Tests Management Disposition Emergency Contraception References Section Seven: Neurology Chapter 87: Stroke Foundations Background and Importance Ischemic Stroke Transient Ischemic Attack Hemorrhagic Stroke Anatomy, Physiology, and Pathophysiology Clinical Features Ischemic Stroke Chemoreceptor Trigger Zone for Emesis Hemorrhagic Stroke Differential Diagnoses Ischemic Stroke Hemorrhagic Stroke Diagnostic Testing Ischemic Stroke Transient Ischemic Attack Hemorrhagic Stroke Management Ischemic Stroke Blood Pressure Management Temperature Blood Glucose Reperfusion Therapy Thrombolytic Therapy Agent and Dosage Time Window Thrombolysis for Mild Disabling Versus Nondisabling Acute Ischemic Stroke Thrombolysis in Patients on Anticoagulants Before the Stroke Symptomatic Intracerebral Hemorrhage Following Thrombolysis Cerebral Microbleeds Mechanical Thrombectomy Timing Mechanical Thrombectomy and Thrombolysis Spontaneous Intracerebral Hemorrhage (Hemorrhagic Stroke) Monitoring Blood Pressure Management Reversal of Anticoagulation Hemostatic Agents Seizures Prognosis Increased Intracranial Pressure Neurosurgical Intervention Transient Ischemic Attack Disposition References Chapter 88: Seizure Foundations Background and Classification Anatomy, Physiology, and Pathophysiology Clinical Features Clinical History Physical Examination Differential Diagnosis Diagnostic Testing Laboratory Studies Radiology Special Procedures and Tests Management Stabilization and Empirical Therapy Definitive Management Special Cases Alcohol-Related Seizures Seizures Related to Other Toxins Post-Traumatic Seizures Seizures in Pregnancy First-Time Seizures Breakthrough Seizures Post-Anoxic Seizures Nonconvulsive Status Epilepticus Inflammation-Related Seizures Disposition References Chapter 89: Headache Disorders Primary Headache Disorders Migraine Headache Principles Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Cluster Headache Principles Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Tension-Type Headache Principles Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Secondary Headache Disorders Subarachnoid Hemorrhage Principles Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Intracranial Neoplasm Principles Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Giant Cell Arteritis Principles Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Carotid and Vertebral Artery Dissection Principles Clinical Features Carotid Artery Dissection Vertebral Artery Dissection Differential Diagnoses Diagnostic Testing Management Disposition Cerebral Venous Thrombosis Principles Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Idiopathic Intracranial Hypertension Principles Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Post–Dural Puncture Headache and Other Low CSF Pressure Headaches Principles Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Post-Traumatic Headache Principles Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Hypertensive Headache Principles Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Reversible Cerebral Vasoconstriction Syndrome Principles Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition References Chapter 90: Delirium and Dementia Overview Delirium Background Pathophysiology Clinical Features Differential Diagnosis Diagnostic Studies Management Disposition Dementia Principles Background Pathophysiology Clinical Features Differential Diagnosis Senescent Forgetfulness Delirium Depression Diagnostic Testing Cognitive Evaluation Laboratory Tests and Imaging Studies Management Disposition References Chapter 91: Brain and Cranial Nerve Disorders Multiple Sclerosis Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Cerebral Venous Thrombosis Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Cranial Nerve Disorders Trigeminal Neuralgia (Cranial Nerve V) Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Facial Nerve Paralysis (Cranial Nerve VII) Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Vestibular Schwannoma (Cranial Nerve VIII) Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Diabetic Cranial Mononeuropathy Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition References Chapter 92: Spinal Cord Disorders Foundations Anatomy Classification of Spinal Cord Syndromes Complete (Transverse) Spinal Cord Syndrome Incomplete (Partial) Spinal Cord Lesions Central Cord Syndrome Brown-Séquard Syndrome Anterior Cord Syndrome Conus Medullaris and Cauda Equina Syndromes Clinical Features History Physical Examination Motor Function Sensory Function Reflexes Differential Diagnoses Diagnostic Testing Management Specific Disease Processes Intrinsic Cord Lesions Multiple Sclerosis Transverse Myelitis Foundations Clinical Features Differential Diagnoses Diagnostic Strategies Management Spinal Subarachnoid Hemorrhage Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Syringomyelia Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Human Immunodeficiency Virus Myelopathy Spinal Cord Infarction Surfer’s Myelopathy Extrinsic Cord Lesions Spinal Epidural Hematoma Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Spinal Epidural Abscess Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Discitis Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Neoplasm Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Chronic Complications of Spincal Cord Injury Autonomic Dysreflexia Foundations Clinical Features Management Spasticity Infection References Chapter 93: Peripheral Nerve Disorders Overview Principles Differential Diagnosis Diagnostic Testing Specific Types of Neuropathies Type 1: Demyelinating Polyneuropathy (Guillain-­Barré Syndrome) Principles Clinical Features Diagnostic Testing Management Disposition Type 2: Distal Symmetrical Polyneuropathy Principles Clinical Findings Differential Diagnosis Diagnostic Testing Management Type 3: Asymmetric Proximal and Distal Peripheral Neuropathies (Radiculopathies and Plexopathies) Type 4: Isolated Mononeuropathies Radial Mononeuropathy Principles Clinical Findings Diagnostic Testing Management Ulnar Mononeuropathy Principles and Clinical Findings Diagnostic Testing Management Median Mononeuropathy Principles Clinical Findings Diagnostic Testing Management Sciatic Mononeuropathy Principles Clinical Findings Diagnostic Testing Management Lateral Femoral Cutaneous Mononeuropathy Principles Clinical Findings Diagnostic Testing Management Common Peroneal Mononeuropathy Principles Clinical Findings Diagnostic Testing Management Type 5: Mononeuropathy Multiplex Principles Clinical Findings Lyme Disease Diagnostic Testing Management Type 6: Amyotrophic Lateral Sclerosis Principles Clinical Findings Diagnostic Testing Management Type 7: Sensory Neuronopathy (Ganglionopathy) Principles Clinical Findings Diagnostic Testing Management References Chapter 94: Neuromuscular Disorders Foundations Clinical Features History Physical Examination Differential Diagnosis Myelopathies Motor Neuron Disease Neuropathies Diseases of the Neuromuscular Junction Myopathies Diagnostic Testing Disorders of the Neuromuscular Junction Myasthenia Gravis Principles Myasthenic crisis Lambert-Eaton syndrome Diagnostic Testing Management Disposition Botulism Principles Clinical Features Diagnostic Testing Management Disposition Tick Paralysis Principles Clinical Features Management Disposition Disorders of the Muscles Inflammatory Disorders Principles Clinical Features Diagnostic Testing Management Disposition Metabolic Disorders Periodic Paralysis Principles Clinical features Diagnostic testing Management Disposition References Chapter 95: Central Nervous System Infections Foundations Background and Pathophysiology Bacterial Meningitis Viral Meningitis Viral Encephalitis Tuberculous Meningitis Fungal Meningitis Central Nervous System Abscess Clinical Features Meningitis Encephalitis Central Nervous System Abscess CSF Shunt Infection Differential Diagnoses Diagnostic Testing Blood Testing Neuroimaging Lumbar Puncture Opening Pressure Cerebrospinal Spinal Fluid Analysis Cerebrospinal Spinal Fluid Cell Count Gram Stain Xanthochromia Glucose Protein Other Stains Lactic Acid Antigen Detection Bacterial Cultures Additional Investigations Management Bacterial Meningitis Tuberculous Meningitis Fungal Meningitis Viral Meningitis Viral Encephalitis Central Nervous System Abscess CSF Shunt Infection Chemoprophylaxis Immunoprophylaxis Disposition References Section Eight: Behavioral Disorders Chapter 96: Thought Disorders Foundations Background and Importance Pathophysiology Clinical Features Differential Diagnoses Medical Disorders Psychiatric Disorders Diagnostic Testing Management Disposition References Chapter 97: Mood Disorders Foundations Background and Importance Epidemiology Neuroanatomy Pathophysiology Neurophysiology Endocrine System Genetics Psychosocial Factors Clinical Features Major Depressive Disorder Mood Disturbances Disturbances in Psychomotor Activity Vegetative Disturbances Thought Process and Content Masked Depression Special Considerations Children and Adolescents Disruptive Mood Dysregulation Disorder Geriatric Patients Other Depressive Disorders Peripartum Depression Persistent Depressive Disorder Premenstrual Dysphoric Disorder Seasonal Affective Disorder Bipolar Disorders Manic Episode Cyclothymic Disorder Mood Disorders Caused by a General Medical Condition Mood Disorders Caused by Medications or Other Substances Differential Diagnoses Medical Disorders, Medications, and Substance Abuse or Withdrawal Grief and Bereavement Adjustment Disorders Borderline Personality Disorder Dementia Diagnostic Testing Management Disposition References Chapter 98: Anxiety Disorders Foundations Background and Importance Epidemiology Pathophysiology Clinical Features Panic Disorder Generalized Anxiety Disorder Post-Traumatic Stress Disorder Specific Phobias Obsessive-Compulsive Disorder Hyperventilation Syndrome Somatic Symptoms and Related Disorders Differential Diagnosis Cardiac Diseases Endocrine Diseases Respiratory Diseases Neurologic Disorders Drug Intoxication and Withdrawal States Diagnostic Testing Management Pharmacologic Treatment Nonpharmacologic Therapy Disposition References Chapter 99: Somatic Symptoms and Related Disorders Foundations Clinical Features Somatic Symptom Disorder Illness Anxiety Disorder Conversion Disorder Factitious Disorder Psychological Factors Affecting Medical Illness Differential Diagnoses Diagnostic Testing Management Disposition References Chapter 100: Factitious Disorders and Malingering Foundations Clinical Features Factitious Disorders Factitious Disorders Imposed on Self Psychological Symptoms Physical Symptoms Munchausen Syndrome Factitious Disorder Imposed on Another Perpetrator Characteristics Victim Characteristics Malingering Differential Diagnoses Diagnostic Testing Factitious Disorder Malingering Management Factitious Disorders Malingering Disposition References Chapter 101: Suicidal Behavior Foundations Background and Importance Epidemiology Risk Factors Precipitating Factors At Risk Populations Mental Illness Alcohol and Substance Abuse Disorders Chronic Illness Pathophysiology Methods of Suicide Clinical Features Initial Recognition and Screening History and Physical Examination Differential Diagnoses Normal Colloquialisms and Expressions of Suffering Malingering Non-Suicidal Self-Injury Unintentional Injury or Ingestion Substance Intoxication, Abuse, or Misuse Suicidal Obsessions or Preoccupations Diagnostic Testing Management Overview Suicide Precautions Pharmacologic Treatment Risk Assessment Documentation Disposition Psychiatric Hospitalization Discharge Brief Patient Education Joint Safety Planning Lethal Means Restriction Counseling Referral for Outpatient Care Caring Contacts Additional Ethical Considerations Do-Not-Resuscitate Orders Physician-Assisted Dying References Section Nine: Immunologic and Inflammatory Chapter 102: Arthritis General Approach to Arthritis Foundations Background Pathophysiology Clinical Features and Differential Diagnosis History Physical Examination General examination Joint examination Inspection Palpation Range of motion Neurovascular evaluation Diagnostic Testing Radiographic Tests Plain radiographs Ultrasound Computed Tomography and Magnetic Resonance Imaging Laboratory Testing Arthrocentesis and Synovial Fluid Analysis Arthrocentesis Indications and contraindications Complications Synovial fluid examination General appearance White blood cell count Lactate and C-reactive protein Crystal evaluation Gram stain and culture Management Disposition Acute Monoarticular Joint Pain Nongonococcal Bacterial Septic Arthritis Foundations Clinical Features and Differential Diagnosis Diagnostic testing Management Chronic Monoarticular Arthritis Osteoarthritis Foundations Clinical Features Diagnostic Testing Management Acute Polyarticular Joint Pain Gonococcal Arthritis Foundations Clinical Features Management Gout Foundations Clinical Features Diagnostic Testing Management Pseudogout Foundations Clinical Features Diagnostic Testing Management Lyme Disease Foundations Clinical Features Diagnostic Testing Management Acute Rheumatic Fever Foundations Clinical Features Diagnostic Testing Management Chronic Polyarthritis Rheumatoid Arthritis Foundations Clinical Features Diagnostic Testing Management Seronegative Spondyloarthropathies Foundations Ankylosing Spondylitis Clinical features Management Reactive Arthritis (Formerly Termed Reiter Syndrome) Clinical features Diagnostic testing Management Psoriatic Arthritis Enteropathic Arthritis References Chapter 103: Tendinopathy and Bursitis Tendinopathy Foundations Background and Importance Pathophysiology Clinical Features General Tendinopathy Specific Tendinopathies Shoulder Impingement Syndrome and Rotator Cuff Tendinopathies Bicipital Tendinopathy Calcific Tendinopathy Elbow Lateral Epicondylitis Medial Epicondylitis Wrist de Quervain’s Tenosynovitis Knee Patellar Tendinopathy Ankle Achilles Tendinopathy Achilles Tendon Rupture Differential Diagnoses Diagnostic Testing Management General Tendinopathy Specific Tendinopathies Impingement Syndrome and Rotator Cuff Tendinopathies Calcific Tendinopathy Lateral and Medial Epicondylitis de Quervain’s Tenosynovitis Achilles Tendinopathy and Rupture Disposition Bursitis Foundations Clinical Features Olecranon and Prepatellar Bursitis Subacromial Bursitis Trochanteric Bursitis Ischiogluteal Bursitis Iliopsoas Bursitis Pes Anserine Bursitis Differential Diagnoses Diagnostic Testing Management Septic Bursitis Nonseptic Bursitis Disposition References Chapter 104: Musculoskeletal Back Pain Foundations Background Epidemiology Anatomy and Physiology Pathophysiology Nonspecific or Uncomplicated Back Pain Nerve Root Syndromes Skeletal Causes of Back Pain Clinical Features History Physical Examination Differential Diagnoses Diagnostic Testing Laboratory Testing Imaging Studies Point-of-Care Ultrasound Plain Radiographs Computed Tomography Magnetic Resonance Imaging Computed Tomography Myelogram Management Nonspecific or Uncomplicated Back Pain Disc Herniation and Nerve Root Pain Epidural Abscess and Spinal Osteomyelitis Epidural Hematoma Cauda Equina Syndrome Malignancy Fracture Disposition References Chapter 105: Systemic Lupus Erythematosus and the Vasculitides Systemic Lupus Erythematosus Foundations Background and Importance Etiology and Pathophysiology Clinical Features Overview Specific Symptoms Fever Cardiopulmonary Presentations Coronary Artery Disease Pericardial and Myocardial Disease Valvular Disease Pulmonary Vascular Disease Pleural Disease Parenchymal Disease Mechanical Respiratory Disease Renal Disease Gastrointestinal Presentations Dermatologic Presentations Musculoskeletal Presentations Hematologic Disease Complications Due To Medications Differential Diagnosis Diagnostic Testing Laboratory Tests Initial Diagnosis Disease Activity Evaluation for Infection Imaging Studies Management Emergent Stabilization General Systemic Disease Activity Patients Diagnosed With Systemic Lupus Erythematosus Patients Not Diagnosed With Systemic Lupus Erythematosus Specific Presentations Infection Musculoskeletal Pain Cutaneous Manifestations Special Considerations Antiphospholipid Syndrome Foundations Clinical Features Diagnostic Testing Management Drug-Induced Lupus Disposition Vasculitis Foundations Large-Vessel Vasculitis Giant Cell Arteritis Background Clinical Features Diagnostic Testing Management Takayasu Arteritis Background Clinical Features Diagnostic Testing Management Small And Medium Vessel Vasculitis Background Clinical Features Differential Diagnosis Specific Disorders ANCA-Associated Vasculitis Granulomatosis With Polyangiitis Microscopic Polyangiitis Eosinophilic Granulomatosis With Polyangiitis Anti-Glomerular Basement Membrane Disease (Goodpasture Disease) Immune Complex Mediated Vasculitis IgA Vasculitis Cryoglobulinemic Vasculitis Polyarteritis Nodosa Other Vasculitides Behçet Disease Cutaneous Vasculitis References Chapter 106: Allergy, Anaphylaxis, and Angioedema Allergy Foundations Background and Terminology Pathophysiology Classification of Reactions Anaphylaxis Foundations Epidemiology and Risk Factors Common Triggers for Anaphylaxis Foods Drugs Insect Stings Natural Rubber Latex Radiocontrast Media Exercise-Induced Anaphylaxis Idiopathic Anaphylaxis Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Overview Positioning Epinephrine Airway Volume Expansion Antihistamines Glucocorticoids Patients Receiving Beta-­Blockade Disposition Urticaria and Angioedema Pathophysiology and Clinical Features Diagnostic Testing Management Angioedema With Urticaria Angioedema Without Urticaria Special Considerations Disposition References Chapter 107: Dermatologic Presentations Overview Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Clinical Features and Differential Diagnoses Diagnostic Testing Management Disposition Infectious Disorders Bacterial Infections Impetigo Folliculitis Cellulitis Abscess Methicillin-Resistant Staphylococcus aureus (MRSA) Erythema Migrans Necrotizing Fasciitis Meningococcal Infection Scarlet Fever Syphilis Disseminated Gonococcal Infection Staphylococcal Scalded Skin Syndrome Toxic Shock Syndrome Rocky Mountain Spotted Fever Viral Infections Herpes Simplex Virus Varicella-­Zoster Virus Varicella Herpes zoster Viral Exanthems Roseola infantum Measles Rubella Erythema infectiosum Fungal Infections Tinea Corporis Tinea Capitis Kerion Tinea Pedis Tinea Versicolor Tinea Unguium (Onychomycosis) Candidiasis Oral candidiasis Cutaneous candidiasis Vulvovaginal candidiasis Sporotrichosis Infestations Scabies Pediculosis Bed Bugs Allergic Reactions Contact Dermatitis Urticaria Poison Ivy Drug Reactions Toxic Epidermal Necrolysis Inflammatory Conditions Atopic Dermatitis Pityriasis Rosea Kawasaki Disease Erythema Multiforme Erythema Nodosum Lichen Planus Autoimmune Disorders Bullous Pemphigoid Pemphigus Vulgaris Cutaneous Malignancies Skin Conditions Associated with Systemic Disease References Section Ten: Hematology and Oncology Chapter 108: Blood and Blood Components Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Blood Banking Blood Typing Type and Screen Type and Crossmatch Titer Testing for Whole Blood Donation Management Decision Making Pharmacology Devices and Techniques Whole Blood Packed Red Blood Cells Special Preparations of PRBCs Washed RBCs Leukocyte-Reduced RBCs Irradiated RBCs CMV Negative Blood Fresh Frozen Plasma Platelets Cryoprecipitate Prothrombin Complex Concentrate Outcomes Safety and Effectiveness Massive Transfusion Protocols Complications and Adverse Effects of Nonmassive RBC Transfusion Acute Transfusion Reactions Minor Allergic Anaphylactic Febrile (Nonhemolytic) Transfusion Reaction Acute Hemolytic Transfusion Reaction Transfusion-Related Acute Lung Injury Transfusion Associated Circulatory Overload Infectious Complications of Transfusions Delayed Transfusion Reactions Delayed Hemolytic Transfusion Reaction Transfusion-Associated Graft-versus-Host Disease Post-transfusion Purpura References Chapter 109: Anemia and Polycythemia Anemia Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Anemias Due to Decreased Red Blood Cell Production Foundations Iron Deficiency Anemia Foundations Clinical Features Diagnostic Testing Management Thalassemia Foundations Pathophysiology Clinical Features Diagnostic Testing Management Sideroblastic Anemia Foundations Clinical Features Differential Diagnoses Management Anemia of Chronic Disease Foundations Clinical Features Diagnostic Testing Management Macrocytic and Megaloblastic Anemias Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Normochromic and Normocytic Anemias Foundations Clinical Features Diagnostic Testing Management Increased Red Blood Cell Destruction Foundations Pathophysiology Clinical Features Differential Diagnoses Intrinsic enzyme defects Intrinsic Membrane Abnormality Intrinsic Hemoglobin Abnormality Extrinsic Alloantibodies Extrinsic Autoantibodies Extrinsic Mechanical Causes Environmental Causes Abnormal Sequestration Diagnostic Testing Management Sickle Cell Disease Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Polycythemia Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition References Chapter 110: White Blood Cell Disorders Foundations Background and Importance Anatomy and Physiology Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Specific Disorders Chronic Myeloid Leukemia Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Lymphocytic Leukocytosis Foundations Clinical Features Diagnostic Testing Management Leukopenia Foundations Clinical Features Diagnostic Testing and Management Disposition References Chapter 111: Disorders of Hemostasis Foundations Anatomy and Physiology Pathophysiology Clinical Features Differential Diagnosis Diagnostic Testing Complete Blood Count and Blood Smear Platelet Count Bleeding Time and Platelet Function Assay Prothrombin Time Partial Thromboplastin Time Anti-Xa Assay Fibrinogen Thrombin Time Clot Solubility Factor Level Assays Management Thrombocytopenia Immune Thrombocytopenia Drug-Induced Thrombocytopenia Heparin-Induced Thrombocytopenia Post-Transfusion Purpura Thrombotic Microangiopathy Thrombotic Thrombocytopenic Purpura Dilutional Thrombocytopenia Hereditary Thrombocytopenia and Thrombocytopathy Thrombocytopathy Adhesion Defects Aggregation Defects Secretory Defects Thrombocytosis Coagulation Disorders Hemophilia A Hemophilia B (Christmas Disease) von Willebrand Disease Miscellaneous Coagulation Disorders Medication-­Induced Anticoagulation Disseminated Intravascular Coagulation Disposition References Chapter 112: Oncologic Emergencies Foundations Febrile Neutropenia Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Malignant Pericardial Disease Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Hypercalcemia Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Tumor Lysis Syndrome Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Leukostasis Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Superior Vena Cava Syndrome Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Monocloncal Antibody Therapies and Complications Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition T-Lymphocyte Checkpoint Inhibitor Therapies and Complications Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Adoptive Cell Transfer Therapies and Complications Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition References Section Eleven: Metabolism and Endocrinology Chapter 113: Acid-Base Disorders Foundations Clinical Features Differential Diagnosis and Diagnostic Testing Diagnostic Testing Basic Metabolic Panel Interpretation Five-Step Acid-Base Approach to the BMP BMP Step 1. Check for Abnormal Values BMP Step 2. Check the Anion Gap BMP Step 3. If a Metabolic Acidosis is Present, Apply the Rule of 15 BMP Step 4. If a Wide Anion Gap Metabolic Acidosis Is Present (Anion Gap ≥15), Check the Delta Gap BMP Step 5. If a Wide Anion Gap Metabolic Acidosis Is Present (Anion Gap ≥15), But the Cause Is Not Evident, Check the Osmolar Gap Blood Gas Interpretation Three-Step Acid-Base Approach to the ABG ABG Step 1. Determine if the Patient Is Acidemic or Alkalemic ABG Step 2. Determine if a Predominant Respiratory or Metabolic Acid-Base Disturbance Is Present ABG Step 3. If a Predominant Respiratory Acid-Base Disturbance Is Present, Determine If There Is a Concurrent Metabolic Disturbance Differential Diagnosis of Acid-­Base Disorders Metabolic Acidosis Wide Anion Gap Metabolic Acidosis Normal Anion Gap Metabolic Acidosis Metabolic Alkalosis Chloride-Responsive Metabolic Alkalosis Chloride-Unresponsive Metabolic Alkalosis Respiratory Acidosis Respiratory Alkalosis Management Intravenous Fluids Sodium Bicarbonate Therapy Disposition Acknowledgements References Acid-Base Disorder Sample Calculations Rule of 15 Example 1 Rule of 15 Example 2 Rule of 15 Example 3 Rule of 15 Example 4 Delta Gap Example 1 Delta Gap Example 2 Chapter 114: Electrolyte Disorders Hyperkalemia Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Hypokalemia Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Hypernatremia Foundations Clinical Features Diagnostic Testing Management Disposition Hyponatremia Foundations Pseudohyponatremia Hypovolemic Hyponatremia Hypervolemic Hyponatremia Euvolemic Hyponatremia Clinical Features Diagnostic Testing Management Hypovolemic Hyponatremia Hypervolemic Hyponatremia Euvolemic Hyponatremia Disposition Hypercalcemia Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Hypocalcemia Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Hypermagnesemia Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Hypomagnesemia Foundations Clinical Features Differential Diagnosis Patients Maintained on Diuretics Malnourished and Alcoholic Patients Patients With Hypokalemia Patients With Acute Coronary Artery Disease and Ventricular Arrhythmias Patients Receiving Specific Medications Diagnostic Testing Management Disposition Hyperphosphatemia Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Hypophosphatemia Foundations Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition References Chapter 115: Diabetes Mellitus and Disorders of Glucose Homeostasis Diabetes Mellitus Diabetes Mellitus Foundations Background and Importance Epidemiology Anatomy, Physiology, and Pathophysiology Normal Physiology Insulin Glucose Regulatory Mechanisms Pathophysiology Types of Diabetes Type 1 Diabetes Mellitus Type 2 Diabetes Mellitus Gestational Diabetes Diabetes of Other Causes Prediabetes Diabetes Mellitus Clinical Features Type 1 Type 2 Diabetes Mellitus Differential Diagnosis Diabetes Mellitus Diagnostic Testing Serum Glucose Level Glycosylated Hemoglobin Urine Glucose Level Urine Ketone Level Dipstick Blood Glucose Level Diabetes Mellitus Management Management of Hyperglycemia Management of Diabetes Mellitus Oral Hypoglycemic Agents Biguanides Sulfonylureas Thiazolidinediones α-Glucosidase Inhibitors Meglitinides Glucagon-Like Peptide Analogs and Agonists Dipeptidyl Peptidase-4 Inhibitors Amylin Analog Sodium-Glucose Cotransporter 2 Inhibitors Insulin Pancreas Transplantation New Trends in Diabetes Management Late Complications of Diabetes Vascular Complications Diabetic Nephropathy Retinopathy Neuropathy The Diabetic Foot Infections Cutaneous Manifestations Skin Conditions Acanthosis Nigricans Necrobiosis Lipoidica Diabeticorum Xanthoma Diabeticorum Bullosis Diabeticorum Diabetic Dermopathy Impetigo or Intertrigo Diabetes Disposition Diabetic Ketoacidosis Foundations Pathophysiology Clinical Features Differential Diagnosis Diagnostic Testing Management Intravenous Fluids Potassium Insulin Magnesium Sodium Bicarbonate Complications Diabetic Ketoacidosis Disposition Hyperglycemic Hyperosmolar State Foundations Pathophysiology Clinical Features Diagnostic Testing Management Intravenous Fluids Electrolytes Insulin Other Considerations Acute Complications Hyperglycemic Hyperosmolar State Disposition Diabetes in Pregnancy Hypoglycemia Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition References Chapter 116: Rhabdomyolysis Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Clinical Features Complications Early Complications Compartment Syndrome Electrolyte Disorders and Acidosis Hypovolemia Hepatic laboratory abnormalities Late Complications Myoglobin-Induced Acute Kidney Injury Disseminated Intravascular Coagulation Differential Diagnosis Diagnostic Testing Serum Creatine Kinase Serum and Urine Myoglobin Urine Dipstick and Urinalysis Other Laboratory Findings Prognostic Tests in Rhabdomyolysis Management Fluid Replacement Mannitol and Other Diuretics Experimental Therapies Renal Replacement Therapy Disposition Prognosis References Chapter 117: Thyroid and Adrenal Disorders Hyperthyroidism Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Clinical Features History and Physical Examination Thyroid Storm Differential Diagnoses Diagnostic Testing Management Supportive Treatment Symptomatic Treatment Thyroid-Directed Treatment Reducing Thyroid Hormone Production Inhibiting Thyroid Hormone Release Inhibiting Conversion of T4 to T3 Miscellaneous Therapies Identification and Treatment of the Precipitating Event Disposition Hypothyroidism Foundations Background and Importance Pathophysiology Clinical Features History and Physical Examination Myxedema Coma Differential Diagnoses Diagnostic Testing Management Hypothyroidism Myxedema Coma Disposition Adrenal Excess States Foundations Background and Importance Cushing Syndrome Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Hyperaldosteronism Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Pheochromocytoma and Paraganglioma Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Adrenal Insufficiency Foundations Background and Importance Anatomy and Physiology Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition References Section Twelve: Infectious Diseases Chapter 118: Bacteria Diphtheria Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Pertussis Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Acute Treatment Vaccination Tetanus Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Clinical Features Generalized Tetanus Localized Tetanus Cephalic Tetanus Neonatal Tetanus Complications Differential Diagnoses Diagnostic Testing Management Supportive Care Elimination of Unbound Toxin and Active Immunization Prevention of Further Toxin Production Vaccination Botulism Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Pneumococcemia Foundations Background Anatomy, Physiology, and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Acute Treatment Vaccination Disposition Meningococcemia Foundations Background Anatomy, Physiology, and Pathophysiology Clinical Features Occult Bacteremia Meningococcal Meningitis Meningococcal Septicemia Fever and a Nonblanching Rash Chronic Meningococcemia Complications Differential Diagnoses Diagnostic Testing Management Acute Treatment Antibiotic Prophylaxis and Vaccination Disposition Toxic Shock Syndrome Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition References Chapter 119: Viruses Foundations Vaccine-Preventable Infections of Childhood Mumps Clinical Features Differential Diagnosis Diagnostic Testing Management and Disposition Measles (Rubeola) Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Rubella (German Measles) Clinical Features Differential Diagnosis Diagnostic Testing Management and Disposition Viral Infections with Vesicular Rash Herpes Simplex Clinical Features Oral Infection Genital Herpes Central Nervous System Infection Other Infections Differential Diagnosis Diagnostic Testing Management Disposition Varicella-Zoster Virus Clinical Features Varicella Zoster Differential Diagnosis Diagnostic Testing Management Varicella Zoster Disposition Viral Infections Causing Nonspecific Febrile Illness Epstein-Barr Virus Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Cytomegalovirus Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Enteroviruses Clinical Features Poliovirus Non-Polio Enteroviruses Differential Diagnosis Diagnostic Testing Management Disposition Viruses Associated With Respiratory Infections Influenza Clinical Features Differential Diagnosis Diagnostic Testing Management Neuraminidase Inhibitors Adamantane Antivirals Other Antivirals Disposition Coronavirus Rhinovirus Clinical Features Differential Diagnosis Diagnostic Testing Management and Disposition Adenovirus Clinical Features Differential Diagnosis Diagnostic Testing Management and Disposition Parainfluenza Clinical Features Differential Diagnosis Diagnostic Testing Management Respiratory Syncytial Virus Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Viruses Associated with Diarrheal Illness Norovirus and Rotavirus Clinical Features Norovirus Rotavirus Differential Diagnosis Diagnostic Testing Management Disposition Viral Infections With Neurologic Manifestations Rabies Epidemiology Pathophysiology Clinical Features Encephalitic Rabies Paralytic Rabies Differential Diagnoses Diagnostic Evaluation and Testing Management Preexposure Prophylaxis Animal Bite Risk Assessment Wound Care Postexposure Prophylaxis Management Disposition Arboviruses Clinical Features West Nile Virus Eastern Equine Encephalitis Virus St. Louis Encephalitis Virus Powasson Virus Differential Diagnosis Diagnostic Testing Management Disposition Other Arboviral Infections Dengue Virus Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Zika Virus Clinical Features Differential Diagnosis Diagnostic Testing Management and Disposition Chikungunya Virus Clinical Features Differential Diagnosis Diagnostic Testing Management and Disposition Viral Hemorrhagic Fevers Yellow Fever Virus Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Ebola Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Marburg Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition Lassa Fever Clinical Features Differential Diagnosis Diagnostic Testing Management Disposition References Chapter 120: Coronaviruses Foundations Transmission Clinical Features Coronavirus Disease 2019 Multisystem Inflammatory Syndrome in Children Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome Differential Diagnoses Diagnostic Testing Coronavirus Disease 2019 Multisystem Inflammatory Syndrome in Children Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome Management Coronavirus Disease 2019 Oxygenation and Ventilation Intubation and Mechanical Ventilation Therapeutics Antivirals Convalescent Serum and Monoclonal Antibodies Immunomodulatory Drugs Including Corticosteroids Anticoagulation Prevention and Vaccination Multisystem Inflammatory Syndrome in Children Middle East Respiratory Syndrome Disposition References Chapter 121: HIV Foundations Background and Importance Pathophysiology Clinical Features Acute HIV Infection Chronic HIV Infection AIDS Clinical Manifestations by Organ System Cardiac Manifestations Pulmonary Manifestations Oropharyngeal and Gastrointestinal Manifestations Central Nervous System Manifestations Renal Manifestations Rheumatologic and Orthopedic Manifestations Hematologic Manifestations Cutaneous Manifestations Differential Diagnoses Initial Evaluation Diagnostic Testing HIV Testing Management Preexposure Prophylaxis Postexposure Prophylaxis ART Initiation and Linkage to Care Disposition References Chapter 122: Parasites Foundations Malaria Background and Importance Pathophysiology Clinical Features Differential Diagnosis Diagnostic Testing Management Babesiosis Background and Importance Clinical Features Diagnostic Testing Management Schistosomiasis and Katayama Fever Background and Importance Diagnostic Testing Management Cysticercosis Background and Importance Clinical Features Diagnostic Testing Management African Trypanosomiasis Background and Importance Clinical Features Diagnostic Testing Management Toxoplasmosis Background and Importance Clinical Features Diagnostic Testing Management Eosinophilic Meningitis Parasites Associated with Fever Leishmaniasis Amebic Abscess Strongyloides Whipworm And Hookworm Tapeworm Elephantiasis Cutaneous Leishmaniasis Cutaneous Larva Migrans Swimmer’s Itch (Cercarial Dermatitis) Strongyloides Dracunculus medinensis Parasites Associated With Ocular Manifestations Onchocerciasis Loiasis Toxocara canis (Dog Roundworm) Parasites Associated With Pulmonary Manifestations Parasitic Diseases With Cardiovascular Manifestations Chagas Disease Parasitic Diseases With Gastrointestinal Manifestations Diarrhea Cryptosporidium and Cyclospora Entamoeba histolytica Balantidium coli Giardia lamblia Echinococcosis Enterobius vermicularis Parasitic Coinfections in Patients With HIV Infection and AIDS Specific Parasitic Coinfections References Chapter 123: Tickborne Illnesses Overview Identification of Ticks Physiology of Tick Feeding Lyme Disease Clinical Features Early Lyme Disease Acute Disseminated Infection Neurologic Manifestations Cardiac Manifestations Arthritis Ophthalmic Manifestations Late Lyme Disease Differential Diagnoses Diagnostic Testing Management Early Disease Early Disseminated Infection Neurologic Disease Cardiac Disease Late Infection Arthritis Neurologic Disease Lyme Disease and Pregnancy Vaccination Prophylaxis and Asymptomatic Tick Bites Southern Tick-Associated Rash Illness Relapsing Fever Clinical Features Differential Diagnoses Diagnostic Testing Management Tularemia Clinical Features Presentations Ulceroglandular Tularemia Glandular Tularemia Oculoglandular Tularemia Oropharyngeal Tularemia Typhoidal Tularemia Pulmonary Tularemia Other Considerations Diagnostic Testing Management Rocky Mountain Spotted Fever Pathophysiology Clinical Features Cutaneous Manifestations Cardiopulmonary Manifestations Neurologic Manifestations Differential Diagnoses Diagnostic Testing Skin Biopsy Serologic Studies Isolation of Organism Management Supportive Care Antibiotics Corticosteroids Q Fever Pathophysiology Clinical Features Diagnostic Testing Management Ehrlichioses Pathophysiology Clinical Features Diagnostic Testing Management Babesiosis Pathophysiology Clinical Features Diagnostic Testing Management Colorado Tick Fever Pathophysiology Clinical Features Diagnostic Testing Management Other Tickborne Viruses Tick Paralysis Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Tick Bite Prophylaxis With Insect Repellents References Chapter 124: Tuberculosis Foundations Background and Importance Pathophysiology Transmission Pathogenesis Stage 1 Stage 2 Stage 3 Stage 4 Clinical Features Risk Factors Physical Examination Complications of Pulmonic Tuberculosis Hemoptysis Pneumothorax Pleural Effusion Empyema Airway Tuberculosis Superinfection with Fungi Primary Tuberculous Pericarditis Differential Diagnoses Pulmonary Tuberculosis Bacterial Pneumonia Fungal and Nontuberculous Mycobacterial Infections Pneumonias in Patients with HIV Infection Cavitary Lesions Mediastinal Lymphadenopathy Extrapulmonary Tuberculosis Lymphadenitis Bone and Joint Infection Renal Disease Genital Disease Multisystem Disease Central Nervous System Disease Gastrointestinal Disease Diagnostic Testing Laboratory Tests White Cell Stimulation Tests Serology Diagnostic Imaging Primary Tuberculosis Postprimary Tuberculosis Microbiologic Testing Sputum Studies Direct Microscopy Nucleic Acid Amplification Tests Culture Tuberculin Skin Test Management Initial Management in the Emergency Department Hemoptysis Fever or Wasting History of Tuberculosis, Therapy Discontinued Antituberculosis Medications First-Line Agents Second-Line Agents Corticosteroids Initial Therapy Drug-Resistant Tuberculosis Multidrug-Resistant Tuberculosis Extensively Drug-Resistant Tuberculosis Vaccines for Mycobacterium tuberculosis Disposition Prevention of Transmission in the Emergency Department Early Identification Isolation and Environmental Control Personal Respiratory Protection Preventive Therapy After Inadvertent Exposure References Chapter 125: Bone and Joint Infections Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Causes and Microbiology Osteomyelitis Clinical Features History and Physical Examination Complications Clinical Subsets of Osteomyelitis Osteomyelitis in Children Vertebral Osteomyelitis Posttraumatic Osteomyelitis Diabetic Foot Osteomyelitis Osteomyelitis in Sickle Cell Disease Chronic Osteomyelitis Differential Diagnoses Diagnostic Testing Laboratory Tests Diagnostic Imaging Conventional Radiography Radionuclide Bone Scanning Computed Tomography Magnetic Resonance Imaging Microbiologic Diagnosis Management Disposition Septic Arthritis Foundations Clinical Features History and Physical Examination Complications Clinical Subsets of Septic Arthritis Bites Infants and Children Gonococcal Septic Arthritis Lyme Arthritis Periprosthetic Joint Infections Patients With Existing Joint Disease Atypical Joints Differential Diagnoses Diagnostic Testing Serum and Urine Tests Joint Fluid Analysis Imaging Management Disposition References Chapter 126: Skin and Soft Tissue Infections Foundations Background and Importance Anatomy and Physiology Pathophysiology Clinical Features Overview Cellulitis Clinical Features Diabetic Foot Infections Bite Wounds Water-Borne Infections Differential Diagnosis Diagnostic Testing Wound Cultures Blood Cultures Radiographic Studies Surface Thermal Imaging Management Disposition Abscess Clinical Features Differential Diagnosis and Diagnostic Testing Management Disposition Impetigo Clinical Features and Management Folliculitis Clinical Features and Management Acne Vulgaris and Hidradenitis Suppurativa (Acne Inversa) Clinical Features and Management Necrotizing Skin and Soft Tissue Infections Clinical Features Differential Diagnosis and Diagnostic Testing Management and Disposition Toxic Shock Syndromes Clinical Features Streptococcal Toxic Shock Syndrome Staphylococcal Toxic Shock Syndrome Staphylococcal Scalded Skin Syndrome Differential Diagnosis and Diagnostic Testing Management Disposition Other Infections With Skin Manifestations References Chapter 127: Sepsis Syndrome Foundations Background Pathophysiology Mediators of Sepsis Organ System Dysfunction Neurologic Impairment Cardiovascular Dysfunction Pulmonary Involvement Gastrointestinal Effects Endocrine Disorders Hematologic Abnormalities Genetic Factors Clinical Features Symptoms and Signs Diagnostic Considerations Differential Diagnoses Diagnostic Testing Laboratory Testing Hematology Blood Chemistry Urinalysis Microbiology Special Procedures Radiology Management Respiratory Support Cardiovascular Support Fluid Resuscitation Vasoactive Drug Therapy Norepinephrine Dopamine Vasopressin Epinephrine Phenylephrine Dobutamine Bicarbonate Antibiotics Steroid Therapy Disposition References Part IV: Environment and Toxicology Section One: Environment Chapter 128: Hypothermia, Frostbite, and Nonfreezing Cold Injuries Accidental Hypothermia Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Temperature Regulation Cardiovascular System Central Nervous System Renal System Respiratory System Predisposing Factors Decreased Heat Production Increased Heat Loss Impaired Thermoregulation Trauma Clinical Features Differential Diagnoses Diagnostic Testing Acid-Base Balance Hematologic Evaluation Hypothermic Coagulation Imaging Management General Measures Volume Resuscitation Advanced Life Support Pharmacologic Treatment Cardiovascular Medications Antibiotics Failure to Rewarm Rewarming Passive External Rewarming Active Rewarming Active External Rewarming Active Core Rewarming Airway Rewarming Peritoneal Dialysis Heated Irrigation Endovascular Rewarming Diathermy Extracorporeal Blood Rewarming Disposition Frostbite and Nonfreezing Cold Injuries Frostbite Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Prehospital Emergency Department Prethaw Thawing by Immersion in Warm Water Postthaw Disposition Nonfreezing Cold Injuries Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Clinical Features Immersion Injury Pernio Differential Diagnoses Diagnostic Testing Management Immersion Injury Pernio Disposition References Chapter 129: Heat Illness Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Heat Production Conduction Convection Radiation Evaporation Heat Regulation Thermosensors Central integrative area Thermoregulatory effectors Acclimatization Predisposing Factors Fever Versus Hyperthermia Minor Heat Illnesses Miliaria Rubra Clinical Features Differential Diagnoses Diagnostic Testing Management and Disposition Heat Cramps Clinical Features Differential Diagnoses Diagnostic Testing Management and Disposition Heat Edema Clinical Features Differential Diagnoses Diagnostic Testing Management and Disposition Heat Syncope Clinical Features Differential Diagnoses Diagnostic Testing Management and Disposition Major Heat Illnesses Heat Exhaustion Foundations Background and importance Anatomy, physiology and pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Heatstroke Foundations Background and importance Anatomy, physiology and pathophysiology Clinical Features Classic heatstroke versus exertional heatstroke Differential Diagnoses Meningitis and encephalitis Thyroid storm Drug-induced heat illness Exercised associated hyponatremia Neuroleptic malignant syndrome Serotonin syndrome Diagnostic Testing Management Cooling Resuscitation Disposition References Chapter 130: Electrical and Lightning Injuries Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Electrical Injury Current and Voltage Current Type Resistance of Tissue Affected Path Taken by Current Through the Body Duration of Contact Lightning Injury Conducted Energy Weapons Clinical Features Electrical Injury Lightning Injury Skin Electrical Injury Lightning Injury Cardiovascular Electrical Injury Lightning Injury Head and Neck Electrical Injury Lightning Injury Extremities Electrical Injury Nervous System Electrical Injury Lightning Injury Other Viscera Electrical Injury Lightning Injury Conducted Electrical Weapon Differential Diagnoses Electrical Injury Lightning Injury Diagnostic Testing Electrical Injury Lightning Injury Conducted Electrical Weapon Management Electrical Injury Lightning Injury Conducted Electrical Weapon Disposition Electrical Injury Lightning Injury Conducted Electrical Weapon Acknowledgments References Chapter 131: Scuba Diving and Dysbarism Foundations Background and Importance Physiology and Pathophysiology Clinical Features Disorders Related to Descent/Barotrauma Middle Ear Barotrauma External Ear Barotrauma Inner Ear Barotrauma Reverse Middle Ear Squeeze Barosinusitis Alternobaric Vertigo Facial Barotrauma or Mask Squeeze Disorders Arising at Depth Nitrogen Narcosis Oxygen Toxicity Contaminated Air Disorders Arising on Ascent Alternobaric Vertigo Barodontalgia Gastrointestinal Barotrauma Pulmonary Barotrauma Decompression Sickness Arterial Gas Embolism Pulmonary Edema Differential Diagnoses Diagnostic Testing Management Diving Disorders Requiring Recompression Therapy Diving Disorders Not Requiring Recompression Therapy External Ear Barotrauma Middle Ear Barotrauma Internal Ear Barotrauma Barosinusitis Facial Barotrauma Nitrogen Narcosis Pulmonary Barotrauma Alternobaric Vertigo Disposition References Chapter 132: High-Altitude Medicine Foundations Background and Importance Epidemiology Definitions Environmental Considerations Anatomy, Physiology, and Pathophysiology Acclimatization Physiologic Response to Hypobaric Hypoxia Acute Mountain Sickness Clinical Features Differential Diagnoses Diagnostic Testing Management Oxygen Therapy Analgesics and Antiemetics Acetazolamide Dexamethasone Disposition Prevention High-Altitude Pulmonary Edema Clinical Features Differential Diagnoses Diagnostic Testing Ultrasonography Chest Radiographs Electrocardiogram and Echocardiogram Management Descent Oxygen Therapy Nifedipine Other Medications Disposition Prevention High-Altitude Cerebral Edema Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Special Considerations High-Altitude Retinal Hemorrhage Carbon Monoxide Poisoning Altitude and Underlying Medical Conditions Respiratory Illnesses Cardiovascular Hypertension Seizures Sickle Cell Disease Pregnancy Radial Keratotomy Acknowledgments References Chapter 133: Drowning Foundations Background and Importance Anatomy, Physiology, and Pathophysiology Clinical Features History and Physical Examination Prognostic Factors Differential Diagnoses Diagnostic Testing Management Disposition Preventive Efforts and Discharge Education References Chapter 134: Radiation Injuries Foundations Background and Importance Radiation Measurements Radiation Protection Radiation Sources Anatomy, Physiology, and Pathophysiology Routes of Exposure Clinical Features Acute Radiation Syndrome Local Radiation Injury Differential Diagnoses Diagnostic Testing Management Prehospital Care Emergency Department Preparation External Contamination Internal Contamination Acute Radiation Syndrome Hematopoietic Sub-Syndrome Gastrointestinal Sub-Syndrome Neurovascular Sub-Syndrome Local Radiation Injury Psychological Consequences Disposition Additional Resources References Section Two: Toxicology Chapter 135: Care of the Poisoned Patient Principles of Toxicity Clinical Features Toxicologic History and Physical Toxidromes Sympathomimetic Anticholinergic Cholinergic Sedative/Hypnotic Opioid Serotonin Syndrome Neuroleptic Malignant Syndrome Differential Diagnoses Diagnostic Testing Management Decontamination Syrup Of Ipecac Gastric Lavage Single-Dose Activated Charcoal Whole Bowel Irrigation Enhanced Elimination Multiple-Dose Activated Charcoal Serum Alkalinization Intravenous Fat Emulsion (Intralipid) Focused Therapy Toxicology Consultation Disposition References Chapter 136: Toxic Alcohols Methanol Foundations Principles of Toxicology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Ethylene Glycol Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Isopropyl Alcohol Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Other Alcohols of Clinical Significance References Chapter 137: Alcohol-Related Disease Foundations Metabolism of Alcohol Clinical Features Alcohol Withdrawal Syndrome Alcohol-Related Seizures Alcohol Withdrawal Seizures Alcoholic Hallucinosis Cardiovascular Effects Pulmonary Effects Gastrointestinal and Hepatic Effects Esophagus and Stomach Gastrointestinal Bleeding Liver Damage Alcoholic Hepatitis Cirrhosis Pancreatitis and Malabsorption Neurologic Effects Neuropathy Wernicke-Korsakoff Syndrome Alcoholic Cerebellar Degeneration Infectious Disease Endocrine Effects Metabolic Effects Carbohydrates Lipids Electrolytes Alcoholic Ketoacidosis Hematologic Effects Anemia Leukocyte Abnormalities Platelet Disorders Hemostasis Oncologic Effects Hypothermia Psychiatric Effects Toxicologic Effects Disulfiram and Similar Reactions Other Considerations—Patient Groups Affected Adolescents Older Patients Pregnant Women Trauma Differential Diagnosis Diagnostic Testing Laboratory Tests Alcohol Screening Questionnaires Management Alcohol Withdrawal Syndrome Pharmacologic Treatment Benzodiazepines Butyrophenones Other Agents Neurologic Examination New-Onset Seizures Prior History of Seizures During Withdrawal Abnormal Neurologic Examination New-Onset Partial Seizures Patients Taking Anticonvulsants Disposition Acute Intoxication Alcohol Withdrawal Seizures Psychiatric and Social Problems References Chapter 138: Acetaminophen Foundations Clinical Features Differential Diagnoses Diagnostic Testing Risk Assessment With Acute Acetaminophen Ingestion Risk Assessment With Chronic Ingestion Risk Assessment in Pregnant Women Management Stabilization and Supportive Care Decontamination Enhanced Elimination Antidote Therapy N-Acetylcysteine Use in Pregnancy Duration of Therapy Disposition Need for Transplantation References Chapter 139: Aspirin and Nonsteroidal Agents Aspirin Principles of Toxicity Overview Epidemiology Salicylate-Containing Products Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Stabilization and Supportive Care Decontamination Enhanced Elimination Antidote Therapy Disposition Nonsteroidal Agents Principles of Toxicity Clinical Features Differential Diagnoses Diagnostic Testing Management Stabilization and Supportive Care Decontamination Enhanced Elimination Antidote Therapy Disposition References Chapter 140: Anticholinergics Principles of Toxicology Overview Clinical Features Differential Diagnoses Diagnostic Testing Laboratory Electrocardiogram Management Stabilization Decontamination Pharmacologic Intervention and Antidote Treatment Disposition Observation at Home Emergency Department Observation Hospital Admission ICU Admission Consultations References Chapter 141: Antidepressants Principles Of Toxicity Monoamine Oxidase Inhibitors Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Tricyclic Antidepressants Principles of Toxicity Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Selective Serotonin Reuptake Inhibitors Principles of Toxicity Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Serotonin-Norepinephrine Reuptake Inhibitors and Norepinephrine Reuptake Inhibitors Principles of Toxicity Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Serotonin Modulators And Stimulators Miscellaneous Antidepressants Bupropion Trazodone Nefazodone Serotonin Syndrome Principles of Toxicity Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Discontinuation Syndromes References Chapter 142: Cardiovascular Drugs Cardioactive Steroids (Digoxin) Foundations Clinical Features Pediatric Considerations Differential Diagnoses Diagnostic Testing Management Fab Fragments (DigiFab) Electrolyte Correction Atropine Pacing and Cardioversion Phenytoin and Lidocaine Extracorporeal Membrane Oxygenation Disposition Beta-Blockers Foundations Principles of Toxicity Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Hypotension, Bradycardia, and Atrioventricular Block Calcium Glucagon High-Dose Insulin Sodium Bicarbonate Vasopressors and Other Inotropes Intravenous Fat Emulsion (Intralipid) Ventricular Dysrhythmias Extracorporeal Elimination and Circulatory Assistance Pediatric Considerations Sequential Approach to Beta-Blocker Poisoning Disposition Calcium Channel Blockers Foundations Principles of Toxicity Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Hypotension and Bradycardia Pediatric Considerations Disposition Clonidine and Other Central Alpha-2 Agonists Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Nitrates, Nitrites, and Methemoglobinemia Foundations Principles of Toxicity Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition References Chapter 143: Caustics Foundations Principles of Toxicity Pathophysiology Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Special Cases Povidone-Iodine Phenol and Formaldehyde Hydrogen Peroxide Button Batteries References Chapter 144: Cocaine and Other Sympathomimetics Foundations Cocaine Epidemiology Formulation Pathophysiology Amphetamine and Its Derivatives Epidemiology Methamphetamine Pathophysiology Ephedrine and Ephedra Caffeine Novel Psychoactive Substances Ecstasy Bath Salts Kratom Clinical Features Hyperthermia Hypertensive Emergencies Cardiac Dysrhythmias Cocaine Use Disorder, Stimulant Use Disorder Cardiomyopathy Washout Nontoxicologic sequelae Differential Diagnoses Diagnostic Testing Urine Drug Screening for Amphetamines and Amphetamine Derivatives Electrocardiogram Management Pharmacologic Sedation for Agitation Hyperthermia Acute Hypertensive Emergencies Dysrhythmias Hyponatremia Cocaine-Related Chest Pain Special Topics Body Packers Body Stuffers Disposition References Chapter 145: THC and Hallucinogens Serotonergic Agents Principles of Toxicity Lysergamides Tryptamines Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Dissociative Agents Principles of Toxicity Phencyclidine Ketamine Methoxetamine Dextromethorphan Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Cannabis and Synthetic Cannabinoids Principles of Toxicity Clinical Features Differential Diagnoses Diagnostic Testing Management and Disposition Other Agents Mescaline Nutmeg Salvia Kratom Ibogaine Isoxazole Mushrooms References Chapter 146: Iron and Heavy Metals Iron Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Stabilization and Supportive Care Decontamination Enhanced Elimination Antidotal Therapy Disposition Lead Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Stabilization and Supportive Care Decontamination Antidotal Therapy Children Adults Disposition Arsenic Foundations Clinical Features Acute Arsenic Toxicity Chronic Arsenic Toxicity Arsine Gas Differential Diagnoses Diagnostic Testing Management Stabilization and Supportive Care Decontamination and Enhanced Elimination Antidotal Therapy Acute Arsenic Poisoning Chronic Arsenic Poisoning Disposition Mercury Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Stabilization and Supportive Care Decontamination Enhanced Elimination Antidotal Therapy Disposition References Chapter 147: Hydrocarbons Foundations Overview Pathophysiology Pulmonary Pathophysiology Central Nervous System Pathophysiology Cardiac Pathophysiology Other Organ Systems Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition References Chapter 148: Inhaled Toxins Simple Asphyxiants Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Pulmonary Irritants Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Smoke Inhalation Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Cyanide and Hydrogen Sulfide Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Hydrogen Cyanide Hydrogen Sulfide Disposition Carbon Monoxide Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Simultaneous Carbon Monoxide and Cyanide Poisoning (Fire Victims) Disposition References Chapter 149: Lithium Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Stabilization and Supportive Care Decontamination Enhanced Elimination Disposition References Chapter 150: Antipsychotics Foundations Background Pathophysiology Toxicity Clinical Features Acute Overdose Acute Extrapyramidal Syndromes Tardive Syndromes Neuroleptic Malignant Syndrome Cardiovascular Toxicity Agranulocytosis Seizures Differential Diagnoses Diagnostic Testing Management General Anticholinergic Toxidrome Seizures Acute Extrapyramidal Syndromes Cardiotoxicity Neuroleptic Malignant Syndrome Disposition References Chapter 151: Opioids Principles of Toxicity Clinical Features Differential Diagnoses Diagnostic Testing Management Stabilization and Supportive Care Decontamination Enhanced Elimination Antidote Therapy Disposition Withdrawal References Chapter 152: Pesticides Organophosphate Insecticides Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Decontamination Stabilization and Supportive Care Enhanced Elimination Antidote Therapy Disposition Carbamate Insecticides Chlorinated Hydrocarbons Insecticides Foundations Principles of Toxicity Clinical Features Differential Diagnoses Diagnostic Testing Management Decontamination Stabilization and Supportive Care Enhanced Elimination Antidote Therapy Disposition Substituted Phenols Foundations Principles of Toxicity Clinical Features Differential Diagnoses Diagnostic Testing Management Decontamination Stabilization and Supportive Care Enhanced Elimination Antidote Therapy Disposition Chlorophenoxy Herbicides Foundations and Principles of Toxicity Clinical Features Differential Diagnoses Diagnostic Testing Management Decontamination Stabilization and Supportive Care Enhanced Elimination Antidote Therapy Disposition Bipyridyl Herbicides Foundations and Principles of Toxicity Clinical Features Differential Diagnoses Diagnostic Testing Management Decontamination Stabilization and Supportive Care Enhanced Elimination Antidote Therapy Disposition Pyrethrin and Pyrethroid Insecticides Foundations and Principles of Toxicity Clinical Features Differential Diagnoses Diagnostic Testing Management Decontamination Stabilization and Supportive Care Enhanced Elimination Antidote Therapy Disposition Glyphosate Foundations and Principles of Toxicity Clinical Features Differential Diagnoses Diagnostic Testing Management Decontamination Stabilization and Supportive Care Enhanced Elimination Antidote Therapy Disposition DEET Foundations and Principles of Toxicology Clinical Features Differential Diagnoses Diagnostic Testing Management Decontamination Stabilization and Supportive Care Enhanced Elimination Antidote Therapy Disposition Rodenticides Foundations Principles of Toxicology Clinical Features Differential Diagnoses Diagnostic Testing Management Decontamination Stabilization and Supportive Care Enhanced Elimination Antidote Therapy Disposition References Chapter 153: Plants, Herbal Medications, and Mushrooms Plants Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Plant Categories Anticholinergics Foundations Principles of toxicity Clinical features Differential diagnoses Diagnostic testing Management Disposition Antimitotic Toxins Foundations Principles of toxicity Clinical features Differential diagnoses Diagnostic testing Management Disposition Cardiac Glycosides Foundations Principles of toxicity Clinical features Differential diagnoses Diagnostic testing Management Disposition Other Cardiotoxic Plants Cicutoxin Principles of Toxicity Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Other Toxic Plants Nicotinic toxin Raphides Toxalbumins Mushrooms Foundations Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Mushroom Categories Hepatotoxic Mushrooms Principles of Toxicity Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Gyromitrin-containing Mushrooms Principles of Toxicity Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Other Mushroom Classes Cholinergic Agonists Disulfiram Reaction-Inducing Mushrooms Hallucinogenic Mushrooms Gastrointestinal Irritants Renal Insufficiency Rhabdomyolysis-­Inducing Mushrooms Herbal Medications Principles of Toxicity Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition References Chapter 154: Sedative-Hypnotics Foundations Benzodiazepines Clinical Features Pharmacokinetics Differential Diagnoses Diagnostic Testing Management Stabilization and Supportive Care Antidote Therapy Disposition Benzodiazepine Withdrawal Syndrome Barbiturates Clinical Features Differential Diagnoses Diagnostic Testing Management Supportive Care and Stabilization Gastrointestinal Decontamination Enhanced Elimination Disposition Individual Medications Zolpidem, Zaleplon, and Zopiclone Eszopiclone Buspirone Flunitrazepam Chloral Hydrate Clinical Features Differential Diagnoses Management Disposition Over-The-Counter Sleep Aids Gamma-Hydroxybutyrate Clinical Features Differential Diagnoses Diagnostic Testing Management Disposition Withdrawal References Part V: Special Populations Section One: The Pediatric Patient Chapter 155: Care of the Pediatric Patient Foundations Pathophysiology Temperature Regulation Airway Cardiovascular System Musculoskeletal System Immunologic System Pharmacologic Considerations Developmental Considerations Young Infants Infants (