Rosen's Emergency Medicine
Concepts and Clinical Practice
Eighth Edition
Editor-in-Chief
John A. Marx, MD
Formerly Adjunct Professor of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Chair Emeritus, Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina
Senior Editors
Robert S. Hockberger, MD
Professor of Clinical Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
Chair Emeritus, HarborUCLA Medical Center, Torrance, California
Ron M. Walls, MD
Professor and Chair, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
Editors
Michelle H. Biros, MD, MS
Professor, Emergency Medicine, University of Minnesota Medical School and Hennepin County Medical Center; Vice-Chair of Research, Emergency Medicine, University of Minnesota Medical School; Associate Research Director, Hennepin County Medical Center, Minneapolis, Minnesota
Daniel F. Danzl, MD
Professor and Chair, Department of Emergency Medicine, University of Louisville School of Medicine, Louisville, Kentucky
Marianne Gausche-Hill, MD
Professor of Clinical Medicine, David Geffen School of Medicine at University of California at Los Angeles; Vice Chair and Chief of the Division of Pediatric Emergency Medicine, Director of Pediatric Emergency Medicine and Emergency Medical Services Fellowships, Department of Emergency Medicine, HarborUniversity of California at Los Angeles Medical Center, Torrance, California
Andy Jagoda, MD, FACEP
Professor and Chair, Mt. Sinai School of Medicine and Medical Director, Mt. Sinai Medical Center, New York, New York
Louis J. Ling, MD
Professor of Emergency Medicine and Pharmacy, University of Minnesota Medical School; Medical Toxicology Consultant, Hennepin Regional Poison Center, Minneapolis, Minnesota; Senior Vice-President, Hospital-Based Accreditation, Accreditation Council for Graduate Medical Education, Chicago, Illinois
Edward J. Newton, MD
Professor of Emergency Medicine, Keck School of Medicine; Chair, Department of Emergency Medicine, Los Angeles County and University of Southern California Medical Center, Los Angeles, California
Brian J. Zink, MD
Professor and Chair, Department of Emergency Medicine, Warren Alpert Medical School of Brown University; Physician-in-Chief, Emergency Medicine, Rhode Island Hospital, The Miriam Hospital, and Hasbro Children's Hospital, Providence, Rhode Island
Copyright
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
ROSEN'S EMERGENCY MEDICINE:CONCEPTS AND CLINICAL PRACTICEISBN: 978-1-4557-0605-1
Volume 1 Part Number: 996087921
Volume 2 Part Number: 996087980
Copyright 2014 by Saunders, an imprint of Elsevier Inc.
Copyright 2010, 2006, 2002, 1998, 1992, 1988, 1983 by Mosby, Inc., an affiliate of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher's permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
Library of Congress Cataloging-in-Publication Data
Rosen's emergency medicine : concepts and clinical practice / editor-in-chief, John A. Marx; senior editors, Robert S. Hockberger, Ron M. Walls ; editors, Michelle H. Biros [et al.].8th ed.
p. ; cm.
Emergency medicine
Includes bibliographical references.
ISBN 978-1-4557-0605-1 (hardcover : alk. paper)
I.Marx, John A.II.Rosen, Peter, 1935- Emergency medicine.III.Title: Emergency medicine.
[DNLM:1.Emergencies.2.Emergency Medicine.WB 105]
RC86.7
616.025dc23
2013015607
Senior Content Strategist: Stefanie Jewell-Thomas
Senior Content Development Specialist: Deidre Simpson
Publishing Services Manager: Patricia Tannian
Senior Project Manager: Claire Kramer
Designer: Steven Stave
Printed in China
Last digit is the print number:987654321
Dedication
We, the authors and editors, dedicate this edition of Rosen's Emergency Medicine: Concepts and Clinical Practice to our late, beloved colleague, John Andrew Marx, who died suddenly and unexpectedly in his sleep on July 1, 2012. The loss of John, as mentor, friend, colleague, and leader, has left an enormous void in our lives and in the lives of countless others in our field who were inspired or counseled by his incisive intellect and sedulous devotion to scientific rigor. This book was born in 1983, when Peter Rosen's dream of a compendium of the biology of emergency medicine, written by those who study, teach, and practice it, was realized with the publication of the first edition. For three subsequent editions, Peter guided, cajoled, and willed the book to completion, all the while grooming John as his obvious and worthy successor. John became editor in chief for the fifth edition and remained so through this eighth edition, on which, in characteristic fashion, he had discharged his duties fully and flawlessly, prior to his untimely death. As editors, we are proud to have shared this vision, Peter's vision, which became John's vision, with one of the most influential and inspiring physicians of our time. Although he did not live to hold a bound copy in his hands, John guided every aspect of this book from beginning to end, and we know that he was particularly proud that, with this edition, he had served as editor in chief for as many iterations of the book as had Peter and that he felt a sense of completeness and of the inevitability of a timeless legacy on reaching that milestone. Although John achieved professional success beyond description and received virtually every conceivable honor and recognition, including the highest awards from each of our three major societies, he remained a humble, devoted emergency physician, deeply rooted in his love for his patients and for his colleagues and trainees. He was endlessly proud of his children, Shelby and Connor, whom he loved without bound, and who were his favorite topic of conversation. He was inspired, supported, and nurtured by his wife, Karin, with whom he was deeply in love, and from whom he received the gifts of extraordinary happiness and peace. We both are humbled and honored to be able to set these final few words to paper and to gently convey this great work to posterity on behalf of our dear friend and beloved editor, John Andrew Marx.