Pocket Emergency
MEDICINE
Third Edition
J OHN D. A NDERSON , MD
N IR H ARISH , MD, MBA
Denver Health Residency in Emergency Medicine
N ICHOLAS G. M ALDONADO , MD
A LEXANDER Y. S HENG , MD
The Harvard Affiliated Emergency Medicine Residency Program
Edited by
R ICHARD D. Z ANE , MD, FAAEM
Professor and Chair
Department of Emergency Medicine
University of Colorado School of Medicine
Aurora, Colorado
J OSHUA M. K OSOWSKY , MD
Assistant Professor, Harvard Medical School
Vice Chair for Clinical Affairs, Department of Emergency Medicine
Brigham and Womens Hospital
Boston, Massachusetts
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CONTRIBUTORS
John D. Anderson, MD
Denver Health Residency in Emergency Medicine
Denver Health Medical Center
Department of Emergency Medicine
University of Colorado School of Medicine
Denver, Colorado
Nir Harish, MD, MBA
Denver Health Residency in Emergency Medicine
Denver Health Medical Center
Department of Emergency Medicine
University of Colorado School of Medicine
Denver, Colorado
Nicholas G. Maldonado, MD
The Harvard Affiliated Emergency Medicine Residency Program
Department of Emergency Medicine
Brigham and Womens Hospital
Massachusetts General Hospital
Boston, Massachusetts
Alexander Y. Sheng, MD
The Harvard Affiliated Emergency Medicine Residency
Department of Emergency Medicine
Brigham and Womens Hospital
Boston, Massachusetts
ACKNOWLEDGMENTS
To our patients who trust that we are always there and know what to do, when to do it, and allow us the privilege of caring for them during the most vulnerable moments of their lives. For Siobhan, Jake, Gaby, and Finn whose support made everything possible.
R ICHARD D. Z ANE , MD
To all those from whom I continue to gain wisdommy teachers, my colleagues, my students, and perhaps foremost, my patients. And to Devorah, Harry, Jake, and Judah, whose support means the world to me.
J OSHUA M. K OSOWSKY , MD
PREFACE
Sir William Olser wrote, He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all. Emergency medicine is a thrilling specialty, demanding exceptional abilities and an increasingly expansive fund of knowledgepatterns of illness and injury, a whole range of diagnostics and therapeutics, all at ones fingertips in real time at the bedside with lives on the line. In this context, we have designed Pocket Emergency Medicine as a life raft for the busy physician, resident, physician assistant, nurse practitioner, or student.
Unlike many traditional textbooks, we have chosen to organize chapters around presenting conditions rather than diagnoses. In this way, the book mirrors the way patients present to the emergency department and allows the reader to develop the thought processes that guide appropriate diagnostic and therapeutic interventions. Each chapter begins with a general approach to a particular condition, followed by a succinct discussion of important diagnostic categories, highlighting essential elements of the history, physical examination, testing, and treatment specific to these diagnoses. Sprinkled throughout the text are clinical pearlsfocused bullet points, emphasizing important clinical findings or warning about common clinical errors.
This book was written by a group of talented emergency medicine residents from the Denver Health and Harvard Affiliated Emergency Medicine Residency programs. The residents undertook studious research on their individual topics, guided by an acute awareness of the needs of busy emergency department providers. Chapters were edited by an experienced team of senior emergency medicine faculty from the Departments of Emergency Medicine at The University of Colorado School of Medicine, Brigham and Womens Hospital and Harvard Medical School. The editors bring over 25 years of experience in clinical and academic emergency medicine, ensuring the accuracy and integrity of the text. The result, we think youll agree, is a supremely useful immediate reference for the emergency medicine practitioner.
R ICHARD D. Z ANE , MD