Chris Ciprian Feier - The Chief Complaint. Emergency Medical Handbook

Author Chris Feier M.D., Pharm.D.
Clinical Assistant Professor of Emergency Medicine
Dept of Emergency Medicine
Keck School of Medicine at LAC+USC Medical Center 5150 Publishing
Hermosa Beach, CA Edition: 2014 Copyright 2014 5150 Publishing. All Rights Reserved.
P.O. Box 887
Hermosa Beach, CA 90254 All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, without the written permission of the copyright owner. ISBN-10: 0989851915
ISBN-13: 978-0-9898519-1-6 Disclaimer:
Every effort was made to ensure the completeness and correctness of this guide.

However, errors are certain. The author disclaims any responsibility for errors or omissions or the results obtained from the use of information within this book. Readers are encouraged to confirm all information. If you do not wish to be bound by the foregoing cautions and conditions, you may return this book at any time. Application of this information in a particular situation remains the professional responsibility of the practitioner. "Everything should be made as simple as possible, but not simpler." Albert Einstein Personally, I dont like to refer to patients as complainers (I would say a 55 yo male presents with, NOT complains of), but the terminology is so ingrained in medicine and so widely used at the bedside that the phrase has become iconic. "Everything should be made as simple as possible, but not simpler." Albert Einstein Personally, I dont like to refer to patients as complainers (I would say a 55 yo male presents with, NOT complains of), but the terminology is so ingrained in medicine and so widely used at the bedside that the phrase has become iconic.

Having noted that, Chris Feiers book of that title is really something totally new in the medical education world. This pocket sized book does something many have tried to do but few have achieved, which is to create an orienteering guide to the med-ed landscape while launching your thought processes AT THE BEDSIDE when confronted with a new undifferentiated and undiagnosed patient. And it is truly pocket sized, not like some of the brick shaped (and brick weighted) books you see dragging a residents white coat into a lopsided drape from some Edvard Munch painting. This book can actually be put in your pocket with reasonable ergonomics and retained balance. This is really important for a book like this to be a functional companion to your stethoscope. When I was medical student and intern it was The Washington Manual that served this purpose, but now this book is too Internal Medicine oriented, and it no longer fits in the pocket of a white coat.

The size also means that the book is not encyclopedic. Rosens it isnt, and that is good because you need BOTH a wheelbarrow and a diagnosis to use that thing (or burning curiosity, a burning fire, and a long cold winter night trapped inside a cabin with a good light source) and Rosens is not chief complaint oriented. While this book will never replace the comprehensive tomes of EM, it WILL follow students and residents into the clinical landscape. This pocket manual also links young doctors to dozens of updated algorithms, podcasts, CME Download, EM-Rap, HIPPO-EM, the NNT, ACEP guidelines, AHA guidelines and the Abstracts of EM and serves to orient them when faced with a patient. In this manner it is more of a map and compass which are crucially important orienteering tools when you are lost in a forest of differential diagnostic considerations. The connectivity of this book is quite unusual because it rapidly bridges to a place all new medical practitioners want to go which is the on-line world.

It lets the computer resources come to bear on the understanding process, which lets this manual be both small AND powerful. This map and compass leads directly into convenient computer resources. It also fits better into the real world of on-line learning, visual comprehension, and on-line images that the modern student and resident are so much more comfortable with. The original cover of The Chief Complaint was a picture of the old (1933) Los Angeles County hospital which is the site of the first academic department of Emergency Medicine (1971), and the second oldest training program in the country. Arguably it is the birthplace of academic EM in the United States. Many of the links represent work by LAC+USC physicians over the years including WR Bukata, Jerome Hoffman, Mel Herbert, Stuart Swadron, Diku Mandavia, and me.

Mel Herbert has been busily making textbooks irrelevant and is inverting the classrooms of EM medical education around the world with on-line teaching. County Hospital as it is known has trained more EM residents than any other training program in the US, and Chris Feier (class of 2008) drew heavily on this heritage when creating his manual. The audience for this book is clinicians at the beginning of their careers. Medical students rotating on an EM clerkship, EM interns, Non-EM interns with an EM service month, and junior EM residents will all find The Chief Complaint to be a useful resource. This little book will open their world to great educators, on-line resources, and help them answer the pesky Whats your plan? question that will be asked of them repetitively when they see a new patient with a common chief complaint in the ED. This book will also lead them to data that challenges the traditional dogma like the NNT (the Number Needed to Treat for benefit and harm) by David Newman, and on-line debates by experts in Emergency Medicine.

In this manner The Chief Complaint moves quickly from the black and white binary world of algorithms into the clinical reality of grey tones, study design, evidence based medicine, expert opinion, and controversy while retaining utility at the bedside. I hope you will enjoy The Chief Complaint which will continue as a living document in its on-line version where updates and rewrites can keep it current. Print versions will follow annually. As a self-published book on-line updates can be added seamlessly. I congratulate Dr. William K. William K.

Mallon MD DTMH FACEP FAAEM
Professor of Clinical Emergency Medicine
Keck School of Medicine at the University of Southern California
LAC+USC Medical Center, Los Angeles, California PEER REVIEWWilliam K Mallon MD DTMH FACEP FAAEM Professor of Clinical Emergency Medicine Keck School of Medicine at the University of Southern California LAC+USC Medical Center, Los Angeles, California