Richard D Zane MD FAAEM - Pocket Emergency Medicine

Pocket Emergency

MEDICINE

Fourth Edition

E RICA A SHLEY M ORSE , MD
G RAHAM I NGALSBE , MD

Denver Health Residency in Emergency Medicine

A MY F OLLMER H ILDRETH , MD

Naval Medical Center San Diego

D AVID S ILVESTRI , MD, MBA

National Clinician Scholars Program

Yale School of Medicine

Edited by

R ICHARD D. Z ANE , MD, FAAEM

The George B. Boedecker Professor and Chair

Department of Emergency Medicine

University of Colorado School of Medicine

Executive Director, Emergency Services

University of Colorado Health

Aurora, Colorado

J OSHUA M. K OSOWSKY , MD, FACEP

Assistant Professor

Harvard Medical School

Department of Emergency Medicine

Brigham and Womens Hospital

Boston, Massachusetts

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4th edition

Copyright 2019 Wolters Kluwer.

2015 by WOLTERS KLUWER

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Library of Congress Cataloging-in-Publication Data

Names: Morse, Erica Ashley, author. | Ingalsbe, Graham, author. | Hildreth, Amy Follmer, author. | Silvestri, David, author.

Title: Pocket emergency medicine / Erica Ashley Morse, Graham Ingalsbe, Amy Follmer Hildreth, David Silvestri; edited by Richard D. Zane, Joshua M. Kosowsky.

Other titles: Pocket notebook.

Description: Fourth edition. | Philadelphia : Wolters Kluwer, [2019] | Series: Pocket notebook | Includes index. | Preceded by Pocket emergency medicine / John D. Anderson [et al.]; edited by Richard D. Zane, Joshua M. Kosowsky. 3rd. ed. Philadelphia : Lippincott Williams & Wilkins, c2015.

Identifiers: LCCN 2017046469 | ISBN 9781975103651

Subjects: | MESH: Emergencies | Emergency Medicine | Handbooks

Classification: LCC RC86.8 | NLM WB 39 | DDC 616.02/5dc23

LC record available at https://lccn.loc.gov/2017046469

This work is provided as is, and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work.
This work is no substitute for individual patient assessment based upon healthcare professionals examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data and other factors unique to the patient. The publisher does not provide medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments.
Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturers package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work.

LWW.com

Amy Follmer Hildreth, MD
Emergency Medicine Physician
Naval Medical Center San Diego
San Diego, California

Graham Ingalsbe, MD
Chief Resident, 20162017
Department of Emergency Medicine
University of Colorado School of Medicine
Denver Health Residency in Emergency Medicine
Denver, Colorado

Erica Ashley Morse, MD
Resident Physician
Department of Emergency Medicine
University of Colorado School of Medicine
Denver Health Residency in Emergency Medicine
Denver, Colorado

David Silvestri, MD, MBA
National Clinician Scholars Program
Department of Emergency Medicine
Yale School of Medicine
New Haven, Connecticut

The views expressed in this publication are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.

Practicing medicine is like having a front row seat at the play of life. If that is true, and I believe it is, emergency medicine is like being back stage. This book is for the dedicated men and women who are often back stage making life and death decisions without a net knowing that the expectation is that they get it right the first time, every time, without blinking.

Siobhan, Jake, Gaby, Finn, for whom I exist, thank you for tolerating my passion of academic medicine.

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

The practice of emergency medicine, like all disciplines, is changing and evolving. More than ever, the care of our patients depends upon having accurate, actionable, and accessible information in real time. Now in its fourth edition, Pocket Emergency Medicine remains the essential, go-to reference for busy clinicians on the front lines of emergency care. Unlike traditional texts, Pocket Emergency Medicine is designed to be used at the bedside, organized around presenting conditions and mirroring the thought process of clinicians: from history and physical exam to differential diagnosis testing; from testing and therapeutics to disposition. Clinical pearls and updates in medical practice are highlighted throughout the text.

This book was written by four dedicated emergency medicine residents from the University of Colorado and Harvard University and edited by senior faculty; the text has been updated and referenced in exacting detail, while retaining the fundamental ease of use so cherished by busy providers. We hope our readers find this edition of