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Emergency Medicine
Mike Romano, John Sauve and Ryan Zufelt, chapter editors
Christophel' Kitamura and Michelle Lam, associate editors Janine Huston, EBM editor Dr. Simon Kingsley, staff editor Initial Patient Assessment/Management ..... 2 Rapid Primary Survey (RPS) Resuscitation Detailed Secondary Survey Definitive Care Ethical Considerations Traumatology ........................... 6 Considerations for Traumatic Injury Head Trauma Spine and Spinal Cord Trauma Chest Trauma Abdominal Trauma Genitourinary Tract Injuries Orthopaedic Injuries Life and Limb Threatening Injuries Upper Extremity Injuries Lower Extremity Injuries Wound Management Trauma in Pregnancy Approach to Common ER Presentations .... 19 Abdominal Pain Acute Pelvic Pain Altered Level of Consciousness (LOC) Chest Pain Epistaxis Headache Joint Pain Otalgia Seizures Shortness of Breath Syncope Sexual Assault Medical Emergencies.. 30 Anaphylaxis and Allergic Reactions Asthma Cardiac Dysrhythmias Chronic Obstructive Pulmonary Disease (COPD) Congestive Heart Failure DVT and Pulmonary Embolism Diabetic Emergencies Electrolyte Disturbances Hypertensive Emergencies Stroke Gynecology/Urology Emergencies......... 39 Vaginal Bleed Pregnant Patient in the ER Nephrolithiasis (Renal Colic) Ophthalmology Emergencies ............. 42 Ophthalmologic Foreign Body and Corneal Abrasion Dermatologic Emergencies .. 43 Life Threatening Dermatoses Environmental Injuries . . . . . . . . . . . . . . . . . . 44 Heat Exhaustion and Heat Stroke Hypothermia and Cold Injuries Burns Inhalation Injury Bites Near Drowning Toxicology ... 48 Alcohol Related Emergencies Approach to the Overdose Patient ABCs of Toxicology D1 -Universal Antidotes D2- Draw Bloods D3- Decontamination and Enhanced Elimination E- Examine the Patient G - Give specific Antidotes and Treatments Disposition from the Emergency Department Psychiatric Emergencies ................. 56 Approach to Common Psychiatric Presentations Acute Psychosis Suicidal Patient Violent Patient Common Pediatric ER Presentations ....... 57 Modified Coma Score Respiratory Distress Febrile Infant and Febrile Seizures Abdominal Pain Common Infections Child Abuse and Neglect Procedural Sedation .................... 61 Common Medications ................... 61 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Airway maintenance with cervical spine (C-spine) control Breathing and ventilation Circulation (pulses, hemorrhage control) Disability (neurological status) Exposure (complete) and Envirorunent (temperature: control) Continually reassessed during secondary survey IMPORTANT: always watch for signs of shock while doing primary survey (see Table 1)
A. AIRWAY
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first priority is to secure airway assume a cervical injury in every trauma patient and immobilize with collar assess ability to breathe: and speak can change rapidly, therefore reassess frequently
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Signs of Airway Obllrualian Agi1iltion, confusion, "universal choking sign" Respirmry dis1Jess Feiuruto IIPaek. dy$phonia Cymosis
Airway Management
goals permit adequate oxygenation and ventilation facilitate ongoing patient management give drugs via endotracheal tube (ETT) if IV not available Note: start with basic management teclmiques before progressing to advanced (see below)