JUST THE FACTS IN EMERGENCY MEDICINE - PART 1 ppt

Just the Facts in
EMERGENCY MEDICINE
EDITORS
David M. Cline, M.D.
Clinical Associate Professor of Emergency Medicine
Department of Emergency Medicine
University of North Carolina School of Medicine
at Chapel Hill, Chapel Hill, North Carolina
Education Director, Department of Emergency Medicine
WakeMed, Raleigh, North Caroline
O. John Ma, M.D.
Associate Professor of Emergency Medicine
Research Director and Vice Chair for Faculty Development
Department of Emergency Medicine
Truman Medical Center
University of Missouri–Kansas City School of Medicine
Kansas City, Missouri
Judith E. Tintinalli, M.D., M.S.
Professor and Chair
Department of Emergency Medicine
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
Gabor D. Kelen, M.D.
Professor and Chair
Department of Emergency Medicine
Johns Hopkins University
Baltimore, Maryland
J. Stephan Stapczynski, M.D.
Professor and Chair
Department of Emergency Medicine

University of Kentucky
Lexington, Kentucky
Just the Facts in
EMERGENCY MEDICINE
David M. Cline
O. John Ma
Judith E. Tintinalli
Gabor D. Kelen
J. Stephan Stapczynski
American College of
Emergency Physicians௡
McGRAW-HILL
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DOI: 10.1036/0071382720
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CONTENTS
Contributors
xv
Preface
xix
Section 1
TEST PREPARATION AND PLANNING 1
1 Facts about Emergency Medicine Board Exams
David M. Cline 1
2 Test-Taking Techniques David M. Cline 3
Section 2
RESUSCITATIVE PROBLEMS AND TECHNIQUES 7
3 Advanced Airway Support Robert J. Vissers 7

4 Dysrhythmia Management and Cardiovascular
Pharmacology David M. Cline 11
5 Resuscitation of Children and Neonates
David M. Cline 30
6 Fluids, Electrolytes, and Acid Base Disorders
David M. Cline 35
Section 3
SHOCK 45
7 Therapeutic Approach to the Hypotensive Patient
James L. Larson 45
8 Septic Shock James L. Larson 47
9 Cardiogenic Shock Rawle A. Seupaul 49
10 Neurogenic Shock Rawle A. Seupaul 50
11 Anaphylaxis and Acute Allergic Reactions
Damian F. McHugh 51
v
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vi
CONTENTS
Section 4
ANALGESIA, ANESTHESIA, AND SEDATION 55
12 Acute Pain Management and Conscious Sedation
Jim Edward Weber 55
13 Management of Patients with Chronic Pain
David M. Cline 59
Section 5
EMERGENCY WOUND MANAGEMENT 63
14 Evaluating and Preparing Wounds
James F. Palombaro 63
15 Methods for Wound Closure

James F. Palombaro 65
16 Lacerations to the Face and Scalp
David M. Cline 66
17 Fingertip and Nail Injuries Martin J. Carey 70
18 Lacerations of the Extremities and Joints
Martin J. Carey 71
19 Soft Tissue Foreign Bodies Martin J. Carey 75
20 Puncture Wounds and Animal Bites
Chris Melton 77
21 Postrepair Wound Care Chris Melton 80
Section 6
CARDIOVASCULAR DISEASES 83
22 Chest Pain and Ischemic Equivalents
Thomas A. Rebbecchi 83
23 Syncope Michael G. Mikhail 85
24 Management of Myocardial Ischemia and
Infarction Thomas A. Rebbecchi 87
25 Heart Failure and Pulmonary Edema
David M. Cline 89
26 Valvular Heart Disease and Endocarditis
David M. Cline 91
27 Cardiomyopathies, Myocarditis, and Pericardial
Disease David M. Cline 97
28 Pulmonary Embolism David M. Cline 101
29 Hypertensive Emergencies Jonathan A. Maisel 104
30 Aortic Dissection and Aneurysms
Suzanne M. Bertollo 107
31 Nontraumatic Peripheral Vascular Disorders
David M. Cline 109
CONTENTS

vii
Section 7
PULMONARY EMERGENCIES 113
32 Respiratory Distress Matthew T. Keadey 113
33 Pneumonia and Bronchitis David M. Cline 117
34 Tuberculosis David M. Cline 121
35 Pneumothorax Rodney L. McCaskill 123
36 Hemoptysis David F. M. Brown 125
37 Asthma and Chronic Obstructive Pulmonary
Disease David L. Leader, Jr. 126
Section 8
GASTROINTESTINAL EMERGENCIES 131
38 Acute Abdominal Pain David M. Cline 131
39 Gastrointestinal Bleeding Mitchell C. Sokolosky 133
40 Esophageal Emergencies Mitchell C. Sokolosky 135
41 Swallowed Foreign Bodies Patricia Baines 137
42 Peptic Ulcer Disease and Gastritis
Mark R. Hess 139
43 Appendicitis David L. Leader, Jr. 141
44 Intestinal Obstruction Roy L. Alson 143
45 Hernia in Adults and Children
Maryanne W. Lindsay 145
46 Ileitis, Colitis, and Diverticulitis David M. Cline 146
47 Anorectal Disorders Maryanne W. Lindsay 151
48 Vomiting, Diarrhea, and Constipation
David M. Cline 157
49 Jaundice, Hepatic Disorders, and Hepatic Failure
David M. Cline 161
50 Cholecystitis and Biliary Colic Nancy A. Wick 167
51 Pancreatitis Robert J. Vissers 169

52 Complications of General and Urologic Surgical
Procedures David M. Cline 171
Section 9
RENAL AND GENITOURINARY DISORDERS 175
53 Acute Renal Failure David M. Cline 175
54 Emergencies in Dialysis Patients
David M. Cline 178
55 Urinary Tract Infections and Hematuria
Kama Guluma 180
56 Male Genital Problems David M. Cline 183
57 Renal Colic Geetika Gupta 186
viii
CONTENTS
58 Complications of Urologic Devices
David M. Cline 188
Section 10
GYNECOLOGY AND OBSTETRICS 191
59 Vaginal Bleeding and Pelvic Pain in the
Nonpregnant Patient Cherri D. Hobgood 191
60 Ectopic Pregnancy Karen A. Kinney 196
61 Emergencies during Pregnancy and the Postpartum
Period Cynthia Madden 197
62 Comorbid Diseases in Pregnancy
Cynthia Madden 200
63 Emergency Delivery David M. Cline 203
64 Vulvovaginitis David A. Krueger 206
65 Pelvic Inflammatory Disease Laura R. Hopson 208
66 Complications of Gynecologic Procedures
David M. Cline 210
Section 11

PEDIATRICS 213
67 Fever David M. Cline 213
68 Common Neonatal Problems Lance Brown 215
69 Pediatric Heart Disease Lance Brown 219
70 Otitis and Pharyngitis David M. Cline 221
71 Skin and Soft Tissue Infections David M. Cline 225
72 Bacteremia, Sepsis, and Meningitis in Children
Lance Brown 229
73 Pneumonia in Children Lance Brown 233
74 Asthma and Bronchiolitis Jonathan L. Jones 235
75 Seizures and Status Epilepticus in Children
David M. Cline 238
76 Vomiting and Diarrhea in Children
David M. Cline 241
77 Pediatric Abdominal Emergencies
David M. Cline 243
78 The Diabetic Child and Diabetic Ketoacidosis
Leslie McKinney 246
79 Hypoglycemia in Children Lance Brown 248
80 Altered Mental Status in Children
Lance Brown 249
81 Syncope and Sudden Death in Children and
Adolescents David M. Cline 251
82 Fluid and Electrolyte Disorders in Children
Lance Brown 253
CONTENTS
ix
83 Upper Respiratory Emergencies
Jonathan L. Jones 256
84 Pediatric Exanthems Lance Brown 259

85 Musculoskeletal Disorders in Children
David M. Cline 263
86 Sickle Cell Anemia in Children David M. Cline 269
87 Pediatric Urinary Tract Infections Lance Brown 273
Section 12
INFECTIOUS DISEASES AND IMMUNOLOGY 277
88 Sexually Transmitted Diseases Gregory S. Hall 277
89 Toxic Shock Leslie McKinney 280
90 HIV Infections and AIDS David M. Cline 283
91 Tetanus and Radies David M. Cline 287
92 Malaria Gregory S. Hall 291
93 Common Parasitic Infections Joel L. Goldberg 294
94 Infections from Animals Gregory S. Hall 297
95 Soft Tissue Infections Chris Melton 302
96 Common Viral Infections David M. Cline 305
97 The Transplant Patient David M. Cline 308
Section 13
TOXICOLOGY 315
98 General Management of Poisoned Patients
Sandra L. Najarian 315
99 Anticholinergic Toxicity Mark B. Rogers 317
100 Psychopharmacologic Agents
Lance H. Hoffman 318
101 Sedatives-Hypnotics Keith L. Mausner 320
102 Alcohols Michael P. Kefer 324
103 Drugs of Abuse Joseph J. Randolph 328
104 Analgesics Keith L. Mausner 331
105 Xanthines Mark B. Rogers 337
106 Cardiac Medications Joseph J. Randolph 338
107 Phenytoin and Fosphenytoin Mark B. Rogers 343

108 Iron O. John Ma 344
109 Hydrocarbons and Volatile Substances
Lance H. Hoffman 346
110 Caustic Ingestions Joseph J. Randolph 347
111 Pesticides M. Chris Decker 349
112 Carbon Monoxide and Cyanide
M. Chris Decker 352
113 Heavy Metals Lance H. Hoffman 355
x
CONTENTS
114 Hazardous Materials Exposure
Joseph J. Randolph 356
115 Dyshemoglobinemias Alex G. Garza 358
Section 14
ENVIRONMENTAL INJURIES 361
116 Frostbite and Hypothermia Mark E. Hoffmann 361
117 Heat Emergencies Mark E. Hoffmann 363
118 Bites and Stings Alex G. Garza 364
119 Trauma and Envenomation from Marine Fauna
Keith L. Mausner 370
120 High Altitude Medical Problems
Keith L. Mausner 371
121 Dysbarism Keith L. Mausner 374
122 Near Drowning Stefanie R. Seaman 375
123 Thermal and Chemical Burns Alex G. Garza 377
124 Electrical and Lightning Injuries
Mark E. Hoffmann 380
125 Radiation Injuries Keith L. Mausner 382
126 Poisonous Plants and Mushrooms
Sandra L. Najarian 384

Section 15
ENDOCRINE EMERGENCIES 387
127 Diabetic Emergencies Michael P. Kefer 387
128 Alcoholic Ketoacidosis Michael P. Kefer 390
129 Thyroid Disease Emergencies
Stefanie R. Seaman 391
130 Adrenal Insufficiency and Adrenal Crisis
Michael P. Kefer 394
Section 16
HEMATOLOGIC AND ONCOLOGIC
EMERGENCIES 397
131 Evaluation of Anemia and the Bleeding Patient
Sandra L. Najarian 397
132 Acquired Bleeding Disorders
Kathleen F. Stevison 400
133 Hemophilias and Von Willebrand’s Disease
John Sverha 403
134 Hemolytic Anemias Sandra L. Najarian 405
135 Blood Transfusions and Component Therapy
Keith L. Mausner 407
CONTENTS
xi
136 Exogenous Anticoagulants and Antiplatelet
Agents Kathleen F. Stevison 411
137 Emergency Complications of Malignancy
John Sverha 414
Section 17
NEUROLOGY 419
138 Headache and Facial Pain Philip B. Sharpless 419
139 Stroke Syndromes Stefanie R. Seaman 423

140 Altered Mental Status and Coma
Philip B. Sharpless 426
141 Gait Disturbances Sandra L. Najarian 431
142 Vertigo and Dizziness Philip B. Sharpless 432
143 Seizures and Status Epilepticus in Adults
Mark E. Hoffmann 434
144 Acute Peripheral Neurologic Lesions
Alex G. Garza 436
145 Chronic Neurologic Disorders Mark B. Rogers 440
146 Meningitis, Encephalitis, and Brain Abscess
O. John Ma 443
Section 18
EYE, EAR, NOSE, THROAT, AND
ORAL EMERGENCIES 449
147 Ocular Emergencies Steven Go 449
148 Ear, Nose, and Facial Disorders
Burton Bentley II 454
149 Oral and Dental Emergencies Burton Bentley II 458
150 Neck and Upper Airway Disorders
William R. Dennis, Jr. 460
Section 19
DISORDERS OF THE SKIN 465
151 Dermatologic Emergencies James Hassen, Jr. 465
152 Other Dermatologic Disorders
James Hassen, Jr. 467
Section 20
TRAUMA 471
153 Initial Approach to the Trauma Patient
William R. Dennis, Jr. 471
xii

CONTENTS
154 Pediatric Trauma Joseph J. Randolph 473
155 Geriatric Trauma O. John Ma 476
156 Trauma in Pregnancy Stefanie R. Seaman 477
157 Head Injury Mark E. Hoffmann 479
158 Spinal Injuries Mark E. Hoffmann 482
159 Maxillofacial Trauma M. Chris Decker 484
160 Neck Trauma M. Chris Decker 487
161 Thoracic Trauma Kent N. Hall 490
162 Abdominal Trauma O. John Ma 496
163 Flank and Buttock Trauma
William R. Dennis, Jr. 499
164 Genitourinary Trauma Gary M. Gaddis 500
165 Penetrating Trauma to the Extremities
Gary M. Gaddis 503
Section 21
FRACTURES AND DISLOCATIONS 505
166 Early Management of Fractures and Dislocations
Michael P. Kefer 505
167 Hand and Wrist Injuries Michael P. Kefer 506
168 Forearm and Elbow Injuries Sarah A. Wurster 509
169 Shoulder and Humerus Injuries
Sarah A. Wurster 512
170 Injuries of the Pelvis, Hip, and Femur
Craig E. Krausz 513
171 Knee and Leg Injuries Sarah A. Wurster 517
172 Ankle and Foot Injuries Sarah A. Wurster 520
173 Compartment Syndromes Stefanie R. Seaman 523
174 Rhabdomyolysis Stefanie R. Seaman 525
Section 22

MUSCULAR, LIGAMENTOUS, AND
RHEUMATIC DISORDERS 527
175 Cervical, Thoracic, and Thoracolumbar Pain
Syndromes Gary M. Gaddis 527
176 Shoulder Pain Gary M. Gaddis 530
177 Acute Disorders of the Joints
Lance H. Hoffman 532
178 Musculoskeletal Disorders in Adults
Michael P. Kefer 534
179 Infectious and Noninfectious Inflammatory
Conditions of the Hand Mark E. Hoffmann 535
180 Soft Tissue Problems of the Foot
Mark B. Rogers 537
CONTENTS
xiii
Section 23
PSYCHOSOCIAL DISORDERS 541
181 Clinical Features of Behavioral Disorders
Lance H. Hoffman 541
182 Assessment and Stabilization of Behavioral
Disorders James Hassen, Jr. 543
Section 24
ABUSE AND ASSAULT 547
183 Child and Elderly Abuse Craig E. Krausz 547
184 Sexual Assault Craig E. Krausz 549
Section 25
IMAGING 553
185 Principles of Emergency Department Use of
Computed Tomography and Magnetic Resonance
Imaging Craig E. Krausz 553

186 Principles of Emergency Department
Ultrasonography Craig E. Krausz 555
Section 26
ADMINISTRATION 559
187 Emergency Medical Services
Lance H. Hoffman 559
188 Emergency Medicine Administration
David M. Cline 560
Index
565
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CONTRIBUTORS
Roy Alson, M.D., Assistant Professor, Medical Director, NC Baptist,
AirCare, Wake Forest University School of Medicine, Department of
Emergency Medicine, Winston-Salem, North Carolina (Chapter 44)
Patricia Baines, M.D., Wake Forest University Baptist Medical Center,
North Carolina Baptist Hospital, Department of Emergency Medicine,
Winston-Salem, North Carolina (Chapter 41)
Burton Bentley II, M.D., Attending Staff Physician, Department of
Emergency Medicine, Northwest Medical Center, Tucson, Arizona
(Chapters 148, 149)
Suzanne Bertollo, M.D., Clinical Instructor, University of North Caro-
lina, Department of Emergency Medicine, Chapel Hill, North Carolina,
WakeMed, Department of Emergency Medicine, Raleigh, North Caro-
lina (Chapter 30)
David F. M. Brown, M.D., Instructor, Division of Emergency Medicine,
Harvard Medical School, Assistant Chief, Department of Emergency
Medicine, Massachusetts General Hospital, Boston, Massachusetts
(Chapter 36)
Lance Brown, M.D., Clinical Assistant Professor, University of

North Carolina, Department of Emergency Medicine, Chapel Hill,
North Carolina, WakeMed, Department of Emergency Medicine,
Raleigh, North Carolina (Chapters 68, 69, 72, 73, 79, 80, 82,
84, 87)
Martin Carey, M.D., University of Arkansas for Medical Science, Depart-
ment of Emergency Medicine, Little Rock, Arkansas (Chapters 17–19)
David M. Cline, M.D., Clinical Associate Professor of Emergency Medi-
cine, Department of Emergency Medicine, University of North Caro-
lina School of Medicine at Chapel Hill, Chapel Hill, North Carolina,
Education Director, Department of Emergency Medicine, WakeMed,
Raleigh, North Carolina (Chapters 1, 2, 4–6, 13, 16, 25–28, 31, 33, 34,
38, 46, 48, 49, 52–54, 56, 58, 63, 66, 67, 70, 71, 75, 76, 77, 81, 85, 86,
90, 91, 96, 97, 188)
M. Chris Decker, M.D., Assistant Professor of Emergency Medicine,
Medical College of Wisconsin, Milwaukee, Wisconsin (Chapters 111,
112, 159, 160)
William R. Dennis, Jr., M.D., Chief Resident, Truman Medical Center,
University of Missouri–Kansas City School of Medicine, Kansas City,
Missouri (Chapters 150, 153, 163)
xv
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xvi CONTRIBUTORS
Gary Gaddis, M.D., Ph.D., Clinical Associate Professor of Emergency
Medicine, St. Luke’s Hospital, University of Missouri–Kansas City
School of Medicine, Kansas City, Missouri (Chapters 164, 165, 175, 176)
Alex G. Garza, M.D., Assistant Professor of Emergency Medicine, Tru-
man Medical Center, University of Missouri–Kansas City School of
Medicine, Kansas City, Missouri (Chapters 115, 118, 123, 144)
Steven Go, M.D., Assistant Professor of Emergency Medicine, Truman
Medical Center, University of Missouri–Kansas City School of Medi-

cine, Kansas City, Missouri (Chapter 147)
Joel L. Goldberg, M.D., Department of Emergency Medicine, Franklin
Regional Medical Center, Louisburg, North Carolina (Chapter 93)
Kama Guluma, M.D., St. Joseph Mercy Hospital, Department of Emer-
gency Medicine, Ann Arbor, Michigan (Chapter 55)
Geetika Gupta, St. Joseph Mercy Hospital, Department of Emergency
Medicine, Ann Arbor, Michigan (Chapter 57)
Gregory Hall, M.D., University of Arkansas for Medical Science, Little
Rock, Arkansas (Chapter 88, 92, 94)
Kent N. Hall, M.D., Attending Staff Physician, Department of Emer-
gency Medicine, Mercy Hospital–Fairfield, Fairfield, Ohio (Chapter
161)
James Hassen Jr., M.D., Attending Staff Physician, Department of Emer-
gency Medicine, Northwest Medical Center, Tucson, Arizona (Chap-
ters 151, 152, 182)
Mark R. Hess, M.D., Assistant Professor, Emergency Medicine, Wake
Forest University Baptist Medical Center, Winston-Salem, North Caro-
lina (Chapter 42)
Cherri Hobgood, M.D., Assistant Professor, Department of Emergency
Medicine, UNC School of Medicine, UNC Hospitals, Chapel Hill,
North Carolina (Chapter 59)
Lance H. Hoffman, M.D., Chief Resident, Truman Medical Center, Uni-
versity of Missouri–Kansas City School of Medicine, Kansas City,
Missouri (Chapters 100, 109, 113, 177, 181, 187)
Mark E. Hoffmann, M.D., Attending Staff Physician, Department of
Emergency Medicine, St. Cloud Hospital, St. Cloud, Minnesota (Chap-
ters 116, 117, 124, 143, 157, 158, 179)
Laura Hopson, M.D., St. Joseph Mercy Hospital, Department of Emer-
gency Medicine, Ann Arbor, Michigan (Chapter 65)
Jonathan Jones, M.D., WakeMed, Department of Emergency Medicine,

Raleigh, North Carolina (Chapters 74, 83)
Matthew T. Keadey, M.D., Department of Emergency Medicine, Univer-
sity of North Carolina School of Medicine, Chapel Hill, North Carolina
(Chapter 32)
Michael P. Kefer, M.D., Associate Professor of Emergency Medicine,
Medical College of Wisconsin, Milwaukee, Wisconsin (Chapters 102,
127, 128, 130, 166, 167, 178)
Karen Kinney, M.D., Clinical Associate Professor of Emergency Medi-
cine, East Carolina University, School of Medicine, Greenville, North
Carolina (Chapter 60)
Craig E. Krausz, M.D., Assistant Professor of Emergency Medicine, St.
Louis University School of Medicine, St. Louis, Missouri (Chapters
170, 183, 184–186)
David Krueger, M.D., St. Joseph Mercy Hospital, Department of Emer-
gency Medicine, Ann Arbor, Michigan (Chapter 64)
James L. Larson, Jr., M.D., Assistant Professor, Assistant Residency
CONTRIBUTORS xvii
Director, University of North Carolina School of Medicine, Depart-
ment of Emergency Medicine, Chapel Hill, North Carolina (Chapters
7, 8)
David L. Leader, Jr., D.O., Clinical Instructor, Department of Emergency
Medicine, University of North Carolina, School of Medicine, Chapel
Hill, North Carolina, Wake Medical Center, Department of Emergency
Medicine, Raleigh, North Carolina (Chapters 37, 43)
Maryanne W. Lindsay, M.D., F.A.C.E.P., Clinical Assistant Professor,
Wake Forest University School of Medicine, Winston-Salem, North
Carolina (Chapter 47)
O. John Ma, M.D., Associate Professor of Emergency Medicine, Re-
search Director and Vice Chair for Faculty Development, Department
of Emergency Medicine, Truman Medical Center, University of Mis-

souri–Kansas City School of Medicine, Kansas City, Missouri (Chap-
ters 108, 146, 155, 162)
Cynthia Madden, M.D., M.P.H., Clinical Associate Professor of Emer-
gency Medicine, University of North Carolina, Chapel Hill, North
Carolina, Director, WakeMed Injury Prevention Center, Raleigh,
North Carolina (Chapters 61, 62)
Jonathan A. Maisel, M.D. Bridgeport Hospital, Bridgeport, Connecticut,
Associate Program Director, Yale University Emergency Medicine
Residency Program, Assistant Clinical Professor of Surgery (Emer-
gency Medicine), Yale University School of Medicine, New Haven,
Connecticut (Chapter 29)
Keith Mausner, M.D., Attending Staff Physician, Department of Emer-
gency Medicine, Saint Luke’s Hospital, Milwaukee, Wisconsin (Chap-
ters 101, 104, 119–121, 125, 135)
Rodney McCaskill, M.D., WakeMed, Department of Emergency Medi-
cine, Raleigh, North Carolina (Chapter 35)
Damian McHugh, M.B., Ch.B., M.R.C.G.P., Department of Emergency
Medicine, University of North Carolina at Chapel Hill, Chapel Hill,
North Carolina (Chapter 11)
Leslie McKinney, M.D., Priority Care, Cary, North Carolina (Chapters
78, 89)
Chris Melton, M.D., Assistant Professor, University of Arkansas for
Medical Science, University Hospital, Department of Emergency Med-
icine, Little Rock, Arkansas (Chapters 20, 21, 95)
Michael Mikhail, M.D., Clinical Instructor, University of Michigan, Asso-
ciate Chairman, St. Joseph Mercy Hospital, Department of Emergency
Medicine, Ann Arbor, Michigan (Chapter 23)
Sandra L. Najarian, M.D., Senior Instructor of Emergency Medicine,
Case Western Reserve University, MetroHealth Medical Center,
Cleveland, Ohio (Chapters 98, 126, 131, 134, 141)

James F. Palombaro, M.D., WakeMed, Department of Emergency Medi-
cine, Raleigh, North Carolina (Chapters 14, 15)
Joseph J. Randolph, M.D., Attending Staff Physician, Department of
Emergency Medicine, Emmanuel Saint Joseph’s–Mayo Health System,
Mankato, Minnesota (Chapters 103, 106, 110, 114, 154)
Thomas A. Rebbecchi, M.D., Assistant Professor of Emergency Medi-
cine, Robert Wood Johnson Medical School, Cooper Hospital, Depart-
ment of Emergency Medicine, Camden, New Jersey (Chapters 22, 24)
Mark B. Rogers, M.D., Attending Staff Physician, Department of Emer-
gency Medicine, Breech Medical Center, Lebanon, Missouri (Chapters
99, 105, 107, 145, 180)
xviii CONTRIBUTORS
Stefanie R. Seaman, M.D., Assistant Professor of Emergency Medicine,
Truman Medical Center, University of Missouri–Kansas City School
of Medicine, Kansas City, Missouri (Chapters 129, 139, 156, 173, 174)
Rawle A. Seupaul, M.D., Carolinas Medical Center, Charlotte, North
Carolina (Chapters 9, 10)
Philip B. Sharpless, M.D., Assistant Professor of Emergency Medicine,
Medical College of Wisconsin, Milwaukee, Wisconsin (Chapters 138,
149, 142)
Mitchell C. Sokolosky, M.D., F.A.C.E.P., Residency Director, Depart-
ment of Emergency Medicine, Wake Forest University School of Medi-
cine, Winston-Salem, North Carolina (Chapters 39, 40)
Kathleen F. Stevison, M.D., Emergency Physician, Department of Emer-
gency Medicine, Christ Hospital Medical Center, Oak Lawn, Illinois
(Chapters 132, 136)
John Sverha, M.D., Attending Staff Physician, Department of Emergency
Medicine, Arlington Hospital, Arlington, Virginia (Chapters 133, 137)
Robert J. Vissers, M.D., University of North Carolina School of Medi-
cine, Department of Emergency Medicine, Chapel Hill, North Carolina

(Chapters 3, 51)
Jim Edward Weber, M.D., Assistant Professor, Department of Emer-
gency Medicine, University of Michigan Medical School, Ann Arbor,
Michigan, Director of Research, Hurley Medical Center, Flint, Michi-
gan (Chapter 12)
Nancy Wick, M.D., Instructor, Pediatrics and Emergency Medicine,
Wake Forest University Baptist Medical Center, Winston-Salem,
North Carolina (Chapter 30)
Sarah A. Wurster, M.D., Attending Staff Physician, Department of Emer-
gency Medicine, Bethany Medical Center, Kansas City, Kansas (Chap-
ters 168, 169, 171, 172)
PREFACE
In a crunch, when interviewing an eyewitness, Dragnet’s Sgt. Joe Friday
would implore, ‘‘Just the facts, ma’am, just the facts.’’ Our textbook, Just
the Facts in Emergency Medicine, aims to provide just that for emergency
physicians who are studying for either the written board (re)certification
examination in emergency medicine or the in-training written exami-
nation.
This book has evolved from Judith Tintinalli’s Emergency Medicine:
A Comprehensive Study Guide, fifth edition, which has long been consid-
ered as a premier source for board certification preparation. Dr. Tinti-
nalli’s first edition of the Study Guide, published in 1978, was designed
to cover the core content of emergency medicine for physicians preparing
for the written board examination. Since then, along with the explosive
growth in the field of emergency medicine, the Study Guide has been
expanded to the point where it may be too voluminous to serve as a
rapid review source. The other book that has evolved from the Study
Guide, the Companion Handbook, was designed as a streamlined pocket
reference guide for the practicing clinician and contains only the essential
information that is pertinent to the clinical care of the patient in the

emergency department.
Each chapter in Just the Facts in Emergency Medicine emphasizes
the key points in the Epidemiology, Pathophysiology, Clinical Features,
Diagnosis and Differential, and Emergency Department Care and Dispo-
sition of the disease entity. The bulleted outline for each factual item is
designed to enhance its use as a rapid study aid.
We would like to express our deep appreciation to the Just the Facts
in Emergency Medicine chapter authors for their commitment and hard
work in helping to produce this textbook. We also are indebted to numer-
ous individuals who assisted us with this project, in particular, we would
like to thank Andrea Seils, Lester A. Sheinis, and Richard C. Ruzycka
at McGraw-Hill. Finally, without the love and encouragement of our
families, this book would not have been possible. DMC thanks his wife,
Lisa, and his secretary, Nell; and OJM thanks Natasha, Gabrielle, Sabrina,
Julius, Rebekah, and Elise.
David M. Cline, M.D.
O. John Ma, M.D.
xix
Copyright 2001 The McGraw Hill Companies, Inc. Click Here for Terms of Use.
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Just the Facts in
EMERGENCY MEDICINE
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Section 1
TEST PREPARATION AND PLANNING
1 FACTS ABOUT EMERGENCY
MEDICINE BOARD EXAMS
David M. Cline
• The American Board of Emergency Medicine
(ABEM) administers three written exams each

year: the Certification Exam, the Recertification
Exam, and the In-Training Exam. For the most
up-to-date information concerning these exams,
review the ABEM web site: www.abem.org.
• The American Board of Osteopathic Emergency
Medicine (ABOEM) administers one certification
examination per year.
ABEM WRITTEN CERTIFICATION
EXAM
• The Certification exam is given each year in early
November at several locations throughout the
country; check for test site information at www.
abem.org. This exam is usually given the day after
the Recertification exam.
• The test consists of approximately 335 questions
and lasts a total of 6 h and 15 min (1.1 min per
question). There is a 60-min break for lunch.
• Of the test questions, 15 percent include a pictorial
stimulus, generally during the first portion of
the exam.
• The pass/fail criterion is 75 percent correct of
those test items, which are included in the exami-
nation for the purpose of scoring.
• Typically, only two-thirds of the test is scored,
with one-third of the test questions representing
new trial content. These investigational questions
are compared with standardized questions for re-
1
liability and may be included as scored items the
following exam cycle. Typically, a question re-

quires 2 years from the time of creation to use as
a scored item.
• The pass rate for the Certification exam during
the 1998 exam cycle was 91 percent for first-time
takers with emergency medicine residency train-
ing and 73 percent for all others.
• Subject matter of the exam is based on the Emer-
gency Medicine Core Content.
1
• A percentage breakdown of the exam content
compared to the chapters of this book is listed in
Table 1-1. Although many of the questions are
different, the content percentages are the same
for all three ABEM written exams. Just the Facts
in Emergency Medicine includes several chapters
that include multiple topics, therefore our chap-
ters do not precisely correlate to the exam ques-
tion content areas.
• Compared to the Recertification exam, the Certi-
fication exam has more pathophysiology-based
questions. Roughly 60 percent of the questions
are management based, many of which require a
diagnosis be made from the clinical description.
There are 20 percent that are diagnosis based,
and 10 percent are pathophysiology based. The
remaining 10 percent of questions relate to admin-
istrative, emergency medical service (EMS), disas-
ter medicine, and miscellaneous issues.
• Certification expires every 10 years.
ABEM WRITTEN RECERTIFICATION

EXAM
• The Recertification exam is given each year in
early November at several locations throughout
the country, check for test site information at
Copyright 2001 The McGraw Hill Companies, Inc. Click Here for Terms of Use.
2 SECTION 1
•
TEST PREPARATION AND PLANNING
TABLE 1-1 Percentage Distribution of Test Items by Core Content Category Compared to Chapter Listing of Just the
Facts in Emergency Medicine
WRITTEN EXAM
PERCENTAGE NUMBER OF JUST THE FACTS IN EMERGENCY MEDICINE
CONTENT AREA DISTRIBUTION (%) CHAPTERS CHAPTERS REPRESENTED
Abdominal and gastrointestinal dis- 7 15 (7.9%) 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52
orders
Cardiovascular disorders 11 15 (7.9%) 4, 5, 9, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 69, 81
Cutaneous disorders 1 2 (1.0%) 151, 152
Endocrine, metabolic, and nutritional 6 8 (4.2%) 6, 78, 79, 82, 127, 128, 129, 130
disorders
Environmental disorders 2 11 (5.8%) 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126
Head, ear, eye, nose, throat dis- 8 8 (4.2%) 16, 70, 83, 138, 147, 148, 149, 150
orders
Hematologic disorders 2 7 (3.7%) 131, 132, 133, 134, 135, 136, 137
Immune system disorders 1 3 (1.6%) 11, 90, 97
Systemic infectious disorders 3 8 (4.2%) 8, 89, 91, 92, 93, 94, 95, 96
Musculoskeletal disorders (nontrau- 3 6 (3.2%) 175, 176, 177, 178, 179, 180
matic)
Nervous system disorders 5 9 (4.7%) 10, 139, 140, 141, 142, 143, 144, 145, 146
Obstetrics and disorders of preg- 2 4 (2.1%) 60, 61, 62, 63
nancy

Pediatric disorders 8 14 (7.4%) 67, 68, 71, 72, 75, 76, 77, 78, 79, 80, 84, 85, 86, 87
Psychobehavioral disorders 3 3 (1.6%) 181, 182, 183
Renal disorders 2 4 (2.1%) 53, 54, 57, 58
Thoracic-respiratory disorders 7 9 (4.7%) 32, 33, 34, 35, 36, 37, 73, 74, 161
Toxicology and clinical pharma- 4 18 (9.5%) 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109,
cology 110, 111, 112, 113, 114, 115
Traumatic disorders 11 22 (11.6%) 7, 153, 154, 155, 156, 157, 158, 159, 160, 162, 163, 164,
165, 166, 167, 168, 169, 170, 171, 172, 173, 174
Urogenital/gynecologic disorders 3 6 (3.2%) 55, 56, 59, 64, 65, 66
Administrative aspects of emergency 2 3 (1.6%) 184, 185, 189
medicine
Emergency medical services/disaster 3 1 (0.6%) 188
medicine
Clinical pharmacology 2 2.5 (1.3%) 4,* 12, 13, plus various chapters
Procedures/skills 4 10 (5.2%) 3, 14, 15, 17, 18, 19, 20, 21, 186, 187, plus various
chapters
* Chapter content divided between two board exam content areas.
www.abem.org. This exam is usually given the day
before the Certification exam.
• The test consists of approximately 310 questions
and lasts a total of 5 h and 45 min (1.1 min per
question). There is a 60-min break for lunch.
• Of the test questions, 15 percent include a pictorial
stimulus, generally during the first portion of
the exam.
• The pass/fail criterion for the Recertification
exam is 75 percent correct of those test items,
which are included in the examination for the pur-
pose of scoring.
• Typically, only two-thirds of the test is scored,

with one-third of the test questions representing
new trial content. These investigational questions
are compared with standardized questions for re-
liability and may be included as scored items the
following exam cycle.
• The pass rate for the Recertification exam during
the 1998 exam cycle was 95 percent.
• Subject matter of the exam is based on the Emer-
gency Medicine Core Content.
1
• A percentage breakdown of the exam content
compared to the chapters of this book is listed in