Ebook Emergency medicine procedure (2nd edition): Part 1

Emergency Medicine
Procedures


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Emergency Medicine
Procedures
Second Edition
Eric F. Reichman, PhD, MD, FAAEM, FACEP
Associate Professor of Emergency Medicine
Attending Physician, Department of Emergency Medicine
Medical Director, Surgical and Clinical Skills Center
University of Texas Health Science Center at Houston-Medical School
Attending Physician, Emergency Department
Memorial Hermann Hospital-Texas Medical Center

Attending Physician, Emergency Department
Lyndon Baines Johnson General Hospital
Houston, Texas

New York Chicago San Francisco Lisbon London Madrid Mexico City
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Copyright © 2013 by Eric F. Reichman, PhD, MD. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication
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To my wife, Kristi. Thanks for your patience with the
semi-permanent card table and computer in the living room,
and the mess with all the papers and files. Thanks for your support
and understanding. Thanks to Joey, Jake, Rocky, and Phoebe
for entertaining me each day.


This page intentionally left blank


Contents
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii

18 Supraglottic Airway Devices . . . . . . . . . . . . . . . . . . . 106
Fred A. Severyn

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiv

19 Laryngeal Mask Airways . . . . . . . . . . . . . . . . . . . . . 110
Katrin Takenaka and Theltonia Howard

SECTION 1 Introductory Chapters . . . . . . . . . . . . . . . . 1

20 Double Lumen Airway Tube Intubation . . . . . . . . . . . . 122
Joseph Weber

1 Informed Consent for Procedures
in the Emergency Department . . . . . . . . . . . . . . . . . . . 1
Eric Isaacs

21 Fiberoptic Endoscopic Intubation . . . . . . . . . . . . . . . 127
Erika D. Schroeder, M. Scott Linscott, and Joseph Bledsoe

2 Aseptic Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
John S. Rose

22 Nasotracheal Intubation . . . . . . . . . . . . . . . . . . . . . 134
Ned F. Nasr, Raed Rahman, and Isam F. Nasr

3 Basic Principles of Ultrasonography . . . . . . . . . . . . . . . 13
Gregory M. Press

23 Retrograde Guidewire Intubation . . . . . . . . . . . . . . . 139
Roland Petri

4 Ultrasound-Assisted Procedures . . . . . . . . . . . . . . . . . 24
Jehangir Meer, Sam Hsu, and Brian Euerle

24 Percutaneous Transtracheal Jet Ventilation . . . . . . . . . . 143
Eric F. Reichman and Aaron Brown

5 Trauma Ultrasound: The FAST Exam . . . . . . . . . . . . . . . 28

Wes Zeger

25 Cricothyroidotomy . . . . . . . . . . . . . . . . . . . . . . . . 148
Eric F. Reichman

SECTION 2 Respiratory Procedures . . . . . . . . . . . . . . 35

26 Tracheostomy . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Teresa M. Romano and Christopher J. Haines

6 Essential Anatomy of the Airway . . . . . . . . . . . . . . . . 35
Ned F. Nasr, Serge G. Tyler,
Gennadiy Voronov, and Isam F. Nasr
7 Basic Airway Management . . . . . . . . . . . . . . . . . . . . 40
Christopher J. Russo and Zach Kassutto
8 Pharmacologic Adjuncts to Intubation. . . . . . . . . . . . . . 47
Ned F. Nasr, David W. Boldt, and Isam F. Nasr
9 Endotracheal Medication Administration . . . . . . . . . . . . 56
Shoma Desai
10 Rapid Sequence Induction . . . . . . . . . . . . . . . . . . . . . 60
Piotr C. Aljindi, Ned F. Nasr, and Isam F. Nasr
11 Orotracheal Intubation . . . . . . . . . . . . . . . . . . . . . . . 64
Eric F. Reichman and Joseph Cornett
12 Confirmation of Endotracheal Intubation . . . . . . . . . . . . 76
Tarlan Hedayati and Leonardo Rodriguez
13 Video-Assisted Orotracheal Intubation Devices . . . . . . . . 80
Pholaphat Charles Inboriboon
14 Fiberoptic-Assisted Orotracheal Intubation Devices . . . . . 89
Michael Lutes and Olga Pawelek

27 Tracheostomy Care . . . . . . . . . . . . . . . . . . . . . . . . 171
H. Gene Hern Jr.
28 Transtracheal Aspiration . . . . . . . . . . . . . . . . . . . . . 177
Joseph A. Salomone III

SECTION 3 Cardiothoracic Procedures . . . . . . . . . . . 181
29 Cardiac Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . 181
Gregory M. Press and Amy Rasmussen
30 Cardioversion and Defibrillation . . . . . . . . . . . . . . . . 193
Payman Sattar
31 Transcutaneous Cardiac Pacing . . . . . . . . . . . . . . . . . 197
Todd M. Larabee
32 Transthoracic Cardiac Pacing . . . . . . . . . . . . . . . . . . 202
Simon M. Pulfrey
33 Transvenous Cardiac Pacing. . . . . . . . . . . . . . . . . . . 205
Eric F. Reichman, Myles C. McClelland, and Brian Euerle
34 Pacemaker Assessment . . . . . . . . . . . . . . . . . . . . . 212
Nnaemeka G. Okafor

15 Endotracheal Tube Intubating Introducers and Bougies . . . 95
Olga Pawelek and Eric F. Reichman

35 Automatic Implantable
Cardioverter-Defibrillator Assessment. . . . . . . . . . . . . 218
Carlos J. Roldan

16 Digital (Tactile) Orotracheal Intubation . . . . . . . . . . . . 100
O. John Ma and Amanda Munk

36 Pericardiocentesis . . . . . . . . . . . . . . . . . . . . . . . . . 225

Eric F. Reichman, Elisabeth Kang, and Jehangir Meer

17 Lighted Stylet Intubation . . . . . . . . . . . . . . . . . . . . . 102
Philip Bossart and Michael Wallace

37 Intracardiac Injection . . . . . . . . . . . . . . . . . . . . . . . 236
Payman Sattar
vii


viii

Contents

38 Needle Thoracostomy . . . . . . . . . . . . . . . . . . . . . . 238
Eric F. Reichman and Elizabeth Sowell

61 Whole Bowel Irrigation. . . . . . . . . . . . . . . . . . . . . . 398
Steven E. Aks and David D. Gummin

39 Tube Thoracostomy . . . . . . . . . . . . . . . . . . . . . . . . 242
Kimberly T. Joseph

62 Esophageal Foreign Body Removal . . . . . . . . . . . . . . 401
Bashar M. Attar

40 Thoracentesis . . . . . . . . . . . . . . . . . . . . . . . . . . . 250
Eric F. Reichman, Cristal R. Cristia, and Jehangir Meer

63 Balloon Tamponade of Gastrointestinal Bleeding . . . . . . 407

Bashar M. Attar

41 Open Chest Wound Management . . . . . . . . . . . . . . . 263
Eric F. Reichman

64 Gastrostomy Tube Replacement . . . . . . . . . . . . . . . . 414
Maggie Ferng and Ryan C. Headley

42 Emergency Department Thoracotomy . . . . . . . . . . . . 267
Kenny Banh

65 Paracentesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421
Susan B. Promes, Elizabeth M. Datner, and Sam Hsu

43 Open Cardiac Massage. . . . . . . . . . . . . . . . . . . . . . 271
Eric F. Reichman

66 Diagnostic Peritoneal Lavage . . . . . . . . . . . . . . . . . . 431
Sandeep Johar and Umashankar Lakshmanadoss

44 Cardiac Wound Repair . . . . . . . . . . . . . . . . . . . . . . 274
Eric F. Reichman

67 Anal Fissure Management . . . . . . . . . . . . . . . . . . . . 439
Marilyn M. Hallock and Eric F. Reichman

45 Hilum and Great Vessel Wound Management . . . . . . . . 280
Eric F. Reichman

68 External Hemorrhoid Management . . . . . . . . . . . . . . 443

Charles Orsay and Eric F. Reichman

46 Thoracic Aortic Occlusion . . . . . . . . . . . . . . . . . . . . 282
Eric F. Reichman

69 Prolapsed Rectum Reduction . . . . . . . . . . . . . . . . . . 446
Jamil D. Bayram and Eric F. Reichman

SECTION 4 Vascular Procedures . . . . . . . . . . . . . . . . 287

70 Anoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449
Charles Orsay and Eric F. Reichman

47 General Principles of Intravenous Access . . . . . . . . . . . 287
Daniel Belmont

71 Rigid Rectosigmoidoscopy . . . . . . . . . . . . . . . . . . . . 453
Charles Orsay and Eric F. Reichman

48 Venipuncture and Peripheral Intravenous Access . . . . . . 296
Daniel Belmont

72 Rectal Foreign Body Extraction . . . . . . . . . . . . . . . . . 458
Charles Orsay and Eric F. Reichman

49 Central Venous Access . . . . . . . . . . . . . . . . . . . . . . 308
Arun Nagdev and Craig Sisson
50 Ultrasound-Guided Vascular Access . . . . . . . . . . . . . . 327
Srikar Adhikari
51 Troubleshooting Indwelling Central Venous Lines. . . . . . 337

James J. McCarthy
52 Accessing Indwelling Central Venous Lines . . . . . . . . . . 340
Lisa Freeman Grossheim
53 Pulmonary Artery (Swan-Ganz) Catheterization . . . . . . 344
Pratik Doshi
54 Peripheral Venous Cutdown. . . . . . . . . . . . . . . . . . . 350
Flavia Nobay
55 Intraosseous Infusion . . . . . . . . . . . . . . . . . . . . . . . 361
Amanda Munk and O. John Ma
56 Umbilical Vessel Catheterization . . . . . . . . . . . . . . . . 369
Eric F. Reichman, Amy Noland, and Antonio E. Muñiz
57 Arterial Puncture and Cannulation . . . . . . . . . . . . . . . 376
Zak Foy and Susan Stroud

SECTION 5 Gastrointestinal Procedures . . . . . . . . . . 387
58 Nasogastric Intubation . . . . . . . . . . . . . . . . . . . . . . 387
Lisa Freeman Grossheim
59 Activated Charcoal Administration . . . . . . . . . . . . . . . 391
Jenny J. Lu
60 Gastric Lavage . . . . . . . . . . . . . . . . . . . . . . . . . . . 393
Jenny J. Lu

SECTION 6 Orthopedic and
Musculoskeletal Procedures . . . . . . . . . . 465
73 Bursitis and Tendonitis Therapy . . . . . . . . . . . . . . . . 465
Dedra Tolson
74 Compartment Pressure Measurement . . . . . . . . . . . . 473
Matt Kleinmaier and Sanjeev Malik
75 Fasciotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 480
Justin Mazzillo, Sobia Ansari, and Eric F. Reichman

76 Extensor Tendon Repair . . . . . . . . . . . . . . . . . . . . . 490
Jaime Harper, Stanley Harper, and Ramasamy Kalimuthu
77 Arthrocentesis . . . . . . . . . . . . . . . . . . . . . . . . . . . 495
Eric F. Reichman, John Larkin, and Brian Euerle
78 Methylene Blue Joint Injection . . . . . . . . . . . . . . . . . 517
Joseph E. Tonna, Heather H. Bohn, and Matthew R. Lewin
79 Basic Principles of Fracture and Joint Reductions . . . . . . 522
Scott C. Sherman
80 Sternoclavicular Joint Dislocation Reduction . . . . . . . . . 526
Eric F. Reichman
81 Shoulder Joint Dislocation Reduction . . . . . . . . . . . . . 531
Eric F. Reichman
82 Elbow Joint Dislocation Reduction . . . . . . . . . . . . . . . 549
Angelique S. Kelly Campen
83 Radial Head Subluxation (“Nursemaid’s Elbow”)
Reduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 553
Mark P. Kling and Eric F. Reichman


Contents

ix

84 Metacarpophalangeal Joint Dislocation Reduction . . . . . 557
Michael Bublewicz and Antonio E. Muñiz

107 Paronychia or Eponychia Incision and Drainage . . . . . . 713
Lisa R. Palivos

85 Interphalangeal Joint Dislocation Reduction . . . . . . . . . 561

Matt Kleinmaier and Sanjeev Malik

108 Felon Incision and Drainage . . . . . . . . . . . . . . . . . . 716
Lisa R. Palivos

86 Hip Joint Dislocation Reduction . . . . . . . . . . . . . . . . 565
George Chiampas and Steve Zahn

109 Pilonidal Abscess or Cyst Incision and Drainage. . . . . . . 718
Lauren M. Smith

87 Patellar Dislocation Reduction . . . . . . . . . . . . . . . . . 571
Mark P. Kling

110 Perianal Abscess Incision and Drainage . . . . . . . . . . . . 722
Maggie Ferng and Ryan C. Headley

88 Knee Joint Dislocation Reduction . . . . . . . . . . . . . . . 574
Sharad Pandit and Zach Kassutto

111 Sebaceous Cyst Incision and Drainage . . . . . . . . . . . . 728
Carlos J. Roldan

89 Ankle Joint Dislocation Reduction . . . . . . . . . . . . . . . 577
Jim Comes

112 Hemorrhage Control . . . . . . . . . . . . . . . . . . . . . . . 731
Christopher Freeman and Eric F. Reichman

90 Common Fracture Reduction . . . . . . . . . . . . . . . . . . 582

Eric F. Reichman and Robert M. Zesut

113 Trigger Point Injections . . . . . . . . . . . . . . . . . . . . . . 738
Danielle Campagne

91 Casts and Splints . . . . . . . . . . . . . . . . . . . . . . . . . 592
Eric F. Reichman and Harold A. Sloas

114 Escharotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 741
Michael A. Schindlbeck

SECTION 7 Skin and Soft Tissue Procedures . . . . . . . 609

SECTION 8 Neurologic and
Neurosurgical Procedures . . . . . . . . . . . . 747

92 General Principles of Wound Management . . . . . . . . . 609
Lisa Freeman Grossheim
93 Basic Wound Closure Techniques . . . . . . . . . . . . . . . 623
Eric F. Reichman and Candace Powell
94 Tissue Adhesives for Wound Repair . . . . . . . . . . . . . . 647
Hagop M. Afarian
95 Advanced Wound Closure Techniques . . . . . . . . . . . . 650
Eric F. Reichman
96 Management of Specific Soft Tissue Injuries . . . . . . . . . 659
Christopher J. Russo and Ajay Desai

115 Lumbar Puncture . . . . . . . . . . . . . . . . . . . . . . . . . 747
Eric F. Reichman, Kevin Polglaze, and Brian Euerle
116 Burr Holes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 761

Eric F. Reichman
117 Lateral Cervical Puncture . . . . . . . . . . . . . . . . . . . . 767
Eric F. Reichman
118 Ventriculostomy . . . . . . . . . . . . . . . . . . . . . . . . . . 770
Eric F. Reichman
119 Ventricular Shunt Evaluation and Aspiration . . . . . . . . . 775
Eric F. Reichman

97 Subcutaneous Foreign Body
Identification and Removal . . . . . . . . . . . . . . . . . . . 669
Samuel J. Gutman and Michael B. Secter

120 Subdural Hematoma Aspiration in the Infant . . . . . . . . 779
Eric F. Reichman

98 Ultrasound-Guided Foreign Body
Identification and Removal . . . . . . . . . . . . . . . . . . . 676
Daniel S. Morrison

121 Skeletal Traction (Gardner-Wells Tongs) for
Cervical Spine Dislocations and Fractures . . . . . . . . . . 783
Eric F. Reichman

99 Tick Removal . . . . . . . . . . . . . . . . . . . . . . . . . . . . 679
Zach Kassutto

122 Edrophonium (Tensilon) Testing . . . . . . . . . . . . . . . . 786
Eric F. Reichman

100 Fishhook Removal . . . . . . . . . . . . . . . . . . . . . . . . 681

Eric F. Reichman and Renee C. Hamilton

SECTION 9 Anesthesia and Analgesia . . . . . . . . . . . . 789

101 Ring Removal . . . . . . . . . . . . . . . . . . . . . . . . . . . 684
Steven H. Bowman

123 Local Anesthesia. . . . . . . . . . . . . . . . . . . . . . . . . . 789
Michael A. Schindlbeck

102 Subungual Hematoma Evacuation . . . . . . . . . . . . . . . 690
Steven H. Bowman

124 Topical Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . 795
Erika D. Schroeder and Peter Taillac

103 Subungual Foreign Body Removal . . . . . . . . . . . . . . . 694
Steven H. Bowman

125 Hematoma Blocks . . . . . . . . . . . . . . . . . . . . . . . . . 799
Thomas P. Graham

104 Nail Bed Repair . . . . . . . . . . . . . . . . . . . . . . . . . . 697
Raemma Paredes Luck and Eric F. Reichman

126 Regional Nerve Blocks (Regional Anesthesia) . . . . . . . . 802
Eric F. Reichman, Jehangir Meer, and Nikesh Seth

105 Ganglion Cyst Aspiration and Injection . . . . . . . . . . . . 704
Thomas P. Graham

127 Intravenous Regional Anesthesia . . . . . . . . . . . . . . . . 843
Christopher Freeman

106 Subcutaneous Abscess Incision and Drainage . . . . . . . . 706
Samuel J. Gutman and Michael B. Secter

128 Nitrous Oxide Anesthesia . . . . . . . . . . . . . . . . . . . . 849
Antonio E. Muñiz


x

Contents

129 Procedural Sedation and
Analgesia (Conscious Sedation) . . . . . . . . . . . . . . . . 854
Hagop M. Afarian

SECTION 10 Obstetrical and
Gynecologic Procedures . . . . . . . . . . . . 869

149 Phimosis Reduction . . . . . . . . . . . . . . . . . . . . . . . . 995
Eric F. Reichman and Natana Peres
150 Dorsal Slit of the Foreskin . . . . . . . . . . . . . . . . . . . . 998
Carlos J. Roldan
151 Manual Testicular Detorsion . . . . . . . . . . . . . . . . . . 1001
Steven Go

130 Ultrasound in Pregnancy . . . . . . . . . . . . . . . . . . . . 869

Srikar Adhikari and Wes Zeger

152 Zipper Injury Management . . . . . . . . . . . . . . . . . . 1004
Zach Kassutto

131 Normal Spontaneous Vaginal Delivery . . . . . . . . . . . . 883
Swati Singh and Susan B. Promes

SECTION 12 Ophthalmologic Procedures . . . . . . . . 1007

132 Episiotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 896
Francisco Orejuela

153 Eye Examination . . . . . . . . . . . . . . . . . . . . . . . . . . 1007
Shari Schabowski

133 Shoulder Dystocia Management . . . . . . . . . . . . . . . . 904
Eric F. Reichman and Camaran E. Roberts

154 Contact Lens Removal . . . . . . . . . . . . . . . . . . . . . 1022
Dino P. Rumoro

134 Breech Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . 910
Irene E. Aga

155 Ocular Burn Management and Eye Irrigation . . . . . . . 1026
Steven J. Socransky

135 Postpartum Hemorrhage Management . . . . . . . . . . . . 917
Leah W. Antoniewicz

156 Intraocular Pressure Measurement (Tonometry) . . . . . 1032
Michelle M. Verplanck, Mark A. Rolain, and Aaron D. Cohn

136 Perimortem Cesarean Section . . . . . . . . . . . . . . . . . 922
Silvia Linares

157 Digital Globe Massage . . . . . . . . . . . . . . . . . . . . . 1038
Carlos J. Roldan and Eric F. Reichman

137 Symphysiotomy . . . . . . . . . . . . . . . . . . . . . . . . . . 928
Ikem Ajaelo

158 Anterior Chamber Paracentesis. . . . . . . . . . . . . . . . . 1041
Rene Pineda Carizey

138 Bartholin Gland Abscess or
Cyst Incision and Drainage . . . . . . . . . . . . . . . . . . . 930
Charlie C. Kilpatrick

159 Corneal Foreign Body Removal. . . . . . . . . . . . . . . . 1043
Eric F. Reichman

139 Sexual Assault Examination . . . . . . . . . . . . . . . . . . . 935
Ann I. Schutt-Ainé and Audra E. Timmins
140 Culdocentesis . . . . . . . . . . . . . . . . . . . . . . . . . . . 945
David L. Levine

160 Corneal Rust Ring Removal . . . . . . . . . . . . . . . . . . . 1047
Eric F. Reichman

161 Eye Patching and Eye Shields . . . . . . . . . . . . . . . . . 1050
Rebecca R. Roberts

141 Prolapsed Uterus Reduction . . . . . . . . . . . . . . . . . . . 948
Eric R. Snoey

162 Lateral Canthotomy and Cantholysis or Acute
Orbital Compartment Syndrome Management . . . . . . 1053
Jamil D. Bayram and Sami H. Uwaydat

SECTION 11 Genitourinary Procedures . . . . . . . . . . . 953

163 Globe Luxation Reduction . . . . . . . . . . . . . . . . . . . 1056
Jeffrey S. Schlab

142 Urethral Catheterization . . . . . . . . . . . . . . . . . . . . . 953
Richard Dean Robinson and Eric F. Reichman

164 Hordeolum (Stye) Incision and Drainage . . . . . . . . . . 1058
Sami H. Uwaydat and Jamil D. Bayram

143 Suprapubic Bladder Aspiration . . . . . . . . . . . . . . . . . 963
Richard Dean Robinson, Sam Hsu, and Eric F. Reichman

SECTION 13 Otolaryngologic Procedures . . . . . . . . 1063

144 Suprapubic Bladder Catheterization
(Percutaneous Cystostomy) . . . . . . . . . . . . . . . . . . . 968
Richard Dean Robinson, Sam Hsu, and Eric F. Reichman
145 Retrograde Urethrography and Cystography . . . . . . . . 976

Richard Dean Robinson and Eric F. Reichman
146 Anesthesia of the Penis, Testicle, and Epididymis . . . . . . 981
Eric F. Reichman
147 Priapism Management . . . . . . . . . . . . . . . . . . . . . . 984
Steven Go
148 Paraphimosis Reduction . . . . . . . . . . . . . . . . . . . . . 989
Ann P. Nguyen

165 External Auditory Canal Foreign Body Removal . . . . . . 1063
Rebecca R. Roberts
166 Cerumen Impaction Removal . . . . . . . . . . . . . . . . . . 1070
Rebecca R. Roberts
167 Tympanocentesis . . . . . . . . . . . . . . . . . . . . . . . . . 1075
Paul J. Jones
168 Auricular Hematoma Evacuation . . . . . . . . . . . . . . . . 1078
Eric F. Reichman
169 Nasal Foreign Body Removal . . . . . . . . . . . . . . . . . 1084
Raemma Paredes Luck


Contents

170 Nasal Fracture Reduction . . . . . . . . . . . . . . . . . . . 1092
Eric F. Reichman
171 Nasal Septal Hematoma Evacuation . . . . . . . . . . . . . 1099
Michael Friedman, Meghan Wilson, and George Chiampas
172 Epistaxis Management . . . . . . . . . . . . . . . . . . . . . . 1103
Stephen M. Kelanic, David D. Caldarelli, and Eric F. Reichman
173 Laryngoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . 1113
Steven Charous

174 Airway Foreign Body Removal . . . . . . . . . . . . . . . . . 1120
David L. Walner

xi

SECTION 15 Podiatric Procedures . . . . . . . . . . . . . 1169
184 Ingrown Toenail Management . . . . . . . . . . . . . . . . . 1169
Jeff Schaider
185 Toe Fracture Management . . . . . . . . . . . . . . . . . . . . 1173
George Chiampas and Steve Zahn
186 Neuroma Management . . . . . . . . . . . . . . . . . . . . . 1177
Eric R. Snoey and Stephen Miller

SECTION 16 Miscellaneous Procedures . . . . . . . . . . 1181

175 Peritonsillar Abscess Incision and Drainage . . . . . . . . . 1125
Eric F. Reichman, Kellie D. Hughes, and Jehangir Meer

187 Relief of Choking and Acute Upper Airway
Foreign Body Removal . . . . . . . . . . . . . . . . . . . . . . 1181
Tamara Espinoza, Shekhar Menon, and John Bailitz

SECTION 14 Dental Procedures . . . . . . . . . . . . . . . 1131

188 Induction of Therapeutic Hypothermia . . . . . . . . . . . . 1185
Mark Hansen, Mike Nelson, and John Bailitz

176 Dental Anesthesia and Analgesia. . . . . . . . . . . . . . . . 1131
Eric F. Reichman

189 Hypothermic Patient Management. . . . . . . . . . . . . . . 1191
Gary An and Nabil Issa

177 Dental Abscess Incision and Drainage. . . . . . . . . . . . . 1141
Daniel J. Ross

190 Hyperthermic Patient Management . . . . . . . . . . . . . . 1201
Eileen F. Couture

178 Post-Extraction Pain and Dry Socket
(Alveolar Osteitis) Management . . . . . . . . . . . . . . . . 1146
Eric F. Reichman

191 Autotransfusion . . . . . . . . . . . . . . . . . . . . . . . . . 1205
Carlos J. Roldan and Amit Mehta

179 Post-Extraction Bleeding Management . . . . . . . . . . . . 1148
Eric F. Reichman
180 Defective Dental Restoration Management . . . . . . . . . . 1150
Daniel J. Ross
181 Subluxed and Avulsed Tooth Management . . . . . . . . . . 1154
Daniel J. Ross
182 Fractured Tooth Management . . . . . . . . . . . . . . . . . 1161
Daniel J. Ross
183 Temporomandibular Joint Dislocation Reduction . . . . . . 1165
Marilyn M. Hallock

192 Helmet Removal . . . . . . . . . . . . . . . . . . . . . . . . . 1209
Eric F. Reichman
193 Hazmat Patient Management . . . . . . . . . . . . . . . . . . 1215

Atilla B. Üner
194 Physical Restraints . . . . . . . . . . . . . . . . . . . . . . . . 1218
Cheryl Person, Dean Sagun, and Mark Fanning
195 Chemical Restraint . . . . . . . . . . . . . . . . . . . . . . . . 1224
David K. Duong and Hemal Kanzaria
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1231


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Contributors
Srikar Adhikari, MD, MS, RDMS [50, 130]

Leah W. Antoniewicz, MD [135]

Associate Professor
Department of Emergency Medicine
University of Arizona Medical Center
Tucson, Arizona

Staff Physician
Obstetrics and Gynecologic Associates
Clear Lake Regional Medical Center
Houston, Texas

Hagop M. Afarian, MD [94, 129]

Bashar M. Attar, MD, PhD,
FACP, FACG, AGAF, FASGE [62, 63]

Assistant Clinical Professor of EM
UCSF School of Medicine
Department of Emergency Medicine
UCSF Fresno
Fresno, California

Irene E. Aga, MD [134]
Assistant Professor
Department of Obstetrics
Gynecology, and Reproductive Sciences
The University of Texas Health Science Center
Houston, Texas

Ikem Ajaelo, MD [137]
Staff Physician
Emergency Medicine
Essentia Health-Sandstone
Sandstone, Minnesota

Steven E. Aks, DO, FACMT, FACEP [61]
Director
The Toxikon Consortium and Division of Toxicology
Associate Professor of Emergency Medicine, Rush University
Department of Emergency Medicine
Cook County Hospital
Chicago, Illinois

Piotr C. Aljindi, MD [10]
Attending Physician

Associate Program Director
Department of Anesthesiology
Cook County Hospital
Assistant Professor of Anesthesiology
Rush University Medical Center
Chicago, Illinois

Gary An, MD [189]

System-wide Chair for Gastroenterology and Hepatology
Cook County Health and Hospitals System
Chairman, Division of Gastroenterology and Hepatology
Director, GI Fellowship Program
John H. Stroger Hospital of Cook County
Professor of Medicine
Rush University Medical Center
Chicago, Illinois

John Bailitz, MD, FACEP, RDMS [187, 188]
Emergency Medicine Ultrasound Director
Department of Emergency Medicine
Cook County Hospital
Assistant Professor of Emergency Medicine
Rush University Medical Center
Chicago, Illinois

Kenny Banh, MD [42]
Assistant Clinical Professor of Emergency Medicine, UCSF
Emergency Medicine
University of California San Francisco Fresno

Fresno, California

Jamil D. Bayram, MD, MPH, EMDM, MEd [69, 162, 164]
Assistant Professor
Emergency Medicine
Johns Hopkins University
Baltimore, Maryland

Daniel Belmont, MD [47, 48]
Attending Physician
Department of Emergency Medicine
Elmhurst Memorial Hospital
Elmhurst, Illinois

Joseph Bledsoe, MD [21]

Associate Professor of Surgery
Department of Surgery
University of Chicago Medicine
Chicago, Illinois

Surgery-Adjunct Assistant Professor
Emergency Medicine
University of Utah School of Medicine
Salt Lake City, Utah

Sobia Ansari, MD, MPH [75]

Heather H. Bohn, DO [78]

Instructor
Emergency Department
Rush University Medical Center
Chicago, Illinois

Staff Physician
Arrowhead Regional Medical Center
Loma Linda University Med Center
Colton, California
xiii


xiv

Contributors

David W. Boldt, MD, MS [8]

Steven Charous, MD, FACS [173]

Assistant Clinical Professor
Anesthesiology and Critical Care Medicine
Department of Anesthesiology
John H. Stroger Hospital of Cook County, Chicago, Illinois
David Geffen School of Medicine
University of California Los Angeles
Los Angeles, California

Clinical Associate Professor
Department of Otolaryngology-Head and Neck Surgery

Loyola University Medical Center
Maywood, Illinois

George Chiampas, DO, FACEM [86, 171, 185]

Professor
Division of Emergency Medicine
University of Utah Medical School
Salt Lake City, Utah

Assistant Professor
Department of Emergency Medicine
Feinberg School of Medicine
Northwestern University
Team Physician Northwestern University
Medical Director Bank of America Chicago Marathon
Chicago, Illinois

Steven H. Bowman, MD, FACEP [101, 102, 103]

Aaron D. Cohn, MD [156]

Program Director
Department of Emergency Medicine
Cook County Hospital
Assistant Professor of Emergency Medicine
Rush University Medical Center
Chicago, Illinois

Glaucoma Specialists

Riddle Eye Associates
Riddle Memorial Hospital
Media, Pennsylvania

Philip Bossart, MD [17]

Jim Comes, MD [89]

Staff Physician
Department of Emergency Medicine
Texas Health Presbyterian
Flower Mound, Texas

Program Director
Health Sciences Clinical Professor
Department of Emergency Medicine
UCSF School of Medicine
UCSF Fresno Emergency Medicine Program
Fresno, California

Michael Bublewicz, MD [84]

Joseph Cornett, MD [11]

Clinical Assistant Professor of Emergency Medicine
Department of Emergency Medicine
University of Texas Health Science Center
Houston, Texas

Staff Physician

Emergency Department
Baptist Health System
San Antonio, Texas

David D. Caldarelli, MD [172]

Eileen F. Couture, DO [190]

Professor and Chairman Emeritus
Department of Otolaryngology-Head and Neck Surgery
Rush University Medical Center
Chicago, Illinois

Attending Physician
Department of Emergency Medicine
Cook County Hospital
Assistant Professor of Emergency Medicine
Rush University Medical Center
Chicago, Illinois

Aaron Brown, MD [24]

Danielle Campagne, MD, FACEP [113]
Assistant Clinical Professor of Emergency Medicine
Department of Emergency Medicine
UCSF-Fresno
Fresno, California

Angelique S. Kelly Campen, MD [82]
Clinical Instructor of Emergency Medicine

Ronald Reagan UCLA Medical Center
UCLA Emergency Medicine Center
Los Angeles, California

Rene Pineda Carizey, DO [158]
Assistant Professor
Department of Emergency Medicine
Rush University Medical Center
Chicago, Illinois

Cristal R. Cristia, MD [40]
Staff Physician
Department of Emergency Medicine
Beth Israel Deaconess Hospital, Milton
Milton, Massachusetts

Elizabeth M. Datner, MD [65]
Vice Chair of Clinical Operations
Department of Emergency Medicine
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania

Ajay Desai, MD [96]
Attending Physician
Emergency Medicine
The Children’s Hospital of Philadelphia
Philadelphia, Pennsylvania


Contributors

Shoma Desai, MD [9]

Steven Go, MD [147, 151]

Assistant Professor
Emergency Medicine
LAC + USC Medical Center
Los Angeles, California

Associate Professor of Emergency Medicine
Department of Emergency Medicine
University of Missouri—Kansas City School of Medicine
Kansas City, Missouri

Pratik Doshi, MD [53]

Thomas P. Graham, MD, FACEP [105, 125]

Assistant Professor of Emergency Medicine and Internal Medicine
Emergency Medicine and Division of Critical Care
Department of Internal Medicine
University of Texas Health Science Center
Houston, Texas

Professor of Medicine/Emergency Medicine
Emergency Medicine Center
UCLA School of Medicine
Los Angeles, California

David K. Duong, MD, MS [195]

Lisa Freeman Grossheim, MD, FACEP [52, 58, 92]

Assistant Professor
Department of Emergency Medicine
University of California, San Francisco
San Francisco, California

Assistant Professor
Department of Emergency Medicine
University of Texas Health Science Center at
Houston-Medical School
Houston, Texas

Tamara Espinoza, MD [187]

David D. Gummin, MD [61]

Assistant Professor of Emergency Medicine
The Emory Clinic
Atlanta, Georgia

Medical Director
Poison Center
Children’s Hospital of Wisconsin
Professor of Emergency Medicine
Section Chief of Medical Toxicology
Medical College of Wisconsin
Milwaukee, Wisconsin

Brian Euerle, MD, RDMS [4, 33, 77, 115]
Associate Professor
Department of Emergency Medicine
University of Maryland School of Medicine
Baltimore, Maryland

Mark Fanning, RN [194]
Director of Nursing
Department of Emergency Medicine
Lyndon Baines Johnson General Hospital
Houston, Texas

Samuel J. Gutman, MD CCFP(EM) [97, 106]
Clinical Associate Professor
Faculty of Medicine, Department of Emergency Medicine
University of British Columbia
Vancouver, British Columbia

Christopher J. Haines, DO, FAAP, FACEP [26]

Instructor
Department of Emergency Medicine
Rush University Medical Center
Chicago, Illinois

Drexel University College of Medicine
Associate Professor of Pediatrics and Emergency Medicine
St. Christopher’s Hospital for Children
Director, Department of Emergency Medicine

Medical Director, Critical Care Transport Team
Philadelphia, Pennsylvania

Zak Foy, MD [57]

Marilyn M. Hallock, MD, MS, FACEP [67, 183]

Emergency Physician
Emergency Department
Memorial Mission Hospital
Asheville, North Carolina

Assistant Professor
Emergency Department
Rush University Medical Center
Chicago, Illinois

Christopher Freeman, MD, FACEP [112, 127]

Renee C. Hamilton, MD [100]

Assistant Professor
Emergency Medicine
Assistant Medical Director University Emergency Department
University of Alabama at Birmingham
Birmingham, Alabama

Staff Physician
Emergency Department
Baptist Health System

San Antonio, Texas

Maggie Ferng, MD [64, 110]

Michael Friedman, MD [171]
Professor and Chairman, Section of Sleep Surgery
Rush University Medical Center
Professor and Chairman, Section of Otolaryngology
Advocate Illinois Masonic Medical Center
Medical Director
Chicago ENT an Advanced Center for Specialty Care
Chicago, Illinois

Mark Hansen, MD [188]
Staff Physician
Emergency Department
Bon Secours-St. Francis Xavier Hospital
Charleston, South Carolina

xv


xvi

Contributors

Jaime Harper, MD [76]

Nabil Issa, MBChB, FRCS, FACS [189]

Emergency Medicine Attending Physician
St Vincent Hospital
Indianapolis, Indiana

Assistant Professor
Department of Surgery
Northwestern University Feinberg School of Medicine
Chicago, Illinois

Stanley Harper, MD [76]
Board Certified Plastic Surgeon
St Vincent Hospital
Indianapolis, Indiana

Ryan C. Headley, MD [64, 110]
General Surgeon
Suburban Surgical Associates
Berwyn, Illinois
Clinical Instructor of Surgery
Feinberg School of Medicine
Northwestern University
Chicago, Illinois

Sandeep Johar, DO, MS, FACEP [66]
Assistant Professor
Department of Emergency Medicine
Hartford Hospital
UCONN School of Medicine
Hartford, Connecticut

Paul J. Jones, MD [167]
Acting Chairman and Assistant Professor
Department of Otolaryngology-Head and Neck Surgery
Section Head, Pediatric Otolaryngology
Rush University Medical Center
Chicago, Illinois

Tarlan Hedayati, MD, FACEP [12]
Assistant Professor
Assistant Program Director
Department of Emergency Medicine
Cook County (Stroger) Hospital
Chicago, Illinois

Kimberly T. Joseph, MD, FACS, FCCM [39]
Division Chair
Trauma ICU and Prevention
Department of Trauma
John H Stroger Hospital of Cook County
Chicago, Illinois

H. Gene Hern Jr., MD, MS [27]
Associate Clinical Professor, UCSF
Residency Director, Emergency Medicine
Alameda County-Highland
Oakland, California

Theltonia Howard, MD [19]
Staff Physician
South Fulton Medical Center

Wellstar Cobb Hospital
Atlanta, Georgia

Sam Hsu, MD, RDMS [4, 65, 143, 144]
Assistant Professor
Emergency Department
University of Maryland School of Medicine
Baltimore, Maryland

Kellie D. Hughes, MD [175]
Attending Physician
Department of Emergency Medicine
Anderson Hospital
Maryville, Illinois

Ramasamy Kalimuthu, MD [76]
Director of Microsurgery Services
Clinical Professor of Plastic and Hand Surgery
Advocate Christ Medical Center
Chicago, Illinois

Elisabeth Kang, MD [36]
Staff Physician
Emergency Department
Baptist Health System
San Antonio, Texas

Hemal Kanzaria, MD [195]
Attending Physician
Emergency Medicine

Ronald Reagan UCLA Medical Center
Los Angeles, California

Zach Kassutto, MD, FAAP [7, 88, 99, 152]

Assistant Professor
Department of Emergency Medicine
University of Missouri Kansas City
Truman Medical Center
Kansas City, Missouri

Director
Pediatric Emergency Medicine
Capital Health, New Jersey
Associate Professor Pediatrics and Emergency Medicine
Drexel University College of Medicine
Philadelphia, Pennsylvania
Attending Physician
Department of Emergency Medicine
St. Christopher’s Hospital for Children
Philadelphia, Pennsylvania

Eric Isaacs, MD [1]

Stephen M. Kelanic, MD, FACS [172]

Clinical Professor
Department of Emergency Medicine
San Francisco General Hospital
University of California, San Francisco

San Francisco, California

Assistant Professor
Department of Otolaryngology and Bronchoesophagology
Rush University Medical Center
Chicago, Illinois

Pholaphat Charles Inboriboon, MD, MPH, FACEP [13]


Contributors

Charlie C. Kilpatrick, MD [138]

M. Scott Linscott, MD [21]

Vice Chairman
Associate Professor
Department of Obstetrics and Gynecology
Texas Tech University Health Science Center School of Medicine
Lubbock, Texas

Surgery-Adjunct Professor
Emergency Medicine
University of Utah School of Medicine
Salt Lake City, Utah

Matt Kleinmaier, MD [74, 85]

Jenny J. Lu, MD, MS [59, 60]

Clinical Instructor
Department of Emergency Medicine
Northwestern Feinberg School of Medicine
Chicago, Illinois

Assistant Professor
Department of Emergency Medicine
Division of Medical Toxicology
Cook County Hospital (Stroger)
Chicago, Illinois

Mark P. Kling, MD, FAAEM, CSCS [83, 87]

Raemma Paredes Luck, MD [104, 169]

Attending Physician
Department of Emergency Medicine
Cook County Hospital
Assistant Professor of Emergency Medicine
Rush University Medical Center
Chicago, Illinois

Assistant Professor
Department of Emergency Medicine
Temple University School of Medicine
Philadelphia, Pennsylvania

Umashankar Lakshmanadoss, MD, CCDS [66]
Cardiovascular Fellow

Division of Cardiology
Guthrie Clinic
Sayre, Pennsylvania

Todd M. Larabee, MD [31]
Assistant Professor
Department of Emergency Medicine
University of Colorado School of Medicine
Aurora, Colorado

John Larkin, MD [77]
Attending Physician
Emergency Medicine
St. Luke’s Episcopal Hospital System
Houston, Texas

David L. Levine, MD, FACEP [140]

Michael Lutes, MD [14]
Assistant Professor of Emergency Medicine
Medical College of Wisconsin
Madison Emergency Physicians
Madison, Wisconsin

O. John Ma, MD [16, 55]
Professor and Chair
Department of Emergency Medicine
Oregon Health and Science University
Portland, Oregon

Sanjeev Malik, MD [74, 85]
Assistant Professor
CAQ Sports Medicine
Assistant Medical Director
Department of Emergency Medicine
Feinberg School of Medicine
Northwestern University
Chicago, Illinois

Medical Director-Adult Emergency Services
Cook County Hospital (Stroger)
Assistant Professor Emergency Medicine
Rush University Medical Center
Chicago, Illinois

Justin Mazzillo, MD [75]

Matthew R. Lewin, MD, PhD, FACEP, FCAS [78]

James J. McCarthy, MD [51]

Director
Center for Exploration and Travel Health
California Academy of Sciences
San Francisco, California

Associate Professor of Emergency Medicine
Vice-Chair of Operations
Department of Emergency Medicine
University of Texas Health Science Center at

Houston-Medical School
Medical Director of Emergency Services
Memorial Hermann Hospital-Texas Medical center
Houston, Texas

Silvia Linares, MD [136]
Assistant Professor
Department of Obstetrics and Gynecology
University of Texas Health Science Center at
Houston-Medical School
Attending Physician
Obstetrics and Gynecology
Lyndon Baines General Hospital
Houston, Texas

Chief Resident
Department of Emergency Medicine
University of Texas Health Science Center
Houston, Texas

Myles C. McClelland, MD, MPH [33]
Attending Physician
Methodist Hospital-Texas Medical Center
Attending Physician
Methodist West Houston Hospital
Houston, Texas

xvii

xviii

Contributors

Jehangir Meer, MD, RDMS,
FACEP, FRCPC [4, 36, 40, 126, 175]

Ned F. Nasr, MD [6, 8, 10, 22]

Director of Emergency Ultrasound
Department of Emergency Medicine
Saint Agnes Hospital
Baltimore, Maryland

Vice Chairman for Academic Affairs and Program Director
Chairman, Division of Neuroanesthesiology
Department of Anesthesiology and Pain Management
John H. Stroger, Jr. Hospital of Cook County
Chicago, Illinois

Amit Mehta, MD [191]

Mike Nelson, MD, MS [188]

Resident
Department of Emergency Medicine
University of Texas at Health Science Center at
Houston-Medical School
Houston, Texas

Attending Physician Emergency Medicine
Medical Toxicology Fellow
Cook County Hospital (Stroger)
Chicago, Illinois

Ann P. Nguyen, MD [148]
Shekhar Menon, MD [187]
Staff Physician
NorthShore Medical Group
Emergency Medicine
Evanston, Illinois

Attending Physician
Emergency Trauma Department
Hackensack University Medical Center
Hackensack, New Jersey

Flavia Nobay, MD [54]
Stephen Miller, MD [186]
Attending Physician
Emergency Medicine
Highland Hospital/Alameda County Medical Center
Oakland, California

Program Director
Department of Emergency Medicine
University of Rochester
Rochester, New York

Amy Noland, MD [56]

Daniel S. Morrison, MD, RDMS, FACEP [98]
Assistant Professor
Department of Emergency Medicine
University of Medicine and Dentistry of New Jersey-Robert Wood
Johnson Medical School
New Brunswick, New Jersey

Assistant Professor of Emergency Medicine
Department of Emergency Medicine
University of Texas Health Science Center at
Houston-Medical School
Houston, Texas

Nnaemeka G. Okafor, MD, MS [34]
Amanda Munk, MD [16, 55]
Staff Physician
Emergency Medicine Associates PC
Southwest Washington Medical Center
Vancouver, Washington

Antonio E. Muñiz, MD [56, 84, 128]
Attending Physician
Dallas Regional Medical Center
Dallas, Texas

Arun Nagdev, MD [49]
Director of Emergency Ultrasound
Ultrasound Fellowship Director
Department of Emergency Medicine
Alameda County Medical Center

Highland General Hospital
Oakland, California

Isam F. Nasr, MD [6, 8, 10, 22]
Attending Physician
Department of Emergency Medicine
Cook County Hospital
Assistant Professor of Emergency Medicine
Rush University Medical Center
Chicago, Illinois

Assistant Professor
Medical Director of Informatics
Department of Emergency Medicine
University of Texas Health Science Center at
Houston-Medical School
Houston, Texas

Francisco Orejuela, MD [132]
Associate Professor
Department of Obstetrics and Gynecology
University of Texas Health Science Center at
Houston-Medical School
Houston, Texas

Charles Orsay, MD [68, 70, 71, 72]
Chair
Department of Colorectal Surgery
Cook County Hospital
Professor of Surgery

Rush University Medical Center
Chicago, Illinois

Lisa R. Palivos, MD [107, 108]
Attending Physician
Department of Emergency Medicine
Cook County Hospital
Assistant Professor of Emergency Medicine
Rush University Medical Center
Chicago, Illinois


Contributors

Sharad Pandit, MBBS, DABP, FACEP [88]

Simon M. Pulfrey, MSc, MD, CCFP(EM) [32]

Attending Physician
Emergency Department
Royal Adelaide Hospital
Adelaide, Australia

Clinical Assistant Professor
Department of Emergency Medicine
University of British Columbia
Vancouver, British Columbia

Olga Pawelek, MD [14, 15]

Raed Rahman, DO [22]

Assistant Professor
Department of Anesthesiology
University of Texas Health Science Center at
Houston-Medical School
Houston, Texas

Medical Director of Pain Management
Cancer Treatment Centers of America
Midwestern Regional Medical Center
Zion, Illinois

Natana Peres, MD [149]
Assistant Professor
Department of Emergency Medicine
University of Texas Health Science Center at
Houston-Medical School
Houston, Texas

Cheryl Person, MD [194]
Assistant Professor of Psychiatry
Department of Psychiatry and Behavioral Sciences
University of Texas Health Science Center at
Houston-Medical School
Houston, Texas

Roland Petri, MD, MPH [23]
Attending Physician
Department of Emergency Medicine

Mayo Clinic Arizona
Scottsdale, Arizona

Kevin Polglaze, DO [115]
Emergency Department Physician
Infinity Healthcare
Milwaukee, Wisconsin

Candace Powell, MD [93]
Attending Physician
Emergency Department
Methodist Willowbrook Hospital
Houston, Texas

Gregory M. Press, MD, RDMS [3, 29]
Assistant Professor
Director of Emergency Ultrasound
Department of Emergency Medicine
University of Texas Health Science Center at
Houston-Medical School
Houston, Texas

Susan B. Promes, MD, FACEP [65, 131]
Professor and Vice Chair for Education
Department of Emergency Medicine
University of California San Francisco
San Francisco, California

xix

Amy Rasmussen, MD [29]
Staff Physician
Emergency Department
Doctors Medical Center of Modesto
Modesto, California

Eric F. Reichman, PhD, MD, FAAEM, FACEP [11, 15, 24,
25, 33, 36, 38, 40, 41, 43, 44, 45, 46, 56, 67, 68, 69, 70, 71, 72,
75, 77, 80, 81, 83, 90, 91, 93, 95, 100, 104, 112, 115, 116, 117,
118, 119, 120, 121, 122, 126, 133, 142, 143, 144, 145, 146, 149,
157, 159, 160, 168, 170, 172, 175, 176, 178, 179, 192]
Associate Professor of Emergency Medicine
Attending Physician, Department of Emergency Medicine
Medical Director, Surgical and Clinical Skills Center
University of Texas Health Science Center at
Houston-Medical School
Houston-Medical School
Attending Physician, Emergency Department
Memorial Hermann Hospital-Texas Medical Center
Attending Physician, Emergency Department
Lyndon Baines Johnson General Hospital
Houston, Texas

Camaran E. Roberts, MD [133]
Staff Physician
Methodist Willowbrook Hospital
Houston, Texas

Rebecca R. Roberts, MD [161, 165, 166]
Director of Research

Department of Emergency Medicine
Cook County Health and Hospitals System
Assistant Professor
Department of Emergency Medicine
Rush University Medical Center
Chicago, Illinois

Richard Dean Robinson, MD [142, 143, 144, 145]
Chairman
Department of Emergency Medicine
John Peter Smith Health Network
Fort Worth, Texas

Leonardo Rodriguez, MD [12]
Assistant Professor of Emergency Medicine
Keck School of Medicine of USC
Emergency Department
LAC + USC Medical Center
Los Angeles, California


xx

Contributors

Mark A. Rolain, MD [156]

Payman Sattar, MD, MS, FACC [30, 37]

Professor of Ophthalmology

Oakland University/William Beaumont Medical School
Director of Refractive Surgery and Clinical Instructor
Beaumont Eye Institute
Royal Oak, Michigan

Attending Physician
Department of Cardiology
Cook County Hospital
Associate Professor of Medicine
Rush University Medical Center
Chicago, Illinois

Carlos J. Roldan, MD, FACEP, FAAEM [35, 111, 150, 157, 191]
Associate Professor of Emergency Medicine
Department of Emergency Medicine
The University of Texas Health Science Center at
Houston-Medical School
Houston, Texas

Teresa M. Romano, MD [26]
Pediatric Emergency Medicine Physician
Emergency Medicine
Lehigh Valley Hospital
Allentown, Pennsylvania

John S. Rose, MD, FACEP [2]
Professor
Department of Emergency Medicine
University of California Health System
Sacramento, California

Daniel J. Ross, MD, DDS, FACEP [177, 180, 181, 182]
Attending Physician
Section of Emergency Medicine
Jesse Brown VA Medical Center
Chicago, Illinois
Clinical Assistant Professor
Department of Emergency Medicine
University of Illinois at Chicago
Chicago, Illinois

Dino P. Rumoro, DO, FACEP [154]
Assistant Professor and Clinical Chairman
Department of Emergency Medicine
Rush University Medical Center
Chicago, Illinois

Christopher J. Russo, MD [7, 96]
Attending Physician
Division of Emergency Medicine
Nemours/A.I. duPont Hospital for Children
Wilmington, Delaware

Dean Sagun, BA, EMT-I [194]
Medical Student (MS4)
Department of Emergency Medicine
The University of Texas at Houston Medical School
Houston, Texas

Joseph A. Salomone III, MD [28]

EMS Medical Director
Section Chief and Associate Professor
EMS Section
Department of Emergency Medicine
UMKC School of Medicine/Truman Medical Center
Kansas City, Missouri

Shari Schabowski, MD [153]
Attending Physician
Department of Emergency Medicine
Cook County Hospital
Assistant Professor of Emergency Medicine
Rush University Medical Center
Chicago, Illinois

Jeff Schaider, MD [184]
Chairman
Department of Emergency Medicine
Cook County Health and Hospital System
Professor
Department of Emergency Medicine
Rush University Medical Center
Chicago, Illinois

Michael A. Schindlbeck, MD, FACEP [114, 123]
Assistant Program Director
Department of Emergency Medicine
Cook County Hospital
Assistant Professor of Emergency Medicine
Rush University Medical Center

Chicago, Illinois

Jeffrey S. Schlab, MD [163]
Staff Physician
Emergency Department
Seton Medical Center
Austin, Texas

Erika D. Schroeder MD, MPH [21, 124]
Attending Physician
Department of Emergency Medicine
Providence Regional Medical Center
Everett, Washington

Ann I. Schutt-Ainé, MD [139]
Assistant Professor of Obstetrics and Gynecology
Department of Obstetrics and Gynecology
Baylor College of Medicine
Houston, Texas

Michael B. Secter, MD [97, 106]
Resident Physician
Department of Obstetrics and Gynecology
University of Toronto
Toronto, Canada

Nikesh Seth, MD [126]
Valley Pain Consultants
St. Joseph’s Hospital and Medical Center-Phoenix
Phoenix, Arizona

Contributors

Fred A. Severyn, MD, FACEP [18]

Susan Stroud, MD [57]

Associate Professor
Emergency Medicine
University of Colorado School of Medicine
Aurora, Colorado

Associate Clinical Professor of Surgery
Division of Emergency Medicine
University of Utah School of Medicine
Salt Lake City, Utah

Scott C. Sherman, MD, FAAEM [79]

Peter Taillac, MD [124]

Associate Residency Director
Department of Emergency Medicine
Cook County Hospital (Stroger)
Associate Professor of Emergency Medicine
Rush University Medical Center
Chicago, Illinois

Clinical Associate Professor

Department of Surgery
Division of Emergency Medicine
University of Utah School of Medicine
Salt Lake City, Utah

Swati Singh, MD [131]
Clinical Instructor
Emergency Medicine
UCSF
San Francisco, California

Craig Sisson, MD [49]
Assistant Professor/Clinical
Emergency Medicine
The University of Texas Health Science Center at San Antonio
San Antonio, Texas

Harold A. Sloas, DO, RDMS [91]
Assistant Clinical Professor of
Adult and Pediatric Emergency Medicine
Department of Emergency Medicine
The University of Texas Health Science Center at
Houston-Medical School
Houston, Texas

Lauren M. Smith, MD [109]
Director, Observation Unit
Department of Emergency Medicine
Cook County Hospital
Assistant Professor of Emergency Medicine

Rush University Medical Center
Chicago, Illinois

Eric R. Snoey, MD [141, 186]
Vice Chair
Department of Emergency Medicine
Alameda County Medical Center, Oakland, California
Clinical Professor of Emergency Medicine, UCSF Medical Center
San Francisco, California

Steven J. Socransky, MD, FRCPC, DABEM [155]
Assistant Professor
Northern Ontario School of Medicine
Emergency Physician and Trauma Director
Health Sciences North
Sudbury, Ontario

Elizabeth Sowell, MD [38]
Assistant Medical Director
Department of Emergency Medicine
St. Luke’s Hospital at The Vintage
Houston, Texas

Katrin Takenaka, MD, Med [19]
Associate Program Director
Associate Professor
Department of Emergency Medicine
The University of Texas at Health Science Center at
Houston-Medical School
Houston, Texas

Audra E. Timmins, MD, MBA [139]
Assistant Professor
Medical Director of Women’s Services
Texas Children’s Hospital Pavilion for Women
Obstetrics and Gynecology
Baylor College of Medicine
Houston, Texas

Dedra Tolson, MD [73]
Staff Physician
Department of Emergency Medicine
Madigan Army Medical Center
Tacoma, Washington

Joseph E. Tonna, MD [78]
Emergency Medicine Resident
Stanford/Kaiser Emergency Medicine Residency
Stanford University
Stanford, California

Serge G. Tyler, MD [6]
Chairman
Department of Anesthesiology and Pain Management
Division of Adult Anesthesia
John H. Stroger, Jr. Hospital of Cook County
Chicago, Illinois

Atilla B. Üner, MD, MPH, FAAEM [193]
Associate Clinical Professor of Medicine/Emergency Medicine

David Geffen School of Medicine at UCLA
Emergency Medicine Center
Ronald Reagan UCLA Medical Center
Los Angeles, California

Sami H. Uwaydat, MD [162, 164]
Assistant Professor
Ophthalmology
Jones Eye Institute/UAMS
Little Rock, Arkansas

xxi


xxii

Contributors

Michelle M. Verplanck, DO [156]

Meghan Wilson, MD [171]

General Ophthalmologist
Kensington Ophthalmology
Brighton, Michigan

Otolaryngology Resident (PGY4)
Department of Otolaryngology
Louisiana State University Health Sciences Center
New Orleans, Louisiana

Gennadiy Voronov, MD [6]
Chairman
Department of Anesthesiology and Pain Management
John H. Stroger, Jr. Hospital of Cook County
Chicago, Illinois

Michael Wallace, MD [17]
Emergency Medicine
University of Utah
Salt Lake City, Utah

David L. Walner, MD [174]
Associate Professor
Department of Otolaryngology
Rush University Medical Center
Chicago, Illinois
Pediatric Otolaryngology
Advocate Children’s Hospital
Park Ridge, Illinois

Joseph Weber, MD [20]
EMS Medical Director
Chicago EMS System
Department of Emergency Medicine
Cook County Hospital
Assistant Professor of Emergency Medicine
Rush University Medical Center
Chicago, Illinois

Steve Zahn, MD [86, 185]
Staff Physician
Emergency Department
Sherman Health
Elgin, Illinois

Wes Zeger, DO [5, 130]
Associate Professor
Department of Emergency Medicine
The Nebraska Medical Center
Omaha, Nebraska

Robert M. Zesut, DO, MPH [90]
Director of Physician Coding and Compliance
Emergency Medicine
Medical Center Emergency Physicians / Endeavor Medical Systems
Houston, Texas


Preface
The scope of Emergency Medicine is extremely broad and covers
the neonate through the geriatric, surgical, and medical, and encompasses all organ systems. Emergency Medicine is rapidly evolving
to reflect our increasing experience, knowledge, and research.
Procedural skills must supplement our cognitive skills. Achieving
proficiency in procedural skills is essential for the daily practice
of Emergency Medicine. We have produced a clear, complete, and
easy-to-understand textbook of Emergency Medicine procedures.
This text will provide all practitioners, from the medical student to
the seasoned Emergentologist, with a single procedural reference on
which to base clinical practices and technical skills.

The primary purpose of this text is to provide a detailed and
step-by-step approach to procedures performed in the Emergency
Department. It is expressly about procedures. While well referenced,
it is not meant to be a comprehensive reference but an easy-touse and clinically useful procedure book that should be in every
Emergency Department. The contents and information are complete.
It is organized and written for ease of access and usability. The detail
is sufficient to allow the reader to gain a thorough understanding of
each procedure. When available, alternative techniques or hints are
presented. Each chapter provides the reader with clear and specific
guidelines for performing the procedure. Although some may use
this text as a library reference, its real place is in the Emergency
Department where the procedures are performed. Despite its size,
we hope that this book will find its way to the bedside to be used by
medical students, residents, and practicing clinicians.
This book will satisfy the needs of physicians with a variety of
backgrounds and training. While this text is primarily written for
Emergentologists, many other practitioners will find this a valuable
reference. This book is written for those who care for people with
acute illness or injury. Medical students and residents will find this
an authoritative work on procedural skills. Medical students, residents, nurse practitioners, physician’s assistants, and practitioners
with limited experiences will find all the information in each chapter to learn the complete procedure. Family Physicians, Internists,
and Pediatricians will find this text useful to review procedures
infrequently performed in the clinic, office, or urgent care center.
Intensivists and Surgeons involved in the care of acutely ill patients
will also find this book a wonderful resource. The experienced
clinician can get a quick refresher on the procedure while enhancing their knowledge and skills. Physicians actively involved in the
education of medical students and residents will find this text an
easy-to-understand and well-illustrated source of didactic material.
The text has 16 sections containing 195 chapters. The contents
are organized into sections, each representing an organ system, an

area of the body, or a surgical specialty. Each chapter is devoted to a
single procedure. This should allow quick access to complete information. The chapters have a similar format to allow information to
be retrieved as quickly and as efficiently as possible. There are often
several acceptable methods to perform a procedure. While alternative techniques are described in many chapters, we have not exhaustively included all alternative techniques. Key information, cautions,
and important facts are highlighted throughout the text in bold type.

Each chapter, with a few exceptions, has a standard format. The
relevant anatomy and pathophysiology are discussed followed by the
indications and contraindications for the procedure. A list is provided of the necessary equipment. The patient preparation, including consent, anesthesia, and analgesia, is addressed. The procedure
is then described in a step-by-step format. Cautions are placed where
problems commonly occur. Alternative techniques and helpful hints
for each procedure are presented. The aftercare and follow-up are
discussed. Any potential complications are described, including the
methods to reduce and care for the complications. Finally, a summary contains a review of any critical or important information.
This book covers a wide variety of procedures. We have made an
effort to think of most procedures that may be performed in a rural
or urban Emergency Department and have incorporated it into
this text. This includes procedures performed routinely or rarely. It
also includes procedures that are often performed in the acute care,
clinic, and office setting. Some of the procedures in this book may be
performed frequently in the daily practice of Emergency Medicine,
such as laceration repair or endotracheal intubation. Other procedures, such as a cricothyroidotomy, are seldom to rarely performed
but critical to the practice of Emergency Medicine. While many of
the procedures are well known to the Emergentologist, some are
uncommon and may not be known to the reader. This provides
an opportunity to acquire new information that may be converted,
with proper practice and training, into a useful skill. A few of the
procedures are performed only by Surgeons. They are included to
promote understanding by those who may later see the patients in
the Emergency Department and have to provide emergent care for

a complication. This edition has added chapters to cover additional
procedures, especially the Respiratory section. A few chapters of
seldom used procedures have been eliminated.
We have drawn on a wide variety of authors. The majority
of authors are residency-trained, board-certified, and practicing
Emergentologists. We have the honor of having many contributors
from outside the field of Emergency Medicine, who are experts
in their own specialty. The authors do have biases because of differences in education, experience, and training. We have tried to
base all recommendations on sound clinical and scientific data.
However, we have not excluded personal experience or preferences
when appropriate. In these cases, the authors also present alternative
techniques.
Hopefully, this book has grown and changed with this second
edition. Suggestions from you, the reader, would be most appreciated. Let us know what additional procedures should be included or
excluded in the future.
Eric F. Reichman, PhD, MD

xxiii


Acknowledgments
This has been educational and time-consuming. I must thank my
wife Kristi for all of her patience during this endeavor that took
thousands of hours and four years. Joey, Phoebe, Jake, and Rocky
always kept me entertained, day and night.
I would like to acknowledge the support of friends, colleagues,
current residents, and former residents in the Departments of
Emergency Medicine at The University of Texas at Houston Medical
School and Cook County Hospital. They provided friendship and
encouragement, and were always there when needed. A special

thanks goes to Bob Simon and Jeff Schaider who got me started and
set me on this academic path.
A special thanks goes to Brent King, MD, Patricia Butler, MD, and
Nancy McNiel, PhD, for all their support and encouragement.

xxiv

I would also like to acknowledge Marcy, Venettea, Shadi, Jim,
Hoan, and especially Yolanda of the SCSC. Their daily support was
invaluable.
I want to thank all the authors. Many of you are good friends that
I cherish and whom gave of themselves and their time.
Susan Gilbert is a wonderful medical illustrator and friend. Her
input and assistance only added to the illustrations of both editions
of this book.
Thanks to all those at McGraw-Hill, especially Anne Sydor and
Brian Kearns. You kept me on track, and provided assistance when
needed and a kick in the butt when needed.
Eric F. Reichman, PhD, MD