Schwartz - Principles and Practice of Emergency Medicine 4th

Principles and Practice of Emergency Medicine 4th edition (January 15, 1999) by George R. Schwartz (Editor), Paul B. Roth (Editor), James S. Cohen (Editor) By Lippincott, Williams & Wilkins
By OkDoKeY
CONTENTS
Preface
Acknowledgments
1–1 Pathophysiology of Dying and Reanimation George R. Schwartz
1–2 Post Intubation: Airway and Ventilator Management

CHAPTER 2 CARDIOVASCULAR SYSTEM FAILURE AND SHOCK
2–1 Shock Max Harry Weil, Eric C. Rackow
2–2 Shock: Clinical Treatment George R. Schwartz
CHAPTER 3 SUDDEN DEATH AND RESUSCITATION
3–1 Sudden Death Barbara K. Hanke, George R. Schwartz
3–2 Cardiopulmonary-Cerebral Resuscitation Peter Safar, Norman S. Abramson
3–3 Advanced Cerebral Resuscitation: The Cutting Edge of ACLS Aiming at Maximal Functional Recovery Peter Safar
CHAPTER 4 BRAIN DEATH AND ORGAN RETRIEVAL James L. Bernat, George R. Schwartz
CHAPTER 5 ETHICAL ISSUES IN RESUSCITATION George R. Schwartz, Kenneth V. Iserson
PART II: TECHNIQUES AND TIPS
CHAPTER 6 PAIN MANAGEMENT James R. Ungar, Daniel Brandes, Bruce M. Reinoehl, George R. Schwartz, Al Ritter
CHAPTER 7 WOUND MANAGEMENT Barbara K. Hanke
CHAPTER 8 ENT TECHNIQUES
8–1 Cricothyrotomy and Tracheotomy William W. Montgomery, David M. Bowling, George R. Schwartz
8–2 Transtracheal Ventilation Peter Safar, George R. Schwartz
8–3 Myringotomy and Tympanocentesis

8–4 Epistaxis (Nosebleed) and Post-tonsillectomy Hemorrhage Donald R. Paugh, Michael J. Sullivan
8–5 Dislocation of the Jaw Cherie A. Hargis
8–6 Dysphonia Andrew Blitzer
8–7 Sudden Hearing Loss

CHAPTER 9 FOREIGN BODY REMOVAL
9–1 External Auditory Canal Stuart R. Fritz, Gabor D. Kelen
9–2 Nose Howard A. Werman
9–3 Skin Robert A. Rusnak
9–4 Ocular Foreign Bodies Stephen F. Larson
9–5 Swallowed Objects Marsha D. Rappley, Sid M. Shah
9–6 Food and Foreign Body Asphyxiation Michael P. Poirier, George R. Schwartz
9–7 Coin Ingestion George R. Schwartz
CHAPTER 10 ROUTES FOR DRUGS AND FLUIDS

11–1 Overview of Imaging Modalities Robin Gaupp, Gloria Birkholz
11–2 Imaging Techniques for Specific Conditions James R. Ungar, George R. Schwartz
11–3 What Test for Blunt Abdominal Trauma—CT, DPL, or Ultrasound? Craig A. Meek, Stephen A. Colucciello, John A. Marx
CHAPTER 12 GENITOURINARY TECHNIQUES
12–2 Suprapubic Bladder Drainage Nanakram Agarwal, Ellen E. Anderson
CHAPTER 13 GASTROINTESTINAL TECHNIQUES: NASOGASTRIC TUBE INSERTION Nanakram Agarwal, Ellen E. Anderson
CHAPTER 14 PRACTICE PARAMETERS, CLINICAL POLICIES, PRACTICE GUIDELINES John Dale Dunn
PART III: TRAUMA
15–1 Kinematics Norman E. McSwain, Jr.
15–2 Injury Control
Arthur L. Kellermann, Knox Todd
15–3 Forensic Emergency Medicine John E. Smialek, George R. Schwartz
CHAPTER 16 PREHOSPITAL MANAGEMENT OF TRAUMA Paul E. Pepe
CHAPTER 17 EMERGENCY MANAGEMENT OF TRAUMA
17–1 Initial Trauma Evaluation Peter Stewart, Frank Ehrlich
17–2 Tips for Evaluation of Trauma: Injury Patterns

18–1 General Considerations Thomas A. Gennarelli
18–2 Head Injuries: Specific Emergency Department Management Issues George R. Schwartz, Thom A. Mayer, H. Warren Goldman
18–3 Spinal Injuries
John R. Mangiardi, George R. Schwartz
18–4 Trauma to the Face Thom A. Mayer, Errikos Constant
CHAPTER 19 TRAUMA TO THE NECK: GENERAL CONSIDERATIONS Prakashchandra M. Rao, Rao R. Ivatury, George R. Schwartz
CHAPTER 20 THORACIC TRAUMA
20–1 General Considerations and Technique of Tube Thoracostomy George R. Schwartz, Paul Pepe
20–2 Emergency Department Patient Management of Chest Trauma Panagiotis N. Symbas
CHAPTER 21 ABDOMINAL TRAUMA C. Gene Cayten
CHAPTER 22 INJURIES OF THE GENITOURINARY TRACT E. James Seidmon, A. Richard Kendall
CHAPTER 23 TRAUMA TO THE PERIPHERAL VASCULAR SYSTEM David V. Feliciano
CHAPTER 24 TRAUMA TO THE HAND AND NAIL
24–1 Trauma to the Hand Mark T. Jobe, E. Jeff Justis, Jr.
24–2 Nail Evaluation and Procedures Richard K. Scher, Karin H. Satra
CHAPTER 25 SPECIAL CONSIDERATIONS
25–1 Trauma in Pregnancy Cloyd B. Gatrell, George R. Schwartz
25–2 Trauma in the Elderly Gerald B. Demarest, George R. Schwartz, Clark Chipman
25–3 Pediatric Trauma George R. Schwartz
25–4 Burns Alan R. Dimick, Russell G. Wagner
25–5 Fat Embolism Syndrome

CHAPTER 26 CARDIOVASCULAR EMERGENCIES
26–1 Evaluation of Chest Pain George R. Schwartz, James R. Ungar, Marvin A. Wayne, Rosanne Carrero
26–2 Diagnosis and Treatment of Arrhythmias Ruth Ann Greenfield, Raymond N. Vitullo, Martin E. Bacon, J. Marcus Wharton, Joseph C. Howton
Appendix/ECG Illustrative Tracings
CHAPTER 27 CARDIOVASCULAR PROCEDURES
27–1 Synchronized and Unsynchronized Cardioversion of Arrhythmias Grant La Farge
27–2 Pericardiocentesis Grant La Farge
27–3 Emergency Pacemaker Use and Evaluation James C. Blankenship, T. Duncan Sellers
27–4 Use of Flow-Directed, Balloon-Tipped Catheters Grant La Farge, Steven G. Rothrock, George I. Litman
27–5 Emergency Physician’s Use of Echocardiography Joseph Rosenblum, James V. Talano
CHAPTER 28 CARDIAC EMERGENCIES
28–1 Acute Myocardial Infarction and Unstable Angina James S. Cohen, George R. Schwartz
28–2 Thrombolytic Therapy for Acute Myocardial Infarction James S. Cohen
28–3 Cardiogenic Shock Mark Mandell
28–4 Congestive Heart Failure and Pulmonary Edema

28–5 Myocarditis, Cardiomyopathies, and Pericardial Disease Joseph Rosenblum, James V. Talano
28–6 Infective Endocarditis Philip L. Henneman
28–7 Valvular Heart Disease Morton J. Kern, Lawrence M. Lewis
28–8 Prosthetic Heart Valves: Identification, Function, and Failure

CHAPTER 29 VASCULAR EMERGENCIES
29–1 Hypertensive Emergencies Abdul M. Memon, Kathleen S. Schrank
29–2 Aortic Aneurysms and Peripheral Arterial Diseases James S. Cohen, Steven G. Rothrock, Nicholas Balsano, C. Gene Cayten, Steven Sornsin
29–3 Carotid Artery Disease Charles L. Emerman, John E. Duldner
29–4 Venous Diseases Earl J. Reisdorff, David E. Pawsat
B. Adul t Respiratory
CHAPTER 31 DYSPNEA
31–1 Evaluation of Dyspnea Robert H. Dailey
31–2 Acute Upper Airway Obstruction Gerard R. Cox, Suzanne M. Shepherd
31–3 Mediastinal Emergencies Sheldon Jacobson
CHAPTER 32 EVALUATION OF PULMONARY FUNCTION IN THE EMERGENCY DEPARTMENT Georges S. Yacoub, Basim A. Dubaybo
CHAPTER 33 SPECIFIC RESPIRATORY CONDITIONS
33–1 Pulmonary Embolism
Terence D. Valenzuela
33–2 Acute Asthma in Adults Steven E. Gentry, Sandra M. Schneider, Joseph C. Howton
33–3 Hemoptysis Francis L. Counselman
33–4 Pneumothorax Jonathan Vargas
33–5 Aspiration

C. Gastrointes tinal
CHAPTER 35 ABDOMINAL PAIN: EVALUATION George R. Schwartz, Steven G. Rothrock, Daniel J. Shea, Paul I. Bulat
CHAPTER 36 GASTROINTESTINAL BLEEDING

Eddy D. Palmer
36–2 Upper Gastrointestinal Bleeding Frederic E. Eckhauser, Steven E. Raper, James A. Knol
36–3 Lower Gastrointestinal Bleeding Gail V. Anderson, Paul F. Cunningham
CHAPTER 37 ESOPHAGEAL EMERGENCIES AND DYSPHAGIA Sid M. Shah, Vincent Pflug, Gregory P. Hess
CHAPTER 38 ACUTE GASTROENTERITIS Louis J. Wilson, Christopher Truss
CHAPTER 39 APPENDICITIS John R. Clarke, John M. Schoffstall, Steven G. Rothrock, George R. Schwartz
CHAPTER 40 PERFORATED VISCUS James K. Bouzoukis
CHAPTER 41 INTRA-ABDOMINAL INFECTIONS Henry W. Murray
CHAPTER 42 GASTRITIS AND PEPTIC ULCER DISEASE Michael W. Mulholland, Frederic E. Eckhauser
CHAPTER 43 CROHN DISEASE AND ULCERATIVE COLITIS Mark A. Peppercorn
CHAPTER 44 DIVERTICULITIS AND DIVERTICULOSIS C. Gene Cayten, George R. Schwartz
CHAPTER 45 ACUTE GALLBLADDER AND BILIARY TRACT DISEASE Richard E. Burney
CHAPTER 46 LIVER DISEASE AND HEPATITIS
46–1 Liver Disease Daniel G. Murphy
46–2 Viral Hepatitis Daniel G. Murphy, George R. Schwartz
CHAPTER 47 PANCREATIC DISEASE Bernard M. Schuman
CHAPTER 48 ANORECTAL DISORDERS George R. Schwartz, Steven G. Rothrock, Monica Ann Rosenthal
D. Renal and Genitourin ary
CHAPTER 49 RENAL FAILURE Demetrius Ellis, Ellis D. Avner, John C. Maino, II, George R. Schwartz
CHAPTER 50 URINARY TRACT INFECTIONS, CYSTITIS, PYELONEPHRITIS Mike Kozminski, George R. Schwartz
CHAPTER 51 HEMATURIA Patricia L. Lamb
CHAPTER 52 MALE GENITAL PROBLEMS Scott B. Freeman
CHAPTER 53 ACUTE URINARY RETENTION AND BLADDER DRAINAGE Lester Karafin, A. Richard Kendall
CHAPTER 54 NEUROGENIC BLADDER: CAUSES AND EVALUATION Scott B. Freeman
CHAPTER 55 RENAL CALCULI (KIDNEY STONES) John J. Pahira
E. Obstetr ics and Gynecology
CHAPTER 56 OBSTETRIC EMERGENCIES
56–1 Emergency Delivery
56–2 Ectopic Pregnancy Russell J. Carlisle, Barbara Hanke
56–3 Hypertensive Disorders of Pregnancy and Preeclampsia Russell J. Carlisle
56–4 Medical Disorders of Pregnancy Van H. Miller
56–5 Medication Use in Pregnancy

56–7 Postpartum Infections Mark D. Westfall
CHAPTER 57 GYNECOLOGIC EMERGENCIES
57–1 Pelvic Pain in Women: Evaluation Stephen J. Wheeler
57–2 Vaginal Infections
Christopher K. Wuerker, Joseph C. Howton
57–3 Vaginal Bleeding Arthur Shapiro
CHAPTER 58 THE SEXUALLY ASSAULTED PATIENT Stephen D. Higgins, George R. Schwartz
F. Infectiou s Disease
59–2 Vaccines and Immunoprophylaxis: Measles, Mumps, Rubella, Diphtheria, Pertussis, Varicella, Rabies, Tetanus, and Other Communicable Diseases David N. Zull

CHAPTER 60 INFECTIOUS DISEASE
60–1 Patients at Higher Risk for Infection George R. Schwartz
60–2 Fever and Sepsis Sid M. Shah, James J. Gordon, M. Jevitz Patterson, Steven G. Rothrock, George R. Schwartz
60–3 Antibiotic Choices Mary Anne Mangelsen, Kenneth A. Murphy, Jr.
CHAPTER 61 SPECIFIC INFECTIONS
61–2 Sinusitis Arnold M. Cohn, John R. Jacobs
61–3 Ear Infections Donald R. Paugh, Steven A. Telian
61–4 Infections Causing Obstruction of the Upper Airway

Suzanne M. Shepherd, Gerard R. Cox
61–5 Community-acquired Pneumonia Ghiath Bayasi, Georges S. Yacoub, Basim A. Dubaybo
61–6 Meningitis and Meningoencephalitis Mary Anne Mangelsen
61–7 Herpes Simplex Meningoencephalitis George R. Schwartz
61–8 Other Infections: Osteomyelitis, Tetanus, Miliary Tuberculosis, Coccidioides, Histoplasmosis, Blastomyces

George R. Schwartz
61–9 Diarrhea W. McDowell Anderson, Robert R. Brinson, George R. Schwartz
CHAPTER 62 ABSCESSES
62–1 Abscesses of the Head and Neck John R. Jacobs, Arthur W. Weaver
62–2 Cutaneous Abscesses, Necrotizing Fasciitis, and Gas Gangrene John I. Ellis, George R. Schwartz, Patrick Connell
CHAPTER 63 SEXUALLY TRANSMITTED DISEASES
63–1 Sexually Transmitted Diseases Sumner E. Thompson, George R.Schwartz, Ralph K. Della Ratta
63–2 HIV-Related Illness in the Emergency Department Gregory J. Moran
G. Endocr ine and Metabol ic Balance
CHAPTER 64 DIABETES AND COMPLICATIONS
64–1 Diabetic Ketoacidosis David K. English, Joseph C. Howton
64–2 Hypoglycemia R. Carter Clements
64–3 Nonketotic Hypertonicity in Diabetes Mellitus Kristi Koenig, Eric Stirling, Joseph C. Howton
64–4 Lactic Acidosis Douglas M. Salyards, Joseph C. Howton
CHAPTER 65 ADRENAL INSUFFICIENCY AND ADRENAL CRISIS David Baldwin, Jr.
CHAPTER 66 INAPPROPRIATE SECRETION OF ANTIDIURETIC HORMONE David L. Vesely
CHAPTER 67 THYROID DISORDERS
67–1 Hypothyroidism and Myxedema Coma Joseph C. Howton
67–2 Hyperthyroidism and Thyroid Storm Joseph C. Howton
CHAPTER 68 PHEOCHROMOCYTOMA Mukarem A. Siddiqui, Sushma Reddy, James R. Sowers
CHAPTER 69 THE PORPHYRIAS Barbara H. Greene

CHAPTER 71 ACQUIRED HEMORRHAGIC DISORDERS Rajalaxmi McKenna
CHAPTER 72 EMERGENCY MANAGEMENT OF COMMON CONGENITAL BLEEDING SYNDROMES: HEMOPHILIA AND ALLIED DISORDERS Wadie F. Bahou
CHAPTER 73 BLOOD CELL DISORDERS
73–1 Thrombocytopenic Disorders Steve Hulsey, Joseph C. Howton
73–2 Leukocyte Dysfunction and Neutropenia Martin R. Klemperer, Joseph C. Howton
73–3 Polycythemias Eric Stirling
CHAPTER 74 SICKLE CELL DISEASE William Reed, Elliott Vichinsky
CHAPTER 75 SPLENOMEGALY Lawrence Dall, Lori Eakin
CHAPTER 76 TRANSFUSION THERAPY IN EMERGENCY MEDICINE Steven J. Davidson, Ilya M.Chern
CHAPTER 77 ONCOLOGIC EMERGENCIES George R. Schwartz, Timothy G. Janz, James Ungar
I . Neurolog ic
CHAPTER 78 NEUROLOGICAL PROCEDURES Venkat Narayan, William F. Bouzarth
CHAPTER 79 EMERGENCY EVALUATION OF NEUROLOGIC DISORDERS J. Stephen Huff, Thomas P. Bleck, Aron S. Buchman
CHAPTER 80 HEADACHE AND FACIAL PAIN
80–1 General Approach George R. Schwartz
80–2 Migraine
Joel R. Saper
80–3 Facial Pain, Trigeminal Neuralgia, and Tics George R. Schwartz
CHAPTER 81 SYNCOPE
81–1 Evaluation and General Considerations Stephen L. Adams, Gary J. Martin
81–2 Selected ED Presentations of Syncope Milton N. Luria, George R. Schwartz
CHAPTER 82 CONFUSION Arthur P. Safran, Thomas D. Sabin
CHAPTER 83 THE COMATOSE PATIENT Michael C. Smith, George Katsamakis
CHAPTER 84 SEIZURES Kevin M. Kelly, James P. Valeriano
CHAPTER 85 DIZZINESS OR VERTIGO Kevin M. Kelly, Steven A. Telian, Thomas M. Stein
CHAPTER 86 STROKE AND TRANSIENT ISCHEMIC ATTACKS Stephen J. Marks, Alan J. Tuchman
CHAPTER 87 NONTRAUMATIC SPINAL CORD SYNDROMES Philippe D. Vaillancourt, George R. Schwartz
CHAPTER 88 NEUROMUSCULAR EMERGENCIES James W. Albers, Mark B. Bromberg
CHAPTER 89 INCREASED INTRACRANIAL PRESSURE Thomas P. Bleck
CHAPTER 90 HYDROCEPHALUS SHUNTS IN THE EMERGENCY DEPARTMENT Robert C. Dauser
CHAPTER 91 NEUROLEPTIC MALIGNANT SYNDROME Barbara S. Koppel
J. Ophthalmology
CHAPTER 92 OCULAR EVALUATION AND PROCEDURES: GENERAL CONSIDERATIONS George L. Spaeth, John Purcell, Jr., John B. Jeffers, John A. Milton
CHAPTER 93 OCULAR TRAUMA John J. Purcell, George L. Spaeth, John A. Milton
CHAPTER 94 ACUTE VISUAL LOSS Douglas D. Brunette, Steven R. Bennett
CHAPTER 95 THE ACUTE PAINFUL EYE Michael E. Whiting
CHAPTER 96 COMMON EYE INFECTIONS Theodore Rabinovitch, Scott S. Weissman, Robert A. Nozik
CHAPTER 97 NEURO-OPHTHALMOLOGIC EMERGENCIES Douglas D. Brunette, Steven R. Bennett
CHAPTER 98 THE EYE AND SYSTEMIC DISEASE

CHAPTER 99 OPHTHALMOLOGIC PHARMACOTHERAPY IN EMERGENCIES Scott S. Weissman, Theodore Rabinovitch, Robert A. Nozik
K. Dermatology
CHAPTER 100 DERMATOLOGIC EXAMINATION Philip D. Shenefelt, Neil A. Fenske
CHAPTER 101 PRURITUS George R. Schwartz, Howard M. Simons
CHAPTER 102 CUTANEOUS SIGNS OF SYSTEMIC DISEASE Eric Stirling
CHAPTER 103 LIFE-THREATENING DERMATOSES Jeffrey P. Callen, Carol L. Kulp-Shorten
CHAPTER 104 DERMATITIS Joseph F. Fowler, Jr.
CHAPTER 105 PURPURA George R. Schwartz, Howard M. Simons
CHAPTER 106 SKIN INFECTIONS George R. Schwartz, Howard M. Simons
CHAPTER 107 VESICULOBULLOUS ERUPTIONS George R. Schwartz, Howard M. Simons
CHAPTER 108 DRUG ERUPTIONS Jeffrey P. Callen, Carol L. Kulp-Shorten
CHAPTER 109 URITICARIA Marc D. Brown
L. Orthopedics
CHAPTER 111 MUSCULOSKELETAL INJURIES
111–1 Trauma to the Extremities and Soft Tissues James R. Ungar, William R. MacAusland, Leo Capobianco, Barbara K. Hanke
111–2 Salter Classification of Growth Plate Injuries

James R. Ungar
CHAPTER 112 ACUTE LOW-BACK PAIN Charles M. Grudem, George R. Schwartz
CHAPTER 113 EMERGENCIES IN SPORTS James G. Garrick, James R. Ungar, Marie D. Schafle, George R. Schwartz
CHAPTER 114 EMERGENCY RHEUMATOLOGY
114–1 Systemic Rheumatic Diseases Rita K. Cydulka, Steven B. Sorin
114–2 The Swollen Joint
114–2.1 Monoarticular Arthritis Rita K. Cydulka, Steven B. Sorin
114–2.2 Polyarticular Arthritis Rita K. Cydulka, Steven B. Sorin
M. Dental and Periodon tal
CHAPTER 115 INTRAORAL LOCAL ANESTHESIA Craig S. Miller, Donald Falace
CHAPTER 116 TOOTHACHE AND PAIN OF DENTAL ORIGIN

CHAPTER 117 GINGIVA
117–2 Gingival and Periodontal Abscesses James T. Amsterdam
N. Psychiatric and Behavio ral Emergencies
CHAPTER 118 TRIAGE Stephanie von Ammon Cavanaugh, William S. Gilmer
CHAPTER 119 TIPS FOR INITIAL EVALUATION OF THE NEUROPSYCHIATRIC PATIENT Craig A. Taylor, Barbara C. Good
CHAPTER 120 EMERGENCY DEPARTMENT PSYCHIATRIC EMERGENCIES Stephanie von Ammon Cavanaugh, William S. Gilmer
CHAPTER 121 PSYCHIATRIC MEDICAL LEGAL CONSIDERATIONS: CODES, RESTRAINTS, COMMITMENTS, TRANSFERS, AND COBRA REGULATIONS Stephanie von Ammon Cavanaugh, William S. Gilmer
CHAPTER 122 ORGANIC BRAIN SYNDROMES AND DISORDERS Stephanie von Ammon Cavanaugh
CHAPTER 123 ANXIETY OR PANIC DISORDERS Wayne J. Katon
CHAPTER 124 SOMATOFORM DISORDERS
Beverly Fauman
CHAPTER 125 DOMESTIC ABUSE, ELDER ABUSE, AND THE ABUSED, ASSAULTED ADULT Susan V. McLeer, Margo J. Krasnoff
PART V: SPECIAL POPULATIONS

126–2 Altered Mental Status in Children Daniel J. Isaacman
CHAPTER 127 RESUSCITATION
127–1 Neonatal Resuscitation and Selected Neonatal Emergencies Kent F. Argubright, Kristi Watterberg
127–2 Pediatric Cardiopulmonary Resuscitation Paula C. Fink
CHAPTER 128 AIRWAYS
128–1 Management of the Pediatric Airway Thom A. Mayer
128–2 Pediatric Asthma Robert G. Bolte
CHAPTER 129 INFECTIONS
129–1 Infection and Bacteremia: Management of the Febrile Child Under Two Years Daniel J. Isaacman, Paul N. Seward
129–2 Acute Respiratory Emergencies in Children: Croup, Epiglottitis, Bronchiolitis, Pneumonia Michael F. Altieri, Thom A. Mayer
129–3 Pediatric Viral Infections: Measles, Mumps, Rubella “Fifth” Disease, Roseola, Chicken Pox, Herpes Virus, Cytomegalovirus, Infectious Mononucleosis, Rotavirus, Adenovirus, Polio, Conjunctivitis, Gingivostomatitis, Rabies Michael R. Sayre, George R. Schwartz
CHAPTER 130 SYSTEMS
130–2 Dehydration, Gastrointestinal Emergencies, Pediatric Appendicitis, Urinary Tract Infections, Hematologic Emergencies, and Neurologic Emergencies (including Meningitis) George R. Schwartz, Thom A. Mayer, Garrett E. Bergman, Ellen B. Bishop
130–3 Sudden Infant Death Syndrome and Apparent Life-Threatening Events Michele R. Wadsworth, George R. Schwartz
130–4 Evaluation and Management of Child Abuse George R. Schwartz, Steve Lesser, Garrett E. Bergman
P. Geriatrics
CHAPTER 131 GERIATRIC EMERGENCY MEDICINE: OVERVIEW George R. Schwartz, Gideon Bosker
CHAPTER 132 ACUTE MENTAL STATUS CHANGE IN THE ELDERLY Curt E. Dill, Dennis P. Price, George R. Schwartz
CHAPTER 133 SEPSIS IN THE ELDERLY George R. Schwartz
PART VI: ENVIRONMENTAL AND TOXICOLOGY EMERGENCIES
Q. Environmental

CHAPTER 135 ENVIRONMENTAL PRESSURE
135–1 Diving and Altitude Emergencies George R. Schwartz, Jeffrey Sipsy, Barbara K. Hanke
135–2 Hyperbaric Medicine Barbara K. Hanke
CHAPTER 136 NEAR-DROWNING Barbara K. Hanke, George R. Schwartz, James E. Gerace
CHAPTER 137 BITES
137–2 Diagnosis and Treatment of Snakebite James R. Roberts
137–3 Toxic Bites and Stings Loren Johnson
137–4 Tick-Borne Diseases Mary Anne Mangelsen
CHAPTER 138 LIGHTNING AND ELECTRICAL INJURIES
138–1 Lightning Injuries Edgar B. Billowitz
138–2 Electrical Injuries Edgar B. Billowitz
138–3 Laser and Microwave Injuries

138–4 Radiation Injury George L. Voelz
CHAPTER 139 SMOKE INHALATION Dennis P. Price, Harvey Silverman, George R. Schwartz
CHAPTER 140 TRAVEL MEDICINE
140–2 Wilderness Medicine Kenneth V. Iserson
140–3 Wilderness Infectious Diseases Sharon Kolber
140–4 Sun-Induced Disorders David A. Kramer, Philip Shayne
140–5 Hypothermia Loren Johnson
140–6 Frostbite and Other Cold Injuries

Loren Johnson
140–7 Heat Stress Diseases Audrey Urbano-Brown, Robert P. Proulx, George R. Schwartz
R. Toxicology
CHAPTER 141 POISON CONTROL CENTERS Randall J. Berlin, Martin J. Smilkstein
CHAPTER 142 PREHOSPITAL AND INTERHOSPITAL CARE OF THE POISONED OR OVERDOSED PATIENT Theodore I. Benzer, Neal Flomenbaum
CHAPTER 143 THE POISONED PATIENT: OVERVIEW George R. Schwartz
CHAPTER 144 CRITICAL CARE MEDICAL TOXICOLOGY Howard C. Mofenson, Thomas R. Caraccio, Joseph Greensher, G. Brady
APPENDIX 144A_INDEX OF SUBSTANCES Howard C. Mofenson, Thomas R. Caraccio, Joseph Greensher, G. Brady
CHAPTER 145 DRUG ABUSE AND TOXICITY James R. Ungar, George R. Schwartz, David G. Levine
CHAPTER 146 ALCOHOL
146–1 Alcohol Toxicodynamics and Forensic Considerations Harold Osborn, James Celentano, John Munyak
146–2 Alcohol Substitutes: Treatment of Poisonings by Methanol, Ethylene Glycol, and Isopropyl Alcohol Harold Osborn
146–3 Alcohol Withdrawal: Differential Diagnosis and Emergency Treatment David B. McMicken
146–4 Alcohol-Related Diseases: Emergency Department Management John I. Ellis, Michael Whiting, Martha Roper
CHAPTER 147 OCCUPATIONAL EXPOSURES AND ART HAZARDS Steven H. Lesser, Steven J. Weiss
CHAPTER 148 FOOD POISONING George R. Schwartz
PART VII: MISCELLANEOUS
S. Emergency Med ical Services (EMS) Systems
CHAPTER 149 EMS SYSTEMS DEVELOPMENT IN THE UNITED STATES Alexander Kuehl
CHAPTER 150 EMS SYSTEMS FACTORS AND SURVIVAL OF CARDIAC ARREST Mickey S. Eisenberg
CHAPTER 151 THE EFFECT OF EMS SYSTEMS FACTORS ON TRAUMA SURVIVAL George R. Schwartz
CHAPTER 152 GROUND AND AIR EMERGENCY TRANSPORT Gregory W. Hendey
CHAPTER 153 DISASTER PLANNING AND OPERATION IN THE EMERGENCY DEPARTMENT Theresa M. Schwab, Eric K. Noji
CHAPTER 154 INTERNATIONAL PERSPECTIVE OF EMS SYSTEMS DEVELOPMENT
154–1 Germany Markus D.W. Lipp, Andreas R. Thierbach
154–2 Emergency Care “Skoraya” in Russia Michail V. Grinev
154–3 Australia Harry F. Oxer
154–4 Terrorism: EMS Issues and Management John E. Prescott, Thom A. Mayer
T. Emergenc y Department Management
CHAPTER 155 INTRODUCTION TO MANAGEMENT: DEFINITIONS, UTILIZATION, AND WORKFORCE ISSUES James S. Cohen
CHAPTER 156 THE WORK ENVIRONMENT IN EMERGENCY MEDICINE: STRESS, SHIFT WORK, AND AVOIDING BURNOUT George R. Schwartz
CHAPTER 157 THE ROLE OF THE EMERGENCY DEPARTMENT DIRECTOR

CHAPTER 158 TIPS FOR CONTINUOUS QUALITY IMPROVEMENT Thom A. Mayer
CHAPTER 159 FAST-TRACK CARE AND OCCUPATIONAL MEDICINE David Brooke
CHAPTER 160 TIPS FOR CONTRACTING WITH MANAGED CARE ORGANIZATIONS Thom A. Mayer
CHAPTER 161 FINANCIAL ASPECTS OF EMERGENCY MEDICINE James S. Cohen
CHAPTER 162 EDUCATION IN EMERGENCY DEPARTMENTS: FOCUS ON DECISION MAKING Sheldon Jacobson, George R. Schwartz
CHAPTER 163 COMPUTERS AND EMERGENCY MEDICINE Mark Mandell, Ashraf Nashed, John Horning
U. Medicolegal Aspects o f Emergency Care
CHAPTER 164 MEDICOLEGAL ISSUES IN EMERGENCY MEDICINE John D. Dunn
APPENDIX A: NORMAL REFERENCE VALUES Dennis R. Ehrhardt
APPENDIX B: USEFUL TABLES
CONTRIBUTORS
Norman S. Abramson, M.D. Professor of Emergency Medicine Ohio State University Columbus, Ohio
Jose A. Acosta, M.D., F.A.C.S. Attending Surgeon Department of General Surgery and Critical Care National Naval Medical Center Bethesda, Maryland
Stephen L. Adams, M.D., F.A.C.P., F.A.C.E.P. Associate Professor of Medicine Northwestern University Medical School
Associate Chief, Division of Emergency Medicine Department of Medicine Clinical Practice Director, Emergency Medicine Northwestern Medical Faculty Foundation
Associate Medical Director, Emergency Medical Services Northwestern Memorial Hospital Chicago, Illinois
Nanakram Agarwal, M.D. New York Medical College Our Lady of Mercy Medical Center Bronx, New York
James W. Albers, M.D., Ph.D. Professor of Neurology Director, Neuromuscular Program Department of Neurology University of Michigan Medical Center
Ann Arbor, Michigan
James T. Amsterdam, D.M.D., M.D. Professor of Emergency Medicine Department of Emergency Medicine Northeastern Ohio Universities College of Medicine Rootstown, Ohio
Ellen E. Anderson, M.D. Currently Missionary Physician in Africa
Gail V. Anderson, Jr., M.D., M.B.A., F.A.C.E.P. Associate Professor Department of Surgery (Emergency Medicine) Emory University School of Medicine Senior Vice President Department of Medical Affairs Grady Health System
Atlanta, Georgia
W. McDowell Anderson, M.D. Associate Professor of Medicine Division of Pulmonary and Critical Care Medicine University of Southern Florida College of Medicine Tampa, Florida
Kent F. Argubright, M.D. Albuquerque, New Mexico

University Hospital and Medical Center Stony Brook, New York
David Baldwin, Jr., M.D. Assistant Professor of Medicine Department of Internal Medicine Rush Medical College Chicago, Illinois
Nicholas Balsano, M.D. Bronx, New York
Ghiath Bayasi, M. D. Genesee Lung Associates Burton, Michigan
Steven R. Bennett, M.D. Clinical Assistant Professor Department of Ophthalmology University of Minnesota Minnesota, Minnesota
Theodore I. Benzer, M.D., Ph.D. Lecturer in Medicine Harvard Medical School Emergency Department Massachusetts General Hospital Boston, Massachusetts
Garrett E. Bergman, M.D. Clinical Professor of Pediatrics Department of Pediatrics
Allegheny University of the Health Sciences Philadelphia, Pennsylvania
Randall J. Berlin, M.D., D.A.C.E.P. Clinical Instructor Department of Emergency Medicine Oregon Health Sciences University Portland, Oregon
James L. Bernat, M.D. Professor of Neurology Dartmouth Medical School Hanover, New Hampshire Neurology Service Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire
Edgar B. Billowitz, M.D., F.A.C.E.P. Staff Physician Department of Emergency Medicine St. Vincent Hospital Santa Fe, New Mexico
Gloria Birkholz, R.N., J.D. Professor of Nursing College of Nursing University of New Mexico
Albuquerque, New Mexico
Ellen B. Bishop, M.D., F.A.A.P. Department of Pediatrics Lehigh Valley Hospital
Allentown, Pennsylvania
James C. Blankenship, M.D., F.A.C.C., F.S.C.A.I. Director, Cardiac Catheterization Laboratories Department of Cardiology, Geisinger Medical Center Pennsylvania State Geisinger Health System Danville, Pennsylvania
Thomas P. Bleck, M.D. Assistant Professor Health and Science Center Department of Neurology University of Virginia Medical Center Charlottesville, Virginia
Andrew Blitzer, M.D., D.D.S. Professor of Clinical Otolaryngology Columbia University Director, New York Center for Voice and Swallowing Disorders New York, New York

James K. Bouzoukis, M.D., F.A.C.S., F.A.A.E.M. Program Director Department of Emergency Medicine Medical Center of Delaware Newark, Delaware
David M. Bowling, M.D., F.A.C.S. Clinical Instructor in Otology & Laryngology Harvard Medical School Department of Otolaryngology-Head and Neck Surgery Massachusetts Eye and Ear Infirmary Boston, Massachusetts
G. Brady, M.D.
Robert R. Brinson, M.D. Montgomery, Alabama
Mark B. Bromberg, M.D., Ph.D. Associate Professor Department of Neurology University of Utah Medical Center Salt Lake City, Utah
David Brooke, M.D., F.A.C.E.P. Medical Director Department of Emergency Services Lakeland Regional Medical Center Lakeland, Florida
Marc D. Brown, M.D. Associate Professor of Dermatology Department of Dermatology University of Rochester Strong Memorial Hospital Rochester, New York
Douglas D. Brunette, M.D. Department of Emergency Medicine Hennepin County Medical Center Minneapolis, Minnesota
Aron S. Buchman, M.D. Associate Professor Department of Neurology Rush-Presbyterian St. Luke’s Medical Center Chicago, Illinois
Paul I. Bulat, M.D., F.A.C.E.P. Instructor in Medicine Division of Emergency Medicine The University of Massachusetts Medical School Director of Emergency Services St. Luke’s Hospital of New Bedford, Inc. New Bedford, Massachusetts
Richard E. Burney, M.D., F.A.C.S. Professor of Surgery University of Michigan
Ann Arbor, Michigan
Jeffrey P. Callen, M.D. Professor and Chief Department of Medicine Division of Dermatology University of Louisville School of Medicine Louisville, Kentucky
Leo J. Capobianco, D.O. Morristown Memorial Hospital Emergency Medicine/Travel Medicine Emergency Medical Associates Livingston, New Jersey

Assistant Professor of Emergency Medicine University Hospital State University of New York at Stony Brook Stony Brook, New York
Russell J. Carlisle, M.D., F.A.C.E.P. Medical Director Emergency Department Providence Seattle Medical Center Clinical Instructor Department of Internal Medicine University of Washington Seattle, Washington
Rosanne Carrero, M.D. St. Joseph Hospital Bellingham, Washington Ketchikan General Hospital Ketchikan, Alaska
C. Gene Cayten, M.D., M.P.H., F.A.C.S. Professor of Surgery and Preventive and Community Medicine Director, Institute for Trauma and Emergency Care Director, Department of Surgery, Our Lady of Mercy Medical Center New York Medical College Valhalla, New York
James J. Celentano, M.D., Ph.D. Attending Physician Department of Emergency Medicine Lincoln Medical and Mental Health Center Bronx, New York
Ilya M. Chern, M.D., F.A.C.E.P. Chief Department of Emergency Medicine Plantation General Hospital Plantation, Florida
Clark Chipman, M.D. Emergency Physician Emanuel Hospital and Health Center Clinical Associate Professor of Emergency Medicine Department of Emergency Medicine Oregon Health Sciences University Portland, Oregon
John R. Clarke, M.D., F.A.C.S. Professor of Surgery
R. Carter Clements, M.D., F.A.C.E.P. Clinical Instructor in Medicine Department of Internal Medicine Division of Emergency Medicine University of California, San Francisco San Francisco, California
Assistant Chief/CQI Coordinator Department of Emergency Medicine
ACMC Highland Hospital Oakland, California
James S. Cohen, M.D., D.A.B.E.M., D.A.B.I.M., F.A.A.E.M. Attending Physician Saratoga Emergency Physicians Saratoga Springs, New York
Arnold M. Cohn, M.D. Professor Department of Otolaryngology-Head and Neck Surgery Wayne State University Medical School Detroit, Michigan
Stephen A. Colucciello, M.D., F.A.C.E.P. Director, Clinical Services Trauma Coordinator Department of Emergency Medicine Carolinas Medical Center Charlotte, North Carolina

Francis L. Counselman, M.D., F.A.C.E.P. Associate Professor and Chairman Department of Emergency Medicine Eastern Virginia Medical School Norfolk, Virginia
Gerard R. Cox, M.D., M.H.A., F.A.C.E.P. Commander Medical Corps, U.S. Navy Clinical Assistant Professor Department of Military and Emergency Medicine Uniformed Services University of the Health Sciences Bethesda, Maryland Clinical Assistant Professor Department of Emergency Medicine University of South Alabama School of Medicine Mobile, Alabama
Paul A. Cunningham, M.B., B.S., F.A.C.E.M. Emergency Physician Emergency Department Concord Hospital Sydney, Australia
Rita K. Cydulka, M.D., F.A.C.E.P. Residency Director Department of Emergency Medicine Metro Health Medical Center
Assistant Professor Department of Surgery Case Western Reserve University Cleveland, Ohio
Robert H. Dailey, M.D., F.A.C.E.P. Clinical Professor Department of Medicine University of California, San Francisco San Francisco, California
Lawrence Dall, M.D. Professor of Medicine Chief, Section of Infectious Diseases University of Missouri-Kansas City School of Medicine Kansas City, Missouri
Jamie Dananberg, M.D. Clinical Research Physician Diabetes Care and Endocrinology Lilly Research Laboratories Indianapolis, Indiana
Robert C. Dauser, M.D. Assistant Professor University of Michigan
Ann Arbor, Michigan
Steven J. Davidson, M.D., M.B.A. Chairman Department of Emergency Medicine Maimonides Medical Center Professor of Clinical Emergency Medicine Department of Emergency Medicine State University of New York Health Sciences Center Brooklyn, New York
Ralph K. Della Ratta, M.D. Mineola, New York
Gerald B. Demarest, M.D. Director, Burn and Trauma Service University of New Mexico Medical Center
Jeffrey B. Dembo, D.D.S., M.S. Professor of Oral and Maxillofacial Surgery Department of Oral Health Practice University of Kentucky College of Dentistry Lexington, Kentucky
Curt E. Dill, M.D.

Stephen J. Dresnick, M.D., F.A.C.E.P. Clinical Professor Department of Emergency Medicine University of North Carolina Chapel Hill, North Carolina President Sterling Health Care Group Miami, Florida
Basim A. Dubaybo, M.D. Associate Professor of Medicine Department of Internal Medicine Wayne State University School of Medicine Detroit, Michigan
John E. Duldner, M.D. Clinical Research Fellow Department of Emergency Medicine MetroHealth Medical Center Cleveland, Ohio
John Dale Dunn, M.D., J.D., F.A.C.E.P., F.A.C.L.M., F.A.A.F.P. Director Emergency Services and Physician Advisor Brownwood Regional Medical Center Brownwood, Texas
Lori Eakin, M.D. Instructor, Clinical Pediatrics University of Missouri-Kansas City School of Medicine Kansas City, Missouri
Frederic E. Eckhauser, M.D. Professor of Surgery Department of Surgery Chief, Division of Gastrointestinal Surgery University of Michigan Medical Center
Ann Arbor, Michigan
Dennis R. Ehrhardt, M.D. St. Vincent Hospital Santa Fe, New Mexico
Frank Ehrlich, M.D., F.A.C.S. Chairman, Department of Surgery St. Joseph’s Hospital and Medical Center Paterson, New Jersey
Mickey S. Eisenberg, M.D., Ph.D. Professor of Medicine Director of Emergency Medicine Service University of Washington Medical Center Seattle, Washington
Demetrius Ellis, M.D. Professor of Pediatrics and Nephrology Director of Pediatric Nephrology University of Pittsburgh School of Medicine Children’s Hospital of Pittsburgh Pittsburgh, Pennsylvania
John I. Ellis, M.D. Assistant Clinical Professor Department of Medicine Division of Emergency Medicine University of California San Francisco San Francisco, California Doctor’s Medical Center San Pablo, California
Charles L. Emerman, M.D. Chairman Department of Emergency Medicine MetroHealth Medical Center Cleveland, Ohio
David K. English, M.D. Medical Student Director Department of Emergency Medicine
Alameda County Medical Center Oakland, California
Assistant Clinical Professor of Medicine Department of Medicine University of California San Francisco San Francisco, California

Lexington, Kentucky
Beverly J. Fauman, M.D., F.A.P.A, F.A.C.Psych. Associate Professor of Psychiatry University of Maryland School of Medicine Senior Psychiatrist Walter P. Carter Center University of Maryland Medical Systems Baltimore, Maryland
David V. Feliciano, M.D., F.A.C.S. Professor of Surgery Emory University School of Medicine Chief of Trauma and Tumor Services Grady Memorial Hospital
Atlanta, Georgia
Neil A. Fenske, M.D., F.A.C.P. Professor and Director Department of Cutaneous Surgery University of South Florida College of Medicine Tampa, Florida
Paula C. Fink, M.D., F.A.A.P. Clinical Assistant Professor of Pediatrics Department of Pediatrics University of Minnesota, Childrens Health Care Minneapolis, Minnesota
Neal Flomenbaum, M.D. Professor of Clinical Medicine Cornell University Medical College Chief, Emergency Medicine The New York Hospital New York, New York
Joseph F. Fowler, Jr., M.D. Associate Clinical Professor of Dermatology Director, Occupational Dermatology and Patch Test Clinic University of Louisville School of Medicine Louisville, Kentucky
Scott B. Freeman, M.D., F.A.C.E.P. Residency Director and Assistant Professor Section of Emergency Medicine Wayne State University Detroit Receiving Hospital and University Health Center Emergency Department Detroit, Michigan
Stuart R. Fritz, M.D., F.A.C.E.P. Emergency Physicians Professional Association Minneapolis, Minnesota
James G. Garrick, M.D. Director, Center for Sports Medicine St. Francis Memorial Hospital San Francisco, California
Cloyd B. Gatrell, M.D., F.A.C.E.P. Colonel, Medical Corps Commander Munson Army Community Hospital Fort Leavenworth, Kansas
Robin J. Gaupp, M.D., D.A.B.R. Attending Radiologist Santa Fe Radiology St. Vincent Hospital Santa Fe, New Mexico
Thomas A. Gennarelli, M.D., F.A.C.S. Professor and Chair Department of Neurosurgery
Steven E. Gentry, M.D. Assistant Professor of Medicine Department of Internal Medicine Eastern Virginia Medical School Norfolk, Virginia
James E. Gerace, M.D. Medical Director USA MCO Chief of Staff Phoenix Memorial Hospital Phoenix, Arizona
William S. Gilmer, M.D. Assistant Professor

Asher Center for Study & Treatment of Depressive Disorders Chicago, Illinois
H. Warren Goldman, Ph.D., M.D. Clinical Professor and Vice Chairman Department of Neurosurgery Jefferson Medical College Director, Center for Minimally Invasive Brain Surgery Wills Neurosensory Institute Thomas Jefferson University Hospital Philadelphia, Pennsylvania
Barbara C. Good, Ph.D. Senior Medical Writer Neurosciences Research Center
Allegheny University of the Health Sciences Pittsburgh, Pennsylvania
James G. Gordon, M.D., F.A.C.P. Assistant Clinical Professor of Medicine Department of Medicine Wayne State University Detroit, Michigan
Barbara H. Greene, M.D. Associate Professor of Medicine Division of General Medicine Emory University
Atlanta, Georgia
Ruth Ann Greenfield, M.D. Assistant Professor of Medicine Division of Cardiology Duke University Medical Center Durham, North Carolina
Joseph Greensher, M.D. Medical Director and Associate Chairman Department of Pediatrics
Associate Director Long Island Regional Poison Control Center Winthrop University Hospital Mineola, New York Professor of Pediatrics University of New York at Stony Brook Stony Brook, New York
David Gregory, M.D. Captain, United States Public Health Service Senior Consultant in Infectious Disease Indian Health Service Santa Fe Indian Hospital Santa Fe, New Mexico
Michail V. Grinev, M.D., Ph.D. Professor Director of Institute of Emergency Care Djanelidze Research Institute of Emergency Care St. Petersburg, Russia
Charles M. Grudem, M.D., D.A.B.E.M., F.N.A.S.S., F.A.A.D.E.P. Medical Director Managed Disability UNICARE
Atlanta, Georgia
Barbara K. Hanke, M.D., F.A.C.E.P. Staff Emergency Physician St. Vincent Hospital Santa Fe, New Mexico Clinical Assistant Professor of Family and Community Medicine University of New Mexico School of Medicine
Cherie A. Hargis, M.D. Attending Physician Department of Emergency Medicine
Alameda County Medical Center, Highland Campus Oakland, California
Gregory W. Hendey, M.D. Assistant Clinical Professor of Medicine University of California San Francisco University Medical Center Fresno, California

Torrance, California Associate Professor of Medicine University of California Los Angeles School of Medicine Los Angeles, California
Gregory P. Hess, M.D. Georgetown Medical Center Washington, D.C.
Stephen D. Higgins, M.D. Medical Director Department of Emergency Services St. Francis Medical Center Lynwood, California
John Horning, M.D. Staff Physician Department of Emergency Medicine Elliot Hospital Manchester, New Hampshire
Joseph C. Howton, M.D. Assistant Clinical Professor of Medicine Department of Medicine University of California School of Medicine San Francisco, California
Attending Physician Department of Emergency Medicine Good Samaritan Hospital Puyallup, Washington
J. Stephen Huff, M.D. Associate Professor of Emergency Medicine and Neurology Department of Emergency Medicine University of Virginia Health Sciences Center Charlottesville, Virginia
Steve Hulsey, M.D. Assistant Professor Department of Surgery University of Vermont Burlington, Vermont
Daniel J. Isaacman, M.D., F.A.A.P. Division Director Pediatric Emergency Medicine Children’s Hospital of the King’s Daughters
Associate Professor of Pediatrics Eastern Virginia Medicine School Norfolk, Virginia
Kenneth V. Iserson, M.D., M.B.A., F.A.C.E.P. Professor of Surgery Director, Arizona Bioethics Program University of Arizona College of Medicine Tucson, Arizona
Rao R. Ivatury, M.D., F.A.C.S. Associate Professor of Surgery New York Medical College Chief of Trauma Co-Director of SICU Lincoln Hospital Bronx, New York
John R. Jacobs, M.D. Professor Otolaryngology-Head and Neck Surgery Wayne State University Medical School Director, Head and Neck Cancer Program Karmanos Cancer Institute Detroit, Michigan
Sheldon Jacobson, M.D. Professor and Chairman Department of Emergency Medicine Mount Sinai School of Medicine New York, New York
Timothy G. Janz, M.D. Associate Professor Department of Emergency Medicine and Pulmonary/Critical Care Division Department of Medicine Wright State University School of Medicine Dayton, Ohio

Mark T. Jobe, M.D. Assistant Professor Department of Orthopaedic Surgery University of Tennessee-Campbell Clinic Memphis, Tennessee
Loren A. Johnson, M.D., F.A.C.E.P. Medical Director Emergency Department Sutter Davis Hospital Davis, California
E. Jeff Justis, Jr., M.D. Clinical Associate Professor Department of Orthopedics University of Tennessee-Campbell Foundation Memphis, Tennessee
Lester J. Karafin, M.D. Professor Emeritus Department of Urology Temple University Professor Emeritus Department of Urology Medical College of Pennsylvania Philadelphia, Pennsylvania
Wayne Katon, M.D. Professor and Chief Division of Consultation-Liaison Department of Psychiatry and Behavioral Sciences University of Washington School of Medicine Seattle, Washington
George Katsamakis, M.D. Department of Neurological Sciences Rush-Presbyterian-St. Luke’s Medical Center Chicago, Illinois
Gabor D. Kelen, M.D. Professor and Chair Johns Hopkins University Emergency Physician-in-Chief Johns Hopkins Hospital Department of Emergency Medicine Baltimore, Maryland
Arthur L. Kellermann, M.D., M.P.H., F.A.C.E.P. Professor of Emergency Medicine Director, Center for Injury Control Rollins School of Public Health of Emory University
Atlanta, Georgia
Kevin M. Kelly, M.D., Ph.D. Associate Professor Department of Neurology
A. Richard Kendall, M.D. Professor of Urology Temple University Hospital Department of Urology Philadelphia, Pennsylvania
Morton J. Kern, M.D. Cardiac Catheterization Laboratory St. Louis, Missouri
Martin R. Klemperer, M.D. Professor of Pediatrics University of South Florida Medical Director, Bone Marrow Transplantation Services Department of Pediatrics
All Children’s Hospital St. Petersburg, Florida
James A. Knol, M.D. Associate Professor of Surgery University of Michigan Medical School
Ann Arbor, Michigan
Kristi Koenig, M.D. Associate Professor of Medicine University of California San Francisco Department of Emergency Medicine
Alameda County Medical Center/Highland General Hospital Oakland, California

Sharon S. Kolber, M.D. Staff Physician Emergency Department Lovelace Medical Center Clinical Assistant Professor University of New Mexico School of Medicine Department of Emergency Medicine
Barbara S. Koppel, M.D. Professor of Clinical Neurology Department of Neurology New York Medical College New York, New York
Mike Kozminski, M.D., F.A.C.S. Private Practice Urologist Phoenix Urology of St. Joseph, Inc. St. Joseph, Missouri
David A. Kramer, M.D., F.A.C.E.P. Associate Professor Department of Emergency Medicine Emory University School of Medicine
Atlanta, Georgia
Margo J. Krasnoff, M.D. Associate Professor of Clinical Medicine Department of Internal Medicine State University of New York at Buffalo Millard Fillmore Health System Buffalo, New York
Alexander Kuehl, M.D., M.P.H., F.A.C.E.P., F.A.C.S. Associate Professor of Surgery and Public Health Cornell University Medical College New York, New York Emergency Physician-in-Chief Champlain Valley Physicians Hospital Plattsburgh, New York
Carol L. Kulp-Shorten, M.D. Assistant Professor of Medicine (Dermatology) Department of Medicine Division of Dermatology University of Louisville Louisville, Kentucky
C. Grant LaFarge, M.D., F.A.C.C., F.A.C.P., F.A.P.S. Pediatric Cardiologist Department of Pediatrics, Cardiology Santa Fe Pediatric Cardiology, PC Santa Fe, New Mexico Clinical Professor of Internal Medicine and Pediatrics University of New Mexico
Patricia L. Lamb, M.D. Attending Staff Physician W.A. Foote Memorial Hospital Jackson, Michigan Clinical Instructor, University of Michigan Emergency Services
Ann Arbor, Michigan
Alta Bates Medical Center Berkeley, California
Steven H. Lesser, M.D., F.A.C.E.P. Associate Professor Medicine Section of Emergency Medicine Charity Hospital of New Orleans Louisiana State University New Orleans, Louisiana
David G. Levine, M.D., F.A.P.A. Associate Clinical Professor Department of Psychiatry University of California Medical Center San Francisco, California
Lawrence M. Lewis, M.D., F.A.C.E.P. St. Louis University Hospital St. Louis, Missouri

Clinic of Anesthesiology University of Mainz Mainz, Germany
George I. Litman, M.D., F.A.C.C. Professor of Medicine Chief of Cardiology
Akron General Medical Center Northeastern Ohio Universities College of Medicine
Akron, Ohio
Milton N. Luria, M.D., F.A.C.P. Professor Emeritus of Medicine Department of Medicine University of Rochester School of Medicine and Dentistry Rochester, New York
Robert C. Luten, M.D. Professor, Pediatric Emergency Services University of Florida Health Science Center Jacksonville, Florida
William MacAusland, M.D. Faulkner Hospital Jamaica Plain, Massachusetts
John C. Maino II, M.D., F.A.C.E.P. Associate Medical Director Department of Emergency Medicine W.A. Foote Memorial Hospital University of Michigan School of Medicine Jackson, Michigan
Mark Mandell, M.D., F.A.C.E.P. Chairman and Program Director Department of Emergency Medicine Morristown Memorial Hospital Morristown, New Jersey
Mary Anne Mangelsen, Ph.D., M.D. Clinical Assistant Professor of Emergency Medicine Department of Emergency Medicine University of Michigan
Ann Arbor, Michigan
John R. Mangiardi, M.D. Chief of Neurosurgery Lenox Hill Hospital Chairman Foundation for Neurosurgical Research New York, New York
Stephen J. Marks, M.D. Associate Professor of Clinical Medicine Department of Neurology New York Medical College Valhalla, New York Director Department of Neurology Saint Agnes Hospital White Plains, New York
Gary J. Martin, M.D., F.A.C.C. Professor of Medicine Chief, Division of General Internal Medicine Department of Medicine Northwestern University Medical School Northwestern Medical Faculty Foundation Chicago, Illinois
Jean T. Martin, M.D., F.A.C.E.P. Medical Director Emergency Department Centennial Healthcare Plaza Englewood, Colorado
John A. Marx, M.D. Chairman Department of Emergency Medicine Carolinas Medical Center Charlotte, North Carolina

Rajalaxmi McKenna, M.D. Associate Professor Department of Medicine and Pharmacology Former Director Venous Thrombosis, Radiohematology and Platelet Function Laboratories Hinsdale, Illinois
Susan V. McLeer, M.D. Professor and Chairman Department of Psychiatry State University of New York at Buffalo Buffalo, New York
David McMicken, M.D., F.A.C.E.P. Clinical Assistant Professor of Family and Preventive Medicine Emory University School of Medicine President, Acute Care Express Columbus, Georgia
Norman E. McSwain, Jr., M.D. Professor of Surgery Department of Surgery Tulane Medical School New Orleans, Louisiana
Craig A. Meek, M.D., F.A.C.E.P. Attending Physician Department of Emergency Medicine Brackenridge Hospital
Austin, Texas
Abdul M. Memon, M.D., F.A.C.P., F.A.C.E.P. Associate Professor Division of Emergency Medicine Department of Medicine University of Miami School of Medicine Miami, Florida
Craig S. Miller, D.M.D. Associate Professor of Oral Medicine Oral Health Science University of Kentucky College of Dentistry Lexington, Kentucky
Van H. Miller, M.D. Chairman Department of Emergency Medicine St. Francis Medical Center Lynwood, California
John A. Milton, M.D. Wills Eye Hospital Philadelphia, Pennsylvania
Howard C. Mofenson M.D., D.A.B.M.T., F.A.A.P., F.H.A.C.T. Medical Director Long Island Regional Poison Control Center Winthrop University Hospital Professor of Pediatrics and Emergency Medicine University Hospital Medical School State University of New York at Stony Brook Mineola, New York
William W. Montgomery, M.D. , F.A.C.S. John M. Merriam Professor of Otolaryngology Harvard Medical School Department of Otolaryngology Massachusetts Eye and Ear Infirmary Boston, Massachusetts
Gregory J. Moran, M.D., F.A.C.E.P. Assistant Professor of Medicine University of California Los Angeles School of Medicine Department of Emergency Medicine Division of Infectious Diseases Olive View-University of California Los Angeles Medical Center Sylmar, California
Michael W. Mulholland, M.D., Ph.D. Professor Department of Surgery University of Michigan
Ann Arbor, Michigan

Daniel G. Murphy, M.D., F.A.C.E.P. Medical Director Department of Emergency Medicine Maimonides Medical Center Brooklyn, New York
Kenneth A. Murphy, Jr., Pharm.D., B.C.P.S. Clinical Manager Department of Pharmacy W.A. Foote Memorial Hospital Jackson, Michigan
Adjunct Assistant Professor of Clinical Pharmacy Ferris State University Big Rapids, Michigan
Henry W. Murray, M.D. Professor and Associate Chairman Department of Medicine Cornell University Medical Center New York, New York
Venkat Narayan, M.D., F.A.C.S., F.I.C.S. Staff Neurosurgeon St. Vincent Hospital Santa Fe, New Mexico
Ashraf Nashed, M.D. Assistant Program Director Residency in Emergency Medicine Department of Emergency Medicine Morristown Memorial Hospital Morristown, New Jersey
Edward Newton, M.D. Vice Chairman Department of Emergency Medicine LAC and University of Southern California Medical Center Los Angeles, California
Eric Noji, M.D. World Health Organization Geneva, Switzerland
Robert A. Nozik, M.D. Clinical Professor of Ophthalmology Department of Ophthalmology University of California San Francisco Research Ophthalmologist Proctor Foundation San Francisco, California
Harold Osborn, M.D. Professor and Chairman Department of Emergency Medicine New York Medical College Valhalla, New York
Harry F. Oxer, M.A., M.B., B.Chir., F.R.C.A. Medical Director Western Australian Ambulance Service St. John Ambulance, WA Perth, Western Australia
John H. Pahira, M.D. Professor of Urology Director, Center for Kidney Stone Disease Department of Surgery Georgetown University Medical Center Washington, D.C.
Eddy D. Palmer, M.D., M.A.C.P. Private Practice Schooley’s Mt., New Jersey
M. Jevitz Patterson, M.D. Professor, Microbiology and Pediatrics Michigan State University East Lansing, Michigan
Donald R. Paugh, M.D. Department of Otolaryngology-Head and Neck Surgery Wenatchee Valley Clinic Wenatchee, Washington

Paul E. Pepe, M.D., M.P.H., F.A.C.E.P., F.C.C.M. Professor and Chairman Department of Emergency Medicine
Allegheny University of the Health Sciences Director, Emergency Services
Allegheny General Hospital Pittsburgh, Pennsylvania
Mark A. Peppercorn, M.D. Professor of Medicine Harvard Medical School Director, Center for Inflammatory Bowel Disease Division of Gastroenterology Beth Israel Deaconess Medical Center Boston, Massachusetts
Vincent Pflug, M.D.
Michael P. Poirier, M.D. Assistant Professor of Pediatrics Children’s Hospital of The King’s Daughters Eastern Virginia Medical School Norfolk, Virginia
John E. Prescott, M.D., F.A.C.E.P. Professor and Chair Department of Emergency Medicine West Virginia University School of Medicine Morgantown, West Virginia
Dennis P. Price, M.D. Attending Physician Emergency Department Bellevue Hospital Center Emergency Medical Services New York, New York
Robert P. Proulx, M.D., F.A.C.E.P. Department of Emergency Medicine St. Joseph Medical Center Burbank, California
John J. Purcell, Jr., M.D. Associate Clinical Professor of Ophthalmology St. Louis University School of Medicine St. Louis, Missouri
Les M. Puretz, D.O. Assistant Professor College of Human Medicine Michigan State University Lansing, Michigan
Theodore Rabinovitch, M.D., F.R.C.S.C. Lecturer University of Toronto Department of Ophthalmology Toronto, Ontario, Canada
Eric C. Rackow, M.D. Professor and Vice Chairman Department of Medicine New York Medical College Chairman, Department of Medicine St. Vincent’s Hospital and Medical Center New York, New York

East Lansing, Michigan
Sushma Reddy, M.D. Assistant Professor of Medicine Division of Endocrinology and Hypertension Harper and Grace Hospitals Wayne State University School of Medicine Detroit, Michigan
William Reed, M.D. Fellow in Hematology and Transfusion Medicine Department of Hematology/Oncology Children’s Hospital of Oakland Oakland, California
Bruce M. Reinoehl, M.D. Associate Professor of Medicine Michigan State University
Assistant Chairman, Emergency Department Sparrow Hospital Lansing, Michigan
Earl J. Reisdorff, M.D., F.A.C.E.P. Program Director Michigan State University, Emergency Medicine Residency Michigan Capital Medical Center, Sparrow Hospital Lansing, Michigan
Karen Rheuban, M.D. Professor of Pediatrics Department of Pediatrics University of Virginia Charlottesville, Virginia
Ronald L. Rhule, D.O., F.A.C.O.E.P. Medical Director and Chairman Department of Emergency Medicine Sparrow Hospital Lansing, Michigan
Albert W. Ritter, M.D. Emergency Medicine Staff Physician Department of Emergency Medicine Mountainside Hospital Montclair, New Jersey
James R. Roberts, M.D., F.A.A.E.M., F.A.C.M.T. Professor and Vice Chair Department of Emergency Medicine Director, Division of Toxicology
Allegheny University of the Health Sciences Mercy Health Systems Director, Institute for the Treatment of Bites and Stings Mercy Hospital of Philadelphia Philadelphia, Pennsylvania
Donald A. Romig, M.D. Associate Clinical Professor Department of Internal Medicine University of New Mexico Medical School
Monica Ann Rosenthal, M.D., F.A.C.E.P. Assistant Chief, Emergency Medicine Highland General Hospital
Assistant Clinical Professor of Medicine University of California at San Francisco Oakland, California
Richard Eric Rothman, M.D., Ph.D. Instructor Department of Emergency Medicine The Johns Hopkins University School of Medicine Baltimore, Maryland
Steven G. Rothrock, M.D., F.A.A.E.M., F.A.A.P., F.A.C.E.P. Department of Emergency Medicine Orlando Regional Medical Center Orlando, Florida Clinical Adjunct Assistant Professor Division of Emergency Medicine

University of Florida Gainesville, Florida Department of Emergency Medicine Loma Linda University School of Medicine Loma Linda, California
Bruce R. Rothwell, D.M.D., M.S.D. Director, Hospital Dentistry University of Washington Department of Restorative Dentistry Seattle, Washington
George J. Rubeiz, M.D. Assistant Professor of Medicine Wayne State University Detroit, Michigan
Wallace Rubin, M.D. Clinical Professor Department of Otolaryngology & Bio-Communications Louisiana State University School of Medicine New Orleans, Louisiana
Brent E. Ruoff, M.D., F.A.C.E.P. Associate Chief Emergency Medicine Division Washington University School of Medicine St. Louis, Missouri
Robert A. Rusnak, M.D. Associate Physician Department of Emergency Medicine Hennepin County Medical Center Minneapolis, Minnesota
Thomas D. Sabin, M.D. Clinical Professor Department of Neurology Tufts University School of Medicine Boston, Massachusetts
Peter Safar, M.D., Dr .h.c., F.C.C.M., F.C.C.P. Distinguished Professor of Resuscitation Medicine Safar Center for Resuscitation Research Pittsburgh, Pennsylvania
Arthur P. Safran, M.D. Department of Neurology Columbia-MetroWest Medical Center Framingham, Massachusetts
Douglas M. Salyards, M.D. Emergency Department W.A. Foote Memorial Hospital Jackson, Michigan
Joel R. Saper, M.D. Director, Michigan Head-Pain & Neurological Institute
Ann Arbor, Michigan
Karin H. Satra, M.D. Associate in Clinical Dermatology Department of Dermatology Columbia Presbyterian Medical Center New York, New York
Michael R. Sayre, M.D. Assistant Professor Department of Emergency Medicine University of Cincinnati Cincinnati, Ohio
Marie D. Schafle, M.D. Director, Sports and Performing Arts Clinic Student Health Service San Francisco State University San Francisco, California
Richard K. Scher, M.D. Professor of Clinical Dermatology Department of Dermatology College of Physicians and Surgeons Columbia University New York, New York

John M. Schoffstall, M.D. Assistant Professor Department of Emergency Medicine
Kathleen S. Schrank, M.D., F.A.C.E.P., F.A.C.P. Professor of Medicine Division of Emergency Medicine University of Miami School of Medicine Miami, Florida
Bernard M. Schuman, M.D., F.A.C.P., M.A.G.G. Professor of Medicine Department of Medicine Director, Special Procedures and Endoscopy Unit Section of Gastroenterology and Hepatology Medical College of Georgia
Augusta, Georgia
Theresa M. Schwab, M.D. Associate Professor of Medicine Department of Emergency Medicine University of California San Francisco University Medical Center Fresno, California
George R. Schwartz, M.D. Director Emergency Medicine of the Southwest Santa Fe, New Mexico
Adjunct Associate Professor of Emergency Medicine Allegheny University of the Health Sciences Philadelphia, Pennsylvania
T. Duncan Sellers, Jr., M.D., F.A.C.C. Electrophysiologist Department of Cardiology Memorial Hospital Colorado Springs, Colorado
Paul N. Seward, M.D., F.A.C.E.P., F.A.A.P. Clinical Assistant Professor of Emergency Medicine Medical College of Georgia Emergency Department University Hospital
Augusta, Georgia
Sid M. Shah, M.D., F.A.C.E.P. Assistant Clinical Professor College of Human Medicine Michigan State University Michigan Capital Medical Center Lansing, Michigan
Arthur G. Shapiro, M.D., F.A.C.O.G., F.A.C.E. Department of Obstetrics and Gynecology University of Florida School of Medicine Miami, Florida
Philip Shayne, M.D., F.A.C.E.P. Assistant Professor Division of Emergency Medicine Emory University School of Medicine
Atlanta, Georgia
Daniel J. Shea, M.D., F.A.C.E.P. Assistant Professor of Emergency Medicine University of Massachusetts Medical School
Associate Director, Emergency Services St. Luke’s Hospital New Bedford, Massachusetts
Philip D. Shenefelt, M.D., M.S. Associate Professor Division of Dermatology and Cutaneous Surgery Department of Internal Medicine University of South Florida Tampa, Florida
Suzanne Moore Shepherd, M.D., F.A.C.E.P. Associate Professor and Program Director Department of Emergency Medicine University of Pennsylvania Medical Center Philadelphia, Pennsylvania
Mukarem A. Siddiqui, M.D. Harvey Silverman, M.D.
Adjunct Assistant Professor of Clinical Medicine

Dartmouth Medical School Emergency Physician Catholic Medical Center Manchester, New Hampshire
Jeffrey Sipsey, M.D. Los Angeles County Department of Health Sciences Emergency Medical Services Medical Alert Center Los Angeles, California
Morton S. Skorodin, M.D. Staff Physician
Ambulatory Care Service Muskogee VA Medical Center Muskogee, Oklahoma Professor of Medicine Department of Medicine University of Oklahoma Tulsa Medical College Tulsa, Oklahoma
Nathan C. Skorodin, Pharm.D. Clinical Pharmacist Heartland Home Infusions Hinsdale, Illinois
John E. Smialek, M.D. Professor and Head Division of Forensic Pathology Department of Pathology University of Maryland School of Medicine Baltimore, Maryland
Martin Smilkstein, M.D., A.C.M.T. Associate Professor of Emergency Medicine Department of Emergency Medicine Oregon Health Sciences University Portland, Oregon
Michael C. Smith, M.D. Director, Rush Epilepsy Center Department of Neurological Sciences Rush-Presbyterian-St. Luke’s Medical Center
Associate Professor Department of Neurological Sciences Rush Medical College Chicago, Illinois
Ronald K. Smith, D.O., F.A.C.E.P. Quality Improvement Coordinator Department of Emergency Medicine Westmoreland Regional Hospital Greensburg, Pennsylvania
Steven B. Sorin, M.D. Assistant Professor of Medicine Case Western Reserve University Chief of Rheumatology Mt. Sinai Medical Center Cleveland, Ohio
Steven M. Sornsin, M.D., F.A.C.E.P. Highland General Hospital Oakland, California
James R. Sowers, M.D. Professor of Medicine and Physiology Director, Division of Endocrinology, Metabolism and Hypertension Department of Internal Medicine Wayne State University School of Medicine Detroit, Michigan
George L. Spaeth, M.D., F.A.C.S. Professor of Ophthalmology Jefferson Medical College Director, William Anna Goldberg Glaucoma Service Wills Eye Hospital Philadelphia, Pennsylvania
Thomas M. Stein, M.D., F.A.C.E.P. Director, Emergency Medical Support Services Medical Director Life Flight Department of Emergency Medicine
Allegheny University of the Health Sciences Allegheny Campus Pittsburgh, Pennsylvania

Michael J. Sullivan, M.D. W.A. Foote Memorial Hospital
Ann Arbor, Michigan
Panagiotis N. Symbas, M.D. Professor of Cardiothoracic Surgery Department of Cardiothoracic Surgery Emory University School of Medicine Director Department of Cardiothoracic Surgery Grady Memorial Hospital
Atlanta, Georgia
James V. Talano, M.D., M.M., F.A.C.C. Chief, Division of Cardiovascular Medicine Department of Medicine Tulane University Medical School New Orleans, Louisiana
Satyanarayana Tatineni, M.D., F.A.C.C., F.A.C.P. Department of Cardiology The Heart Group Evansville, Indiana
Craig A. Taylor, M.D. Community Neuropsychiatric Services, Inc. Leetsdale, Pennsylvania
Steven A. Telian, M.D. University of Michigan W.A. Foote Memorial Hospital
Ann Arbor, Michigan
Knox Todd, M.D., M.P.H. Associate Professor Department of Emergency Medicine Emory University School of Medicine
Atlanta, Georgia
Christopher Truss, M.D. Professor of Medicine Department of Medicine University of Alabama at Birmingham Birmingham, Alabama
James R. Tryon, M.D., F.A.C.E.P. New Mexico Family Practice Associates, Inc.
Alan J. Tuchman, M.D. Professor of Neurology New York Medical College Valhalla, New York
James R. Ungar, M.D., F.A.C.E.P. Co-Director Center for Emergency Medicine
Assistant Medical Director Air Med Team Redding Medical Center Redding, California
Audrey Urbano-Brown, M.D., F.A.C.E.P. Assistant Professor Department of Emergency Medicine University of New Mexico School of Medicine

James P. Valeriano, M.D. Associate Professor Department of Neurology
Michel Vandormael, M.D. Hôpital de la Citadelle Liege, Belgium
Jonathan Vargas, M.D., F.A.C.E.P. Clinical Associate Professor of Emergency Medicine Wright State University Dayton, Ohio
David L. Vesely, M.D., Ph.D., F.A.C.P., F.A.C.E. Professor of Medicine, Physiology and Biophysics Department of Internal Medicine Chief of Endocrinology and Metabolism University of South Florida for Health Sciences Tampa Veterans Administration Hospital Tampa, Florida
Elliott P. Vichinsky, M.D. Director Department of Hematology/Oncology Children’s Hospital of Oakland Oakland, California
Raymond N. Vitullo, M.D. Duke University Medical Center Durham, North Carolina
George L. Voelz, M.D. Occupational Health Specialist Occupational Medical Group Los Alamos National Laboratory Los Alamos, New Mexico
Stephanie von Ammon Cavanaugh, M.D. Professor and Chief, Section of Psychiatry and Medicine Department of Psychiatry Rush Presbyterian St. Luke’s Medical Center Chicago, Illinois
Michele R. Wadsworth, M.D. Assistant Professor of Pediatrics Eastern Virginia Medical School Norfolk, Virginia
Russel G. Wagner, M.D. Assistant Professor Department of Emergency Medicine University of Alabama at Birmingham Birmingham, Alabama
Kristi Watterberg, M.D. Associate Professor Department of Pediatrics, Division of Newborn Medicine Pennsylvania State University College of Medicine Hershey, Pennsylvania
Marvin A. Wayne, M.D., F.A.C.E.P. Clinical Associate Professor University of Washington Clinical Assistant Professor Yale University Medical Director of Emergency Medical Services Bellingham, Washington Senior Attending Emergency Department St. Joseph Hospital Bellingham, Washington
Arthur W. Weaver, M.D. University Health Center Detroit, Michigan

Nashville, Tennessee
Scott S. Weissman, M.D. Associate Director Department of Ophthalmology New York Eye and Ear Infirmary New York, New York
Howard A. Werman, M.D. Associate Professor of Clinical Emergency Medicine The Ohio State University College of Medicine and Public Health Columbus, Ohio
Mark Westfall, M.D. Department of Emergency Medicine Mercy Hospital Dubuque, Iowa
J. Marcus Wharton, M.D. Duke University Medical Center Durham, North Carolina
Stephen J. Wheeler, M.D. Department of Emergency Medicine Royal Jubilee Hospital Victoria, Canada
Robert R. Whipkey, M.D., F.A.C.E.P. Director, Department of Emergency Medicine Westmoreland Regional Hospital Greensburg, Pennsylvania
Michael E. Whiting, M.D. Staff Physician Emergency Department St. Vincent Hospital Santa Fe, New Mexico
Louis J. Wilson, M.D. Fellow in Gastroenterology Department of Medicine University of Alabama Birmingham Birmingham, Alabama
Christopher K. Wuerker, M.D., F.A.C.E.P. Assistant Clinical Professor of Emergency Medicine George Washington University Medical Center Medical Director MedSTAR Transport Washington Hospital Center Washington, D.C.
Georges S. Yacoub, M.D. Chief Fellow, Pulmonary and Critical Care Medicine Department of Internal Medicine Wayne State University Detroit, Michigan
Robert J. Zimmerman, M.D. Department of Emergency Medicine MetroHealth Medical Center Cleveland, Ohio
David N. Zull, M.D., F.A.C.E.P. Associate Professor of Medicine Northwestern University
Associate Firm Chief (Medicine) Northwestern Memorial Hospital Chicago, Illinois

Dedication
This work is dedicated to the men and women who have worked ardently to make this edition happen; to the editors, secretaries, typesetters, production people, and in particular Joyce Murphy and Helen Powers. To shorten, refine, and distill the textbook has been a difficult assignment, and one needed by the practitioners of
emergency medicine. This work also is dedicated to the men and women who practice emergency medicine—those who labor joyfully to help their patients and advance their chosen field.
Theodore Roosevelt said:

George R. Schwartz, M.D. Director, Emergency Medicine of the Southwest
Santa Fe, New Mexico Partner, Brain Resuscitation Research, LLC
Sewickley, Pennsylvania Adjunct Associate Professor of Emergency Medicine

Associate Editors
Barbara K. Hanke, M.D. Staff Emergency Physician St. Vincent Hospital Santa Fe, New Mexico Clinical Assistant Professor of Family and Community Medicine University of New Mexico School of Medicine
Thomas A. Mayer, M.D. Professor of Emergency Medicine and Pediatrics Georgetown University School of Medicine George Washington University School of Medicine Washington, D.C. Chairman Department of Emergency Medicine, Fairfax Hospital Falls Church, Virginia
James S. Cohen, M.D. Attending Physician Saratoga Emergency Physicians Saratoga Springs, New York
John Dale Dunn, M.D., J.D. Director Emergency Services and Physician Advisor Brownwood Regional Medical Center Brownwood, Texas
Joseph C. Howton, M.D. Assistant Clinical Professor of Medicine Department of Medicine University of California School of Medicine San Francisco, California
Attending Physician Department of Emergency Medicine Good Samaritan Hospital Puyallup, Washington
Daniel J. Isaacman, M.D. Division Director Pediatric Emergency Medicine Children’s Hospital of the King’s Daughters
Associate Professor of Pediatrics Eastern Virginia Medicine School Norfolk, Virginia
Paul B. Roth, M.D. Dean, University of New Mexico, School of Medicine
Associate Vice President for Clinical Affairs, Health Sciences Center Professor of Emergency Medicine Director, Center for Disaster Medicine Department of Emergency Medicine University of New Mexico Medical Center
Steven G. Rothrock, M.D. Department of Emergency Medicine Orlando Regional Medical Center Orlando, Florida Clinical Adjunct Assistant Professor Division of Emergency Medicine University of Florida Gainesville, Florida Department of Emergency Medicine Loma Linda University School of Medicine Loma Linda, California
James R. Ungar, M.D. Co-Director Center for Emergency Medicine

PREFACE
The Fourth Edition of Principles and Practice of Emergency Medicine breaks new ground with a refined and streamlined edition. Clinical usefulness has been the touchstone. We have maintained the encyclopedic and authoritative nature of the previous editions, but have aimed for a single, user-friendly volume, which brings the essential knowledge, time orientation, and procedures required for emergency medicine. To help achieve our goals we have expanded our use of tables, guidelines, charts, radiographs and photographs.
We have listened to our readers who require “cutting-edge” accessible information in a single volume rather than ponderous presentations in a multivolume format. The use of capsules, heads, and subheads allows easier indexing and rapid availability of needed information. Clinical pitfalls have been highlighted as have medical-legal pearls. Whenever possible, we have offered access to ways to network, including databases, national contact telephone numbers, and Internet addresses. The field of emergency medicine has changed to include many experienced and board-certified practitioners who do not need the extensive pathophysiology found in prior editions.
This edition of Principles and Practice of Emergency Medicine has a new section on “tips and techniques” that organizes information on common emergency conditions, such as foreign bodies in the skin, eyes, ears, esophagus, airway, and nose and a new chapter dealing with the most common ingestion—that of coins, in an accessible format. Aspirated foreign bodies are an important focus (e.g., balloons in children), and a chapter is devoted to this life-threatening event. Common techniques such as reduction of jaw dislocation and epistaxis are presented in easy-to-use formats. At the beginning of each chapter the usual emergency procedures (e.g., emergency delivery leads the obstetrics/gynecology section, emergency burr-holes leads the neurology/neurosurgery section) are presented to allow the reader rapid access to that information.
The emergency medicine services (EMS) section has changed to a focussed format that shows what can be done in the field to aid survival in acute illness and injury based on scientific data—with all of the “bells and whistles” we are now looking at what actually works.
Nine additional associate editors who are active practitioners as well as scholars have contributed to this edition. All of the editors understand the reality of being faced with myriad emergencies in a busy emergency department (ED) where the emergency physician is alone and is the “trauma center” instead of being in an academic environment where multiple specialists are seconds away. As a result, the tendency to be “academic” and not practical has been avoided.
Time and critical decision making have been an important focus. What is the time of appendiceal perforation, how much time is there for a successful outcome from a leaking abdominal aortic aneurysm, how much time for successful thrombolytic therapy in myocardial infarction and stroke? How long is the time period to treat meningitis to avoid complications? The flowering of the art of the emergency physician has always been that of understanding the added dimension of time and the need for rapid diagnosis and action.
Changes in health care have been rapid. To this end we have completely revised and updated the sections related to management and added new sections on practice parameters, guidelines, and standards as well as the various regulations with which we must live.
On this twentieth anniversary year of our first edition, we hark back to the original reviews that hailed the publication of the first textbook defining clinical standards in emergency medicine. Now, in the fourth edition, Principles and Practice of Emergency Medicine is still the book for the clinical practitioner who wants rapid, authoritative standard-of-care answers. We have created a lean and ready work. With its comprehensive and encyclopedic coverage, the fourth edition of Principles and Practice of Emergency Medicine will be the book used in the emergency department — open on the desk, coffee stained, cover frayed, but ready for action—ready for the man or woman “in the arena.”

ACKNOWLEDGMENTS
To shorten, consolidate, and focus an expansive textbook such as the Principles and Practice of Emergency Medicine was a formidable task as we were going into the fourth edition. There are many books published, and we were acutely aware that most don’t survive into multiple editions, but Principles and Practice of Emergency Medicine had weathered some storms since the first edition in 1978. As the original comprehensive text in emergency medicine, our task was to adjust to the changing need for rapid and focused access to pertinent material in the most convenient form, rather than continue with a two-, three -, or even four-volume unwieldy format.
Kathleen Schwartz, my indomitable wife, kept the work on course and Corie Conwell used her formidable computer skills to allow a worldwide search in new areas. Family is all important, and our many children helped in the ways they could. As we had changed publisher (to Williams and Wilkins) there were many adjustments to be made. Katey Millet, editor, took the project on with energy and stamina, and when she needed a leave, Joyce Murphy, managing editor, filled the breach and worked to keep the book on a reasonable schedule and edited, coordinated, and stepped in wherever there was a need. Keith Murphy ably assisted Joyce (no relation) as she and Katey encouraged, cajoled, and ordered essential cutting and shortening. For this I am very grateful, and they did it all with charm, grace, and continued good humor.
As to the many accomplished contributors who took the time to update or develop their chapters, these thanks are a humble tribute. The associate editors listed on the cover helped to bring forgotten areas to light and entered in at important stages. Drs. James Ungar, Joseph Howton, and James S. Cohen took time out of their busy schedules and came to Santa Fe to help steer the fourth edition.
Certainly the previous editors and associates brought us to where we are today. It is a competitive world of books and Principles and Practice of Emergency Medicine throughout its three editions was able to garner superior reviews and, most important, reader feedback that confirmed the usefulness of the text. Drs. Peter Safar, Dave Wagner, Jim Roberts, and many others have helped to support these endeavors, and I take my hat off to them.
I would like to offer particular thanks to Saul Cohen, friend and attorney, who helped with legal issues and scheduling, working with Susan Gay and Ted Hutton, senior executives who took over when George Stamathis left to pursue other interests. George’s early work set the stage, and I wish to acknowledge his fervent approach.

ASSOCIATE EDITOR ACKNOWLEDGMENTS
Barbara Kate Hanke, M.D.: To my wonderful family: Rod, Austin and Will, who continue to put up with the odd hours. To all the hard-working front-line emergency physicians who find the personal motivation to work compassionately and expertly, taking care of the tides of humanity at their most vulnerable.
Thomas A. Mayer, M.D.: To my wife, Maureen, and our sons, Josh, Kevin and Gregory, whose love and support sustain me in all things.
James S. Cohen, M.D.: To Major W. Bradshaw, M.D. and Richard B. Pesikoff, M.D. “Minds are like parachutes: they work best when opened.” Thanks for being good skydivers. To Joseph Braver, M.D.: You don’t play golf or tie toe tags but your sense of ethics and clinical acumen exceeds that of any emergency physician I have ever known. To Joel R. Gernsheimer, M.D.: Your dedication to emergency medicine is an inspiration to us all. Thank you for being my residency director.
John Dale Dunn, M.D., J.D.: To Dale E. Dunn, M.D., gone now, but still my inspiration, and thanks to my love, Patty, for advice and support.
Daniel J. Isaacman, M.D.: For Fran, Alissa, and Michael. You make life wonderful. I am forever grateful for your love and support.
Steven G. Rothrock, M.D.: To Angela, for her love, support, patience, and encouragement. To the students, residents, colleagues, and mentors who are the source of my professional inspiration and growth.

Principles and Practice of Emergency Medicine
CHAPTER 1 MECHANISMS OF DYING AND TECHNIQUES OF RESUSCITATION

George R. Schwartz

Resuscitation and the Postresuscitation Syndrome Fundamental Mechanisms of Rapid Dying and Resuscitation Alternatives to Tracheal Intubation Other Airway Control Procedures Use of Open-Chest CPR
INTRODUCTION
The clinical practice of cardiopulmonary resuscitation (CPR) has been expanded to cardiopulmonary cerebral resuscitation (CPCR) ( 1). Its scientific basis, “resuscitology” (2) or “reanimatology” (3), has also expanded to encompass a variety of acute dying processes, including the derangements of the entire organism. Resuscitation potentials have also expanded beyond emergency resuscitation into prolonged life support, which is sometimes necessary with multiorgan system failure from postresuscitation disease. The derangements after cardiac arrest, in order of acute importance, involve the microcirculation, brain, cardiovascular-pulmonary system, kidneys, and the gastrointestinal, hematologic, immune, and endocrine systems. This order of importance seems different after prolonged shock-trauma states, a condition in which the brain is less likely to suffer ischemic damage but kidneys and lungs frequently fail and endocrine derangements are important. Sepsis has also gained recognition as a final common pathway in dying processes.
The scientific importance of resuscitology lies in its ability to establish the pathophysiologic mechanisms of the postresuscitation syndrome ( 4,5). This helps define the ultimate potentials and limitations of resuscitation for the treatment of cardiac arrest.
When CPR attempts inside or outside the hospital have succeeded in restoring some cerebral oxygenation within about 4 minutes of arrest, and adequate spontaneous circulation was accomplished within minutes thereafter, one-half to two-thirds of patients so treated have recovered, with central nervous system (CNS) function grossly equivalent to the prearrest state ( 6,7,8 and 9). Most of the remaining patients died before leaving the hospital from complications secondary to coma or from underlying disease. Among the long-term survivors of all CPR attempts, including the delayed attempts, about 5 to 20% seem to have a permanent major neurologic deficit ( 6,7 and 8,10), depending on the type and quality of post-CPR life support. The use of selective hypothermia will likely alter the neurologic status. Young, healthy people who suffer accidental deep hypothermia and circulatory arrest have shown little neurologic deficit even after prolonged time ( 10A).
CARDIAC ARREST
Death in the terminal stages of incurable disease does not result from sudden cardiac arrest. We define sudden cardiac arrest as “the clinical picture of abrupt cessation of circulation in a person who was not expected to die at that time” ( 1). Cardiac arrest is clinically diagnosed when the following four conditions coexist:
1. Unconsciousness (Fig. 1–1.1, Fig. 1–1.2, Fig. 1–1.3 and Fig. 1–1.4).
Figure 1–1.1. Phases and steps of cardiopulmonary-cerebral resuscitation. (See protocols for ACLS details ) (Reprinted with permission from Safar P. Cardiopulmonary cerebral resuscitation. Stavanger, Norway: Asmund S. Laerdal, 1981.)

Figure 1–1.3. Positioning of the unconscious patient. Supported supine-aligned position—for resuscitation or for an injured person. Hold the head, neck, and chest aligned with slight traction. With both hands at the sides of the face, provide a jaw thrust, open the patient's mouth, and moderate backward tilt of the head. Prevent flexion and rotation of the head. (Reprinted with permission from Safar P. Cardiopulmonary cerebral resuscitation. Stavanger, Norway: Asmund S. Laerdal, 1981.)
Figure 1&

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