LAST MINUTE EMERGENCY MEDICINE - PART 10 doc

HEAD AND NECK 545 trauma, cancer, radiation, etc., there is a potential for bowel perforation and the risk/benefit ratio should be considered. Complications: Complications including bowel perforation, intra-abdominal viscera or pelvic organ in- juries, bleeding, vascular injury, peritonitis, hematuria, infection are potential issues. Use of ultrasound may decrease the complication risk. HEAD AND NECK Corneal Rust Ring Removal Indications: All metallic corneal FBs and rust rings should be removed in a timely fashion to avoid further damage to the cornea. Contraindications: Violation of the anterior chamber by a FB is a contraindication to removal in the ED. X-rays for intraocular FB are indicated if there is any concern for this. Complications: Avoid multiple attempts at removing stubborn rust rings, as excessive scraping or burring may cause unneeded injury. Comments: Always refer to the ophthalmologist for evaluation within 24 hours. A cycloplegic may improve ciliaryspasm and pain. The patientshould be prescribeda suitable ocular antibiotic as wellas pain medication and their tetanus status should be addressed. Control of Epistaxis Indications: When local measures fail to control epistaxis, anterior or posterior packing of the effected nares is indicated. Contraindications: No absolute contraindications. Technique: The bloody clots in the nares should be removed, with the simple technique of the patient blowing their nose unless contraindication by a sinus fracture. Further clearing of the nares can be done with suction. Topical anesthetic and vasoconstrictive agents are then used, generally by soaking cotton pledgets and placing into the nares. Locate bleeding by inspection and cauterize if possible. Pack using Vaseline gauze or any of the newer nasal tampons or balloons if bleeding persists. Complication: Patient may not be able to tolerate packing. Obstruction of sinus ostia may lead to infection. Posterior packingwill require admission toobserve for possible dislodgment into the airway and risk of hypoxia and hypercarbia. Needle Aspiration of Peritonsillar Abscess Indications: All peritonsillar abscesses require aspiration or incision and drainage. Contraindications: Most small children, patients with severe coagulopathies, and patients with severe trismus will likely need an ENT consult with possible admission to the hospital for the procedure to be done under sedation. 546 CHAPTER 20 / PROCEDURES AND SKILLS Technique: Care must be taken to avoid carotid artery injury or aspiration as this vessel is just lateral and deep to the peritonsillar abscess. A technique that may prevent this involves trimming the end of the needle cap to serve as a depth guard so that only 1 cm of the needle is protruding from the cap. The tongue should be depressed with a tongue blade, then the guarded needle should be inserted into the most superior portion of the abscess, aspirating while advancing. Tooth Replacement Indications: Any whole, avulsed permanent tooth should be replaced as soon as possible. Contraindications: A damaged tooth or socket or a fracture of the alveolar ridge is a contraindication for replacing the tooth. Technique: The tooth shouldbe transported inmilk orother transport mediasince the periodontal ligament cells will otherwise begin to die within 10 minutes. The root should be gently cleansed without suctioning and without vigorously rubbing the ligaments. The socket should be gently rinsed and the clot suctioned from it. Implantation of the tooth should be done with care to maintain proper alignment and placement. Complications: The most common complication of reimplantation is loss of the tooth. Pain, cosmetic deformity, instability of the tooth, infection, and abscess are also complications. Comments: Always arrange follow-up with a dentist or oral surgeon. A splint may be applied to the tooth to keep it in place using a cold curing periodontal packing material. Provide pain medication, antibiotics if indicated and insure that the patient’s tetanus is up to date. HEMODYNAMIC TECHNIQUES Arterial Catheter Placement Indications: The need for continuous arterial blood pressure monitoring or the need for frequent arterial blood gas sampling are the two most common indications for arterial catheter placement. Contraindications: Placement ofthe catheterin an area that is traumatized, infected,or withsevere preex- isting vascular disease is contraindicated. Avoid placement of catheter in patients with severe coagulopathies or in patients recently treated with thrombolytic therapies. Complications: Infection, bleeding, vascular injury, thrombosis formation, nerve injury, aneurysms, pseu- doaneurysms, AV fistulas are all potential complications. Comments: When attempting radial artery cannulation, if unable to cannulate the radial artery, do not attempt to cannulate the ulnar artery on the ipsilateral side, as this could cause complete arterial occlusion to the hand. Central Venous Access Indications: There are several indications for central venous access including hemodynamic monitoring, rapid high-volume fluid administration, administration of concentrated solutions that can cause irritation of peripheral veins, and need for frequent blood draws. HEMODYNAMIC TECHNIQUES 547 Contraindications: Contraindications of placement of central venous access include infection over the puncture site, an uncooperative patient, or distorted anatomy. Complications: All techniques and access sites carry the risk for potential line infection, arterial injury, nerve injury, bleeding, hemorrhage, hematoma, lymphatic injury, cardiac arrhythmia, and death. More specific complications per access site include the following. Internal Jugular: PTX, carotid artery dissection, aneurysm, CVA. Subclavian: PTX, inability to compress SC artery if punctured. Femoral: Increased infection rates compared to IJ and SC, risk for retroperitoneal hematoma. Comments: During the procedure, the physician should always have visualization of the guide wire and excessive force should not be used when inserting the guide wire. If strict sterile technique was not used, the central venous line should be removed as soon as possible upon hospital admission and this information should be passed on to the admitting physician. When available ultrasound should be used to identify the vein and confirm proper placement. Umbilical Vein Catheterization Indications: The neonate who is in shock and requires rapid administration of IV fluids, medications, or other blood products may benefit from an umbilical vein catheter. Contraindications: Signs of infection in or around the umbilical vessels, a patient older than 2 weeks of age, or the presence of other accessible vessels are contraindications to placement of an umbilical vein catheter. Technique: Three vessels should be visible: the two smaller umbilical arteries and the larger, thick-walled umbilical vein. A 3.5–5.0 Fr catheter should be inserted approximately 4–5 cm to avoid placing the tip of the catheter in the portal system. It should then be secured at the base with suture. Complications: Infection, embolism, placement of catheter in the portal system that can lead to hepatic necrosis, or perforation of great vessels or organs are possible complications. Venous Cutdown Indications: Venous cutdown can be used when venous access is necessary and peripheral or central venous access is contraindicated or cannot be obtained. Contraindications: The cutdown should not be performed over the site of a vascular injury or if there is fracture proximal to the placement site of the catheter. There should be no infection at the access site, no distortion of the anatomy, nor any history of severe bleeding disorder. Techniques: Three primary sites are commonly referred to when discussing the access of a vein via the cutdown techniques—the brachial vein at the elbow, the greater saphenous vein at the ankle, and the greater saphenous vein at the groin. Complications: The complications include the usual IV access concerns of infection, phlebitis and em- bolism, as well as possible arterial and nerve injury. 548 CHAPTER 20 / PROCEDURES AND SKILLS Intraosseous Line Placement Indications: Inability to obtain traditional means of vascular access during an emergent situation where rapid IV access is needed is the primary indication for intraosseous (IO) access. Contraindications: The intraosseous needle should not be placed in a diseased or severely osteoporotic bone, through areas of infection, burns nor in bones with fractures. Technique: The primary sites for intraosseous line placement are the proximal tibia, distal tibia, the distal femur, and the sternum. Fluids and medication need to be infused under pressure. Complications: Complications of the placement of an IO line include subperiosteal extravasation of fluid, fractures, compartment syndrome, necrosis, injury to growth plate in pediatric patients, infection, embolism, and pain. OTHER TECHNIQUES Excision of Thrombosed Hemorrhoids Indications: A painful, thrombosed hemorrhoid can be treated by local excision. Contraindications: The hemorrhoid should not be excised if the onset of pain was greater than 4 days prior to presentation, or if the hemorrhoid is not thrombosed. Large thrombosed external hemorrhoids associated with grade 4 internal hemorrhoids should not be excised, or if the patients have other anorectal comorbid conditions. Complications: Pain is a common complication and should be addressed prior to the procedure. Bleeding is also common if a hemorrhoid is not completely thrombosed. Injury to the anal sphincter, infection, and strictures may occur. Technique: In order to remove the thrombosed hemorrhoids, an elliptical incision should be made and the clot excised. Comments: After excision of a hemorrhoid, the dressing should be left in place for 1 day or until the next bowel movement. Good aftercare instructions should include sitz baths, stool softeners, proper local cleaning, and follow-up in 24 hours. Rectal Foreign Body Removal Indications: Most FBs that are inserted into the rectum will not pass on their own. Delay in treatment will likely cause more irritation and edema making removal more difficult. As a general rule, the patient should undergo procedural sedation and analgesia to facilitate relaxation. Contraindications: Found in Table 20-16. Gastrostomy Tube Replacement Indications: A gastrostomy tube should be replaced in the ED if there is accidental removal, the tube is broken, cracked or clogged, and cannot be opened. OTHER TECHNIQUES 549 TAB L E 20 -16 RECTAL FOREIGN BODIES—I NDICATIONS FOR REMOVAL IN THE OPERATING ROOM Evidence of peritonitis Large foreign body Evidence of perforation Irregularly-shaped foreign body Nonpalpable foreign body Sharp object Nonvisible foreign body Objects likely to cause damage upon removal Contraindications: An attempt to replace the tube should not be made if there is an immature tract (if original tube was placed within 1–2 weeks), if there is evidence of peritonitis, infection, abscess, or significant pain at the skin entry site. Complications: The possible complicationsof replacing a gastrostomytube include perforationof a viscous organ, peritonitis if feeding is instituted and tube is not in the stomach, disruption of the tract, obstruction if tube occludes the pylorus, hemorrhage, pain, and infection. Incision and Drainage of Subcutaneous Abscess Indications: An obvious fluctuant mass in an area with pain, tenderness, and erythema indicates an abscess that should be drained. An abscess can also be seen as a subcutaneous fluid collection on ultrasound. Contraindications: An abscess should not be drained if it involves a possible association with a mycotic aneurysm, a mass which is pulsatile, an abscess involving a joint, an area on the face in the danger trian- gle (corner of mouth to the glabella), proximity to important neurovascular bundles, and any periorbital structures. Complications: Complications that make this procedure less successful for the patient include inadequate anesthesia and pain control, inadequate size of incision, incomplete dissection so all loculations are not broken up, or not repeatedly packing the space until the wound heals. Procedural complications include scarring, septicemia, endocarditis, bleeding, and damage to neurovascular structures. Comments: Arrange follow-up for the patient in 24 hours for repacking and teaching of wound care. Packing should be changed once to twice a day. Traditionally, antibiotics were considered of no benefit unless significant cellulitis, signs of systemic infection, or other complicating factors existed. In light of the recent emergence of community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA), antibiotics may be considered in more complex abscesses or high-risk populations. The exact utility of antibiotics in these cases has not been determined at the time of this writing. Sexual Assault Examination Indications: All patients who complain of a sexual assault should have an exam. Evidence collection has the highest yield if done within 72 hours of the event. Contraindications: Patients with other life-threatening injuries may be too unstable for a formal sexual assault exam to be performed at that time. 550 CHAPTER 20 / PROCEDURES AND SKILLS Technique: The procedure involves what would be considered standard medical and psychologic care for the patient as well as evidence collection. Safety and privacy must be addressed. The patient may refuse the evidentiary exam or any intervention. A complete physical exam should be performed even when the patient does not want to pursue legal recourse. The patient should disrobe over a clean sheet and place all clothing and debris in a paper bag. The patient should be examined from head to toe, recording and photographing as necessary. A Wood lamp can be used to detect semen that will fluoresce. Any fluorescing areas should be swabbed including the oral, vaginal, and anal areas. Nail bed scrapings head hair and pubic hair combings must be collected. Colposcopy may be performed to document findings consistent with assualt. Use of toluidine blue staining can aid in detecting subtle abrasions, tears, and lacerations. The chain of evidence must be maintained for legal proceedings. All collected items should be clearly labeled and sealed and secured in locked storage until it can be turned over to law enforcement. The patient should be offered pregnancy and sexually transmitted infection prophylaxis. Complications: The physical complications of the exam are minimal. However, the psychological impact of the entire event including the patient care rendered cannot be overstated. Nail Bed Repair and Nail Trephination Indications: Injuries to the nail bed should be treated based on the extent of injury. Technique: In a simple subungal hematoma covering 2/3 or more of the nail bed, nail trephination (creating a hole through the nail to release the blood) may result in significant pain relief. If the nail has been disrupted, or if there is a significant nail bed injury, repair of the tissue with 6–0 absorbable sutures may be indicated. A common injury seen in fingers slammed in doors is an avulsion of the nail root, with an intact nail and nail bed. Cleaning and replacing the nail root into the eponychium without disrupting the firmly implanted nail is appropriate. Contraindications: Though previously thought to be a contraindication, draining a subungal hematoma associated with a tuft fracture has not been shown to result in an increased infection rate. Complications: Permanent deformation of the nail is the most common complication of any nail or nail bed procedure. Osteomyelitis is a theoretical complication that is almost never seen and antibiotics are not indicated in simple, noncrush injuries. Simple Wound Closure An extended discussion of wound closure is outside the bounds of this text. Contraindications: Lacerations that should not be closed primarily include bite or puncture wounds, wounds that occurred more than 12 hours prior to repair, and extremely contaminated wounds that cannot be adequately cleansed or are likely to become infected. Comments: Missing retained FBs and failure to irrigate/clean the wound adequately are the two most common pitfalls in wound care. Complications: The complication rate for wound closure is worsened by the following factors: increasing age, diabetes, increased laceration width, and the presence of FB in the wound. The complication rate for lacerations decreases for wounds on the head or neck. RESUSCITATION 551 RESUSCITATION Cardiopulmonary Resuscitation For 2005 Basic Life Support (BLS) guidelines, see Table 20-17. For 2005 Advanced Cardiac Life Support (ACLS) guidelines, see Tables 20-18 to 20-20. TAB L E 20 -17 2005 SUMMARY OF BLS MANEUVERS FOR INFANTS, CHILDREN, AND ADULTS FOR HEALTH- CARE PROVIDERS MANEUVER ADULT CHI LD IN FANT Airway Head tilt-chin lift. If suspected trauma, use jaw thrust Head tilt-chin lift. If suspected trauma, use jaw thrust. Head tilt-chin lift. If suspected trauma, use jaw thrust Rescue breathing without chest compressions 10–12 breaths/min (approx. 1 breath every 5–6 s) 12–20 breaths/min (approx. 1 breath every 3–5 s) 12–20 breaths/min (approx. 1 breath every 3–5 s) Rescue breathing for CPR with advanced airway 8–10 breaths/min (approx. 1 breath every 6–8 s) 8–10 breaths/min (approx. 1 breath every 6–8 s) 8–10 breaths/min (approx. 1 breath every 6–8 s) Compression rate Approximately 100/min Approximately 100/min Approximately 100/min Compression–ventilation ratio 30:2 (1 or 2 rescuers) 30:2 (single rescuer) 15:2 (2 rescuers) 30:2 (single rescuer) 15:2 (2 rescuers) Adult: Adolescent and older; Children: 1 year to adolescent; Infant: Under 1 year of age. TAB L E 20 -18 DEFIBRILLATOR ENERGY SETTINGS (MONOPHASIC) CARDIAC RHY THM IN ITIAL SUBSEQUENT SYNCHRONIZE SVT and atrial flutter (adults) 50 J 100, 200, 300, 360 J Synch SVT (pediatric) 0.5 J/kg 1 J/kg Synch Atrial fibrillation (adults) 100 J 200, 300, 360 J Synch Ventricular tachycardia and fibrillation (adults) 360 J 360 J Asynch Vent tachycardia and fibrillation (pediatrics) 2 J/kg 4 J/kg Asynch 552 CHAPTER 20 / PROCEDURES AND SKILLS TABLE 20-19 ACLS PHARMACOLOGY MEDICATION ADULT IV DOSAGE INDICATION V ASOPRESSORS Epinephrine 1 mg Repeat every 3–5 min 2–10 µg/kg/min drip VT/VF Profound bradycardia Vasopressin 40 units—one time May replace epinephrine for first or second dose VT/VF Atropine 1 mg Maximum 3 mg Asystole, PEA, Bradycardia Dopamine 2–10 µg/kg/min drip Bradycardia ANTIARRHYTHMICS Wide complex Amiodarone 300 mg: pulseless 150 mg: stable or subsequent doses VT/VF Ventricular arrhythmias Lidocaine 1.0 mg/kg: pulseless 0.5–0.75 mg/kg: stable or subsequent doses Maximum 3 mg/kg VT/VF Ventricular arrhythmias Magnesium 1–2 mg Torsades de Pointes Hypomagnesemia Narrow complex Adenosine 6 mg first dose, 12 mg second and third dose SVT Diltiazem 15–20 mg May repeat Tachycardia Metoprolol 5 mg every 5 min to total dose 15 mg Tachycardia Neonatal Resuscitation Neonatal resuscitation has a few basicprinciples. First,the newborn should be warmedas they areat increased risk of hypothermia. Bradycardia and poor tone are both most likely due to hypoxia, and so oxygenation is the primary treatment for all neonates. Endotracheal meconium suctioning is now only indicated for neonates SKELETAL PROCEDURES 553 TAB L E 20 -20 POSSIBLE CONTRIBUTING FACTORS TO CARDIAC DYSRHYTHMIA Hypovolemia Toxins Hypoxia Tamponade Hydrogen ion (acidosis) Tension pneumothorax Hypo/hyperkalemia Thrombosis Hypoglycemia Trauma Hypothermia in distress (bradycardia, respiratory distress, central cyanosis, or poor muscle tone). Epinephrine and volume are secondary treatments for ongoing bradycardia and hypotension. Hypoglycemia (<40 mg/dL) should be considered and is treated with 2–4 mL/kg of D 10 W. Naloxone should be administered if the infant is at risk of respiratory depression from maternal narcotics. SKELETAL PROCEDURES Fracture/Dislocation Immobilization Techniques Indications: There are a variety of immobilization techniques used after reduction of a fracture or disloca- tion, such as splinting, casting, slings, immobilizers, or traction. They are indicated to stabilize the reduction of a fracture, prevent loss of anatomic alignment, and to decrease bleeding, edema, and pain. Contraindications: Relative contraindications to splinting are covering a wound requiring frequent care. Circumferential casting is contraindicated in the acute setting to prevent increased pressures from edema in a close space. Complications: Skin breakdown from pressure points orunpadded splintingmaterial is a common compli- cation. Cast failure from inadequate number of layers of padding, inappropriate placement, poor lamination, or improper care should be prevented. Skin burn from the exothermic reaction of the cast material is possible if the water is too warm. Fracture/Dislocation Reduction Techniques Indications: Early reduction of fractures and dislocations will decrease pain, swelling, and bleeding. It may reduce nerve or vascular injury from traction. Additionally, early reduction will make the reduction easier due to less muscular spasm. Contraindications: The major contraindication is an indication for immediate surgical repair of the injury. Pitfalls: There arespecific reductionmaneuvers forthe various typesof fractures anddislocation. However, the underlying principles are similar for most reductions. 554 CHAPTER 20 / PROCEDURES AND SKILLS r Adequate anesthesia must be given to the patient. r Appropriate neurovascular exam should be performed prior to and after any reduction. r Steady longitudinal traction should be applied to the bones that are being reduced. r Knowledge of the muscles and tendons that apply a force on the fracture fragment will aid in successful reduction. r The physician should be aware of when the reduction technique has failed. Complications: The most common complication is failure of adequate closed reduction. This may be from fracture or joint instability, soft tissue or bony fragment entrapment in the fracture, or just due to the severity of the injury. More serious complications include injury to theneurovascular structuresor conversion of a closed fracture to an open fracture during reduction. THORACIC Transcutaneous Cardiac Pacing Indications: Transcutaneous cardiac pacing is a temporizing measure during symptomatic or unstable bradycardias that are not responsive to medications. Contraindications: Transcutaneous pacing is relatively contraindicated in significant hypothermia- induced bradycardias, as the rhythm may be physiologic and the myocardium is more prone to fibrillation. Complications: The most common complication is pain due to high-pacing current. Sedation is indicated in conscious patients. Burns can occur with poor electrode contact. Transvenous Cardiac Pacing Indications: The indications for transvenous cardiac pacing are the same as for transcutaneous pacing: symptomatic bradycardias, unresponsive to medications, caused by sinus node dysfunction, heart block, AV dissociation, and tachycardias requiring overdrive pacing. Contraindications: Patients with an irritable myocardium, such as those in hypothermia, should not be paced by this method. Procedure: Placement can be verified by EKG tracing, bedside ultrasound, or fluoroscopy. Complications: Previously listed complications of central line access are applicable in this setting. Cardiac perforation is another serious complication as is ventricular arrhythmias. Infection is also possible. Thoracostomy Tube Indications: Emergent tube thoracostomy is indicated in the treatment of a PTX, hemothorax, hemop- neumothorax, and after needle decompression of a PTX. Contraindications: Patients with a small PTX, less than 20% on chest x-ray or one only diagnosed on chest CT, may be managed conservatively without tube thoracostomy. If these patients are placed on positive pres- sure ventilation, then a thoracostomy may be indicated. In patients with atraumatic causes of PTX, the [...]... Lelyveld S, Schafermeyer RW Pediatric Emergency Medicine: A Comprehensive Study Guide, 2nd ed New York: McGraw-Hill, 2002 Tintinalli JE, Kelen G, Stapczynski JS Emergency Medicine: A Comprehensive Study Guide, 6th ed New York: McGrawHill, 2004 CHAPTER 21 OTHER COMPONENTS OF THE PRACTICE OF EMERGENCY MEDICINE ADMINISTRATION Contract Principles Contracts exist to establish and document an employment relationship... Chameides L, Elling B, Hemphill R 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Circulation 2005;112 Reichman EF, Simon RR Emergency Medicine Procedures New York: McGraw-Hill, 2004 Roberts JR, Hedges JR Clinical Procedures in Emergency Medicine 4th ed Philadelphia, PA: Saunders, 2004 Stapleton ER, Aufderheide TP, Hazinski MF, Cummins RO BLS for... 20 min from arrival in room Discharge Within 10 min from time of disposition decision Average length of stay 3.2 h Saluzzo RF, et al Emergency Department Management: Principles and Applications Elsevier, pp 201–205, 1997 Staffing: Also important to the overall process is staffing ratios within the department Approximately 70% of visits occur between 10 am and 10 pm Staffing levels during these hours should... ED They should be examined for concealed weapons and disarmed The entire unit should be locked down Documentation The primary purpose of documentation in the ED is to communicate to other healthcare providers However, documentation is also an important component of medico-legal protection and third-party payer reimbursement In addition, Joint Commission on Accreditation of Healthcare Organizations... patient should be documented as well Other documentation essentials include: r Document when the care of a patient is transferred to another physician r A specific Emergency Medical Treatment and Active Labor Act (EMTALA) form should be used to ensure that all appropriate documentation and consents are obtained for hospital transfers r The time when consultants are contacted should be documented 562 CHAPTER... THE PRACTICE OF EMERGENCY MEDICINE r Never use the medical record to assign blame to other healthcare providers for perceived errors in care Such issues should be addressed through an internal review process Adequacy of documentation can be monitored in several ways, including: r Peer review with feedback to the emergency physician r Frequency of “down-coding” as a result of inadequate documentation... between the on-scene providers and the ED On-line control falls under the responsibility of the licensed physician providing the direction Credentialing of Pre-Hospital Providers On-going credentialing is generally done by the EMS medical director There are three levels of emergency medical technician (EMT) certification For each successive level of EMT, the training is more extensive: r EMT-basic—authorized... to the patient All such attempts should be thoroughly documented Studies show that once a patient’s wait time before being seen by a physician reaches 2 hours, lawsuits increase dramatically If long wait times occur repeatedly, the system should be repaired In-house Emergency Coverage: Occasionally, emergency physicians agree to provide in-house emergency coverage for a hospital If such an agreement... of hearing, 32 mastoiditis, 179 otitis externa, 178, 258 otitis media, 178–179 perichondritis, 178 eating disorders, 366–367 Eaton-Lambert syndrome, 11 eclampsia, 106 ectopic pregnancy, 18, 310 311, 396 INDEX edema, 5–7, 9, 16, 28–29, 34–36, 52, 57–60, 91–93, 99, 101 , 106 , 110, 112, 118, 131, 135, 138, 152, 160–161, 167, 173, 175, 178, 181, 192, 196, 222–223, 233, 239, 255–256, 264, 275, 298, 314–315,... 19–22, 59, 69, 352 hematuria, 20–22, 24, 66, 103 , 105 , 125, 173, 207, 230, 356, 389–392, 397, 478–480, 545 hemodialysis, 52, 101 , 213, 223, 387, 438, 442–448, 465–467 hemodynamic techniques, 546–548 hemolysis, 113 hemolytic uremic syndrome (HUS), 21, 211, 213–215, 384, 390–391 hemophilia A, 209– 210, 270, 539 hemophilia B, 210, 270, 539 hemoptysis, 22, 26, 110, 158, 252–253, 255, 258, 346, 405, 416, 425, . Table 2 0-1 7. For 2005 Advanced Cardiac Life Support (ACLS) guidelines, see Tables 2 0-1 8 to 2 0-2 0. TAB L E 20 -1 7 2005 SUMMARY OF BLS MANEUVERS FOR INFANTS, CHILDREN, AND ADULTS FOR HEALTH- CARE. and Emergency Cardiovascular Care. Circulation 2005;112. Reichman EF, Simon RR. Emergency Medicine Procedures. New York: McGraw-Hill, 2004. Roberts JR, Hedges JR. Clinical Procedures in Emergency. Schafermeyer RW. Pediatric Emergency Medicine: A Comprehensive Study Guide, 2nd ed. New York: McGraw-Hill, 2002. Tintinalli JE, Kelen G, Stapczynski JS. Emergency Medicine: A Comprehensive Study