Professor of emergency Medicine

Sách gồm 250 tình huống lâm sàng cấp cứu thường gặp, với những hình ảnh minh họa cụ thể và câu trả lời chi tiết. Sách rất thích hợp cho các bạn sinh viên, các bác sĩ chuyên khoa hồi sức cấp cứu, các bác sĩ nội khoa

Also in the Self-Assessment Color Review series: Brennan: Paediatric Emergency Medicine Chapman: Hepatobiliary Medicine Copley: Thoracic Medicine Evans: Clinical Anatomy Forbes: Neuroimaging Goodship: Renal Medicine Horst: General Critical Care Kitchen: Clinical Neurology and Neurosurgery Marks: Dermatology Rosen: Cardiology 2nd edition Spiro: Respiratory Medicine 3rd edition Self-Assessment Color Review The book will appeal to a wide readership, ranging from trainees to practitioners in emergency medicine or primary care, for examination revision and continuing education Adult Emergency Medicine Each case consists of one or more questions, illustrated by stimulating visual material including clinical photographs, imaging and electrocardiograms Answers and full discussion then follow covering differential and definitive diagnoses, management and subtle insights to provide optimal care and prevent complications Self-Assessment Color Review This new volume in the established and wellrespected series of Self-Assessment Color Reviews covers all aspects of adult emergency medicine Over 250 cases are presented randomly to reflect real-life practice LEARN • REVISE • REINFORCE Adult Emergency Medicine John F O’Brien O’Brien Clinical cases Problem based Fully illustrated ISBN: 978-1-84076-178-8 MANSON PUBLISHING O’Brien cover CMYK O'Brien prelims final v7.qxp:MANSON 10/24/12 8:00 PM Page Self-Assessment Color Review Adult Emergency Medicine John F O’Brien MD Associate Program Director/Emergency Medicine Residency Orlando Regional Medical Center Orlando, Florida, USA Clinical Associate Professor of Emergency Medicine University of Central Florida College of Medicine Orlando, Florida, USA Associate Professor of Emergency Medicine Faculty of Emergency Medicine University of Florida College of Medicine Gainesville, Florida, USA MANSON PUBLISHING O'Brien prelims final v7.qxp:MANSON 10/24/12 8:00 PM Page Acknowledgements I would like to thank several people who were instrumental in helping create this textbook Many of my colleagues in Orlando helped with finding interesting cases, particularly Dr Mark Clark Several emergency medicine residents served as primary reviewers for much of the material in this endeavor, particularly Dr Clifford Denney My son, Nathan O’Brien, who recently completed his medical school training at Vanderbilt University and has begun his post-graduate training in emergency medicine, was perhaps the most detailed reviewer of all The formal reviewers, Dr John Younger and Dr Peter Thomas, added many specific suggestions for improving the case discussions Peter Beynon was a great help in word crafting the discussions to make them more interesting and succinct Paul Bennett was instrumental in formatting the cases into an attractive casebook My commissioning editor at Manson Publishing, Jill Northcott, was ever supportive in helping me accomplish this complicated task Last, but most importantly, I wish to thank my wonderful wife Rhonda, who served as primary typist, organizer, and encourager Without her tremendous help it is unlikely this would have ever been completed Copyright © 2013 Manson Publishing Ltd ISBN: 978-1-84076-178-8 All rights reserved No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means without the written permission of the copyright holder or in accordance with the provisions of the Copyright Act 1956 (as amended), or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 33–34 Alfred Place, London WC1E 7DP, UK Any person who does any unauthorized act in relation to this publication may be liable to criminal prosecution and civil claims for damages A CIP catalogue record for this book is available from the British Library For full details of all Manson Publishing Ltd titles please write to: Manson Publishing Ltd, 73 Corringham Road, London NW11 7DL, UK Tel: +44(0)20 8905 5150 Fax: +44(0)20 8201 9233 Email: manson@mansonpublishing.com Website: www.mansonpublishing.com Commissioning editor: Jill Northcott Project manager: Paul Bennett Copy editor: Peter Beynon Design and layout: Cathy Martin Colour reproduction: Tenon & Polert Colour Scanning Ltd, Hong Kong Printed by: New Era Printing Company Ltd, Hong Kong CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2013 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S Government works Version Date: 20140110 International Standard Book Number-13: 978-1-84076-632-5 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made The publishers wish to make clear that any views or opinions expressed in this book by individual editors, authors or contributors are personal to them and not necessarily reflect the views/opinions of the publishers The information or guidance contained in this book is intended for use by medical, scientific or health-care professionals and is provided strictly as a supplement to the medical or other professional’s own judgement, their knowledge of the patient’s medical history, relevant manufacturer’s instructions and the appropriate best practice guidelines Because of the rapid advances in medical science, any information or advice on dosages, procedures or diagnoses should be independently verified The reader is strongly urged to consult the drug companies’ printed instructions, and their websites, before administering any of the drugs recommended in this book This book does not indicate whether a particular treatment is appropriate or suitable for a particular individual Ultimately it is the sole responsibility of the medical professional to make his or her own professional judgements, so as to advise and treat patients appropriately The authors and publishers have also attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained If any copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint Except as permitted under U.S Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers For permission to photocopy or use material electronically from this work, please access www.copyright.com (http:// www.copyright.com/) or contact the Copyright Clearance Center, Inc (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400 CCC is a not-for-profit organization that provides licenses and registration for a variety of users For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com O'Brien prelims final v7.qxp:MANSON 10/24/12 8:00 PM Page Preface The provision of competent emergency medical care is frequently both challenging and exhilarating An ever-expanding knowledge base is necessary, coupled with clinical judgement and the ability to process often quite complex information Much can be gained from experience in the emergency medicine clinical arena, and this selfassessment book attempts to assist in that endeavor through a case-based approach Using a series of common as well as more unusual presentations, this text attempts to inform and refresh the reader across the entire spectrum of adult emergency medicine Although pediatrics is not covered in these pages, a similar case book specific to children is available through this publisher Medical trainees and qualified practitioners working not only in general emergency medicine, but also in primary care and other specialties, may use these cases to test and refine their abilities to care for a wide variety of patients This book employs questions to stimulate the reader to think about the evaluation and management of each patient, using a combination of photographs, radiographs, electrocardiograms, and other data Discussions ensue, which should highlight various aspects of the case including differential diagnoses, management issues, and subtle insights to provide optimal care and prevent complications Please enjoy the ride as you assimilate much of what is necessary to practice the art of emergency medicine Note that regional variations in the provision of emergency care exist The reader should feel free to add to the learning experience by exploring the references attached to each case In addition, specific practice guidelines should be sought from reliable local resources and societies Clearly, a variety of management techniques can be thoughtfully applied to many clinical situations, and this book can only provide some evidence-based approaches John O’Brien Classification of cases Cardiology 1, 16, 45, 57, 73, 75, 91, 94, 102, 108, 112, 114, 120, 128, 131, 146, 147, 153, 157, 163, 165, 167, 176, 178, 182, 191, 197, 203, 207, 209, 217, 220, 225, 227, 232, 239, 245 Dermatology 18, 19, 24, 32, 38, 72, 76, 103, 110, 121, 127, 145, 162, 175, 181, 183, 184, 199, 208, 229, 233, 237, 242 Gastroenterology 5, 27, 35, 50, 62, 64, 74, 83, 100, 104, 115, 125, 139, 143, 151, 170, 173, 179, 195, 215, 246 Genitourinary 17, 42, 43, 47, 51, 52, 54, 71, 99, 118, 150, 161, 168, 211, 219, 231 Infectious disease 6, 11, 21, 25, 49, 68, 70, 82, 93, 101, 113, 119, 123, 124, 130, 132, 133, 152, 177, 223, 226, 250 Miscellaneous 12, 37, 41, 58, 59, 86, 87, 105, 111, 116, 141, 146, 159, 169, 189, 193, 198, 210, 221, 224, 249 O'Brien prelims final v7.qxp:MANSON 10/24/12 8:00 PM Page Neurology 23, 24, 40, 60, 66, 67, 96, 107, 166, 180, 201, 234, 235 Pulmonary 4, 30, 53, 55, 61, 65, 78, 79, 106, 109, 137, 156, 196, 212, 244 Orthopedics 2, 7, 9, 20, 28, 34, 48, 77, 80, 85, 88, 95, 98, 117, 126, 136, 138, 154, 155, 158, 171, 204, 206, 240, 243, 247 Toxicology 8, 10, 14, 22, 26, 33, 39, 69, 92, 122, 135, 144, 187, 213, 236, 248 Ophthalmology 29, 31, 44, 63, 90, 149, 160, 164, 185, 200, 205, 238, 241 Trauma 3, 13, 15, 36, 46, 81, 84, 89, 97, 129, 134, 140, 142, 172, 174, 186, 188, 190, 192, 194, 202, 214, 216, 222, 228, 230 Abbreviations ABC airway, breathing, and circulation AIDS acquired immunodeficiency syndrome beta-hCG beta human chorionic gonadotropin BP blood pressure bpm beats per minute CBC complete blood count CNS central nervous system COPD chronic obstructive pulmonary disease CPR cardiopulmonary resuscitation CSF cerebrospinal fluid CT computerized tomography DBP diastolic blood pressure ECG electrocardiogram ELISA enzyme-linked immunosorbent assay FAST focused assessment by sonography in trauma GABA gamma-aminobutyric acid HAART highly active anti-retroviral therapy HIV INR IV LAD MRA MRI NSAID NSR P Pox PCR RBCs RNA RR SAH SBP STEMI T WBCs human immunodeficiency virus international normalized ratio intravenous/intravenously left anterior descending (artery) magnetic resonance angiography magnetic resonance imaging nonsteroidal antiinflammatory drug normal sinus rhythm pulse pulse oximetry polymerase chain reaction red blood cells ribonucleic acid respiratory rate subarachnoid hemorrhage systolic blood pressure ST segment elevation myocardial infarction temperature white blood cells O'Brien final.qxp:SACR 10/16/12 10:17 PM Page 1, 2: Questions 1 A 49-year-old male had diabetes mellitus and known hyperlipidemia He presented with hours of severe precordial chest pain, shortness of breath, and nausea He appeared ill and was very diaphoretic i What does this ECG suggest (1)? ii What are indications for reperfusion therapy? 2 A 34-year-old male sustained this injury when he twisted his ankle while running (2) i What is the diagnosis? ii What associated complications are likely, and how should they be managed? O'Brien final.qxp:SACR 10/16/12 10:17 PM Page 1, 2: Answers i The ECG demonstrates normal sinus rhythm at about 70 bpm (premature atrial contraction in sixth beat) ST segments are elevated over mm in lateral leads (I and aVL), with slight reciprocal ST depression in inferior leads III and aVF T waves are inverted in leads V4 to V6 This is consistent with acute lateral wall myocardial infarction Cardiac catheterization revealed acute LAD coronary artery occlusion ii Rapid and aggressive management of acute myocardial infarction greatly reduces morbidity and mortality New ST elevation of mm or more in contiguous associated leads, in the setting of chest pain or anginal equivalents of recent onset (usually [...]... large amount of surrounding blood (15b, arrows) iii Aggressive crystalloid volume resuscitation along with CBC, coagulation studies, electrolytes, and type and crossmatch for several units of blood The patient remained hemodynamically unstable despite large volumes of crystalloid and blood, and he required emergency splenectomy 16 i This is a fine example of Twiddler’s syndrome, a rare cause of permanent... have significant neurologic deficits 24 This is an example of skin changes due to coining, or cao gio (pronounced gow yaw), a form of alternative medicine most commonly practiced in Southeast Asia In this culture it is thought to create a path for release of ‘bad wind’, believed to be the cause of illness Coining is advocated for treatment of various illnesses including colds, headaches, and fever... swelling of dead tissue makes reduction difficult Successful reduction is marked by loss of scrotal swelling, along with pain resolution Evidence of peritonitis, ongoing pain after hernia manipulation, failure of reduction, or suspected ischemic bowel dictates prompt surgical involvement (also eventually necessary for definitive surgical repair) 28 i Segond fracture, a type of vertical avulsion injury of. .. past week This was not his first time with this swelling He was off all of his medications i What is the problem here? ii What treatment does he require? 22 22 A 79-year-old male presented with weakness and difficulty walking, along with multiple episodes of nausea and vomiting He denied chest pain or shortness of breath He had a history of COPD and atrial fibrillation, for which he took prednisone,... usually recognize tibial plateau fractures CT is often necessary to further characterize degree of tibial depression, displacement of fracture parts, and help plan orthopedic repair MRI is excellent for recognition of meniscus or ligament injury Arteriography may be indicated if popliteal artery injury is suspected ii CT confirmed a surprising degree of tibial plateau depression and bony separation... applied to acupuncture sites or areas of pain As the cups cool, skin suction with resultant bruising occurs Moxibustion involves the application of heat generated by burning small bundles of herbs, or moxa, to targeted areas, thus promoting flow of blood and vital energy Many Eastern cultures have similar practices with various techniques and names Complications of these treatments are rare and mostly... proximal part of the tibia, and fractures of this important load-bearing area affect range -of- motion, stability, and alignment Careful evaluation is necessary for proper management Tibial plateau fractures are usually due to valgus stress with axial load, often from falls or trauma from automobile bumpers The lateral plateau is more commonly injured than the medial The superficial nature of the knee... in association with tears of the anterior cruciate ligament (75–100%), with concomitant injury of the medial meniscus (66–75%), along with soft tissue injuries to the posterior knee This injury is usually the result of varus stress combined with internal rotation to the knee A more rare reverse Segond fracture has also been described Here, a medial tibial avulsion is pulled off by the medial collateral... evidence of infection The immune system is quite suppressed in renal insufficiency, with occult infection common Lack of erythema, purulent discharge, or significant tenderness is common early in vascular access infection, making delayed recognition common Primary arteriovenous fistulas have the lowest rates of infection, while indwelling catheters have the highest Infection accounts for about 15% of all... cause cutaneous larva migrans Skin biopsy of the leading edge of a tract may show a larva in a burrow ii The condition is self-limiting, but most patients want rapid, effective therapy A topical 10–15% suspension of thiabendazole will decrease pruritis within 1–2 days and resolve dermatitis in a week or so For widespread cutaneous larva migrans or failure of topical therapy, oral albendazole, mebendazole,