There is, of course, more than one way to approach any patient, or any procedure, so this text is not a dictum. This book does not attempt to define standard of care. It is a compendium of self proclaimed tried and true, but occasionally prospectively tested, techniques, practical hints, and successful tactics gleaned from years of practice, all blended with a modicum of newer modalities (such as ultrasound). As with prior editions, this version also significantly incorporates the personal opinions of the authors and editors. This book is intended to help the clinician and the patients who rely upon them. It's simply a clinical guide, not a legal document. Don't reference this book if you testify in court, for either the defense or the plaintiff. Today's dogma too often becomes tomorrow's heresy, and physician hubris is worse than incompetence. Simply stated, Emergency Medicine, and the human body, too often readily defy the written word, personal opinion, or local custom, and humble even the venerable and universally praised gray haired professor.
Many new authors have been added, as well as a number of new concepts and approaches. My personal thanks are hereby conveyed to those who contributed to previous editions. The updated chapters often merely refine or further manipulate the scholarly work of others who originally assisted us. The current contributors include an enviable blend of friends and colleagues, former students of mine, up and coming stars in their own right, and my prior mentors and role models—all are accomplished physicians, and leaders in their own milieu. Most know more than I know, and most are likely infinitely more capable and facile with procedures. All are capable of writing a text themselves, but are now enlightened and eschew that primal urge since they now know how difficult it is to write even a single chapter. My able and erudite associate editors, Arjun Chanmugam, Cathy Custalow, Carl Chudnofsky, and John McManus provided the bulk of the original editing; but, in the end, my personal bias likely prevailed. If any of our editing changed, altered, or misinterpreted the original thoughts of the contributors, we apologize; but, hard decisions had to be made, and waffling was rarely an option. We attempted to squarely address such omnipresent vague topics as prophylactic antibiotics, and accepted the fact that not all foreign bodies or tendon lacerations will be identified in the heat of the moment. The prescient and sagacious clinician knows that the ability to practice medicine from a book is limited, and one learns best from past experiences; and, for certain, the most instructive past experience is one that was not textbook perfect.
James R. Roberts
FOREWORD
The emergency physician has the unique responsibility of offering his or her skills at all times to all people (young and old, friendly and hostile, rich and poor). No other health providers are always collectively there at the entrance to the hospital. As emergency physicians, our responsibilities have grown and our horizons have been expanded because of our commitment to people. We have built a system that creates a caring environment from the home to the street and to the hospital, and a system that also integrates firefighters, police officers, paramedics, nurses, clerks, students, pharmacists, and physicians into this caring service. Each new clinical problem and each creative intervention has led to innovations in thought and technical advances. The Fifth Edition of Roberts and Hedges’ text, Clinical Procedures in Emergency Medicine, takes another step in the pursuit of excellence in the provision of that care.
One of the newest chapters—the use of chemical and physical restraints demonstrates the skill of the authors in integrating the physical (the device) and the chemical (the pharmaceutical). The editors' and the authors' effective integration of the discussion of all the aspects of our care has been the hallmark of this text since the first edition. Each task is described and each goal is defined allowing for a rigorous approach as to how, why, when and with what device and pharmacologic agent each procedure is most safely and effectively performed.
The past 40 years in the history of emergency medicine have seen a remarkably rapid evolution in care. Organized medicine has often been criticized for its inability to change thought patterns and approaches to care, but the ability to change current patterns is the recognized strength of emergency physicians. We have undertaken our responsibilities, created new relationships, and developed new perspectives on clinical medicine in an area where previously no one dared to serve. This text exemplifies and describes the tremendous progress in thought, new techniques, new technology, new pharmaceuticals and their integration for the improved and safer care of the emergency patient. The rapid growth of prehospital care, the ever-increasing roles of emergency care, and the diversity of clinical issues and research dilemmas in emergency medicine have led to the development of a new type of physician in the emergency department. This text defines the breadth of investigative and clinical emergency medicine and the enormous technical skill and intellectual responsibility required of each emergency physician.
These chapters are written by emergency physicians and other physicians working closely with emergency patients who have highly specialized knowledge in particular aspects of emergency medicine. Almost a third of these authors are new contributors to this edition. The further integration of the clinical, investigative and educational roles of the emergency physician has led to the refinement of this Fifth Edition. As the basic science and clinical practice of emergency medicine have further developed, this book has grown to represent a complete view of our specialty. This text offers a balanced analysis of the entirety of the armamentarium at our disposal in the emergency department for the care of those with urgent and emergent problems. The authors attempt to simplify and clarify while focusing on knowledge and process in the environment where we practice. This text permits any practitioner the opportunity to perform his or her first emergency procedures with a foundation that emphasizes evidence and limits bias and ignorance.
This text has filled a void in medical practice. Procedural interventions in the emergency department had previously been largely undefined and certainly inadequately analyzed. The emergency physician who is trained to address the airway, an obstetrical or cardiac emergency for example will be able to utilize this text to review, better understand and develop the requisite cognitive and technical skills. Knowledge of these skills and their indications, as well as the risks and benefits of practice, will permit emergency physicians to achieve the highest level of service and will foster their potential to initiate quality research.
This book is also about motivating physicians to appreciate the clinical norms and expectations in our field. The editors have recognized for years many of the problems defined in the report To Err is Human released by the Institute of Medicine of the National Academy of Sciences in 1999. This text has moved the physician from anecdote to a rigorous analysis. The reader will not only feel more secure while performing an essential procedure with specific technical and pharmaceutical adjuncts but he or she will also become more confident about making the decision not to perform a procedure that entails more risk than benefit to an individual patient. The editors and authors have attempted to enhance education and limit the errors of commission as well as omission while improving the safety and occupational health of the emergency physician.
Recognizing that the emergency department environment is by definition unpredictable and often chaotic, these authors have prepared us to change the human response in an attempt to make errors more difficult to commit. Understanding the remarkable spectrum of responsibility of the emergency physician is our essential task. We shall succeed as health providers if we understand our patients and their needs, the pathophysiology of emergency medicine and its therapeutics, and our procedures and their pitfalls. The Fifth Edition of Roberts and Hedges’ Clinical Procedures in Emergency Medicine provides enough thought-provoking information about the task, the appropriate technology and the appropriate pharmaceutical at the appropriate dose at the right time to prepare the emergency physician to care for the emergency department patient in a humane and intellectually sound manner. Although few physicians other than emergency physicians will use all the techniques, technology and pharmaceuticals detailed in this text, many other physicians can and will profit immensely from the use of this text. The techniques are well defined, well illustrated, and well referenced by clinicians who obviously use them daily. In this edition, there are many more helpful photographs and graphics with an esthetically pleasing and visually useful commitment to colors. This text remains unique with respect to the depth and breadth with which the editors and authors critically evaluate the tools of our trade. The two leaders of our field, Roberts and Hedges, are once again assisted by four associate editors in this edition. These respected emergency physicians expand the excellent foundation of editorial contributions and ensure continued successful presentation of this complex material to help guide our clinical care.
The understanding and application of the principles defined in this edition should be considered essential for each emergency physician in his or her attempt to continuously improve the delivery of the best possible health care to our patients.
LEWIS R. GOLDFRANK, MD
Book Features
- Provides over 1,700 detailed illustrations, 1,350 in full color, allowing you to visualize procedures clearly so you can perform them correctly.
- Explains not only how to perform each rocedure but also why, when, and what other procedures you should consider.
Website Features
- Consult the book from any computer at home, in your office, or at any practice location.
- Instantly locate the answers to your clinical questions via a simple search query.
- Quickly find out more about any bibliographical citation by linking to its MEDLINE abstract.
New in this edition
- Covers the latest equipment, devices, drug therapies, and techniques, including new devices for cricothyrotomy, monitoring CPR effectiveness, intraosseous infusion, autotransfusion and transfusion therapy, and wound closure.
- Incorporates coverage of ultrasound-guided procedures throughout the book to assist you in the use of these increasingly pervasive new techniques.
- Presents a new chapter on Chemical and Physical Restraints to facilitate management of violent or aggressive patients.
- Features a brand new full-color design together with all-new algorithms, illustrations, and tables for expedited reference and streamlined clinical decision making.
- Reflects the most recent clinical evidence and guidelines for dependable decision-making guidance.
- Includes online access via Expert Consult, allowing you to rapidly reference the book's complete contents from any computer. A perfect source for quick answers in your challenging, fast-paced field!
- Offers updated coverage of tracheal intubation and infectious exposure management, so you can make spilt-second decisions on these difficult procedures.
Contents
SECTION I - VITAL SIGNS AND PATIENT MONITORING TECHNIQUES
- CHAPTER 1 - Vital Signs Measurement
- CHAPTER 2 - Devices for Assessing Oxygenation and Ventilation
SECTION II - RESPIRATORY PROCEDURES
- CHAPTER 3 - Basic Airway Management and Decision-Making
- CHAPTER 4 - Tracheal Intubation
- CHAPTER 5 - Pharmacologic Adjuncts to Intubation
- CHAPTER 6 - Cricothyrotomy and Transtracheal Jet Ventilation
- CHAPTER 7 - Tracheostomy Care
- CHAPTER 8 - Mechanical Ventilation
- CHAPTER 9 - Thoracentesis
- CHAPTER 10 - Tube Thoracostomy
SECTION III - CARDIAC PROCEDURES
- CHAPTER 11 - Techniques for Supraventricular Tachycardias
- CHAPTER 12 - Defibrillation and Cardioversion
- CHAPTER 13 - Assessment of Implantable Devices
- CHAPTER 14 - Basic Electrocardiographic Techniques
- CHAPTER 15 - Emergency Cardiac Pacing
- CHAPTER 16 - Pericardiocentesis
- CHAPTER 17 - Artificial Perfusion during Cardiac Arrest
- CHAPTER 18 - Resuscitative Thoracotomy
SECTION IV - VASCULAR TECHNIQUES AND VOLUME SUPPORT
- CHAPTER 19 - Pediatric Vascular Access and Blood Sampling Techniques
- CHAPTER 20 - Arterial Puncture and Cannulation
- CHAPTER 21 - Peripheral Intravenous Access
- CHAPTER 22 - Central Venous Catheterization and Central Venous Pressure Monitoring
- CHAPTER 23 - Venous Cutdown
- CHAPTER 24 - Indwelling Vascular Devices: Emergency Access and Management
- CHAPTER 25 - Intraosseous Infusion
- CHAPTER 26 - Alternative Methods of Drug Administration
- CHAPTER 27 - Autotransfusion
- CHAPTER 28 - Transfusion Therapy: Blood and Blood Products and Reversal of Warfarin-Induced Coagulopathy
SECTION V - ANESTHETIC AND ANALGESIC TECHNIQUES
- CHAPTER 29 - Local and Topical Anesthesia
- CHAPTER 30 - Regional Anesthesia of the Head and Neck
- CHAPTER 31 - Nerve Blocks of the Thorax and Extremities
- CHAPTER 32 - Intravenous Regional Anesthesia
- CHAPTER 33 - Systemic Analgesia and Sedation for Procedures
SECTION VI - SOFT TISSUE PROCEDURES
- CHAPTER 34 - Principles of Wound Management
- CHAPTER 35 - Methods of Wound Closure
- CHAPTER 36 - Foreign Body Removal
- CHAPTER 37 - Incision and Drainage
- CHAPTER 38 - Burn Care Procedures
SECTION VII - GASTROINTESTINAL PROCEDURES
- CHAPTER 39 - Esophageal Foreign Bodies
- CHAPTER 40 - Nasogastric and Feeding Tube Placement
- CHAPTER 41 - Balloon Tamponade of Gastroesophageal Varices
- CHAPTER 42 - Decontamination of the Poisoned Patient
- CHAPTER 43 - Peritoneal Procedures
- CHAPTER 44 - Abdominal Hernia Reduction
- CHAPTER 45 - Anorectal Procedures
SECTION VIII - MUSCULOSKELETAL PROCEDURES
- CHAPTER 46 - Prehospital Immobilization
- CHAPTER 47 - Management of Amputations
- CHAPTER 48 - Extensor and Flexor Tendon Injuries in the Hand, Wrist, and Foot
- CHAPTER 49 - Management of Common Dislocations
- CHAPTER 50 - Splinting Techniques
- CHAPTER 51 - Podiatric Procedures
- CHAPTER 52 - Injection Therapy of Bursitis and Tendinitis
- CHAPTER 53 - Arthrocentesis
- CHAPTER 54 - Compartment Syndrome Evaluation
SECTION IX - GENITOURINARY, OBSTETRIC, AND GYNECOLOGIC PROCEDURES
- CHAPTER 55 - Urologic Procedures
- CHAPTER 56 - Emergency Childbirth
- CHAPTER 57 - Culdocentesis
- CHAPTER 58 - Examination of the Sexual Assault Victim
- CHAPTER 59 - Radiation in Pregnancy and Clinical Issues of Radiocontrast Agents
SECTION X - NEUROLOGIC PROCEDURES
- CHAPTER 60 - Management of Increased Intracranial Pressure and Intracranial Shunts
- CHAPTER 61 - Spinal Puncture and Cerebrospinal Fluid Examination
- CHAPTER 62 - Special Neurologic Tests and Procedures
SECTION XI - OPHTHALMOLOGIC, OTOLARYNGOLOGIC, AND DENTAL PROCEDURES
- CHAPTER 63 - Ophthalmologic Procedures
- CHAPTER 64 - Otolaryngologic Procedures
- CHAPTER 65 - Emergency Dental Procedures
SECTION XII - SPECIAL PROCEDURES
- CHAPTER 66 - Procedures Pertaining to Hypothermia and Hyperthermia
- CHAPTER 67 - Ultrasound-Guided Procedures
- CHAPTER 68 - Bedside Laboratory and Microbiologic Procedures
- CHAPTER 69 - Standard Precautions and Infectious Exposure Management
- CHAPTER 70 - Educational Aspects of Emergency Department Procedures
- CHAPTER 71 - Physical and Chemical Restraint
APPENDIX: Commonly Used Formulas and Calculations
- Weight Conversion from Pounds to Kilograms
- Temperature Conversions from Celsius to Fahrenheit
- Calculation of the Mean Arterial Pressure
- QT and QTc Intervals
- Predicted Peak Expiratory Flow Rate
- Endotracheal Intubation and Mechanical Ventilation
- Renal Function
- Acid-Base, Fluid, and Electrolyte Balance
- Hyponatremia
- Hypernatremia
- Potassium
- Maintenance IV Fluid Rate
- Burn Patient Fluid Resuscitation
- Arterial Blood Gas Analysis
- Acid-Base Balance
- Winter's Formula
- GlasGow Coma Scale
- National Institutes of Health Stroke Score
- Diagnostic Probability
- Acknowledgment
Product Details
- Hardcover: 1416 pages
- Publisher: Saunders; 5 edition (October 6, 2009)
- Language: English
- ISBN-10: 1416036237
- ISBN-13: 978-1416036234
- Product Dimensions: 11.1 x 8.8 x 1.8 inches
List Price: $207.00