The Atlas of Emergency Medicine, Third Edition

Kevin J. Knoop. M.D., Program Director, Emergency Medicine Residency, Naval Medical Center, Portsmouth, VA. Lawrence B. Stack, M.D., Associate Professor of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN. Alan B. Storrow, M.D., Associate Professor of Emergency Medicine, Clinical Research Director, University of Cincinnati College of Medicine, Cincinnati, OH.

Contributors
Photography Credits
Foreword
Preface
PART 1: REGIONAL ANATOMY
1. Head & Facial Trauma, David W. Munter and Timothy D. McGuirk
Basilar Skull Fracture
Depressed Skull Fracture
Nasal Injuries
Fractures of the Zygoma
Lefort Facial Fractures
Orbital Floor Fractures
Mandibular Fractures
External Ear Injuries
Frontal Sinus Fracture
Traumatic Exophthalmos
Penetrating Facial Trauma
Uncal Herniation Syndrome
2. Ophthalmologic Conditions, Marc E. Levsky and Paul DeFlorio
Neonatal Conjunctivitis (Ophthalmia Neonatorum)
Bacterial Conjunctivitis
Viral Conjunctivitis
Epidemic Keratoconjunctivitis
Allergic Conjunctivitis
Dacryocystitis
Dacryoadenitis
Pinguecula/Pterygium
Hordeolum/Chalazion
Scleritis
Episcleritis
Acute Angle Closure Glaucoma
Anterior Uveitis (Iritis)
Anisocoria
Herpes Zoster Ophthalmicus
Ocular Herpes Simplex
Corneal Ulcer
Afferente Pupillary Defect (Marcus Gunn Pupil)
Horner Syndrome
Sixth-Nerve Palsy
Third-Nerve Palsy
3. Funduscopic Findings, David Effron, Beverly C. Forcier, and Richard E. Wyszynski
Normal Fundus
Age-Related Macular Degeneration
Exudate
Roth Spots
Emboli
Central Retinal Artery Occlusion
Central Retinal Vein Occlusion
Hypertensive Retinopathy
Diabetic Retinopathy
Vitreous Hemorrhage
Retinal Detachment
Cytomegalovirus Retinitis
Papilledema
Optic Neuritis
Anterior Ischemic Optic Neuropathy
Glaucoma
Subhyaloid Hemorrhage in Subarachnoid Hemorrhage
4. Ophthalmic Trauma, Dallas E. Peak, Christopher S. Weaver, and Kevin J. Knoop
Corneal Abrasion
Subconjunctival Hemorrhage
Corneal Foreign Body
Hyphema
Intraocular Foreign Body
Iridodialysis
Lens Dislocation
Penetrating Globe Injury
Globe Rupture
Traumatic Cataract
Eyelid Laceration
Chemical Exposure
5. Ear, Nose, & Throat Conditions, Edward C. Jauch, Sean P. Barbabella, Francisco J. Fernandez, and Kevin J. Knoop
Otitis Media
Bullous Myringitis
Cholesteatoma and Osteoma
Tympanic Membrane Perforation
Otitis Externa
Mastoiditis
Auricular Perichondritis
Herpes Zoster Oticus (Ramsay Hunt Syndrome)
Facial Nerve Palsy
Angioedema
Pharyngitis
Septal Hematoma
Diphtheria
Peritonsillar Abscess
Epiglottitis
Uvulitis
Mucocele (Ranula)
Sialoadenitis
Sinusitis
Nasal Cellulitis
6. Mouth, Edward C. Jauch and Brent E. Gottesman
A. Oral Trauma
Tooth Subluxation
Tooth Impaction (Intrusive Luxation)
Tooth Avulsion
Tooth Fractures
Alveolar Ridge Fracture
Temporal Mandibular Joint Dislocation
Tongue Laceration
Vermilion Border Lip Laceration
B. Odontogenic Infections
Gingival Abscess (Periodontal Abscess)
Periapical Abscess
Pericoronal Abscess
Buccal Space Abscess
Canine Space Abscess
Ludwig Angina
Parapharyngeal Space Abscess
C. Oral Conditions
Trench Mouth (Acute Necrotizing Ulcerative Gingivitis)
Acid Tooth Erosion (Bulimia)
Thrush (Oral Candidiasis)
Oral Herpes Simplex Virus (Cold Sores)
Aphthous Ulcers (Canker Sores)
Strawberry Tongue
Torus Palatinus
Black Hairy Tongue
Oral Cavity Piercing Complications
7. Chest & Abdomen, Stephen W. Corbett, Lawrence B. Stack, and Kevin J. Knoop
A. Chest and Abdominal Trauma
Traumatic Asphyxia
Flail Chest
Sternoclavicular Dislocation
Tension Pneumothorax with Needle Thoracentesis
Cardiac Tamponade with Pericardiocentesis
Emergency Department Thoracotomy
Diagnostic Peritoneal Lavage
Seat Belt Injury
Grey Turner Sign and Cullen Sign
Impaled Foreign Body
Abdominal Evisceration
Traumatic Abdominal Hernia
Pelvic Fracture
B. Nontraumatic Chest and Abdominal Conditions
Respiratory Retractions
Superior Vena Cava Syndrome
Situs Inversus
Apical Lung Mass
Jugulovenous Distension
Caput Medusae
Abdominal Hernias
Umbilical Hernia
Patent Urachal Duct
Sister Mary Joseph Node (Nodular Umbilicus)
Abdominal Distension
Abdominal Wall Hematoma
Pectus Excavatum
Stoma Prolapse
8. Urologic Conditions, Jeffery D. Bondesson
Testicular Torsion
Torsion of a Testicular or Epididymal Appendix
Acute Apididymitis
Orchitis
Hydrocele
Testicular Tumor
Scrotal Abscess
Fournier Gangrene
Paraphimosis
Priapism
Urethral Rupture
Fracture of the Penis
Penile Hair Tourniquet
Straddle Injury
Balanoposthitis
Penile Zipper Injury
9. Sexually Transmitted Infections & Anorectal Conditions, Diane M. Birnbaumer and Lynn K. Flowers
A. Sexually Transmitted Infections
Primary Syphilis
Secondary Syphilis
Gonorrhea
Chlamydial Infection
Genital Herpes
Lymphogranuloma Venereum
Chancroid
Condyloma Acuminata (Genital Warts)
Pediculosis
Anal Fissure
Perianal-Perirectal Abscesses
Internal-External Hemorrhoids
Prolapsed Rectum
Pilonidal Abscess
Rectal Foreign Body
Melena
10. Gynecologic and Obstetric Conditions, Robert G. Buckley and Kevin J. Knoop
A. Gynecologic Conditions
Vaginitis
Mucopurulent Cervicitis
Cervical Polyps
Bartholin Gland Abscess
Spontaneous Abortion
Genital Trauma and Sexual Assault
Uterine Prolapse
Cystocele
Rectocele
Imperforate Hymen
Ectopic Pregnancy: Ultrasonographic Imaging
Molar Pregnancy (Hydatidiform Mole)
B. Obstetric Conditions
Third-Trimester Abdominal Trauma
Emergency Delivery: Imminent Vertex Delivery--Crowning
Emergency Delivery: Normal Delivery Sequence
Breech Delivery
Umbilical Cord Prolapse in Emergency Delivery
Nuchal Cord in Emergency Delivery
Shoulder Dystocia in Emergency Delivery
Postpartum Perineal Lacerations
Intrauterine Fetal Demise
11. Extremity Trauma, Neha P. Raukar, George J. Raukar, and Daniel L. Savitt
Acromioclavicular Joint Separation
Shoulder Dislocation
Elbow Fractures
Elbow Dislocation
Biceps Tendon Rupture
Forearm Fractures
Fractures of the Distal Radius
Carpal and Carpometacarpal Dislocations
Clenched Fist Injury (Fight Bite)
Boxer's Fracture
Peripheral Nerve Injury
Bennett and Rolando Fractures
Boutonniere and Swan-Neck Deformities
High-Pressure Injection Injury
Gamekeeper's Thumb (Skier's Thumb)
Phalangeal Dislocations
Mallet Finger and Jersey Finger
Compartment Syndrome
Subungual Hematoma
Hip Dislocations
Hip Fracture
Knee Extensor Injuries
Patellar Dislocations
Knee Dislocation
Femur Fracture
Tibial-Fibular Fractures
Fracture Blisters
Achilles Tendon Rupture
Ankle Dislocation
Calcaneus Fracture
Ankle Sprain
Fractures of the Fifth Metatarsal Base
Lisfranc Fracture-Dislocation
Amputations
12. Extremity Conditions, Robert J. Tubbs, Daniel L. Savitt, and Selim Suner
Cellulitis
Felon
Gangrene
Gas Gangrene (Myonecrosis)
Necrotizing Fasciitis
Crystal-Induced Synovitis (Gout and Pseudogout)
Ingrown Toenail (Onychocryptosis)
Lymphangitis
Lymphedema
Olecranon and Prepatellar Bursitis
Palmar Space Infection
Tenosynovitis
Paronychia
Subclavian Vein Thrombosis
Cervical Radiculopathy
Digital Clubbing
Phlegmasia Dolens
Deep Venous Thrombosis
Dupuytren Contracture
Achilles Tendonitis
Ganglion (Synovial) Cyst
Raynaud Disease
Arterial Embolus
13. Cutaneous Conditions, J. Matthew Hardin
Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis
Erythema Multiforme
Fixed Drug Eruption
Drug Eruptions
Hidradenitis Suppurativa
Pyogenic Granuloma
Pyoderma Gangrenosum
Seborrheic Dermatitis
Psoriasis
Nummular Eczema/Xerotic Eczema
Dyshydrotic Eczema
ID Reaction
Atopic Dermatitis
Statis Dermatitis
Acne Vulgaris
Vasculitis (Leukocytoclastic Vasculitis)
Idiopathic Thrombocytopenic Purpura
Thhrombotic Thrombocytopenic Purpura
Pityriasis Rosea
Livedo Reticularis
Urticaria, Dermatographism, and Angioedema
Allergic Contact Dermatitis
Phytophotodermatitis and Phototoxic Drug Reactions
Erythema Nodosum
Erythema Chronicum Migrans
Rocky Mountain Spotted Fever
Disseminated Gonococcus
Infective Endocarditis
Erysipelas
Hot Tub Folliculitis
Ecthyma Gangrenosum
Secondary Syphilis
Dissecting Cellulitis of the Scalp
Squamous Cell Carcinoma
Basal Cell Carcinoma
Melanoma
Herpes Zoster
Nongenital Herpes Simplex Infections
Autoimmune Bullous Diseases
Sweet Syndrome
Dermatophyte Infections
Tinea (Pityriasis) Versicolor
Onychomycosis
Vitiligo
Scabies and Norwegian Scabies
Uremic Frost
Bacillus Anthracis (Anthrax)
Intertrigo
Abdominal Striae (Striae Atrophicae)
Melasma
Jaundice
Alopecia
Systemic Lupus Erythematosus
Porphyria Cutanea Tarda
PART 2: SPECIALTY AREAS
14. Pediatric Conditions, Matthew R. Mittiga, Javier A. Gonzalez del Rey, and Richard M. Ruddy
A. Newborn Conditions
Erythema Toxicum Neonatorum
Salmon Patches(Nevus Simplex)
Neonatal Jaundice
Neonatal Milk Production (Witch's Milk)
Neonatal Mastitis
Umbilical Granuloma
Hypertrophic Pyloric Stenosis
B. Rashes and Lesions
Erythema Infectiosum (Fifth Disease)
Roseola Infantum (Exanthem Subitum)
Impetigo
Measles
Varicella (Chickenpox)
Herpes Zoster
Hand, Foot, and Mouth Disease
Cold Panniculitis (Popsicle Panniculitis)
Herpetic Gingivostomatitis
Meningococcemia
Urticaria
Staphylococcal Scalded Skin Syndrome
Scarlet Fever
Blistering Distal Dactylitis
Henoch-Schonlein Purpura
Strawberry Hemangioma
Orbital and Periorbi
tal (Preseptal) Cellulitis
Branchial Cleft Cyst
Thyroglossal Duct Cyst
Cystic Hygroma (Lymphangiomas)
Cat-Scratch Disease
C. General Conditions
Epiglotitis
Retropharyngeal Abscess
Button Battery Ingestion
Membranous (Bacterial) Tracheitis
Physeal Fractures: Salter-Harris Classification
Acute Sickle Dactylitis (Hand-Foot Syndrome)
Hair Tourniquet
Failure to Thrive
Nursing Bottle Caries
Nursemaid's Elbow (Radial Head Subluxation)
Inguinal Hernia
Pinworm Infection (Enterobiasis)
Oculogyric Crisis
Kawasaki Disease
15.Child Abuse, Robert A. Shapiro, Charles J. Schubert, Kathi L. Makoroff, and Megan L. McGraw
A. Physical Abuse
Inflicted Burns
Inflicted Burns and Soft-Tissue Injuries
Lesions Mistaken for Physical Abuse
Fractures Suggestive of Physical Abuse
Inflicted Head Injury (Shaken Baby Syndrome)
B. Sexual Abuse
The Child Sexual Abuse Examination
Injuries and Findings Indicative of Penetrating Genital or Anal Trauma
C. Findings Mistaken for Sexual Abuse
Straddle Injuries
Labial Adhesions
Urethral Prolapse
Toilet Seat Injuries
Perianal Streptococcal Infection
Lichen Sclerosus Atrophicus
16. Environmental Conditions, Ken Zafren, R. Jason Thurman, and Ian D. Jones
High-Altitude Retinal Hemorrhage
High-Altitude Pulmonary Edema
High-Altitude Cerebral Edema
Hypothermia
Frostbite
Pernio
Immersion Injury (Trench Foot)
Ultraviolet Radiation Exposure
Lightning Injuries
Large Terrestrial Animal Attacks
Coral Snake Envenomation
Pit Viper Envenomation
Black Widow Spider Envenomation
Brown Recluse Spider Envenomation
Scorpion Envenomation
Ticks
Hymenoptera Envenomation
Caterpillar, Mite, and Centipede Envenomation
Middle Ear Squeeze
Mask Squeeze
Stingray Envenomation
Sea Urchin Envenomation
Coelenterate Envenomation
Marine Dermatitis
Scorpion Fish Sting
Sea Snake Envenomation
Cephalopod Envenomation
Erysipeloid
Toxicodendron Exposure
Sporotrichosis
17. Toxicological Conditions, Saralyn R. Williams, Matthew D. Sztajnkrycer, and R. Jason Thurman
Methamphetamine Toxicity
Cocaine Toxicity
Anticholinergic (Antimuscarinic) Toxidrome
Heroin and Opioid Toxicity
Tricyclic Antidepressant Poisoning
Poisoning by B-Blocker and Calcium Channel Blocker Agents
Salicylate Poisoning
Acetaminophen Poisoning
Caustic Ingestion
Toxic Alcohol Ingestion
Cellular Asphyxiants
Methemoglobinemia
Inhalant Abuse
Hydrofluoric Acid Burns
Botulism
Arsenic Poisoning
Mercury Poisoning
Lead Poisoning
Iron Ingestion
Amatoxin Ingestion
Cardiac Glycoside Plant Ingestion
Dieffenbachia Ingestion
Jimsonweed Ingestion
Peyote Ingestion
Toxalbumin Ingestion
Vancomycin-Induced Red Man Syndrome
18. Wounds & Soft Tissue Injuries, Chan W. Park, Michael L. Juliano, and Dana Woodhall
Wound Cleaning and Irrigation
Wound Assessment
Would Foreign Bodies
Traumatic Wounds
Ear Lacerations
Lip Lacerations
Tendon Lacerations
Animal Bite Wounds
Fishhook Injuries
Simple Wound Closures
Complex Wound Closures
Wound Care Complications
Burns
Decubitus Ulcers
Electrical Injury
19. Forensic Medicine, William S. Smock and Lawrence B. Stack
Gunshot Wounds
A. Pattern Injuries of Domestic Violence, Assault, and Abuse
Sharp-Force-Pattern Injuries
Blunt-Force-Pattern Injuries
Thermal-Pattern Injuries
20. HIV Conditions, J. Michael Ballester and Roderick Morrison
Primary HIV Infection
Oral Hairy Leukoplakia
Candidiasis Associated with HIV
Kaposi Sarcoma
Toxoplasma Gondii Infection
Cryptococcal Infections
Cytomegalovirus Infections
Leishmaniasis
Herpes Zoster in HIV Patients
Eosinophilic Folliculitis
Herpes Simplex Virus in HIV Patients
Scabies
Molluscum Contagiosum
Dermatophyte (Tinea) Infections
Pneumocystis
Thrombocytopenia
Drug Reactions
Acute Necrotizing Ulcerative Gingivitis
21. Tropical Medicine, Seth W. Wright and Meg Jack
Free-Living Ameba Infection
Anemia in the Tropics
Cholera
Ascariasis
Cutaneous Larva Migrans
Cysticercosis
Dengue Fever
Elephantiasis
Epidemic Meningitis
Goiter
Leishmaniasis
Hydatid Cyst
Nontuberculosis Mycobacteria Infections
Leprosy
Malaria
Mycetoma
Myiasis
Protein Energy Malnutrition--Kwashiorkor and Marasmus
Rabies
Tropical Sporotrichosis
Tuberculosis
Tetanus
Trachoma
Tropical Snake Envenomations
Traditional Medicine in the Tropics
22. Airway Procedures, Steven J. White, Richard M. Levitan, and Lawrence B. Stack
Airway Maxim One
Airway Maxim Two
Airway Maxim Three
Airway Maxim Four
Airway Maxim Five
Laryngoscopic Orotracheal Intubation
Bougie-Assisted Intubation
Optical Stylet-Assisted Intubation
Optical Laryngoscope-Assisted Intubation
Lighted Stylets and Wands
Glidescope-Assisted Intubation
Digital (Tactile) Intubation
Laryngeal Mask Airway
Intubating Laryngeal Mask Airway
Intubating Laryngeal Airway
Esophageal-Pharyngeal Combitube Airway
Blind Nasotracheal Intubation
Nasal Flexible Fiberoptic Intubation
Transtracheal Jet Ventilation
Cricothyrotomy (Seldinger Technique)
Open Cricothyrotomy
23. ECG Abnormalities, James V. Ritchie, Michael L. Juliano, and R. Jason Thurman
Part 1: ST-T Abnormalities
Acute Anterior Myocardial Infarction
Acute Inferior Myocardial Infaraction
Acute Right Ventricular Myocardial Infarction
Acute Posterior Myocardial Infarction
Left Main Lesion
Sgarbossa Criteria for AMI in Setting of LBBB
Subendocardial Ischemia
Hyperacute T Waves
Wellens Waves
"Cerebral" T Waves
Early Repolarization
Left Ventricular Aneurysm
Pericarditis
Part 2: Conduction Disturbances
First-Degree AV Block
Type 1 Second-Degree AV Block (Mobitz I, Wenckebach)
Type 2 Second-Degree AV Block (Mobitz II)
Third-Degree (Complete) AV Block
QT Interval Prolongation
Right Bundle Branch Block
Left Bundle Branch Block(br)Left Anterior Fascicular Block
Left Posterior Fascicular Block
Ashman Phenomenon
Part 3: Rhythm Disturbances
Junctional Rhythm
Ventricular Rhythm
Paced Rhythm
Atrial Fibrillation
Atrial Flutter
Multifocal Atrial Tachycarida
Supraventricular Tachycardia (SVT)
SVT with Aberrancy
Ventricular Tachycardia
Ventricular Flutter
Torsades de Pointes
Part 4: Structural Abnormalities
Dextrocardia
Left Ventricular Hypertrophy
Right Ventricular Hypertrophy
Left Atrial Hypertrophy
Right Atrial Hypertrophy
Hypertrophic Cardiomyopathy
Brugada Syndrome
Wolff-Parkinson-White Syndrome
Part 5: ECG Abnormalities of Non-cardiac Origin
Hypothermia
Hypokalemia
Hyperkalemia
Pulmonary Embolism
Pericardial Effusion
Digoxin Effect, Toxicity
Tricyclic Antidepressant Effect
Limb Lead Reversal
Low Voltage
24. Emergency Ultrasound, Paul R. Sierzenski, Jason Gukhool, and Stephen J. Leech
Emergency Ultrasound
Trauma Ultrasound
E-Fast Window 1: Subxiphoid-Cardiac (Subcostal View)
E-Fast Window 2: Right Upper Quadrant (Morison Pouch)
E-Fast Window 3: Left Upper Quadrant (Splenorenal View)
E-Fast Window 4: Suprapubic
E-Fast Window 5: Thorax (Right and Left)
Cardiac Ultrasound
Echo Window 1: Subxiphoid-Cardiac (Subcostal View)Echo Window 2: Parasternal Long-Axis View (PSLAx)
Echo Window 3: Parasternal Short-Axis View (PSLAx)
Echo Window 4: Apical Four-Chamber View (4AC)
Echo Window 5: Subxiphoid Long-Axis (IVC)
Gallbladder Ultrasound
Abdominal Aorta Ultrasound
Renal Ultrasound
Pelvic Ultrasound
Deep Venous Thrombosis Ultrasound
Ultrasound-Guided Venous Access
Ocular Ultrasound
Superficial Ultrasound
25. Microscopic Findings, Diane M. Birnbaumer
Microscopic Urianalysis
Synovial Fluid Analysis for Crystals
Gram Stain
Dark-Field Examination
Vaginal Fluid Wet Mount
Potassium Hydroxide Mount
Stool Examination for Fecal Leukocytes
Skin Scraping for Dermatoses and Infestations
Cerebrospinal Fluid Examination: India Ink Preparation
Cerebrospinal Fluid Examination: Wright Stain--Thin Smear for Malaria
Ferning Pattern for Amniotic Fluid
Peripheral Blood Smear for Schistocytes
Tape Test for enterobias Vermicularis Eggs
Tzanck Preparation
Index