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REICHMAN’S
EMERGENCY
MEDICINE PROCEDURES
THIRD EDITION
Eric F. Reichman
Procedures
Reichman_FM_pi-xxx.indd 1 13/08/18 6:28 PM

NOTICE
Medicine is an ever-changing science. As new research and clinical experience broaden our
knowledge, changes in treatment and drug therapy are required. The authors and the publisher of
this work have checked with sources believed to be reliable in their efforts to provide information
that is complete and generally in accord with the standards accepted at the time of publication.
However, in view of the possibility of human error or changes in medical sciences, neither the
editors nor the publisher nor any other party who has been involved in the preparation or pub-
lication of this work warrants that the information contained herein is in every respect accurate
or complete, and they disclaim all responsibility for any errors or omissions or for the results
obtained from use of the information contained in this work. Readers are encouraged to confirm
the information contained herein with other sources. For example and in particular, readers are
advised to check the product information sheet included in the package of each drug they plan to
administer to be certain that the information contained in this work is accurate and that changes
have not been made in the recommended dose or in the contraindications for administration. This
recommendation is of particular importance in connection with new or infrequently used drugs.

Procedures
Third Edition
Eric F. Reichman, PhD, MD, FAAEM, FACEP, NBPAS

Clinical Associate Professor of Emergency Medicine
Attending Physician, Department of Emergency Medicine
UT-Health
McGovern Medical School
University of Texas Health Science Center at Houston-Medical School
Voluntary Attending Physician, Emergency Department
Memorial Hermann Hospital-Texas Medical Center
Houston, Texas
New York Chicago San Francisco Athens London Madrid Mexico City
Milan New Delhi Singapore Sydney Toronto

Reichman’s Emergency Medicine Procedures, Third Edition
Copyright © 2019 by Eric F. Reichman, PhD, MD. All rights reserved. Printed in China. Except as permitted under the United States
Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a data base
or retrieval system, without the prior written permission of the editor.
1 2 3 4 5 6 7 8 9 DSS 23 22 21 20 19 18
ISBN 978-1-259-86192-5
MHID 1-259-86192-9
This book was set in Minion Pro by Cenveo Publisher Services.

The editors were Amanda Fielding and Kim J. Davis.
The production supervisor was Catherine Saggese.
Project management was provided by Shivani Salhotra and Neha Bhargava, Cenveo Publisher Services.
The illustrations were done by Susan Gilbert, CMI.
This book is printed on acid-free paper.
Library of Congress Cataloging-in-Publication Data

Names: Reichman, Eric F., editor.
Title: Reichman’s emergency medicine procedures / [edited by] Eric F.
Reichman.
Other titles: Emergency medicine procedures.
Description: Third edition. | New York : McGraw-Hill Education, [2019] |
Preceded by Emergency medicine procedures / [edited by] Eric F. Reichman.
2nd. ed. c2013. | Includes bibliographical references and index.
Identifiers: LCCN 2018024915 (print) | LCCN 2018025655 (ebook) | ISBN
9781259861932 (ebook) | ISBN 1259861937 (ebook) | ISBN 9781259861925
(hardback : alk. paper) | ISBN 1259861929 (hardback : alk. paper)
Subjects: | MESH: Emergency Medicine—methods
Classification: LCC RC86.7 (ebook) | LCC RC86.7 (print) | NLM WB 105 | DDC
616.02/5—dc23
LC record available at https://lccn.loc.gov/2018024915
McGraw-Hill Education Professional books are available at special quantity discounts to use as premiums and sales promotions, or for use
in corporate training programs. To contact a representative, please visit the Contact Us pages at www.mhprofessional.com.

To my wife, Kristi. Thanks for your patience and help.
I appreciate your tolerance with the mess from all the papers and files and
your trips for printer paper. Thanks for your support and understanding.
Thanks to Phoebe, Joey, Ken, Russ, Rick, Kobi, and Freya
for the help and entertaining me each day.

Contents
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii 19 Confirmation of Endotracheal Intubation. . . . . . . . . . . . 139

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxix Tarlan Hedayati
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxx 20 Video Assisted Orotracheal Intubation Devices . . . . . . . . . 147
Pholaphat Charles Inboriboon and Curtis Blake Buchanan
SECTION 1 Introductory Chapters . . . . . . . . . . . . . . . . . . 1 21 Fiberoptic-Assisted Endotracheal Intubation Devices . . . . . 163
1 Informed Consent . . . . . . . . . . . . . . . . . . . .......1 Igor V. Kolesnikov, Gennadiy G. Voronov, and Ned F. Nasr
Eric Isaacs 22 Endotracheal Tube Intubating Introducers and Bougies . . . . 170
2 Against Medical Advice . . . . . . . . . . . . . . . . .......8 Marco Mikhael, Gennadiy G. Voronov, and Ned F. Nasr
Ryan P. Kirby, Jessica J. Kirby, and Richard Dean Robinson 23 Digital (Tactile) Orotracheal Intubation. . . . . . . . . . . . . 178
3 Family Presence . . . . . . . . . . . . . . . . . . . . . . . . . . 15 James A. Heilman, Beech S. Burns, and O. John Ma
Yanina Purim-Shem-Tov and Louis G. Hondros 24 Lighted Stylet Intubation . . . . . . . . . . . . . . . . . . . . 181
4 Procedures on Recently Deceased . . . . . . . . . . . . . . . . 18 Jaroslav Tymouch, Gennadiy G. Voronov, and Ned F. Nasr
Bryan Darger and Eric Isaacs 25 Supraglottic Airway Devices . . . . . . . . . . . . . . . . . . 187
5 Aseptic Technique . . . . . . . . . . . . . . . . . . . . . . . . . 20 Fred A. Severyn
John S. Rose 26 Laryngeal Mask Airways . . . . . . . . . . . . . . . . . . . . 193
6 Basic Principles of Ultrasonography . . . . . . . . . . . . . . . 28 Ned F. Nasr, Gennadiy G. Voronov, and Luis Sequera-Ramos
Basem F. Khishfe 27 Double Lumen Airway Tube Intubation . . . . . . . . . . . . . 211
7 Ultrasound Assisted Procedures . . . . . . . . . . . . . . . . . 41 Joseph M. Weber and Katie Tataris
Jehangir Meer and Brian Euerle 28 Fiberoptic Endoscopic Intubation . . . . . . . . . . . . . . . . 217
8 Trauma Ultrasound: The FAST and EFAST Scans . . . . . . . . . . 45 Ruth E. Moncayo, Alia Safi, and Ned F. Nasr
Wesley Zeger 29 Nasotracheal Intubation . . . . . . . . . . . . . . . . . . . . 228
Ned F. Nasr, Abed Rahman, and Isam F. Nasr
SECTION 2 Respiratory Procedures . . . . . . . . . . . . . . . . 55 30 Retrograde Guidewire Intubation. . . . . . . . . . . . . . . . 236
9 Essential Anatomy of the Airway . . . . . . . . . . . . . . . . . 55 Ned F. Nasr, Anna Tzonkov, and Gennadiy G. Voronov
Divya Karjala Chakkaravarthy, Serge G. Tyler, and Isam F. Nasr 31 Percutaneous Transtracheal Jet Ventilation . . . . . . . . . . . 240
10 Basic Airway Management . . . . . . . . . . . . . . . . . . . . 61 Gennadiy G. Voronov, Tamer Elattary, and Ned F. Nasr
Christopher J. Russo 32 Cricothyroidotomy . . . . . . . . . . . . . . . . . . . . . . . 247
11 Noninvasive Airway Management . . . . . . . . . . . . . . . . 72 Charles Boland, Ned F. Nasr, and Gennadiy G. Voronov
Gennadiy G. Voronov, Tamer Elattary, and Ned F. Nasr 33 Tracheostomy . . . . . . . . . . . . . . . . . . . . . . . . . . 264
12 Pharmacologic Adjuncts to Intubation . . . . . . . . . . . . . . 79 Eric S. Levy and Christopher J. Haines
Ned F. Nasr, David W. Boldt, and Isam F. Nasr 34 Tracheostomy Care . . . . . . . . . . . . . . . . . . . . . . . 275
13 Endotracheal Medication Administration. . . . . . . . . . . . . 92 H. Gene Hern Jr and Julie K. Oliva
Megan Johnson and Shoma Desai 35 Transtracheal Aspiration . . . . . . . . . . . . . . . . . . . . 284
14 Management of the Difficult Airway . . . . . . . . . . . . . . . 98 Joseph A. Salomone III
Konstantin Inozemtsev, Gennadiy G. Voronov, and Ned F. Nasr 36 Ventilator Management . . . . . . . . . . . . . . . . . . . . 288
15 Obese Airway . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Ahmad M. Abou Leila, Abayomi E. Akintorin, and Ned F. Nasr
Charles Boland, Piotr C. Al-Jindi, and Ned F. Nasr
16 Rapid Sequence Intubation . . . . . . . . . . . . . . . . . . . 111 SECTION 3 Cardiothoracic Procedures . . . . . . . . . . . . . . 301
Ned F. Nasr, Piotr C. Al-Jindi, and Isam F. Nasr 37 Cardiac Ultrasound . . . . . . . . . . . . . . . . . . . . . . . 301
17 Delayed Sequence Intubation . . . . . . . . . . . . . . . . . 118 Basem F. Khishfe
Kevin J. Donnelly, Gennadiy G. Voronov, and Ned F. Nasr 38 Chemical Cardioversion . . . . . . . . . . . . . . . . . . . . . 313
18 Orotracheal Intubation . . . . . . . . . . . . . . . . . . . . . 121 Paul Casey and Thomas Alcorn
Hyang won Paek, Gennadiy G. Voronov, and Ned F. Nasr
vii

viii Contents
39 Automated External Defibrillation . . . . . . . . . . . . . . . 319 63 Central Venous Access . . . . . . . . . . . . . . . . . . . . . . 516

James Montoya and Molly Garcia Arun Nagdev, Craig Sisson, Benjamin Thomas, and Peter C. Wroe
40 Cardioversion and Defibrillation . . . . . . . . . . . . . . . . 324 64 Ultrasound-Guided Vascular Access. . . . . . . . . . . . . . . 541
Chirag N. Shah, Patrick J. Rogers, and Daniel S. Morrison Srikar Adhikari and Lori Stolz
41 Transcutaneous Cardiac Pacing . . . . . . . . . . . . . . . . . 330 65 Troubleshooting Indwelling Central Venous Lines . . . . . . . 559
Chirag N. Shah, Patrick J. Rogers, and Daniel S. Morrison James J. McCarthy
42 Transthoracic Cardiac Pacing . . . . . . . . . . . . . . . . . . 336 66 Accessing Indwelling Central Venous Lines . . . . . . . . . . . 563
Chirag N. Shah, Guillermo Ortega, and Daniel S. Morrison John Cruz and Chad Gorbatkin
43 Transvenous Cardiac Pacing . . . . . . . . . . . . . . . . . . . 339 67 Pulmonary Artery (Swan-Ganz) Catheterization . . . . . . . . 570
Myles C. McClelland, Thuy Tran T. Nguyen, and Alfred Coats III J. Elizabeth Neuman and Jessica Mann
44 Transesophageal Cardiac Pacing . . . . . . . . . . . . . . . . 348 68 Noninvasive and Minimally Invasive Cardiac
John Bass and Chad Gorbatkin Output Monitoring . . . . . . . . . . . . . . . . . . . . . . . 577
45 Pacemaker Assessment . . . . . . . . . . . . . . . . . . . . . 353 Caleb P. Canders, Daniel W. Weingrow, and Alan T. Chiem
Elizabeth Kwan 69 Peripheral Venous Cutdown. . . . . . . . . . . . . . . . . . . 586
46 Automatic Implantable Cardioverter-Defibrillator Jason M. Rotoli and Flavia Nobay
Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . 373 70 Intraosseous Infusion . . . . . . . . . . . . . . . . . . . . . . 599
Carlos J. Roldan Beech S. Burns, James A. Heilman, and O. John Ma
47 Left Ventricular Assist Device (LVAD) Assessment . . . . . . . 384 71 Umbilical Vessel Catheterization . . . . . . . . . . . . . . . . 615
Paulino A. Alvarez, Myles C. McClelland, and Ashrith Guha Jeanne A. Noble
48 Pericardiocentesis . . . . . . . . . . . . . . . . . . . . . . . . 394 72 Arterial Puncture and Cannulation . . . . . . . . . . . . . . . 623
Marianne Juarez and Jacqueline Nemer Justin Grisham and Jennifer L’Hommedieu Stankus
49 Intracardiac Injection . . . . . . . . . . . . . . . . . . . . . . 408 73 Extracorporeal Membrane Oxygenation . . . . . . . . . . . . 635
Tiffany Abramson and Shoma Desai Jean W. Hoffman and Jordan R. H. Hoffman
50 Needle Thoracostomy . . . . . . . . . . . . . . . . . . . . . . 410 74 Catheter-Based Hemorrhage Control . . . . . . . . . . . . . . 646
Michael Gottlieb Matthew Rosen and Andrew Grock
51 Tube Thoracostomy . . . . . . . . . . . . . . . . . . . . . . . 417
Kimberly T. Joseph and John C. Kubasiak SECTION 5 Gastrointestinal Procedures . . . . . . . . . . . . 657
52 Thoracentesis . . . . . . . . . . . . . . . . . . . . . . . . . . 429 75 Nasogastric Intubation . . . . . . . . . . . . . . . . . . . . . 657
Marianne Juarez and Jacqueline Nemer Alex Koo and Ryan Walsh
53 Open Chest Wound Management. . . . . . . . . . . . . . . . 447 76 Activated Charcoal Administration . . . . . . . . . . . . . . . 665
Eric F. Reichman Jenny J. Lu
54 Emergency Department Thoracotomy . . . . . . . . . . . . . 452 77 Gastric Lavage . . . . . . . . . . . . . . . . . . . . . . . . . 669
Kenny Banh Jenny J. Lu and Rosaura Fernandez
55 Open Cardiac Massage . . . . . . . . . . . . . . . . . . . . . 458 78 Whole Bowel Irrigation . . . . . . . . . . . . . . . . . . . . . 673
Eric F. Reichman Henry D. Swoboda and Steven E. Aks
56 Cardiac Wound Repair. . . . . . . . . . . . . . . . . . . . . . 461 79 Video Capsule Endoscopy for Gastrointestinal Bleeding . . . . 676
Eric F. Reichman Eric S. Levy, Christopher J. Haines, and Grant Wei
57 Hilum and Great Vessel Wound Management . . . . . . . . . 468 80 Esophageal Foreign Body Removal . . . . . . . . . . . . . . . 684
Eric F. Reichman Bashar M. Attar
58 Thoracic Aortic Occlusion . . . . . . . . . . . . . . . . . . . . 471 81 Balloon Tamponade of Gastrointestinal Bleeding . . . . . . . 696
Eric F. Reichman Bashar M. Attar
82 Gastrostomy Tube Complications and Replacement . . . . . . 706
SECTION 4 Vascular Procedures . . . . . . . . . . . . . . . . . 475 Erika Flores Uribe and Erick A. Eiting
59 General Principles of Intravenous Access . . . . . . . . . . . . 475 83 Paracentesis . . . . . . . . . . . . . . . . . . . . . . . . . . . 717
Daniel Belmont Alex Koo and Ryan Walsh
60 Heel Stick Blood Sampling . . . . . . . . . . . . . . . . . . . 492 84 Diagnostic Peritoneal Lavage . . . . . . . . . . . . . . . . . . 729
Kimberly Lynn Fugok and Christopher J. Russo Leann Mainis and René Ramirez
61 Venipuncture and Peripheral Intravenous Access . . . . . . . . 495 85 Anal Fissure Management . . . . . . . . . . . . . . . . . . . 738
Daniel Belmont Eric F. Reichman
62 Peripheral Inserted Central Catheter (PICC) Lines. . . . . . . . 508 86 External Hemorrhoid Management. . . . . . . . . . . . . . . 744
Elizabeth Barrall Werley Katherine Holmes, Michael Balkin, and Hao Wang

Contents ix
87 Prolapsed Rectum Reduction . . . . . . . . . . . . . . . . . . 748 110 Knee Joint Dislocation Reduction . . . . . . . . . . . . . . . . 928
Jamil D. Bayram and Eric F. Reichman Michael Gottlieb
88 Anoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 752 111 Ankle Joint Dislocation Reduction . . . . . . . . . . . . . . . 933
Charles Huggins, Claudia Kim, and Hao Wang Crystal Ives Tallman
89 Rigid Rectosigmoidoscopy . . . . . . . . . . . . . . . . . . . 757 112 Common Fracture Reduction . . . . . . . . . . . . . . . . . . 938
Hao Wang, Nicole Remish, and Nestor Zenarosa Christopher A. Gee
90 Rectal Foreign Body Extraction . . . . . . . . . . . . . . . . . 762 113 Casts and Splints . . . . . . . . . . . . . . . . . . . . . . . . 951
Chad Holmes, Jon Wolfshohl, and Hao Wang Eric F. Reichman
91 Proctoclysis . . . . . . . . . . . . . . . . . . . . . . . . . . . 769
Hao Wang, Tyson Jay Higgins, and Richard Dean Robinson SECTION 7 Skin and Soft Tissue Procedures . . . . . . . . . . 971
114 General Principles of Wound Management . . . . . . . . . . . 971
SECTION 6 Orthopedic and Musculoskeletal Ivette Motola and John E. Sullivan
Procedures . . . . . . . . . . . . . . . . . . . . . . . 775 115 Burn Wound Management . . . . . . . . . . . . . . . . . . . 988
92 Bursitis and Tendonitis Therapy . . . . . . . . . . . . . . . . . 775 Stephen Sandelich and Christopher J. Russo
Dedra R. Tolson, Brandon M. Fetterolf, and Elaine H. Situ-LaCasse 116 Basic Wound Closure Techniques . . . . . . . . . . . . . . . . 994
93 Compartment Pressure Measurement . . . . . . . . . . . . . 788 Eric F. Reichman
Danielle D. Campagne and Scott T. Owens 117 Tissue Adhesives for Wound Repair . . . . . . . . . . . . . . 1018
94 Fasciotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . 797 Hagop M. Afarian
Andrew Rotando and Justin Mazzillo 118 Advanced Wound Closure Techniques. . . . . . . . . . . . . 1025
95 Field Amputation of the Extremity . . . . . . . . . . . . . . . 808 Eric F. Reichman
Joshua T. Bucher and Michael S. Westrol 119 Management of Specific Soft Tissue Injuries . . . . . . . . . 1034
96 Extensor Tendon Repair . . . . . . . . . . . . . . . . . . . . . 813 Thomas M. Kennedy and Christopher J. Russo
JoAnna Leuck and Keegan Bradley 120 Subcutaneous Foreign Body Identification
97 Arthrocentesis . . . . . . . . . . . . . . . . . . . . . . . . . 819 and Removal . . . . . . . . . . . . . . . . . . . . . . . . . 1049
Eric F. Reichman, John Larkin, and Brian Euerle David Murray, Laura Chun, and Dhara Patel Amin
98 Methylene Blue Joint Injection . . . . . . . . . . . . . . . . . 842 121 Ultrasound-Guided Foreign Body Identification
Pholaphat Charles Inboriboon and Katherine Gloor Willet and Removal . . . . . . . . . . . . . . . . . . . . . . . . . 1060
99 Basic Principles of Fracture and Joint Reductions. . . . . . . . 848 Daniel S. Morrison and Chirag N. Shah
Scott C. Sherman and John Robert Hardwick 122 Hair Tourniquet Management . . . . . . . . . . . . . . . . 1066
100 Ultrasound for Fracture and Dislocation Identification Asim A. Abbasi
and Management . . . . . . . . . . . . . . . . . . . . . . . . 852 123 Tick Removal . . . . . . . . . . . . . . . . . . . . . . . . . 1069
Adrian H. Flores Laurie Krass and Dhara Patel Amin
101 Sternoclavicular Joint Dislocation Reduction . . . . . . . . . . 864 124 Fishhook Removal . . . . . . . . . . . . . . . . . . . . . . 1073
Michael D. Burg Eric F. Reichman
102 Shoulder Joint Dislocation Reduction. . . . . . . . . . . . . . 871 125 TASER Probe Removal . . . . . . . . . . . . . . . . . . . . . 1076
Damali N. Nakitende, Tina Sundaram, and Michael Gottlieb Myles C. McClelland, Alfred Coats III, and Thuy Tran T. Nguyen
103 Elbow Joint Dislocation Reduction . . . . . . . . . . . . . . . 895 126 Ring Removal . . . . . . . . . . . . . . . . . . . . . . . . . 1080
Angelique Campen Abraham Berhane, Abdoulie Njie, Robert Needleman, and
104 Radial Head Subluxation (Nursemaid’s Elbow) Steven H. Bowman
Reduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 900 127 Subungual Hematoma Evacuation . . . . . . . . . . . . . . 1088
Mark P. Kling Steven H. Bowman, Neera Khattar, and Natasha Thomas
105 Carpometacarpal Dislocation Reduction . . . . . . . . . . . . 904 128 Subungual Foreign Body Removal . . . . . . . . . . . . . . 1094
Rene Carizey and Priya D. Perumalsamy Ginger Clinton, Ameera Haamid, and Steven H. Bowman
106 Metacarpophalangeal Joint Dislocation Reduction . . . . . . . 908 129 Nail Bed Repair . . . . . . . . . . . . . . . . . . . . . . . . 1097
Michael Gottlieb Dayle Davenport
107 Interphalangeal Joint Dislocation Reduction . . . . . . . . . . 914 130 Ganglion Cyst Aspiration and Injection . . . . . . . . . . . . 1105
Michael Gottlieb Thomas P. Graham
108 Hip Joint Dislocation Reduction. . . . . . . . . . . . . . . . . 919 131 Subcutaneous Abscess Incision and Drainage . . . . . . . . 1108
Michael Gottlieb Priya D. Perumalsamy
109 Patellar Dislocation Reduction . . . . . . . . . . . . . . . . . 925 132 Paronychia or Eponychia Incision and Drainage . . . . . . . 1119
Mark P. Kling Lisa Palivos and Tim Richardson

x Contents
133 Felon Incision and Drainage . . . . . . . . . . . . . . . . . 1123 154 Topical and Noninvasive Anesthesia . . . . . . . . . . . . . 1257
Lisa Palivos and Sonali Gandhi Sonali Gandhi and Michael A. Schindlbeck
134 Pilonidal Abscess or Cyst Incision and Drainage . . . . . . . 1126 155 Hematoma Blocks. . . . . . . . . . . . . . . . . . . . . . . 1267
Carolyn Chooljian Thomas P. Graham
135 Perianal Abscess Incision and Drainage. . . . . . . . . . . . 1130 156 Regional Nerve Blocks (Regional Anesthesia) . . . . . . . . 1271
John Ramos and Deena Ibrahim Bengiamin Eric F. Reichman and Jehangir Meer
136 Sebaceous Cyst Incision and Drainage . . . . . . . . . . . . 1137 157 Intravenous Regional Anesthesia . . . . . . . . . . . . . . . 1312
Carlos J. Roldan Christopher Freeman and Emily Cooper
137 Hemorrhage Control . . . . . . . . . . . . . . . . . . . . . 1141 158 Nitrous Oxide Analgesia. . . . . . . . . . . . . . . . . . . . 1320
Christopher Freeman and Ariana Wilkinson René Ramirez and Leann Mainis
138 Trigger Point Injections . . . . . . . . . . . . . . . . . . . . 1154 159 Procedural Sedation and Analgesia
Danielle D. Campagne (Conscious Sedation) . . . . . . . . . . . . . . . . . . . . . 1328
139 Escharotomy . . . . . . . . . . . . . . . . . . . . . . . . . 1159 Hagop M. Afarian
Michael A. Schindlbeck and Carlos E. Brown, Jr.
140 Subcutaneous Hydration (Hypodermoclysis) . . . . . . . . . 1163 SECTION 10 Obstetrical and Gynecologic Procedures . . . . 1347
Mary J. O 160 Ultrasound in Early Pregnancy . . . . . . . . . . . . . . . . 1347
141 Subcutaneous Extravasation and Infiltration Srikar Adhikari, Wesley Zeger, and Lori Stolz
Management . . . . . . . . . . . . . . . . . . . . . . . . . 1168 161 Uterine Bleeding . . . . . . . . . . . . . . . . . . . . . . . 1363
Henry D. Swoboda Leah W. Antoniewicz, Beth R. Davis, Kara N. Purdy, Alexis R. Taylor,
Lindsay K. Grubish, and Sarah J. Christian-Kopp
SECTION 8 Neurologic and Neurosurgical 162 Normal Spontaneous Vaginal Delivery . . . . . . . . . . . . 1371
Procedures . . . . . . . . . . . . . . . . . . . . . . 1175 Stephen N. Dunay and Simeon W. Ashworth
142 Lumbar Puncture . . . . . . . . . . . . . . . . . . . . . . . 1175 163 Episiotomy . . . . . . . . . . . . . . . . . . . . . . . . . . 1384
Damali N. Nakitende, Michael Gottlieb, and Tina Sundaram Francisco Orejuela and Padraic Chisholm
143 Blood Patching for Postdural Puncture (Lumbar Puncture) 164 Shoulder Dystocia Management . . . . . . . . . . . . . . . 1393
Headache . . . . . . . . . . . . . . . . . . . . . . . . . . . 1195 Christopher Freeman and Adi Abramovici
Gunnar Subieta-Benito, Maria L. Torres, and Ned F. Nasr 165 Breech Delivery . . . . . . . . . . . . . . . . . . . . . . . . 1401
144 Burr Holes . . . . . . . . . . . . . . . . . . . . . . . . . . . 1200 Sarah J. Christian-Kopp
Caleb P. Canders, Noah T. Sugerman, and Amir A. Rouhani 166 Postpartum Hemorrhage Management . . . . . . . . . . . 1409
145 Lateral Cervical Puncture . . . . . . . . . . . . . . . . . . . 1207 Leah W. Antoniewicz
Eric F. Reichman 167 Perimortem Cesarean Section
146 Intracranial Pressure Monitoring . . . . . . . . . . . . . . . 1210 (Perimortem Cesarean Delivery) . . . . . . . . . . . . . . . 1418
Hannah Kirsch, Shahed Toossi, and Debbie Yi Madhok Jeanne A. Noble
147 Ventriculostomy . . . . . . . . . . . . . . . . . . . . . . . 1217 168 Symphysiotomy . . . . . . . . . . . . . . . . . . . . . . . . 1424
John Burke, Shahed Toossi, and Debbie Yi Madhok Ikem Ajaelo
148 Ventricular Shunt Evaluation and Aspiration . . . . . . . . . 1223 169 Bartholin Gland Abscess or Cyst Incision and Drainage . . . . 1427
Daniel W. Weingrow and Jacob Lentz Alison Uyemura and Charlie C. Kilpatrick
149 Subdural Hematoma Aspiration in the Infant . . . . . . . . 1231 170 Sexual Assault Examination . . . . . . . . . . . . . . . . . 1433
Sarah J. Christian-Kopp Monique A. Mayo and Christopher J. Russo
150 Skeletal Traction (Gardner-Wells Tongs) for Cervical Spine 171 Culdocentesis . . . . . . . . . . . . . . . . . . . . . . . . . 1445
Dislocations and Fractures . . . . . . . . . . . . . . . . . . 1236 JoAnna Leuck and Jennalee Cizenski
Thomas W. Engel and Rebecca R. Roberts 172 Prolapsed Uterus Reduction . . . . . . . . . . . . . . . . . 1449
151 Reflex Eye Movements Andrea Dreyfuss and Eric R. Snoey
(Caloric Testing and Doll’s Eyes) . . . . . . . . . . . . . . . . 1241
Atilla Üner SECTION 11 Genitourinary Procedures . . . . . . . . . . . . . 1455
152 Myasthenia Gravis Testing . . . . . . . . . . . . . . . . . . 1245 173 Urethral Catheterization . . . . . . . . . . . . . . . . . . . 1455
Eric F. Reichman Richard Dean Robinson and Caleb Andrew Rees
174 Suprapubic Bladder Aspiration . . . . . . . . . . . . . . . . 1466
SECTION 9 Anesthesia and Analgesia . . . . . . . . . . . . . . 1249 Richard Dean Robinson, Teresa Proietti, and Andrew Shedd
153 Local Anesthesia . . . . . . . . . . . . . . . . . . . . . . . 1249 175 Suprapubic Bladder Catheterization
Mark Supino and Daniel Yousef (Percutaneous Cystotomy) . . . . . . . . . . . . . . . . . . 1473
Richard Dean Robinson, Aaron W. Bull, and Andrew Shedd

Contents xi
176 Retrograde Urethrography and Cystography . . . . . . . . . 1481 199 Tympanocentesis . . . . . . . . . . . . . . . . . . . . . . . 1622

Richard Dean Robinson and Sasha Michael Dib Paul J. Jones
177 Anesthesia of the Penis, Testicle, and Epididymis. . . . . . . 1487 200 Auricular Hematoma Evacuation . . . . . . . . . . . . . . . 1625
Eric F. Reichman Eric F. Reichman
178 Priapism Management . . . . . . . . . . . . . . . . . . . . 1493 201 Nasal Medication Administration . . . . . . . . . . . . . . . 1633
Steven Go Crystal Ives Tallman and Joel Tallman
179 Paraphimosis Reduction . . . . . . . . . . . . . . . . . . . 1500 202 Nasal Foreign Body Removal . . . . . . . . . . . . . . . . . 1637
Matthew D. Schwartz and Ann P. Nguyen G. Carolyn Clayton, Katarzyna M. Gore, and Melissa M. Rice
180 Phimosis Reduction . . . . . . . . . . . . . . . . . . . . . . 1506 203 Nasal Fracture Reduction . . . . . . . . . . . . . . . . . . . 1646
Kevin O’Rourke Eric F. Reichman
181 Dorsal Slit of the Foreskin . . . . . . . . . . . . . . . . . . . 1510 204 Nasal Septal Hematoma Evacuation . . . . . . . . . . . . . 1655
Carlos J. Roldan Michael Friedman and Jessica Tang
182 Manual Testicular Detorsion . . . . . . . . . . . . . . . . . 1514 205 Epistaxis Management . . . . . . . . . . . . . . . . . . . . 1660
Steven Go Steven Lai and Matthew Waxman
183 Zipper Injury Management . . . . . . . . . . . . . . . . . . 1519 206 Laryngoscopy . . . . . . . . . . . . . . . . . . . . . . . . . 1676
Anthony W. Catalano and Ricky N. Amii Steven J. Charous
184 Genitourinary Foreign Body Removal. . . . . . . . . . . . . 1523 207 Airway Foreign Body Removal . . . . . . . . . . . . . . . . 1683
Dennis Hsieh, Claire H. Lyons, and Karen Lind Guy Shochat, Jacqueline Nemer, David L. Walner, and
Martin E. Anderson, Jr.
SECTION 12 Ophthalmologic Procedures. . . . . . . . . . . . 1535 208 Peritonsillar Abscess Incision and Drainage . . . . . . . . . 1690
185 Eye Examination . . . . . . . . . . . . . . . . . . . . . . . 1535 Daniel S. Morrison and Chirag N. Shah
Shari Schabowski and Carmen Alcala
186 Contact Lens Removal . . . . . . . . . . . . . . . . . . . . 1556 SECTION 14 Dental Procedures . . . . . . . . . . . . . . . . . . 1699
Scott A. Heinrich and Dino P. Rumoro 209 Dental Anesthesia and Analgesia . . . . . . . . . . . . . . . 1699
187 Ocular Burn Management and Eye Irrigation . . . . . . . . . 1560 Eric F. Reichman
Steven J. Socransky 210 Dental Abscess Incision and Drainage . . . . . . . . . . . . 1711
188 Intraocular Pressure Measurement (Tonometry) . . . . . . . 1567 Richard Dean Robinson and Peter S. Kim
Rosalia Njeri Mbugua and Adam Jennings 211 Post-Extraction Pain and Dry Socket (Alveolar Osteitis)
189 Digital Globe Massage . . . . . . . . . . . . . . . . . . . . 1576 Management . . . . . . . . . . . . . . . . . . . . . . . . . 1718
Carlos J. Roldan and Eric F. Reichman Eric F. Reichman
190 Anterior Chamber Paracentesis . . . . . . . . . . . . . . . . 1579 212 Post-Extraction Bleeding Management . . . . . . . . . . . 1720
Rene Carizey Eric F. Reichman
191 Corneal Foreign Body Removal . . . . . . . . . . . . . . . . 1582 213 Defective Dental Restoration Management . . . . . . . . . 1724
Scott A. Heinrich and Dino P. Rumoro Richard Dean Robinson and Daisha McLarty
192 Corneal Rust Ring Removal . . . . . . . . . . . . . . . . . . 1588 214 Subluxed and Avulsed Tooth Management . . . . . . . . . . 1728
Adam Jennings, Marcus Holmes, and Devin Sandlin Richard Dean Robinson, Adam Flink, and Ryan Nathaniel Krech
193 Eye Patching and Eye Shields . . . . . . . . . . . . . . . . . 1591 215 Fractured Tooth Management . . . . . . . . . . . . . . . . 1736
Teresa D. Le and Adam Jennings Richard Dean Robinson, Mahmuda Farha, and Bharti R. Chaudhari
194 Acute Orbital Compartment Syndrome 216 Temporomandibular Joint Dislocation Reduction . . . . . . 1740
(Retrobulbar Hemorrhage) Management . . . . . . . . . . 1595 Marilyn M. Hallock
Andrew F. Perin, Jamil D. Bayram, and Sami H. Uwaydat 217 Arch Bar Separation . . . . . . . . . . . . . . . . . . . . . . 1747
195 Globe Luxation Reduction . . . . . . . . . . . . . . . . . . 1600 Richard Dean Robinson, Amanda Pientka,
Briana D. Mazur, Adam Jennings, and Heidi Knowles and Phuc Ba Duong
196 Hordeolum (Stye) Incision and Drainage . . . . . . . . . . . 1603
Sami H. Uwaydat, Andrew F. Perin, and Jamil D. Bayram SECTION 15 Podiatric Procedures . . . . . . . . . . . . . . . . 1751
218 Ingrown Toenail Management . . . . . . . . . . . . . . . . 1751
SECTION 13 Otolaryngologic Procedures . . . . . . . . . . . 1607 Sean Dyer and Jeffrey Schaider
197 External Auditory Canal Foreign Body Removal . . . . . . . 1607 219 Plantar Puncture Wound Management . . . . . . . . . . . . 1755
G. Carolyn Clayton, Katarzyna M. Gore, and Melissa M. Rice Vishal Bhuva and Dhara Patel Amin
198 Cerumen Impaction Removal . . . . . . . . . . . . . . . . . 1616 220 Toe Fracture Management . . . . . . . . . . . . . . . . . . 1760
Dayle Davenport JoAnna Leuck and Tyler Hedman

xii Contents
221 Plantar Wart Management . . . . . . . . . . . . . . . . . . 1764 227 Hyperthermic Patient Management . . . . . . . . . . . . . 1821
Kevin O’Rourke Jessica Mann and J. Elizabeth Neuman
222 Neuroma Management . . . . . . . . . . . . . . . . . . . . 1769 228 Autotransfusion . . . . . . . . . . . . . . . . . . . . . . . . 1828
Justin C. Bosley and Eric R. Snoey Carlos J. Roldan and Amit Mehta
223 Management of Select Podiatric Conditions . . . . . . . . . 1775 229 Helmet Removal . . . . . . . . . . . . . . . . . . . . . . . 1833
JoAnna Leuck, Jacob Hurst, and Anant Patel Ashley N. Sanello and Atilla Üner
230 Pneumatic Antishock Garment (MAST Trousers) . . . . . . . 1841
SECTION 16 Miscellaneous Procedures . . . . . . . . . . . . . 1789 Evan J. Weiner
224 Relief of Choking and Acute Upper Airway 231 Hazmat Patient Management . . . . . . . . . . . . . . . . 1845
Foreign Body Removal . . . . . . . . . . . . . . . . . . . . 1789 Atilla Üner
Guy Shochat and Jacqueline Nemer 232 Physical Restraints . . . . . . . . . . . . . . . . . . . . . . 1859
225 Induction of Therapeutic Hypothermia Dean Sagun
(Targeted Temperature Management) . . . . . . . . . . . . 1797 233 Chemical Restraint . . . . . . . . . . . . . . . . . . . . . . 1867
Eleanor Dunham David K. Duong and Dara Mendelsohn
226 Hypothermic Patient Management . . . . . . . . . . . . . . 1806
Jessen D. Schiebout Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1879

Contributors
Asim A. Abbasi, MD, MPH [122] Steven E. Aks, DO, FACMT, FACEP [78]
Assistant Professor Director, the Toxikon Consortium
Department of Pediatric Emergency Medicine Division of Toxicology, Department of Emergency Medicine
University of Rochester Cook County Health and Hospitals System
Rochester, New York Professor of Emergency Medicine
Rush Medical College
Adi Abramovici, MD [164] Chicago, Illinois
Maternal-Fetal Medicine
Sinai Perinatal, LLC Carmen Alcalá, MD [185]
Plantation, Florida Resident Physician
Department of Emergency Medicine
Tiffany Abramson, MD [49] Cook County Health and Hospital Systems
Chicago, Illinois
Resident Physician
LAC+USC Medical Center Thomas Alcorn, MD [38]
Keck School of Medicine of USC Assistant Professor
Los Angeles, California Rush University Medical Center
Srikar Adhikari, MD, MS [64, 160] Chicago, Illinois
Chief, Section of Emergency Ultrasound
Associate Professor Piotr C. Al-Jindi, MD [15, 16]
Department of Emergency Medicine Associate Program Director
University of Arizona Attending Physician
Tucson, Arizona Department of Anesthesiology
John H. Stroger, Jr. Hospital
Hagop M. Afarian, MD, MS, FACEP [117, 159] Cook County Health and Hospitals System
Chicago, Illinois
Associate Clinical Professor of Emergency Medicine
UCSF School of Medicine
Attending Physician, Department of Emergency Medicine Paulino A. Alvarez, MD [47]
UCSF Fresno Cardiology Fellow
Associate Chief Medical Informatics Officer Houston Methodist Hospital
Community Medical Centers Houston, Texas
Fresno, California
Ricky N. Amii, MD [183]
Ikem Ajaelo, MD [168] Assistant Clinical Professor
Independent Attending Physician Department of Emergency Medicine
John Muir Urgent Care David Geffen School of Medicine at UCLA
John Muir Medical Group Los Angeles, California
Walnut Creek, California
Dhara Patel Amin, MD [120, 123, 219]
Abayomi E. Akintorin, MD [36] Assistant Program Director of Cook County Emergency Medicine
Chairman Department of Emergency Medicine
Division of Pediatric Anesthesia John H. Stroger, Jr. Hospital
Division of Critical Care Cook County Health and Hospital Systems
Attending Physician Assistant Professor of Emergency Medicine
Department of Anesthesiology Rush University Medical College
John H. Stroger, Jr. Hospital Chicago, Illinois
Cook County Health and Hospitals System
Clinical Assistant Professor Martin E. Anderson, Jr., MD, FACS [207]
University of Illinois at Chicago
Division of Pediatric Otolaryngology
Chicago, Illinois
Advocate Children’s Hospital
Park Ridge, Illinois
xiii

xiv Contributors
Leah W. Antoniewicz, MD [161, 166] Abraham Berhane, MD [126]

Assistant Professor Department of Emergency Medicine
Department of Obstetrics and Gynecology Cook County Health and Hospitals System
Baylor College of Medicine Chicago, Illinois
Houston, Texas
Vishal Bhuva, MD [219]
Simeon W. Ashworth, DO [162] Resident Physician
Clerkship Director Department of Emergency Medicine
Department of Emergency Medicine Cook County Hospital
Madigan Army Medical Center Chicago, Illinois
Tacoma, Washington
Clinical Instructor of Emergency Medicine Charles Boland, MD [15, 32]
University of Washington School of Medicine
Former Chief Resident
Seattle, Washington
Cook County Hospital
Chicago, Illinois
Bashar M. Attar, MD, PhD, MPH (Epid), MBA, FACP, FACG, Cardiothoracic Fellow
AGAF, FASGE, AGSF, FAASLD [80, 81] Virginia Commonwealth University
Systemwide Chair for Gastroenterology and Hepatology Richmond, Virginia
Director, GI Fellowship Program David W. Boldt, MD [12]
John H. Stroger, Jr. Hospital of Cook County Associate Clinical Professor
Professor of Medicine and Surgery Department of Anesthesiology
Rush University Medical Center Division of Critical Care Medicine
Chicago, Illinois University of California Los Angeles School of Medicine
Los Angeles, California
Michael Balkin, MD [86]
Chief Resident Justin C. Bosley, MD, CAQSM [222]
Department of Emergency Medicine Emergency Medicine Physician
John Peter Smith Hospital Sports Medicine Physician
Fort Worth, Texas The Permanente Medical Group
Oakland, California
Kenny Banh, MD [54]
Associate Professor of Clinical Emergency Medicine Steven H. Bowman, MD, FACEP [126-128]
Assistant Dean of Undergraduate Medical Education Program Director
University of California San Francisco Fresno Department of Emergency Medicine
Fresno, California Cook County Health and Hospitals System
Associate Professor of Emergency Medicine
John Bass, MD [44] Department of Emergency Medicine
Resident Physician Rush Medical College
Madigan Army Medical Center Chicago, Illinois
Tacoma, Washington
Keegan Bradley, MD [96]
Jamil D. Bayram, MD, MPH, EMDM, MEd, PhDc [87, 194, 196] Resident Physician
Associate Professor Department of Emergency Medicine
Department of Emergency Medicine John Peter Smith Hospital
Johns Hopkins University School of Medicine Fort Worth, Texas
Department of International Medicine
Bloomberg School of Public Health Carlos E. Brown, Jr., MD [139]
Medical Director, National Capital Region Resident Physician
Johns Hopkins Medicine International Department of Emergency Medicine
Baltimore, Maryland Cook County Health and Hospital System
Chicago, Illinois
Daniel Belmont, MD [59, 61]
Attending Physician Curtis Blake Buchanan, MD [20]
Department of Emergency Medicine Attending Physician
Elmhurst Hospital US Acute Care Solutions
Elmhurst, Illinois Department of Emergency Medicine
Florida Hospital Tampa
Deena Ibrahim Bengiamin, MD, RDMS [135] Temple, Florida
Clinical Assistant Professor
Loma Linda University Medical Center
Loma Linda, California

Contributors xv
Joshua T. Bucher, MD, FAAEM [95] Paul Casey, MD, FACEP [38]
Assistant Professor Associate Professor
EMS Medical Director, RWJ-MHS Vice Chairman, Operations
Department of Emergency Medicine Associate Chief Medical Informatics Officer
Rutgers–Robert Wood Johnson Medical School Department of Emergency Medicine
New Brunswick, New Jersey Rush University Medical Center
Chicago, Illinois
Aaron W. Bull, MD [175]
Department of Emergency Medicine Anthony W. Catalano, MD [183]
John Peter Smith Health Network Emergency Medicine Physician
Fort Worth, Texas Cottage Hospital
Santa Barbara, California
Michael D. Burg, MD [101]
Associate Clinical Professor of Emergency Medicine Divya Karjala Chakkaravarthy, MD [9]
Department of Emergency Medicine Anesthesiologist and Fellowship in Pain Management
UCSF/Fresno Medical Education Program Department of Anesthesiology and Pain Management
Fresno, California John H. Stroger, Jr. Hospital, Cook County
Chicago, Illinois
John Burke, MD, PhD [147]
Resident Physician Steven J. Charous, MD, FACS [206]
Department of Neurological Surgery Clinical Professor
University of California at San Francisco Director, Voice and Swallow Center
San Francisco, California Department of Otolaryngology–Head and Neck Surgery
Loyola University Medical Center
Beech S. Burns, MD, MCR [23, 70] Maywood, Illinois
Assistant Professor
Departments of Emergency Medicine and Pediatrics Bharti R. Chaudhari, DO [215]
Division of Emergency Medicine Attending Physician
Oregon Health & Science University Department of Emergency Medicine
Portland, Oregon John Peter Smith Health Network
Fort Worth, Texas
Danielle D. Campagne, MD, FACEP [93, 138]
Associate Professor of Clinical Emergency Medicine Alan T. Chiem, MD, MPH [68]
Department of Emergency Medicine Assistant Clinical Professor
UCSF School of Medicine Department of Emergency Medicine
Fresno, California Olive View–UCLA Medical Center
David Geffen School of Medicine
Angelique Campen, MD, FACEP [103] Los Angeles, California
Emergency Department
Providence Saint Joseph Medical Center Padraic Chisholm, MD [163]
Clinical Instructor of Emergency Medicine Former Resident
Ronald Reagan UCLA Medical Center Department of Obstetrics and Gynecology
Emergency Department Baylor College of Medicine
Providence Saint Joseph Medical Center Houston, Texas
Assistant Adjunct Professor of Medicine Obstetrician Gynecologist
UCLA Emergency Department Women’s Clinic of South Texas
Los Angeles, California Edinburg, Texas
Caleb P. Canders, MD [68, 144] Carolyn Chooljian, MD [134]

Clinical Associate Professor Clinical Professor, Emergency Medicine
Department of Emergency Medicine Department of Emergency Medicine
David Geffen School of Medicine at UCLA UCSF Fresno Emergency Medicine Residency Program
Los Angeles, California University of California, San Francisco
Fresno, California
Rene Carizey, DO [105, 190]
Associate Professor
Rush University
Chicago, Illinois

xvi Contributors
Sarah J. Christian-Kopp, MD, FAAP [149, 161, 165] Dayle Davenport, MD [129, 198]
Clinical Assistant Professor of Pediatric Emergency Medicine & Assistant Professor
Emergency Medicine Department of Emergency Medicine
Loma Linda University Medical Center and Children’s Hospital Rush University Medical Center
Clinical Assistant Professor of Emergency Medicine Chicago, Illinois
UCLA/Olive View Medical Center
Attending Physician Beth R. Davis, MD [161]
Assistant Professor
Providence Tarzana Medical Center
Baylor College of Medicine
Attending Physician
Houston, Texas
Kaiser Permanente Hospitals
Fontana and Ontario, California Shoma Desai, MD [13, 49]
Clinical Associate Professor of Emergency Medicine
Laura Chun, MD [120] Department of Emergency Medicine
Keck School of Medicine
Resident Physician
University of Southern California
Cook County Health and Hospital Systems
Chicago, Illinois Sasha Michael Dib, MD [176]
Emergency Medicine Resident
Jennalee Cizenski, MD [171] John Peter Smith Hospital
Fort Worth, Texas
Resident, Emergency Medicine
John Peter Smith Hospital
Fort Worth, Texas Kevin J. Donnelly, MD [17]
Resident Physician
G. Carolyn Clayton, MD [197, 202] Department of Anesthesiology and Pain Management
John H. Stroger, Jr. Hospital of Cook County
Chicago, Illinois
Rush University Medical Center Andrea Dreyfuss, MD, MPH [172]
Chicago, Illinois Ultrasound Fellow
Ginger Clinton, MD [128] Highland Hospital–Alameda Health System
Oakland, California
Emergency Medicine
Chicago, Illinois Stephen N. Dunay, MD, MHS [162]
Resident Physician
Alfred Coats, III, FNP-C [43, 125] Department of Emergency Medicine
Madigan Army Medical Center
Nurse Practitioner
Tacoma, Washington
San Jacinto Methodist Hospital
University of Texas Health Science Center at Houston Eleanor Dunham, MD [225]
Houston, Texas Assistant Professor
Emily Cooper, MD [157] Penn State Health Milton S. Hershey Medical Center
Penn State University College of Medicine
Chief Resident
Hershey, Pennsylvania
Jackson Memorial Hospital
Miami, Florida David K. Duong, MD, MS, FACEP [233]
Alameda Health System, Highland Hospital
John Cruz, DO [66] Department of Emergency Medicine
Associate Professor
Resident Physician
University of California, San Francisco School of Medicine
Oakland, California
Tacoma, Washington
Phuc Ba Duong, DO [217]
Bryan Darger, MD [4] Resident Physician
John Peter Smith Health Network
University of San Francisco School of Medicine
Fort Worth, Texas
San Francisco, California

Contributors xvii
Sean Dyer, MD [218] Christopher Freeman, MD [137, 157, 164]

Department of Emergency Medicine Program Director Emergency Medicine
Cook County Health and Hospital System Jackson Memorial Hospital
Instructor, Department of Emergency Medicine Affiliated Assistant Professor
Rush Medical College Department of Surgery
Chicago, Illinois University of Miami Miller School of Medicine
Miami, Florida
Erick A. Eiting, MD, MPH, MMM, FACEP [82]
Vice Chair of Operations Michael Friedman, MD [204]
Mount Sinai Downtown Professor and Chairman
Assistant Professor of Emergency Medicine Section of Otolaryngology
Icahn School of Medicine at Mount Sinai Advocate Illinois Masonic Medical Center
New York, New York Medical Director
ChicagoENT
Tamer Elattary, MB, ChB [11, 31] Chicago, Illinois
Anesthesia Resident
Department of Anesthesiology and Pain Management Kimberly Lynn Fugok, DO [60]
Cook County Health and Hospitals System Emergency and Hospital Medicine
Chicago, Illinois Pediatric Emergency Medicine
Nemours/Alfred I. duPont Hospital for Children
Thomas W. Engel, II, MD [150] Wilmington, Delaware
Resident
Department of Emergency Medicine Sonali Gandhi, MD [133, 154]
Cook County Hospital Resident Physician
Chicago, Illinois Department of Emergency Medicine
Brian Euerle, MD [7, 97] Chicago, Illinois
Associate Professor
Department of Emergency Medicine Molly Garcia [39]
University of Maryland School of Medicine Emergency Medical Technician
Baltimore, Maryland Sacramento, California
Mahmuda Farha, DO [215] Christopher A. Gee, MD, MPH [112]

Emergency Medicine Resident Clinical Associate Professor
Department of Emergency Medicine Department of Orthopaedics
John Peter Smith Hospital University of Utah School of Medicine
Fort Worth, Texas Salt Lake City, Utah
Rosaura Fernandez, MD [77] Steven Go, MD, FACEP [178, 182]

Assistant Program Director of Cook County Emergency Medicine Professor of Emergency Medicine
Cook County Health and Hospital Systems Truman Medical Center, Hospital Hill
Assistant Professor of Emergency Medicine University of Missouri—Kansas City School of Medicine
Rush Medical College Kansas City, Missouri
Chicago, Illinois
Chad Gorbatkin, MD [44, 66]
Brandon M. Fetterolf, DO [92] Assistant Professor
Special Operations Resuscitation Team “A” Medical Director Department of Military and Emergency Medicine
528th Sustainment Brigade (SO)(A) Uniformed Services University of the Health Sciences
1st Special Forces Command Staff Physician, Madigan Army Medical Center
Fort Bragg Tacoma, Washington
Fort Bragg, North Carolina
Katarzyna M. Gore, MD [197, 202]
Adam Flink, MD [214] Clinical Assistant Professor
John Peter Smith Hospital Rush University Medical Center
Fort Worth, Texas Chicago, Illinois
Adrian H. Flores, MD, MPH [100]

Assistant Clinical Professor

xviii Contributors
Michael Gottlieb, MD, RDMS [50, 102, 106, 107, 108, 110, 142] John Robert Hardwick, MD [99]
Director of Emergency Ultrasound Associate Emergency Physician
Assistant Professor Northern Nevada Emergency Physicians
Department of Emergency Medicine Reno, Nevada
Rush University Medical Center
Chicago, Illinois Tarlan Hedayati, MD, FACEP [19]
Assistant Professor
Thomas P. Graham, MD [130, 155] Associate Program Director
Professor of Emergency Medicine Department of Emergency Medicine
Department of Emergency Medicine Cook County Health and Hospitals System
UCLA School of Medicine Chicago, Illinois
Tyler Hedman, MD [220]
Justin Grisham, DO [72] Emergency Medicine Resident
Resident Department of Emergency Medicine
Madigan Army Medical Center Fort Worth, Texas
Tacoma, Washington
James A. Heilman, MD, MBA [23, 70]
Andrew Grock, MD [74] Assistant Professor
Faculty Physician Department of Emergency Medicine
Division of Emergency Medicine Oregon Health and Science University
Greater Los Angeles VA Healthcare System Portland, Oregon
Assistant Clinical Professor of Emergency Medicine
David Geffen School of Medicine Scott A. Heinrich, MD [186, 191]
University of California Los Angeles
Assistant Professor
Lindsay K. Grubish, DO [161] Chicago, Illinois
Staff Physician
Madigan Army Medical Center H. Gene Hern, Jr., MD [34]
Tacoma, Washington
Associate Clinical Professor
University of California, San Francisco
Ashrith Guha, MD, MPH, FACC [47] Vice Chair of Education, Emergency Medicine
Assistant Professor Alameda Health System–Highland General Hospital
Department of Cardiology Oakland, California
Methodist DeBakey Heart and Vascular Center
JC Walter Transplant Canter Tyson Jay Higgins, MD [91]
Houston Methodist Hospital
Resident Physician
Houston, Texas
Ameera Haamid, MD [128] Fort Worth, Texas
Resident Physician
Department of Emergency Medicine Jean W. Hoffman, MD [73]
Assistant Professor
Chicago, Illinois
Departments of Emergency Medicine and Anesthesia
University of Colorado School of Medicine
Christopher J. Haines, DO [33, 79] Aurora, Colorado
Clinical Associate Professor
Department of Pediatrics Jordan R. H. Hoffman, MPH, MD [73]
Division of Pediatric Emergency Medicine
Fellow, Cardiothoracic Surgery
Rutgers Robert Wood Johnson Medical School
Department of Surgery
New Brunswick, New Jersey
Division of Thoracic Surgery
University of Colorado School of Medicine
Marilyn M. Hallock, MD, MS, FACEP [216] Aurora, Colorado
Department of Emergency Medicine Chad Holmes, DO [90]
Rush University Medical College
Associate Ultrasound Director
Chicago, Illinois
JPS Health Network
Fort Worth, Texas

Contributors xix
Katherine Holmes, DO [86] Adam Jennings, DO, FACEP [188, 192, 193, 195]
Medical Student Clerkship Director Assistant Professor
JPS EM Director of New Media Department of Emergency Medicine
Department of Emergency Medicine TCU & UNTHSC School of Medicine
John Peter Smith Hospital Fort Worth, Texas
Fort Worth, Texas
Megan Johnson, MD [13]
Marcus Holmes, DO [192] Department of Emergency Medicine
Chief Resident LAC+USC Medical Center
Department of Emergency Medicine Keck School of Medicine of USC
John Peter Smith Health Network Los Angeles, California
Fort Worth, Texas
Paul J. Jones, MD, FACS [199]
Louis G. Hondros, DO, FACEP [3] Associate Professor
Director Pediatric/General Otolaryngology
Emergency Medical Systems Department of Otolaryngology–Head and Neck Surgery
Assistant Professor Loyola University Medical Center
Department of Emergency Medicine Maywood, Illinois
Assistant Professor
Department of Anatomy and Cell Biology Kimberly T. Joseph, MD, FACS, FCCM [51]
ATLS Subcommittee Chair
Chicago, Illinois
Committee on Trauma of the American College of Surgeons
Assistant Professor
Dennis Hsieh, MD, JD [184] Department of General Surgery
Assistant Professor Rush University Medical College
Department of Emergency Medicine Voluntary Attending Surgeon
Harbor-UCLA Medical Center Department of Trauma & Burns
University of California, Los Angeles John H. Stroger, Jr. Hospital
Torrance, California Cook County Health and Hospitals System
Chicago, Illinois
Charles Huggins, MD, FACEP [88]
Core Faculty Emergency Medicine Residency Program Marianne Juarez, MD [48, 52]
Department of Emergency Medicine Assistant Clinical Professor
John Peter Smith Hospital Department of Emergency Medicine
Fort Worth, Texas University of California San Francisco
Jacob Hurst, MD [223]
Resident Physician Thomas M. Kennedy, MD [119]
Department of Emergency Medicine Fellow, Pediatric Emergency Medicine
John Peter Smith Health Network Sidney Kimmel Medical College at Thomas Jefferson University
Fort Worth, Texas Nemours/Alfred I. duPont Hospital for Children
Division of Pediatric Emergency Medicine
Pholaphat Charles Inboriboon, MD, MPH, FACEP [20, 98] Wilmington, Delaware
Clinical Associate Professor
Department of Emergency Medicine Neera Khattar, MD [127]
University of Missouri Kansas City School of Medicine Resident Physician
Kansas City, Missouri John H. Stroger, Jr. Hospital of Cook County
Chicago, Illinois
Konstantin Inozemtsev, MD [14]
Resident Physician Basem F. Khishfe, MD [6, 37]
Department of Anesthesiology and Pain Management Emergency Ultrasound Director
John H. Stroger, Jr. Hospital of Cook County Mercy Hospital and Medical Center
Chicago, Illinois Assistant Professor of Emergency Medicine
Chicago Medical School
Eric Isaacs, MD [1, 4] Chicago, Illinois
Clinical Professor
Department of Emergency Medicine Charlie C. Kilpatrick, MD, MEd [169]
University of California, San Francisco Residency Program Director, Vice Chair of Education
San Francisco, California Associate Professor | Female Pelvic Medicine, Reconstructive
Surgery
Department of Obstetrics and Gynecology
Baylor College of Medicine
Houston, Texas

xx Contributors
Claudia Kim [88] Ryan Nathaniel Krech, MD, JD, FACEP [214]
Resident Physician Medical Director
John Peter Smith Health Network John Peter Smith Health Network
Fort Worth, Texas Fort Worth, Texas
Peter S. Kim, MD [210] John C. Kubasiak, MD [51]

Emergency Medicine Resident Assistant Instructor of Surgery
John Peter Smith Hospital Department of Surgery
Fort Worth, Texas Division of General and Acute Care Surgery
UT Southwestern School of Medicine
Jessica J. Kirby, DO, FACEP [2] Dallas, Texas
Associate Medical Director
Department of Emergency Medicine Elizabeth Kwan, MS, MD [45]
John Peter Smith Health Network Assistant Professor
Fort Worth, Texas Department of Emergency Medicine
University of California San Francisco
Ryan P. Kirby, MD, FACEP [2] San Francisco, California
Program Director
Department of Emergency Medicine Steven Lai, MD [205]
John Peter Smith Healthcare Network Assistant Residency Program Director
Fort Worth, Texas UCLA Emergency Medicine Residency
Olive View-UCLA Medical Center | Ronald Reagan-UCLA
Hannah Kirsch, MD [146] Medical Center
Assistant Clinical Professor
Resident in Neurology
Department of Neurology
David Geffen School of Medicine at UCLA
University of California, San Francisco School of Medicine
Mark P. Kling, MD, FAAEM, CSCS [104, 109] John Larkin, MD [97]
Assistant Medical Director
Former Assistant Clinical Professor
Attending Physician
Cook County (Stroger) Emergency Medicine Residency
Emergency Department
Former Private Practice Emergency Healthcare Physicians and
CHI Baylor–St. Luke’s Medical Center
IEMS of Illinois Senior Attending Physician
Houston, Texas
TeamHealth NW–Franciscan Affiliates
Gig Harbor, Washington
Teresa D. Le, MD [193]
Heidi Knowles, MD, FACEP [195] Resident Physician
Core Faculty
John Peter Smith Hospital
Fort Worth, Texas
Fort Worth, Texas
Ahmad M. Abou Leila, MD [36]
Igor V. Kolesnikov, MD, PharmD [21] Assistant Professor of Anesthesiology
Cleveland Clinic
Senior Attending Physician
Anesthesiology Attending
Chief of Head and Neck Anesthesia Section
Department of Anesthesiology
Assistant Professor of Anesthesiology
Hillcrest Hospital
Mayfield Heights, Ohio
Attending Physician
Department of Anesthesiology and Pain Management
John H. Stroger, Jr. Hospital Jacob Lentz, MD [148]
Chicago, Illinois Resident
Alex Koo, MD [75, 83] University of California at Los Angeles
Joint Base Lewis McChord, Washington JoAnna Leuck, MD, FACEP [96, 171, 220, 223]
Assistant Professor
Laurie Krass, MD [123] Academic Vice Chair
Program Director
Chicago, Illinois
Fort Worth, Texas

Contributors xxi
Eric S. Levy, DO [33, 79] Briana D. Mazur, DO [195]

Rutgers Robert Wood Johnson Medical School John Peter Smith Health Network
New Brunswick, New Jersey Fort Worth, Texas
Karen Lind, MD, MACM, FACEP [184] Justin Mazzillo, MD [94]

Faculty Physician Assistant Professor
Department of Emergency Medicine Assistant Medical Director
Alameda Health System/Highland Campus Department of Emergency Medicine
Oakland, California University of Rochester Medical Center
Rochester, New York
Jenny J. Lu, MD, MS [76, 77]
Assistant Professor Rosalia Njeri Mbugua, MD [188]
Rush University Medical College Staff Physician
Cook County Health and Hospitals System Department of Emergency Medicine
Department of Emergency Medicine Medical City Healthcare, Alliance
Division of Medical Toxicology Fort Worth, Texas
Chicago, Illinois
James J. McCarthy, MD, FACEP, FAEMS [65]
Claire H. Lyons, MS, MD [184] Professor
Resident Physician Department of Emergency Medicine
Department of Emergency Medicine McGovern Medical School, Part of UTHealth
Highland Hospital–Alameda Health System The University of Texas Health Science Center at Houston
University of California at San Francisco–Medical School Houston, Texas
Myles C. McClelland, MD, MPH, CMQ [43, 47, 125]
O. John Ma, MD [23, 70] Medical Director
Professor and Chair Department of Emergency Medicine
Department of Emergency Medicine Willowbrook Methodist Hospital
Oregon Health & Science University Houston, Texas
Portland, Oregon
Daisha McLarty, MD [213]
Debbie Yi Madhok, MD [146, 147] Emergency Medicine Resident
Assistant Clinical Professor John Peter Smith Hospital
Zuckerberg San Francisco General Hospital Fort Worth, Texas
University of California San Francisco Jehangir Meer, MD [7, 156]
Seattle Emergency Physicians
Leann Mainis, MD [84, 158] First Hill & Cherry Hill Campuses
Chief Resident Swedish Medical Center
Department of Emergency Medicine Seattle, Washington
UCSF Fresno
Fresno, California Amit Mehta, MD, CMQ [228]
Assistant Professor
Jessica Mann, MD, MS [67, 227] Department of Emergency Medicine
Assistant Professor of Emergency Medicine Director of Medical Informatics
Life Lion EMS Medical Director–Berks County and Community McGovern Medical School at UTHealth
Paramedicine Houston, Texas
EMS Fellowship Core Faculty
Department of Emergency Medicine Dara Mendelsohn, MD [233]
Penn State Health Milton S. Hershey Medical Center
Resident
Highland Hospital
Monique A. Mayo, MD [170] Oakland, California
Attending Physician
Department of Emergency Medicine Marco Mikhael, MD [22]
Division of Pediatrics
Senior Pediatric Anesthesiologist
Nemours/Alfred I. duPont Hospital for Children
Sidney Kimmel Medical College at Thomas Jefferson University
Pediatric Anesthesia Attending
Wilmington, Delaware
St. Alexius Medical Center
AMITA Heath-Hoffman Estates
Chicago, Illinois

xxii Contributors
Ruth E. Moncayo, MD [28] Robert Needleman, MD [126]

Senior Faculty Attending Physician Resident Physician
Department of Anesthesiology and Pain Management Department of Emergency Medicine
Cook County Health and Hospital Systems John H. Stronger, Jr. Hospital
Chicago, Illinois Cook County Health and Hospital Systems
Chicago, Illinois
James Montoya, MD, FAAEM, FACEP [39]
CEP Physician, Partner Jacqueline Nemer, MD, FACEP [48, 52, 207, 224]
Vice-Chief, Department of Emergency Medicine Professor of Emergency Medicine
Sutter Medical Center-Sacramento Director of Advanced Clinical Skills
Sacramento, California Department of Emergency Medicine
Clinical Associate Professor University of California San Francisco School of Medicine
Department of Emergency Medicine San Francisco, California
California Northstate University College of Medicine
Elk Grove, California J. Elizabeth Neuman, DO, FACEP [67, 227]
Assistant Professor of Emergency Medicine
Daniel S. Morrison, MD, FACEP [40, 41, 42, 121, 208] Department of Emergency Medicine
Associate Professor Penn State Hershey Medical Center
Department of Emergency Medicine Hershey, Pennsylvania
Rutgers Robert Wood Johnson Medical School
New Brunswick, New Jersey Ann P. Nguyen, MD [179]
Attending Physician
Ivette Motola, MD, MPH [114] Emergency Trauma Center
Assistant Director, Gordon Center for Research in Medical Hackensack University Medical Center
Education Hackensack, New Jersey
Director, Division of Prehospital & Emergency Healthcare
Associate Professor of Emergency Medicine Thuy Tran T. Nguyen, FNP-C [43, 125]
University of Miami Miller School of Medicine
Nurse Practitioner
Miami, Florida
Methodist Hospital
David Murray, MD [120] University of Texas Medical Branch
Department of Emergency Medicine Galveston, Texas
Chicago, Illinois Abdoulie Njie, MD [126]
Arun Nagdev, MD [63] Cook County Hospital
Director, Emergency Ultrasound Chicago, Illinois
Alameda Health System
Highland General Hospital Flavia Nobay, MD [69]
Associate Clinical Professor
Associate Professor of Emergency Medicine
Associate Dean for Admissions
University of Rochester School of Medicine and Dentistry
Damali N. Nakitende, MD, RDMS [102, 142] University of Rochester
Ultrasound Faculty at Advocate Christ Medical Center Rochester, New York
Chicago, Illinois Jeanne A. Noble, MD, MA [71, 167]
Isam F. Nasr, MD [9, 12, 16, 29] UCSF-SFGH Emergency Medicine Residency Simulation Director
Clinical Assistant Professor Department of Emergency Medicine
Department of Emergency Medicine University of California, San Francisco
Rush Medical College San Francisco, California
Chicago, Illinois
Mary J. O, MD, FACEP [140]
Ned F. Nasr, MD [11, 12, 14-18, 21, 22, 24, 26, 28-32, 36, 143] Assistant Professor of Emergency Medicine
Vice Chairman for Academic Affairs and Program Director Frank H. Netter MD School of Medicine
Chairman, Division of Neuroanesthesiology Quinnipiac University
Department of Anesthesiology and Pain Management St. Vincent’s Medical Center
Cook County Health and Hospitals System Bridgeport, Connecticut
Chicago, Illinois

Contributors xxiii
Julie Kautz Oliva, MD [34] Priya D. Perumalsamy, MD [105, 131]

Resident Physician Associate Professor
Highland Hospital Rush University Medical Center
Oakland, California Chicago, Illinois
Francisco Orejuela, MD [163] Amanda Pientka, MD [217]

Associate Professor Chief Resident
Department of Obstetrics and Gynecology Department of Emergency Medicine
Division of Female Pelvic Medicine and Reconstructive Surgery John Peter Smith Health Network
Baylor College of Medicine Fort Worth, Texas
Houston, Texas
Teresa Proietti, DO [174]
Kevin O’Rourke, MD [180, 221] Resident
Assistant Professor Department of Emergency Medicine
Truman Medical Center Fort Worth, Texas
University of Missouri at Kansas City School of Medicine
Kansas City, Missouri Kara N. Purdy, MD, MS [161]
Doctor, Department of Emergency Medicine
Guillermo Ortega, MD [42] Madigan Army Medical Center
Emergency Medicine Resident Tacoma, Washington
Rutgers–Robert Wood Johnson Medical School
New Brunswick, New Jersey Yanina Purim-Shem-Tov, MD, MS, FACEP [3]
Associate Professor
Scott T. Owens, MD, MPH [93] Vice Chairperson
Acting Instructor, Senior Fellow Faculty Development and Research
University of Washington Medical Director of Chest Pain Center
Seattle, Washington Rush University Medical Center
Chicago, Illinois
Hyang won Paek, MD, MBA [18]
Pediatric Anesthesiologist Abed Rahman, MD, MS [29]
Department of Anesthesiology and Pain Management Interventional Pain Service
John H. Stroger, Jr. Hospital of Cook County Oak Forest Health Center
Assistant Professor of Anesthesiology Anesthesiology and Pain Management
Rush Medical College John H. Stroger, Jr. Hospital
Chicago, Illinois Chicago, Illinois
Lisa Palivos, MD, FACEP [132, 133] René Ramirez, MD, FACEP [84, 158]
Assistant Professor Scribe Director
Rush Medical College Assistant Clinical Professor
Attending Physician Department of Emergency Medicine
Department of Emergency Medicine Community Regional Medical Center
Cook County Health and Hospital Systems University of California San Francisco-Fresno
Chicago, Illinois Fresno, California
Anant Patel, DO [223] John Ramos, MMS, PA-C [135]

Assistant Medical Director Assistant Professor
Core Faculty Dominican University of California
Department of Emergency Medicine: John Peter Smith Health Department of Emergency Medicine
Network Marin General Hospital
Integrative Emergency Services San Rafael, California
Fort Worth, Texas
Caleb Andrew Rees, MD [173]
Andrew F. Perin, MD [194, 196] Resident Physician
Little Rock Eye Clinic Department of Emergency Medicine
Little Rock, Arkansas John Peter Smith Health Network
Fort Worth, Texas

xxiv Contributors
Eric F. Reichman, PhD, MD, FAAEM, FACEP, NBPAS [53, 55-58, John S. Rose, MD, FACEP [5]
85, 87, 97, 113, 116, 118, 124, 145, 152, 156, 177, 189, 200, Professor
203, 209, 211, 212] Department of Emergency Medicine
Clinical Associate Professor of Emergency Medicine University of California, Davis Health System
Attending Physician, Department of Emergency Medicine Sacramento, California
UT-Health
McGovern Medical School Matthew Rosen, MD [74]
University of Texas Health Science Center at Houston-Medical Resident
School Department of Emergency Medicine
Voluntary Attending Physician, Emergency Department UCLA Emergency Medicine Residency Program
Memorial Hermann Hospital-Texas Medical Center Ronald Reagan UCLA Medical Center
Houston, Texas Olive View-UCLA Medical Center
Nicole Remish, DO [89]
Department of Emergency Medicine Andrew Rotando, DO [94]
John Peter Smith Hospital Attending Physician
Fort Worth, Texas Department of Emergency Medicine
Rochester Regional Health
Melissa M. Rice, MD [197, 202] Rochester, New York
Assistant Professor
Department of Emergency Medicine Jason M. Rotoli, MD [69]
Rush University Medical College Assistant Professor
Chicago, Illinois Department of Emergency Medicine
University of Rochester
Tim Richardson, MD [132] Assistant Residency Director
John H. Stroger, Jr. Cook County Hospital Deaf Health Pathways, Director
Chicago, Illinois University of Rochester Medical Center
Rochester, New York
Rebecca R. Roberts, MD [150]
Attending Physician
Amir A. Rouhani, MD [144]
Research Director Assistant Clinical Professor
Department of Emergency Medicine Director of Simulation Education
John H. Stroger, Jr. Hospital Olive View-UCLA Medical Center
Assistant Professor of Emergency Medicine Department of Emergency Medicine
Rush University Medical College David Geffen School of Medicine at UCLA
Chicago, Illinois Los Angeles, California
Richard Dean Robinson, MD [2, 91, 173-176, 210, Dino P. Rumoro, DO, MPH [186, 191]
213-215, 217] Associate Professor
Vice Chairman Department of Emergency Medicine
Department of Emergency Medicine Rush Medical College
John Peter Smith Health Network Chicago, Illinois
Associate Professor
Department of Emergency Medicine Christopher J. Russo, MD [10, 60, 115, 119, 170]
University of North Texas Health Science Center Clinical Assistant Professor of Pediatrics
Fort Worth, Texas Sidney Kimmel Medical College of Thomas Jefferson University
Philadelphia, Pennsylvania
Patrick J. Rogers, DO [40, 41] Attending Physician
Department of Emergency Medicine Division of Emergency Medicine
Jersey Shore University Medical Center Nemours/Alfred I. duPont Hospital for Children
Neptune, New Jersey Wilmington, Delaware
Carlos J. Roldan, MD, FACEP, FAAEM [46, 136, 181, 189, 228] Alia Safi, MD [28]
Associate Professor of Emergency Medicine Former Anesthesiology Resident
The University of Texas, Health Science Center at Houston Medical Department of Anesthesiology
School John H. Stroger, Jr. Hospital
Assistant Professor of Pain Medicine Cook County Health and Hospitals System
The University of Texas MD Anderson Cancer Center Chicago, Illinois
Houston, Texas

Contributors xxv
Dean Sagun, MD [232] Luis Sequera-Ramos, MD [26]

Attending Physician Anesthesia Resident
Department of Emergency Medicine Department of Anesthesiology and Pain Management
TeamHealth Cook County Health System
Memorial Hermann Hospital Northeast Chicago, Illinois
Humble, Texas
Fred A. Severyn, MD [25]
Joseph A. Salomone, III, MD [35] Associate Professor of Emergency Medicine
St. Croix, United States Virgin Islands University of Colorado School of Medicine
Aurora, Colorado
Stephen Sandelich, MD [115]
Emergency Medicine Physician Chirag N. Shah, MD, FACEP [40-42, 121, 208]
Division of Emergency Medicine Associate Professor
Summerville Medical Center Department of Emergency Medicine
Trident Health System Rutgers-Robert Wood Johnson Medical School
Charleston, South Carolina New Brunswick, New Jersey
Devin Sandlin, MD [192] Andrew Shedd, MD, FACEP [174, 175]

Clinical Faculty Associate Residency Director
Department of Emergency Medicine Ultrasound Director
John Peter Smith Hospital Department of Emergency Medicine
Fort Worth, Texas John Peter Smith Health Network
Fort Worth, Texas
Ashley N. Sanello, MD [229]
Emergency Medicine Physician Scott C. Sherman, MD [99]
Torrance Memorial Medical Center Associate Residency Director
Medical Director, City of Compton Fire Department Cook County Emergency Medicine Residency
Torrance, California Associate Professor of Emergency Medicine
Shari Schabowski, MD [185] Chicago, Illinois
Assistant Professor
Rush Medical College Guy Shochat, MD [207, 224]
Attending Physician Clinical Associate Professor
Cook County Health and Hospital Systems University of California, San Francisco School of Medicine
Chicago, Illinois San Francisco, California
Jeffrey Schaider, MD [218] Craig Sisson, MD, RDMS, FACEP [63]

Chairman, Department of Emergency Medicine Clinical Associate Professor
Cook County Health and Hospital System Director, Division of Ultrasound
Professor, Department of Emergency Medicine Director, Emergency Ultrasound Fellowship
Rush Medical College Co-Director, Combined Ultrasound and Global Health Fellowship
Chicago, Illinois Co-Director, Longitudinal Medical Student Ultrasound
Curriculum
Jessen D. Schiebout, MD [226] Adjunct Associate Professor, Department Cell Systems and
Anatomy
Associate Professor
UTHSCSA Department of Emergency Medicine
Joe R. and Teresa Lozano Long School of Medicine
San Antonio, Texas
Chicago, Illinois
Michael A. Schindlbeck, MD, FACEP [139, 154] Elaine H. Situ-LaCasse, MD [92]

Associate Program Director
Cook County Emergency Medicine Training Program
University of Arizona College of Medicine
Banner University Medical Center
Tucson, Arizona
Chicago, Illinois
Matthew D. Schwartz, DO [179] Eric R. Snoey, MD [172, 222]

Clinical Professor of Emergency Medicine
Attending Emergency Physician
Designated Institutional Official and Vice Chair
Southside Hospital
Bay Shore, New York
Alameda Health System–Highland Hospital
Oakland, California

xxvi Contributors
Steven J. Socransky, MD, FRCPC [187] Crystal Ives Tallman, MD [111, 201]
Associate Professor Assistant Clinical Professor of Emergency Medicine
Northern Ontario School of Medicine Department of Emergency Medicine
Sudbury, Ontario, Canada UCSF Fresno
Fresno, California
Jennifer L’Hommedieu Stankus, MD, JD, FACEP [72]
Contract Emergency Physician Joel Tallman, PharmD [201]
Department of Emergency Medicine Clinical Pharmacist
Madigan Army Medical Center Department of Pharmacy
Tacoma, Washington Community Regional Medical Center
Fresno, California
Lori Stolz, MD, RDMS [64, 160]
Assistant Professor Jessica Tang, MD [204]
Banner University Medical Center Fellow in Otolaryngologic Research
Tucson, Arizona Chicago ENT
Advanced Center for Specialty Care
Gunnar Subieta-Benito, MD [143] Advocate Illinois Masonic Medical Center
Chicago, Illinois
Attending Physician
Department of Anesthesiology
John H. Stroger, Jr. Hospital Katie Tataris, MD, MPH, FAEMS, FACEP [27]
Cook County Health and Hospitals System Assistant Professor of Medicine
Assistant Professor Section of Emergency Medicine
Rush Medical College EMS Medical Director, Chicago South EMS System–Region XI
Chicago, Illinois The University of Chicago Medicine and Biological Sciences
Chicago, Illinois
Noah T. Sugerman, MD [144]
Health Sciences Assistant Clinical Professor Alexis R. Taylor, MD, MSc [161]
Department of Emergency Medicine Emergency Medicine Resident
Olive View-UCLA Medical Center Madigan Army Medical Center
Los Angeles, California Tacoma, Washington
Staff Physician
Department of Emergency Medicine Benjamin Thomas, MD [63]
Los Robles Hospital and Medical Center
Senior Resident
Thousand Oaks, California
Highland Hospital
John E. Sullivan, MD [114] Oakland, California
Attending Physician, Emergency Medicine
Boca Raton Regional Hospital Natasha Thomas, MD [127]
Voluntary Clinical Assistant Professor
Resident Physician
Florida Atlantic University
School of Medicine
Boca Raton, Florida
Chicago, Illinois
Tina Sundaram, MD, MS [102, 142]
Clinical Instructor Dedra R. Tolson, MD [92]
Staff Physician
Rush University Medical School
Chicago, Illinois
Tacoma, Washington
Mark Supino, MD, FACEP [153]
Associate Program Director Shahed Toossi, MD [146, 147]
Neurocritical Care Attending
Jackson Memorial Hospital
Departments of Neurology and Neurosurgery
Miami, Florida
Cedars-Sinai Medical Center
Henry D. Swoboda, MD [78, 141]
Departments of Emergency Medicine and Psychiatry Maria L. Torres, MD [143]
Director Pain Management Center
Assistant Professor
Department of Anesthesiology and Pain Management
Cook County Health and Hospital System
Chicago, Illinois
Chicago, Illinois

Contributors xxvii
Serge G. Tyler, MD [9] David L. Walner, MD [207]

Chairman, Adult Anesthesia Pediatric Otolaryngology
Senior Attending, Section of Airway Anesthesia Anesthesiology Advocate Children’s Hospital
OR Manager, Department of Anesthesiology and Pain Park Ridge, Illinois
Management Clinical Professor
Cook County Health and Hospitals System Departments of Surgery and Pediatrics
Chicago, Illinois Rosalind Franklin University of Medicine and Science
North Chicago, Illinois
Jaroslav Tymouch, MD [24]
Department of Anesthesiology Ryan Walsh, MD [75, 83]
Division of Cardio-Thoracic Anesthesia Assistant Professor
John H. Stroger, Jr. Hospital of Cook County Department of Emergency Medicine
Clinical Associate Professor Vanderbilt University Medical Center
Anesthesiology Department Nashville, Tennessee
Rush University
Chicago, Illinois Hao Wang, MD, PhD [86, 88-91]
Director of Research
Anna Tzonkov, MD [30] Department of Emergency Medicine
Clinical Associate Professor Integrative Emergency Services
Department of Anesthesiology and Pain Management John Peter Smith Health Network
Cook County Hospital and Health Systems Fort Worth, Texas
Chicago, Illinois
Matthew Waxman, MD, DTM&H [205]
Atilla Üner, MD, MPH [151, 220, 231] Associate Clinical Professor of Emergency Medicine and
Health Science Clinical Professor of Emergency Medicine and Internal Medicine
Nursing Department of Emergency Medicine Olive View-UCLA
David Geffen School of Medicine at UCLA Medical Center
Los Angeles, California David Geffen School of Medicine at UCLA
Erika Flores Uribe, MD, MPH [82]
Assistant Professor of Clinical Emergency Medicine Ariana Wilkinson Weber, MD [137]
Department of Emergency Medicine Emergency Medicine Resident
LAC + USC Medical Center Jackson Memorial Hospital
Keck School of Medicine Miami, Florida
Joseph M. Weber, MD [27]
Sami H. Uwaydat, MD [194, 196] Associate Professor of Emergency Medicine
Associate Professor Rush Medical College
Director, Vitreoretinal Service Department of Emergency Medicine
Jones Eye Institute Cook County Hospital
University of Arkansas for Medical Sciences Chicago, Illinois
Little Rock, Arkansas
Grant Wei, MD [79]
Alison Uyemura, MD [169] Associate Professor
Obstetrics and Gynecology Department of Emergency Medicine
Baylor College of Medicine Rutgers Robert Wood Johnson Medical School
Houston, Texas New Brunswick, New Jersey
Gennadiy G. Voronov, MD [11, 14, 17, 18, 21, 22, 24, 26, 30-32] Evan J. Weiner, MD, FAAP, FACEP, FAAEM [230]
Assistant Professor of Anesthesiology Program Director, Pediatric Emergency Medicine Fellowship
Rush University Medical Center St. Christopher’s Hospital for Children
Chairman Assistant Professor of Pediatrics
Department of Anesthesiology and Pain Management Drexel University College of Medicine
Cook County Health & Hospitals System Philadelphia, Pennsylvania
Chicago, Illinois
Daniel W. Weingrow, DO [68, 148]
Ronald Reagan UCLA Medical Center
David Geffen School of Medicine at UCLA

xxviii Contributors
Elizabeth Barrall Werley, MD [62] Peter C. Wroe, MD [63]

Assistant Professor Resident Physician
Penn State Health Milton S. Hershey Medical Center Highland Hospital–Alameda Health System
Penn State University College of Medicine Oakland, California
Daniel Yousef, PharmD [153]
Michael S. Westrol, MD [95] Clinical Pharmacy Specialist
Assistant EMS Medical Director Department of Pharmacy
Department of Emergency Medicine Jackson Memorial Hospital
AtlantiCare Regional Medical Center Miami, Florida
Atlantic City, New Jersey
Wesley Zeger, DO, FACEP [8, 160]
Katherine Gloor Willet, MD [98] Director of Clinical Operations
Attending Physician Department of Emergency Medicine
Department of Emergency Medicine University of Nebraska Medical Center
Hickson-Lied Medical Center Omaha, Nebraska
Omaha, Nebraska
Nestor Zenarosa, MD, FACEP [89]
Jon Wolfshohl, MD [90] Attending Physician
Chief Resident Department of Emergency Medicine
Department of Emergency Medicine John Peter Smith Health Network
John Peter Smith Hospital Fort Worth, Texas
Fort Worth, Texas

Preface
Emergency Medicine is extremely broad and the advances have to perform a procedure. While alternative techniques are described
been amazing in recent years. The field covers the neonate through in many chapters, we have not exhaustively included all alternative
the geriatric, surgical and medical, and encompasses all organ sys- techniques. Key information, cautions, and important facts are
tems. Emergency Medicine is rapidly evolving. Procedural skills highlighted throughout the text in bold type.
must supplement our cognitive skills. Achieving proficiency in Each chapter, with a few exceptions, has a standard format. The
procedural skills is essential for the daily practice of Emergency relevant anatomy and pathophysiology is discussed followed by
Medicine. We have produced a clear, complete, and easy to under- the indications and contraindications for the procedure. A list is
stand textbook of Emergency Medicine procedures. This new edi- provided of the necessary equipment. The patient preparation
tion addresses the diverse topic of Emergency Medicine. This text including consent, anesthesia, and analgesia is addressed. The
will provide medical students, residents, advanced practice practi- procedure is then described in a step-by-step format. Cautions are
tioners, and the seasoned Emergentologist with a single procedural placed where problems commonly occur. Alternative techniques
reference on which to base clinical practices and technical skills. and helpful hints for each procedure are presented. The aftercare
The primary purpose of this text is to provide a detailed and and follow-up are discussed. Any potential complications are
step-by-step approach to procedures performed in the Emergency described including the methods to reduce and care for the com-
Department. It is expressly about procedures. It is not meant to be plications. Finally, a summary contains a review of any critical or
a comprehensive reference but an easy to use and clinically useful important information.
procedure book that should be in every Emergency Department. This book covers a wide variety of procedures that may be per-
The contents and information are complete. It is organized and formed in a rural or urban Emergency Department. This includes
written for ease of access and usability. The detail is sufficient to procedures performed routinely or rarely; procedures that are often
allow the reader to gain a thorough understanding of each proce- performed in the acute care, clinic, and office settings; procedures
dure. When available, alternative techniques or hints are presented. that are performed frequently in the daily practice of Emergency
Each chapter provides the reader with clear and specific guidelines Medicine; and procedures that are seldom to rarely performed but
for performing the procedure. Although some may use this text as critical to the practice of Emergency Medicine. Some procedures
a library reference, its real place is in the Emergency Department are uncommon, may not be known to the reader, and provide an
where the procedures are performed. Despite its size, I hope that opportunity to acquire new information that may be converted
this book will find its way to the bedside to be used by medical with proper practice and training into a useful skill. A few of the
students, residents, advanced practice providers, and practicing procedures are performed only by Surgeons and are included to
clinicians. promote understanding when the patient presents to the Emergency
This book will satisfy the needs of a variety of backgrounds and Department with a complication. This new edition has added
training. While this text is primarily written for Emergentologists, chapters, algorithms, clinical pictures, cutting-edge technological
many other practitioners will find this a valuable reference. This advancements, radiographs, and tables based upon readers’ com-
book is written for those who care for people with acute illness or ments, input, and suggestions.
injury. Medical students and residents will find this an authorita- We have drawn on a wide variety of authors. The majority
tive work on procedural skills. Medical students, residents, nurse of authors are residency-trained, board-certified, and practicing
practitioners, physician’s assistants, and practitioners with lim- Emergentologists. We have the honor of having some contributors
ited experiences will find all the information in each chapter from outside the field of Emergency Medicine and who are experts
to learn the complete procedure. Family Physicians, Internists, in their own specialty. All authors do have biases because of dif-
and Pediatricians will find this text useful to review procedures ferences in education, experience, and training. We have tried to
infrequently performed in the clinic, office, or urgent care center. base all recommendations on sound clinical and scientific data.
Intensivists and Surgeons involved in the care of acutely ill patients However, we have not excluded personal experience or preferences
will also find this book a wonderful resource. The experienced cli- when appropriate. In these cases, the authors also present alterna-
nician can get a quick refresher on the procedure while enhancing tive techniques.
their knowledge and skills. Physicians actively involved in educa- This book has grown and changed with this third edition. I
tion will find this text an easy to understand and well-illustrated am happy and privileged to edit this third edition of the text.
source of didactic material. Continued input and suggestions from you, the reader, would be
The book is organized into sections with each representing an most appreciated. Let me know what additional procedures should
organ system, an area of the body, or a surgical specialty. Each chap- be included or excluded in the future. Any errors, in the end, are
ter, with a few exceptions, is devoted to a procedure. This should mine. Please let me know of any mistakes or omissions, big or small,
allow quick access to complete information. The chapters have a at eric.f.reichman@gmail.com.
similar format to allow information to be retrieved as quickly and
Eric F. Reichman, PhD, MD
as efficiently as possible. There are often several acceptable methods
xxix

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"Well, now, I do feel cheerful, and I just hope I'm not like Ignorance in the
'Pilgrim.' Fred read me that book, and surely, next to the Bible, it comes
home to one. But I don't really think I'm like he, though I'm ignorant
enough. Not ignorant of my dear Saviour, though. I feel Him keeping me,
somehow."
"Ah, old friend, many a learned man might envy you. I came to talk to
you about Fred. Where is he?"
"Playing cricket on the green. Schoolmaster tells him he's getting too old
for school, and that he won't learn much by staying on. I sometimes wish
we could find his people. He's growing up—poor Fred!"
"That is just what I came to talk about, Betty. Dale spoke to me about
him. He thinks him very clever."
"About book cleverness, sir, I know naught, but he reads as well as any
clergyman; I'm told he's quite as good at writing and cyphering. But as to
hand cleverness, that I can speak to. There's nothing ever was done with
hands that he couldn't learn to do."
"Well, I want an assistant in the dispensary. Fred is rather young, but

Fletcher will not leave me at once, and I will teach the boy carefully. If he
turns out well, I will take care of his future. You'll be glad, I dare say, to
have a big fellow like him off your hands; you must find it hard to do for
him now."
"I don't, then," said Betty, shortly. "I'll find it harder to do without him.
But I won't stand in his way. I suppose you want to take him altogether—
to live in your house, maybe?"
"I did think of that. You see, my wife could teach him so much, and so
could I. But, to get the full benefit of this, he must be always at hand."
"Ay, ay, I understand. Well, I've had him a long time, and he's been as a
son to me, and a good son, too. I won't stand in his way."
"I see him coming now, Betty."
And in a moment more, Fred stood before them, having taken off his
straw hat to pay due respect to the doctor.
"Fred, my dear boy, here's good news for you," began Betty, briskly.
"Many a time have I taken a little fret, wondering what would become of
you when I die, and that can't be very far off, for I'm getting very old and
failed. Now, here's Dr. Wentworth offering you a good place with him,
where you'll get learning, and have work to do more suitable to you than
gardening. And I'm thankful to know it, Fred."
Fred looked from one to the other.
"I don't quite understand," he said, "but I'm much obliged to Dr.
Wentworth; he's always been very kind to me."
The doctor, who by this time had found a seat on the doorstep, began to
explain. Fred listened attentively. Then he looked at Betty, who forthwith
assumed what she intended for a pleased and encouraging smile. Fred
laughed, and for a healthy boy, he laughed but seldom.
FRED LISTENED ATTENTIVELY.

"Ah, Mrs. Betty, that won't do!" he said. "'Tis nine years, or more, since I
crept up to the door, half frozen and half starved, and asked you to come
to—to Frank. I remember all, Betty dear, though I never could talk of it.
Ever since then, you've kept me and cared for me, and nursed me and
borne with me, and—loved me. And now, doctor, she's not as strong as
she used to be, she couldn't live alone now, she couldn't keep up the
garden or the plants and slips without help, and she couldn't carry the
things home. I earn a little money, too, and what I earn is needed now.
I'm very grateful for your kind offer, but I can't leave her, and if I did,
every one would cry shame on me, and I should deserve it."
"Fred, I won't stand in your way. I shall do very well. I'll get my
grandchild, John's little Kate, to come and stay with me; I know they'll let
me have her. And suppose your own people find you by-and-by, won't
they be glad to find you something better than a working gardener? No,
no, boy; you must go."
Fred stood, looking far away over the fields. He seemed to be trying to
put some thought into words, for his lips moved from time to time. At
last, without looking at them, but still gazing away over the fields, he said
—
"I can remember her face. It was like Frank's, fair and loving. I think we
were well off once, but I don't remember. I seem just going to remember
sometimes, but it all dies off. Mrs. Betty, you know Kate is only ten, and a
little baby of a thing; even if she came, she could not do all that I do, and
the garden would run waste, and there would be no earnings coming in.
And if my mother—if it is my mother that I remember—I'm very sure that
she would be more sorry to find me an ungrateful brute than to find me a
gardener, or anything else. No, Dr. Wentworth, I cannot leave Mrs. Betty.
As she cared for me, so must I care for her now, and she has been a
mother to me all these years. But I'm not ungrateful to you, sir, and there
is nothing I should like better than to learn from you if it could be; but it
cannot."
"I would not say another word, my boy, if I did not see a way out of the
difficulty. I like you the better for being grateful and faithful to Betty, and
I was not aware how dependent she has become upon you. But I'll tell
you how it can be managed. Instead of coming to live with me, and
studying hard, you must go on living here, and only give me so many
hours a day, say from ten a.m. to six in the evening. This will give you
time for your gardening under Betty, and your wages will be better than
your chance earnings now. What do you say to this?"
"May I just run home for a few moments at about one, sir, to see that she
gets her dinner?"
"It is not far; yes, we will manage that. You shall have your dinner at our
luncheon-time, which will save Betty a good deal of cooking."
"Mrs. Betty, does this suit you?"
"That it do!" said Betty. "I won't deny that my heart sank to think of being
without you, Fred, and seeing my poor garden, that's all my living, going
to waste. I was thinking it meant the poorhouse."
"Yet you wanted me to believe you were delighted. Oh, Mrs. Betty, I'm
ashamed of you! I never can thank you enough, Dr. Wentworth, but I'll
serve you faithfully," said the boy, earnestly; and, kneeling down beside a
patch of annuals, he began tenderly to pick out minute weeds from
among the tiny plants.
"Thin 'em, Fred, thin 'em. You're always too shy of thinning. Leave each
plant standing by itself. Yes, that's more like. Doctor, come closer. I
wouldn't allow this, but that I don't think it will be for very long. I feel
very weak sometimes, and they're all doing well, and now that Fred's
provided for, I'm quite ready to go. What is it now, Fred?"
"I want to ask the doctor a question. Can you tell me, sir, what it will cost
to get a well-made wooden cross, with words cut on it and painted for
Frank? I've saved up a few shillings for it."
"I am going to town to-morrow, and I will order it for you; if it costs more
than you have saved, you must let me pay the rest, as my thanks to you
for all your care of our little grave. What shall I have carved on it?"
"Just this, sir. First, 'Frank' by itself, and then 'Tell muddie I took care of
Fred.' That's to go across the arms of it. And below the date, 'September
14, 18—.'"
"Why, Fred, I'd no idea you understood or remembered those words,"

cried Betty. "You know, doctor, that's what the little fellow said."
"Yes," said Fred, "I never forgot them. Frank died to save me; I can see
that now. We called her muddie. Some day, perhaps, among the people
who come to see our church and the churchyard, there may be some one
who knows her, who will know what the words mean. Some day, I shall
put a marble cross with the whole story on it, but this will do now."
Fred went back to his weeding, and Dr. Wentworth said to Betty—
"I never heard the boy speak so much before."
"Nor I, sir."
"And he can say Frank and Fred now, I perceive."
"Oh yes, sir; only if he is in a hurry, he slips back into the old way. Well,
Dr. Wentworth, I'm easy in my mind about the boy now."
"You may be, Betty. As far as I can, I will make him my care. He is a fine
fellow."
So, when the midsummer holidays began, Fred left school and began his
new work. The doctor began to teach him enough Latin to read the
prescriptions, or at least that was what he first intended, but the boy was
so eager to learn that the lessons did not stop there, nor was Latin the
only thing studied. Study was a delight to the silent, somewhat lonely boy,
and he made such progress that the good doctor was proud of his pupil.
And the cross was placed at the head of Frank's grave, but the doctor
persuaded Fred to allow him to give Frank's message in a slightly different
form. Thus—"His last words were a message to his mother, to tell her that
he had taken care of Fred."
For a little more than a year, this arrangement continued to work very
well. Fred became very useful to the doctor, and Betty had no reason to
feel neglected. Then the dear old woman began to fail more and more
rapidly, and Fred spent the greater part of his time with her, but it was
with the doctor's full consent.
One evening—it was now September, and Dr. Wentworth had told Fred
that old Betty could not last much longer—the boy was sitting beside the
bed on which she lay; not suffering, only, as she said herself, "dying, and
very slow about it." They had both been silent for some time, and when
she said suddenly, "Is there any one here but us two, Fred?" poor Fred
started, for his thoughts were far away.
"No, Betty. Mrs. Summers—" Betty's eldest daughter—"has gone home to

see after the children, and John and his wife are coming presently to stay
all night with you."
"Very good children they've always been to me, and I must tell their
father that, for he laid it on them to be good to me. But I'm glad of a
quiet half-hour with you, dear. Sometimes I think you're nearer my heart
than my own children. You're so young, I suppose that's it. It's just the
day, Fred, and very near the hour, when you came knocking, with your
little soft hand, at the door yonder. I think I'd like to die to-night. I'd like
to be able to say, 'Lord, I'm only a poor ignorant and hardworking woman,
and it was very little I ever could do, beyond earning my bread; but there
was one thing—the boy that was sent to me this very night many years
ago, I took him for Thy sake, and I wasn't bad to him.' I think I'd like to
say that."
"It is less than the truth, dear Mrs. Betty. You saved me from misery, and
made me as happy as one so parted from his own people, and with Frank
dead, could ever be. And you'll meet Frank."
"I'll tell him that you were worth saving," said the old woman, fondly.
"Now, my dear, just one word. I've no doubt you'll do well and prosper.
The doctor's fond of you, and he's a good man. But when you're a
gentleman, with learning, and money and all your heart can desire, don't
you forget what I say to you now: If you let those things fill your heart so
that you forget God, and never read the Bible, nor go to church, nor pray,
it would have been better for you if you had died there on my hearthstone
along with your little brother. Don't turn God's favour into a misfortune,
Fred. Mind, Frank's waiting for you in heaven. Do you know why I say all
this? Because I do fancy that, although the doctor and his wife are kind
and good, and will be true friends to you, yet you won't learn from them
such lessons as I'd have you put first of all. Don't forget God, Fred dear,
nor begin to have high thoughts of yourself, and forget that you're just a
sinner, and want the Saviour, and will never get to heaven any other way.
Will you remember, dear?"
"I will, Betty. God helping me, I will. Oh, dear Betty, how good you've
been to me!"
"And you to me. Ah, here's John and my good Deb. Go you, Fred, and get
a little rest. You're tired out, I know."
Before the day dawned, the simple, true-hearted old woman had breathed
her last. And none of her children or grandchildren mourned for her more
truly, nor half so long, as did the boy she had so lovingly befriended.
CHAPTER XI.
MRS. RAYBURN'S LETTER.
FROM the time of Betty Giles' death, Fred lived altogether with the
Wentworths, and they eventually became so fond of him that he was like
a son to them both. He studied under Dr. Wentworth, at first only with a
view to becoming his assistant in the dispensary, but after a time with the
intention of becoming a doctor himself. Mr. Hewson, the curate, who had
been a very distinguished man in college, gave him lessons in various
branches of learning; in fact, Dr. Wentworth gave him every advantage
that he would have given to his own son had he lived.
Of course, as he grew up, the preparations for his profession took him
away frequently from what was now his home, and no one missed him
more than did Mrs. Wentworth, who had at one time quite shrunk from
the idea of having him to live with her.
With his studies and all concerning his profession we have nothing to do,
except with one event which took place in London.
Fred was now engaged in what is called "walking the hospitals" in London,
and was a very ardent and industrious student. One day, he heard that
there was to be a wonderful operation performed at a certain hospital by
one of the first surgeons of the day, and he was fortunate enough to get
leave to be present, though it was not one of the hospitals he generally
attended. When the affair was over, one of the junior doctors, who knew
him, took him through the wards.
In one of these, there was a woman who had come up from the country to
take a place as cook in an hotel, but had fallen ill, and been sent to this
hospital. Her name was Rayburn, and she came from Hemsborough.
The arrangements of this hospital were supposed to be almost perfect,
and the system of ventilation was quite new. Young Dr. Vernon was
explaining it to Fred, and consequently their progress through the ward
was slow. And if they had looked at the old woman in the corner of the
room, they would have seen that for some reason she was frightened—or,
at least, greatly excited—at the appearance of Fred Giles.
Fred, however, saw nothing of this; neither did Dr. Vernon; but when the
latter was going his rounds in the evening, No. 24 in the first ward was
found in a rather excited state.
"She's been quite odd all the afternoon, Dr. Vernon," said the nurse, "and
she was going on nicely before."
"I'm not worse," the woman said, "but I want to know, doctor, who was
the tall young man that went through the ward with you this morning?"
"A dark-haired fellow? His name is Giles, and he's the son—adopted son, I
believe—of a Dr. Giles—no, his name is not Giles—but a doctor
somewhere in the country. Why do you ask?"
"Oh, I have no reason, sir; only I'm a curious woman—always was. Thank
you, sir."
"Did you think you knew him?"
"Oh no; but he's like some one I knew once. I'm sleepy now—I'm much
better."
"Well, good night. Nurse, I don't think she's so well. Watch her carefully."
"Is the young man going to be a doctor, Dr. Vernon?" inquired the patient,
suddenly.
"Yes, and a very promising student he is."
"Has he—has he—a brother?" she asked in a low voice.
"I don't know. What interests you so much in this particular student, may
I ask?"
She laughed in an odd, constrained manner, and replied—
"Indeed, sir, you may ask much easier than I can answer. I have no
reason at all."
"Except that he is like some one you knew?"
"Just so, sir."
Mr. Vernon went away, this being the last bed he had to visit. Next day,
the patient was very much worse, and it was some days before she again
began to mend. When she was really recovering, Dr. Vernon spoke to her
about Fred Giles, but she declared that she remembered nothing about
him, and that she must have been dreaming. And in a day or two more,
she left the hospital.
Her history since the loss of the children can be told in a few words. She
was a long time under medical care, her mind not having recovered
completely from the effects of the attack she had at Kelmersdale. When at
last she was herself again, she went to Hemsborough, and found an
asylum with her sister-in-law. She heard from Lord Beaucourt of her
stepson's visit to England, and she guessed that he had discovered that
she had not been kind to the children. So she never wrote to him, though
in her misery—for she was a very miserable woman—she would have
given much to beg for his and Janet's forgiveness. She had lived
principally with her sister-in-law, who was not unkind; but sometimes she
quarrelled with her nieces, and then she would leave them and take a
place somewhere. But her health and her nerves were shattered, and she
always broke down before long, and returned to Hemsborough. She did so
now, when she left the hospital.
When she was again comfortably settled in her sister-in-law's house, she
wrote the following letter to Janet:
"MY DEAR JANET,
"If this ever comes to your hand, try to think less bad
of me than I deserve of you. I have suffered for my
unkindness, Heaven knows. I have been a wretched
woman. I hope you and Fred have not been as wretched as
I am, but I dare not think of what you must have felt.
"I would not venture to write now but for one thing. I
have always felt that there was a chance that the children
were not drowned in the Kelmer. And I think I saw one of
them, a tall, handsome young man, studying to be a
doctor. I could not think any one could be so like your
husband but little Fred, who was always so like him. But he
calls himself Frederick Giles, and when I was well and left
the hospital, I found out where he was lodging, and made
what inquiry I could. He comes from a place near
Cirencester, called Edgestone, and he had gone home. I
could do no more, having no money but what would take
me home to my sister's house in Hemsborough. I am weak
and ill, more in mind than in body, and so the best thing I
can do is to tell you this, and if you tell me what to do, I
will do it. But I know that you and Fred will come home to
see for yourselves, if you can afford it.
"I am not long for this world. I suppose there is no use

in asking you two to forgive me; I cannot forgive myself. I
am a wretched woman, and have no hope. But if you find
the boys, perhaps you might forgive me. Fred Giles is the
adopted son of a doctor in Edgestone. That is all I know.
"LYDIA RAYBURN."
In the years that had passed since the loss of the boys, Fred Rayburn had
quite lived down the prejudice against him which had prevented Gilbert
Gray from making him the first manager of the Royal Victoria Hotel in
Gattigo. But when the first manager gave up the situation, Fred was able
to take it; and the hotel had been most successful under him and Janet,
and had made both Gilbert Gray and Fred Rayburn rich and prosperous
men. The Rayburns now lived in a pretty house two or three miles from
Old Man's Ferry Farm, where Janet and her daughter had no more
arduous work to do than to keep house and see after their garden. Fred
drove into Gattigo every day, and the hotel still flourished without a rival.
The important letter was addressed to Old Man's Ferry Farm, and when it
arrived there, Gilbert and his wife, always glad to visit the Rayburns,
ordered their well-appointed phaeton, with its two pretty ponies, and
inquired if any of the young people would like to fill the back seat.
Several of the young people wanted to go, for cousin Lily was a general
favourite; and while the boys were arguing about their claims to the seat,
the two elder girls slipped quietly away to the stable and came round to
the door in possession of the places. Gil and Emile and the rest were
naturally very indignant, but the girls only smiled serenely, and were soon
bowling smoothly along the well-made road, very different from the rough
track by which Janet reached the farm on her first arrival.
"The Gables," as the Rayburns called their home, certainly deserved its
name. It had been added to by many hands, and in many styles, and how
many gables there were I should be afraid to conjecture. Janet and her
daughter had made a pretty garden close to the house; to be sure, it was
only a corner of a field well fenced with high palisades and wire netting,
but it was full of flowers in summer, and afforded as much pleasure to its
owners as any walled garden in the dear "old country." Lily and her
mother were at work among their flowers when the Grays drove up. Out
ran Lily, followed by Janet, who, however, remembered to shut the gate.
"You've come to stay all day, haven't you?" cried Lily, joyously.
She was a fair, bright-haired lassie, very like her mother and poor little
Frank.
"You must stay," she went on, "for father's in Gattigo, and won't be home
until dinner-time."
"Well, we can stay, Miss Apple-cheeks," said her uncle. "Janet, we've
brought you a letter. Who on earth can be so behind the times as to write
to you still at the Ferry Farm?"
"I don't know, but I'm glad of anything that brings you here. You and
Aimée don't take a holiday half often enough. Lily, call Karl to take the
ponies."
Karl having been found, the others all went into the house and had some
luncheon, after which Janet asked for her letter.
"I declare I had forgotten it!" said Gilbert. "Here it is."
"The Hemsborough postmark!" Janet said. "I don't know the hand. Who
can it be from? Oh, Gilbert, it is from Mrs. Rayburn!"
"Fred's mother—stepmother, I mean?"
They all crowded round Janet. Janet gave the letter to her brother.
"Somehow I can't see it," she said. "Read it aloud, Gilbert."
Which Gilbert did; and then they all looked at each other, not knowing
what to think.
Before any one spoke, a man appeared at the window, which opened like
a door, and, with a cry of "Gilbert and Aimée here! How lucky that I got
off so early!" He pushed the window wide and came in.
It was our old friend Fred Rayburn, and a very fine-looking man he had
become. And if ever a man had cause to give thanks for a good wife, Fred
Rayburn was that man. For, by the blessing of God, Janet's love for him,
and Janet's faith in him in spite of his follies, had made a man of him.
"Fred, Fred!" cried Janet. "Our boys—she has seen Fred—Mrs. Rayburn—
here is her letter; read it, and tell me may I believe it?"
Fred took the letter and read it. He looked at Janet and began to speak,
but turned back to the letter and read it again.
"Janet, when I was in England, Mrs. Rayburn was not quite in her right
mind. It may be so still."
"Do you think the letter shows that she is out of her mind?" Janet said.
"No, Fred, I don't think so. She says she is weak in mind and body, and I
suppose she was unable to make a thorough inquiry, but we must make
it."
"Certainly—of that, there can be no doubt. But do not build too much
upon it, Janet, my darling; I fear it was but too plain that our boys were
lost in the Kelmer."
"I have never been able to believe it; and, you see, Mrs. Rayburn has felt
the same. But what do you think of doing, Fred?"
"I shall go to England as soon as I can be ready, and go direct to this

place, Edgestone, near Cirencester. The truth must be easily ascertained
on the spot. My fear is that her conscience, poor soul, being so burthened,
she was startled by an accidental likeness—and the name being Frederick,
and the young man an adopted son."
"Yes," Gilbert Gray said, "and if the boys were alive all this time, why did
they never let you know? Frank was seven years old; he surely could have
told his name, and where you had lived, and then you would have heard.
Take my advice, Rayburn, and write to this young Giles."
"No, no—we must go," Janet said. "Fred, I am not often unreasonable, but
I cannot rest till we are on our way home. Give me this satisfaction, let us
go, and find out the truth together. We will take Lily too. Fred, you will
take us?"
"I will indeed, Janet. I wish you could feel how unlikely it is that there is
anything in what this wretched woman says, but I can quite understand
your longing to see for yourself. I have a few arrangements to make, of
course. Gilbert, you and Emile will see after the hotel, I am sure."
"I will do anything you like; but do remember how ill Janet was on the
voyage out. Even if you must go, rather than write—"
"No, no!" said Aimée. "They must go. It is but a poor little straw of a
hope, yet I feel that Janet must go. Only, dear, why take Lily? Leave her
with me."
"Ah, no! I cannot bear to part with her, Aimée. I never parted with my
boys but that once. Lily must come too."
Janet was ill enough on the voyage, but by no means as ill as she had
been when coming out. Fortunately, Lily proved a good sailor, and was
able to take care of her after the first day or so.
They had a good passage, and, on reaching England, at once went on to

Cirencester, where Janet was so worn out that Fred would not hear of
going on to Edgestone that evening.
Next day, she still seemed so weak that Fred proposed to go alone to
Edgestone, as she seemed unfit for any exertion. But for once Janet was
obstinate; she would go.
Edgestone was about fifteen miles from Cirencester, and no railways went
near it. Fred Rayburn hired a wagonette, and at about twelve o'clock they
set out.
CHAPTER XII.
FRANK'S MESSAGE REACHES "MUDDIE."
AS the Rayburns drove out of town, a gentleman in a small trap passed

them, and just where the road to Edgestone joins the main road, they
overtook him. Something had gone wrong with his harness. Fred Rayburn
called out—
"Can we help you in any way, sir?"
And the other replied, "Thank you, but I've got it all right now."
Jumping into the trap, he drove on, soon passing the heavier vehicle
again. As he did so, he took off his hat to the occupants.
Little thought the Rayburns that this pleasant-looking man could have told
them about their boys very easily. As little thought Dr. Wentworth, as he
wondered what was bringing a trio of strangers to quiet Edgestone, that
they came to clear up the story that had baffled him so long, and to rob
him of his adopted son. Had he seen Fred Rayburn nearer, or had an
opportunity of conversing with him, the likeness both to young Fred and
to his cherished photograph would have struck him; but a magnificent
dark beard had altered the elder Fred a good deal, and the likeness
escaped the doctor's notice. He was soon out of sight.
The travellers reached Edgestone presently, and stopped at the little inn,
as the Cygnet called itself, though it really was only a decent kind of
public-house. Here they alighted, and told the driver to put up his horses
for a time.
"Can we have a private sitting-room?" Mr. Rayburn asked, looking

doubtfully round the parlour they had been requested to enter; it
possessed a strong smell of tobacco and a sanded floor.
"This is our only parlour, sir, and the Edgestone Club meets here most
evenings."
"Janet, you must stay here while I inquire where the doctor lives. It will
be better, dear; you look very tired, and this will spare you a little. I will
come back to you as soon as I find him."
Now that the truth must soon be known, poor Janet's hopes and courage
had deserted her. Till now she could not know soon enough. Now she
would gladly have put off certainty a little longer. It was all she could do
not to entreat her husband to wait a little, but she held her peace and
subsided into a very unpromising wooden armchair. Fred turned to the
mistress of the Cygnet, and said—
"Will you bring Mrs. Rayburn some tea as soon as possible?" He followed
her out of the room, shutting the door. "Stay, if you please. Can you tell
me where the doctor lives? You have not more than one, I suppose, in so
small a place?"
"I may say there's only one, though his son is well-nigh a doctor too, and
they do say he set Jerry Davidson's leg as handsome as possible, the
doctor being away at the time. He lives on the green, sir, the second
house from the church. I'll show you the green. Step this way, sir; you
can see it from our door, and the second house is Dr. Wentworth's."
"Wentworth! I thought his name was Giles?"
"Oh, that's his son—his adopted son, sir."
"Thank you. Well, come what may, we shall know soon—my poor Janet!"
Janet and Lily had some tea. The Cygnet knew a great deal more about
beer and punch than about tea, and consequently, it was not very
refreshing. Lily began to feel anxious about her mother, she looked so
pale.
"Mother dear," the girl said, "let us go out and get a little fresh air. We
need not go out of sight of the door, you know."
"It is very close indeed; I am half smothered," poor Janet said; and, more
to please Lily than because she hoped for relief, she tied her bonnet and
stood up. The busy landlady heard the door open, and came into the
passage.
"We are going to walk about a little," said Lily.
"Maybe you'd like to see the church, ladies? Sexton lives next door, and
will lend you the key of yonder little gate, just t'other side of the road; it
opens into the churchyard—the seminary, I believe, gentlefolk call it—and
it's a matter of general remark that our church and the churchyard are
very pretty; I've known people come from a distance to see them. I'll just
get you the key."
She rushed into the nearest cottage, and came out carrying a key. "Here
'tis, ma'am; and if you go up the steps you'll see, just before you, near
the top, two little graves, kept beautiful with flowers, and when you come
back, I'll tell you the story of them two graves, which is worth hearing, I
assure you, besides being true. Here's the key of the gate—the wicked
gate, sexton calls it, but it's a good gate enough, and handy when one
don't want to go round to the big one."
To stop the torrent of words, Janet took the key, and she and Lily crossed
the road.
"How she does chatter!" Lily said. "But we may as well go in, mother. It
will be quieter than out here, don't you think?"
"Yes, so it will. We can watch for your father well enough there."
Once inside the wicket, Janet would have been content to sit on the steps
which led up to the church, but she found that she could not see over the
wall; so they began to climb upwards. And the place was so pretty, and,
moreover, so unlike anything that Lily had ever seen, that they went on
and on, till they reached the top of the bank, and saw before them the
beautiful old church, with a wide, low porch; and between them and it a
number of graves. All were nicely kept, but two were quite beautiful,
covered completely with blue and white flowers, while the grass
surrounding them was like velvet. Round the white marble cross at the
head of one grave, a white clematis was trained so skilfully that the
inscription was not obscured. The other grave had a cross, but it was of
wood, and round it clung a rose-tree, with small crimson roses in great
profusion. But here, too, the growth was not allowed to interfere with the
inscription.
"Oh, mother, is not that lovely? What constant care some one must take
of these two graves—such little graves, too! These must be the two the
landlady spoke of; we must hear the story. I wonder why one has a
marble cross and the other only a wooden one?"
While Lily spoke, they were drawing nearer to the little graves, and now
the girl began to read aloud—
"'Charles William Wentworth, only child of Dr. Alexander Wentworth

and Lucy, his wife. Died April 3, 18—, aged seven years.'"
Suddenly her mother caught her by the arm, and said in a low, strange
voice—
"Lily! The other—look at it, read it!"
Lily was frightened, and she was more frightened when she saw her
mother's face. She looked at the wooden cross, and exclaimed—
"Oh, mother, what can it mean?"
"Read it to me; I may have read it wrong. Be quick, Lily, read it."
And Lily read—
"'Frank. Died September 14, 18—, aged about seven years.

He laid down his life to save his brother's. His last words
were a message to his mother, to tell her he had taken care of Fred.'"
"Oh, mother, mother, what does it mean?"
"That I have found one of my little boys," Janet said, and she trembled so
that Lily put her arms round her and tried to hold her up.
A step rang on the gravel, a young man came round the corner of the
church and stopped short on seeing strangers near the graves he came to
visit. Lily, though usually very shy, was so beside herself with fright, that
she called aloud to him—
"Please, please come here; mother is ill, and I am afraid she will fall!"
The stranger was at her side in a moment.
"Has she fainted? I'll carry her up to the seat in the porch, and run for
water."
But Janet had not fainted, and now she steadied herself, laid her hand on
his arm, and said—
"Tell me what this means, if you are Fred?" pointing to the wooden cross.
He looked at her earnestly. "Who are you?" he said. "Is my childish dream
come true at last? Oh, I can tell you what those words mean! My brother
lies there. We had wandered—I don't know where from. He was the elder,
and—he laid down his life to save mine."
"Then you are my little Fred, and I have found both my boys," said Janet.
"Child, don't you know me?"
"Is it true? Are you really my mother? But you are ill; don't try to speak.
Let me help you up to the porch; you can hardly stand."
He put his arm round her and guided her faltering steps to the porch,
followed by the distracted Lily, who felt as if walking in her sleep. In the
porch, there was a broad stone seat, on which Fred placed his mother; he
knelt beside her, and said—
"Is it true that you are really my mother?—the 'muddie' for whom Frank
and I fretted so—to find when we ran away? From whom we escaped, I
cannot remember. I only recall an angry, cruel face. For pity's sake, tell
me who you are."
"I am surely your mother, my son. You always called me 'muddie.' Come
here, Lily; this is your brother Fred. Why, where has the child gone?"
For Lily, having caught sight of her father and Dr. Wentworth at the door
of the Cygnet, had run down the steps to the gate, and across the road to
her father's side.
"Father," she cried, "we have found him! Mother and I, up there. Come, I
will show you the way."
"Lily, tell me—does my poor Janet know that Frank is dead?"
"I think she does. It was a little grave, all over flowers—and then he came
round the church. I did not quite understand, but mother did."
"It must have been the inscription that I told you of: she understood, no
doubt. Tell her the exact words were, 'Tell muddie that I took care of
Fred.' Mr. Rayburn, in finding Fred you've found a good and noble son; but
little Frank was a hero and a martyr, to my mind."
"He was his mother's son," was the answer.
Then they went up the steep steps, and found mother and son standing
by the flower-clad cross.
"Dr. Wentworth, I have found my mother!" cried Fred, hardly seeing that
the doctor was not alone in his agitation.
"Fred, I have found both our boys," said Janet, leaving her son and taking
her husband's arm; "and God has taken care of both of them."
CHAPTER XIII.
"AS WE FORGIVE."
THE Wentworths contrived to find room for the Rayburns,

and begged of them to stay as long as they conveniently
could. Indeed, for some days Janet could hardly have
travelled, but she soon regained her usual health and quiet
cheerfulness. She and her husband, with Lily for their
companion, made Fred show them every spot connected
with the story of Frank's death, and his own life since then.
Betty Giles's cottage, the very spot on the road where the
child-hero at last stumbled and fell, were visited and
revisited. But the mystery as to how the children had so
quickly got so far away from Rugeley was never thoroughly
solved. Fred had no remembrance of the long railway
journey.
The Rayburns were the more inclined to linger at Edgestone

because they could not bring themselves to take Fred away
from the kind friends who had long regarded him as their
own son. But this difficulty was ended by a conversation
between Mrs. Wentworth and Janet, one day when the rest
had gone for a long walk, leaving them to keep each other
company. They talked of various matters for some time.
Then there was a short silence, broken by Mrs. Wentworth,
who said—
"Janet—I may call you Janet, may I not?—I want to ask

you, if you don't mind, what you mean to do about Fred?"
"Oh," said Janet, quickly, "he has not yet finished his
studies. There is a fine opening for a doctor in Gattigo, but

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Reichman_FM_pi-xxx.indd 1 13/08/18 6:28 PM

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Eric F. Reichman, PhD, MD, FAAEM, FACEP, NBPAS

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This book was set in Minion Pro by Cenveo Publisher Services.

This book is printed on acid-free paper.

Library of Congress Cataloging-in-Publication Data

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Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii 19 Confirmation of Endotracheal Intubation. . . . . . . . . . . . 139

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39 Automated External Defibrillation . . . . . . . . . . . . . . . 319 63 Central Venous Access . . . . . . . . . . . . . . . . . . . . . . 516

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176 Retrograde Urethrography and Cystography . . . . . . . . . 1481 199 Tympanocentesis . . . . . . . . . . . . . . . . . . . . . . . 1622

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Leah W. Antoniewicz, MD [161, 166] Abraham Berhane, MD [126]

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Caleb P. Canders, MD [68, 144] Carolyn Chooljian, MD [134]

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Sean Dyer, MD [218] Christopher Freeman, MD [137, 157, 164]

Mahmuda Farha, DO [215] Christopher A. Gee, MD, MPH [112]

Rosaura Fernandez, MD [77] Steven Go, MD, FACEP [178, 182]

Adrian H. Flores, MD, MPH [100]

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Peter S. Kim, MD [210] John C. Kubasiak, MD [51]

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Eric S. Levy, DO [33, 79] Briana D. Mazur, DO [195]

Karen Lind, MD, MACM, FACEP [184] Justin Mazzillo, MD [94]

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Ruth E. Moncayo, MD [28] Robert Needleman, MD [126]

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Julie Kautz Oliva, MD [34] Priya D. Perumalsamy, MD [105, 131]

Francisco Orejuela, MD [163] Amanda Pientka, MD [217]

Anant Patel, DO [223] John Ramos, MMS, PA-C [135]

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Dean Sagun, MD [232] Luis Sequera-Ramos, MD [26]

Devin Sandlin, MD [192] Andrew Shedd, MD, FACEP [174, 175]

Jeffrey Schaider, MD [218] Craig Sisson, MD, RDMS, FACEP [63]

Michael A. Schindlbeck, MD, FACEP [139, 154] Elaine H. Situ-LaCasse, MD [92]

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