Free Rosen & Barkin's 5-Minute Emergency Medicine Consult by Jeffrey J. Schaider, Adam Z. Barkin, Roger M. Barkin, Philip Shayne, Richard E. Wolfe, Stephen R. Hayden, Peter Rosen

Colorado
    Gary D. Zimmer, MD
    Assistant Professor
    Drexel University
    Philadelphia, PA
    Chairman
    Emergency Medicine
    St. Mary Medical Center
    Langhorne, PA
    Karen P. Zimmer, MD
    Assistant Professor
    Pediatrics
    Johns Hopkins University
    Baltimore, Maryland
    Pediatrics
    Thomas Jefferson University Hospital
    Philadelphia, Pennsylvania
    David N. Zull, MD
    Professor of Emergency Medicine and Internal Medicine
    Northwestern University
    Attending Physician
    Department of Emergency Medicine
    Northwestern Memorial Hospital
    Chicago, Illinois

FOURTH EDITION AUTHOR ACKNOWLEDGMENTS
    The editors and authors of the 5 th edition gratefully acknowledge the past contributions of the following previous edition authors:
    John Bailitz
    Todd Baumbacher
    Jefferson D. Bracey
    Colleen Campbell
    Jamila Danishwar
    Chirag A. Dholakia
    Arunchalam Einstein
    Tala R. Elia
    David Feldman
    Maggie Fernig
    Steven Furer
    Bret E. Ginther
    Judd L. Glasser
    Ian Greenwald
    Mark A. Hostetler
    Thea James
    David Jerrard
    Cade Lawrence
    James M. Leaming
    David Listman
    Trevor J. Mills
    Elizabeth L. Mitchell
    Carol R. Okada
    Janet M. Poponick
    Marcelo Sandoval
    Elaine Sapiro
    Ghazala Q. Sharieff
    Arash Soroudi
    Vaishal M. Tolia
    Karen B. Van Hoesen
    Beth A. Zelonis

Rosen & Barkin’s
5-Minute
Emergency
Medicine
Consult
5TH EDITION
     

Rapid-Sequence Intubation *
    1. Pre-oxygenate with 100% oxygen
    2. Apply cricoid pressure
    3. Induction: etomidate (0.3 mg/kg), propofol (0.5–2 mg/kg) or ketamine (2 mg/kg) IV push
    4. Neuromuscular blockade: succinylcholine 1.5 mg/kg IV push
    5. Wait 30–45 sec
    6. Intubate when optimal conditions achieved
    *Consider pretreatment with fentanyl (1–2 μg/kg) IV push (over 1–2 min) and lidocaine
(1.5 mg/kg) IV push if concern for increased intracranial pressure or severe hypertension
    *Consider defasciculating dose of paralytic if concern for increased intracranial pressure (see table for dosage)
    *Atropine: 0.02 mg/kg IV push (for children <1 y)
Neuromuscular Blocking Agents

Sedative and Induction Agents

Pediatric Vital Signs and Resuscitation Equipment Sizes

Temperature Conversion: Celsius ↔ Fahrenheit

Weight Conversion: Pounds ↔ Kilograms

ABDOMINAL AORTIC ANEURYSM
Daniel J. Henning • Jason C. Imperato • Carlo L. Rosen
BASICS
DESCRIPTION
Focal dilation of the aortic wall with an increase in diameter by at least 50% (>3 cm).
95% are infrarenal.
Rapid expansion or rupture causes symptoms.
Rupture can occur into the intraperitoneal or retroperitoneal spaces
Intraperitoneal rupture is usually immediately fatal
Average growth rate of 0.2–0.5 cm/yr
Of ruptures:
90% overall mortality
80% mortality for patients who reach the hospital
50% mortality for patients who undergo emergency repair
Geriatric Considerations
Risk increases with advanced age.
Present in:
4–8% of all patients older than 65 yr
5–10% of men 65–79 yr old
12.5% of men 75–84 yr old
5.2% of women 75–84 yr old
ETIOLOGY
Risk factors:
Male gender
Age >65 yr
Family history
Cigarette smoking
Atherosclerosis
HTN
Diabetes mellitus
Connective tissue disorders:
Ehlers–Danlos syndrome
Marfan syndrome
Uncommon causes:
Blunt abdominal trauma
Congenital aneurysm
Infections of the aorta
Mycotic aneurysm secondary to endocarditis
Rupture risk factors:
Size (annual rupture rates):
Aneurysms 5–5.9 cm = 4%
Aneurysms 6–6.9 cm = 7%
Aneurysms 6.9–7 cm = 20%
Expansion:
A small aneurysm that grows >0.5 cm in 6 mo is at high risk for rupture.
Gender:
For aneurysms 4.0–5.5 cm, women have 4× higher risk of rupture compared to men with similar sized aneurysms.
DIAGNOSIS
SIGNS AND SYMPTOMS
History
Abdominal, back, or flank pain:
Vague, dull quality
Constant, throbbing, or colicky
Acute, severe, constant
Radiates to chest, thigh, inguinal area, or scrotum
Flank pain radiating to the groin in 10% of cases
Lower extremity pain
Syncope, near-syncope
Unruptured are most often asymptomatic
Physical-Exam
Unruptured:
Abdominal mass or fullness
Palpable,