Emergency Medicine Orthopedic Assessment
Acute musculoskeletal injuries are commonly seen in our emergency departments, and are commonly missed. There are many reasons for more missed injures and a significant one is over-reliance on radiographs. An emergency department orthopedic assessment goes far beyond the radiographs. A focused, yet comprehensive history is vital to understand the forces and mechanism of injury. That injury must be understood in the context of the patient, because older and much younger patients have weaker bone. Finally, the physical examination is instrumental in localizing the pathology and is essential to put radiograph results in the p...
Source: Emergency Medicine Clinics of North America - November 20, 2019 Category: Emergency Medicine Authors: Arun Sayal Source Type: research

Emergency Orthogeriatrics
Appropriate recognition of the physiologic, psychological, and clinical differences among geriatric patients, with respect to orthopedic injury and disease, is paramount for all emergency medicine providers to ensure they are providing high-value care for this vulnerable population. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - November 20, 2019 Category: Emergency Medicine Authors: Phillip D. Magidson, Allison K. Thoburn, Teresita M. Hogan Source Type: research

The Emergency Evaluation and Management of Pediatric Extremity Fractures
This article focuses on the diagnosis and management of pediatric extremity injuries. The article describes the anatomic features and healing principles unique to children and discusses pediatric upper and lower extremity fractures and presents evidence-based and standard practice for their management. Finally, the article describes the conditions under which emergency physicians are likely to miss pediatric fractures by highlighting specific examples and discussing the general factors that lead to th ese errors. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - November 20, 2019 Category: Emergency Medicine Authors: Kathy Boutis Source Type: research

The Emergent Evaluation and Treatment of Hand and Wrist Injuries
This article provides the necessary knowledge to diagnose and treat common hand and wrist injuries encountered in the emergency department. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - November 20, 2019 Category: Emergency Medicine Authors: Mark Sanderson, Bruce Mohr, Michael K. Abraham Source Type: research

The Emergent Evaluation and Treatment of Elbow and Forearm Injuries
This article provides an updated review of the emergent evalution and treatment of elbow and forearm injuries in the emergency department. Clinically necessary imaging is discussed. Common and uncommon injuries of the elbow and forearm are reviewed with an emphasis on early recognition, efficient management, and avoidance of complications. The astute emergency physician will rely on a focused history and precise examination, applied anatomic knowledge, and strong radiographic interpretative skills to avoid missed injuries and complications. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - November 20, 2019 Category: Emergency Medicine Authors: Dennis P. Hanlon, Vasilios Mavrophilipos Source Type: research

The Emergent Evaluation and Treatment of Shoulder, Clavicle, and Humerus Injuries
This article summarizes common diagnoses of shoulder pain, including bony, infectious, and connective tissue pathologies and their proper treatment. It also reviews which shoulder pain conditions are emergency diagnoses and need immediate treatment and which diagnoses need conservative management and outpatient follow-up. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - November 20, 2019 Category: Emergency Medicine Authors: Jacob Stelter, Sanjeev Malik, George Chiampas Source Type: research

The Emergent Evaluation and Treatment of Neck and Back Pain
This article discusses the efficient and effective evaluation, management, and treatment of patients with neck and back pain in the ED. Emphasis is placed on vertebral osteomyelitis, epidural abscess, acute transverse myelitis, epidural compression syndrome, spinal malignancy, and spinal stenosis. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - November 20, 2019 Category: Emergency Medicine Authors: Brian N. Corwell, Natalie L. Davis Source Type: research

Risk Management and Avoiding Legal Pitfalls in the Emergency Treatment of High-Risk Orthopedic Injuries
Many orthopedic injuries can have hidden risks that result in increased liability for the emergency medicine practitioner. It is imperative that emergency medicine practitioners consider the diagnoses of compartment syndrome, high-pressure injury, spinal epidural abscess, and tendon lacerations in the right patient. Consideration of the diagnosis and prompt referrals can help to minimize the complications these patients often develop. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - November 20, 2019 Category: Emergency Medicine Authors: Michael C. Bond, George C. Willis Source Type: research

Ultrasound Imaging of Orthopedic Injuries
This article reviews the common MSK injuries that can be diagnosed with ultrasound with a focus on point-of-care ultrasound. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - November 20, 2019 Category: Emergency Medicine Authors: Robert Simard Source Type: research

Sports Medicine Update
A systematic approach is required for patients with a suspected concussion. Although standardized tools can aid in assessment, the diagnosis of concussion remains a clinical one. At the time of diagnosis, patients should be given both verbal and written review of the common symptoms of concussion, expected course of recovery, as well as strategies to manage symptoms. Most patients benefit from a brief period of rest, followed by a gradual reintroduction of activities, and a graduated return-to-sport protocol. Patients with prolonged recovery from a concussion may benefit from exercise, vestibular, and cognitive rehabilitat...
Source: Emergency Medicine Clinics of North America - November 20, 2019 Category: Emergency Medicine Authors: Michael Robert Misch, Neha P. Raukar Source Type: research

Traumatic Injuries of the Pelvis
This article equips all emergency medicine practitioners with the knowledge to expertly diagnose, treat, and disposition these patients. Pelvic fractures occurring in young patients tend to be associated with high-energy mechanisms and polytrauma. Pelvic and hip fractures in the elderly are often a result of benign trauma but are associated with significant morbidity and mortality. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - November 20, 2019 Category: Emergency Medicine Authors: Jason V. Brown, Sharleen Yuan Source Type: research

Knee and Leg Injuries
Knee and leg injuries are extremely common presentations to the emergency department. Understanding the anatomy of the knee, particularly the vasculature and ligamentous structures, can help emergency physicians (EPs) diagnose and manage these injuries. Use of musculoskeletal ultrasonography can further aid EPs through the diagnostic process. Proper use of knee immobilizers can also improve long-term patient outcomes. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - November 20, 2019 Category: Emergency Medicine Authors: Moira Davenport, Matthew P. Oczypok Source Type: research

Pain Management for Orthopedic Injuries
Pain management in acute orthopedic injury needs to be tailored to the presentation and patient. Subjective and objective assessment, in conjunction with pathophysiology, should be used to provide symptom control. Ideally, treatment should be administered in an escalating fashion, attempting to manage pain with the lowest dose of the safest medication available. There are also adjunctive therapies, including those that are nonpharmacologic, that can provide additional relief. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - November 20, 2019 Category: Emergency Medicine Authors: Nupur Nischal, Evangeline Arulraja, Stephen P. Shaheen Source Type: research

Orthopedic Emergencies
Patients with orthopedic complaints in the emergency department (ED) are very commonly seen, and their injuries are of widely variable significance. The spectrum runs from injuries that are relatively minor to serious injuries that can compromise function, and rarely, can be limb or even life threatening. Many of the serious injuries are clinically obvious. But some are fairly occult, especially on plain radiographs. These subtle but serious complaints are commonly missed and can be easily mismanaged due to a variety of factors. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - November 20, 2019 Category: Emergency Medicine Authors: Michael C. Bond, Arun Sayal Tags: Preface Source Type: research

Orthopedic Emergencies
Emergency orthopedics is the “bread and butter” of emergency medicine. This area of emergency medicine constitutes everything from mild bumps and bruises all the way through major traumatic injuries, which can result in hemorrhagic shock. It includes injuries to every region of the body, and these injuries, no matter how mi ld or severe, are among the most common reasons patients present to emergency departments (EDs) and urgent care centers around the world. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - November 20, 2019 Category: Emergency Medicine Authors: Amal Mattu Tags: Foreword Source Type: research

Orthopedic Emergencies
EMERGENCY MEDICINE CLINICS OF NORTH AMERICA (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - November 20, 2019 Category: Emergency Medicine Authors: Michael C. Bond, Arun Sayal Source Type: research

Copyright
ELSEVIER (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - November 20, 2019 Category: Emergency Medicine Source Type: research

Contributors
AMAL MATTU, MD (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - November 20, 2019 Category: Emergency Medicine Source Type: research

Contents
Amal Mattu (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - November 20, 2019 Category: Emergency Medicine Source Type: research

Forthcoming Issues
Risk Management in Emergency Medicine (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - November 20, 2019 Category: Emergency Medicine Source Type: research

Emergency Diagnosis and Management of Genitourinary Trauma
Genitourinary trauma often occurs concomitantly with other abdominopelvic trauma, but nevertheless is important to master in diagnosis, management, and treatment. There are subtleties to diagnosis and important steps that should not be missed to properly manage patients. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - September 26, 2019 Category: Emergency Medicine Authors: Matthew J. Coppola, Joshua Moskovitz Source Type: research

Evaluation of the Renal Transplant Recipient in the Emergency Department
This article discusses these risks and management decisions that the emergency department physician should be aware of in order to prevent adverse outcomes for the patient and transplanted kidney. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - September 26, 2019 Category: Emergency Medicine Authors: John David Gatz, Ryan Spangler Source Type: research

The Approach to the Patient with Hematuria
Hematuria is common; whether gross or microscopic, it is incumbent on emergency providers to consider life-threatening and benign processes when evaluating these patients. Most workup is driven by a focused history and physical, including laboratory studies and diagnostic imaging. The cause originates in the genitourinary tract and, as long as the patient remains stable, they can be discharged with close outpatient follow-up. The importance of this cannot be stressed enough because hematuria, especially in the elderly, frequently signals the presence of urologic malignancy. In addition, the workup occasionally yields a non...
Source: Emergency Medicine Clinics of North America - September 26, 2019 Category: Emergency Medicine Authors: George C. Willis, Semhar Z. Tewelde Source Type: research

Female Nonobstetric Genitourinary Emergencies
This article discusses these diagnoses and appropriate evaluation and management in the emergency department. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - September 26, 2019 Category: Emergency Medicine Authors: Sarah Mahonski, Kami M. Hu Source Type: research

Imaging Modalities in Genitourinary Emergencies
Emergency physicians rely on a multitude of different imaging modalities in the diagnosis of genitourinary emergencies. There are many considerations to be taken into account when deciding which imaging modality should be used first, as oftentimes several diagnostic tools can be used for the same pathologic condition. These factors include radiation exposure, sensitivity, specificity, age of patient, availability of resources, cost, and timeliness of completion. In this review, the strengths and weaknesses of different imaging tools in the evaluation of genitourinary emergencies are discussed. (Source: Emergency Medicine C...
Source: Emergency Medicine Clinics of North America - September 26, 2019 Category: Emergency Medicine Authors: Julian Jakubowski, Joshua Moskovitz, Nicole J. Leonard Source Type: research

Genitourinary Procedures
Emergency medicine providers may encounter serious GU conditions that need rapid diagnosis and early intervention to avoid severe life- and limb-threatening complications. A fundamental knowledge of several key procedural interventions is incredibly important to optimal patient outcomes. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - September 26, 2019 Category: Emergency Medicine Authors: Michael P. Jones, Kumelachew Mekuria Source Type: research

The Importance of Genitourinary Emergencies
We hope you find this issue of Genitourinary Emergencies to be diverse with sufficient breadth and depth to help the pit doctor everywhere treat patients presenting with these complaints without angst or hesitation. We chose these articles to represent common presentations of genitourinary pathology that physicians in Emergency Departments everywhere may encounter. The majority of us treat these diseases each and every day, and we wanted to bring everyone up to speed on the latest and greatest in diagnosis, management, and intervention so we can all provide better quality care wherever we work to the patients we serve. (So...
Source: Emergency Medicine Clinics of North America - September 26, 2019 Category: Emergency Medicine Authors: Joshua Moskovitz, Ryan Spangler Tags: Preface Source Type: research

Genitourinary Emergencies in Emergency Medicine
I was recently talking to a colleague in emergency medicine about how he prioritizes his reading time, given how busy he is. He responded by stating that he focuses first on those organ systems that “make you die if they go bad.” No surprise, he listed the cardiovascular system and neurologic system as his 2 main priorities when trying to keep up with the literature, and certain other organ systems, including the genitourinary (GU) system get only a passing glance with his limited time. At first, I thought this was quite a sensible method of time management. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - September 26, 2019 Category: Emergency Medicine Authors: Amal Mattu Tags: Foreword Source Type: research

Genitourinary Emergencies
EMERGENCY MEDICINE CLINICS OF NORTH AMERICA (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - September 26, 2019 Category: Emergency Medicine Authors: JOSHUA MOSKOVITZ, RYAN SPANGLER Source Type: research

Copyright
ELSEVIER (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - September 26, 2019 Category: Emergency Medicine Source Type: research

Contributors
AMAL MATTU, MD (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - September 26, 2019 Category: Emergency Medicine Source Type: research

Contents
Amal Mattu (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - September 26, 2019 Category: Emergency Medicine Source Type: research

Forthcoming Issues
Orthopedic Emergencies (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - September 26, 2019 Category: Emergency Medicine Source Type: research

Pediatric Genitourinary Infections and Other Considerations
Pediatric patients pose a unique host of challenges to the emergency provider across all complaints and ages, but this is particularly notable in the genitourinary (GU) system. The pediatric GU system is different from that of the adult in its etiology of symptoms, complications, and treatments. Based on age, there are variations in the anatomy. These differences result in symptoms and diagnoses that must be managed differently. Although in many respects management is similar to GU emergency conditions in adults, there are, occasionally subtle, differences between the care of children and adults, which can greatly impact o...
Source: Emergency Medicine Clinics of North America - August 31, 2019 Category: Emergency Medicine Authors: Kathleen Stephanos, Andrew F. Bragg Source Type: research

Approach to Acute Kidney Injuries in the Emergency Department
This article is an evidence-based overview of acute kidney injuries in patients seen in the emergency department setting. The article outlines the current definition of acute kidney injuries and most common causes of injuries. Furthermore, it details clinical evaluations important to appreciate and intervene on, such as volume overload, hypertension, life-threatening electrolyte derangements, and threshold for urgent dialysis. Finally, the article describes special populations that are at higher risk for acute kidney injuries and acute conditions, such as rhabdomyolysis, and the controversy of contrast-induced acute kidney...
Source: Emergency Medicine Clinics of North America - August 30, 2019 Category: Emergency Medicine Authors: Tanveer Gaibi, Aditi Ghatak-Roy Source Type: research

Acute Scrotal Emergencies
This article explains how to diagnose and manage scrotal emergencies such as testicular torsion, Fournier gangrene, and testicular trauma. These diagnoses are often difficult to discern from less-concerning causes. This article helps to elucidate the differences between the dangerous and the less-harmful pathologic conditions. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - August 24, 2019 Category: Emergency Medicine Authors: Molly M. Bourke, Joshua Z. Silverberg Source Type: research

Sexually Transmitted Infections
The diagnosis and treatment of sexually transmitted infections is a crucial component of providing evidence-based care in the emergency department. Understanding how to make the diagnosis and implement effective treatment is essential to maintaining and improving public health. Providers should also be adept at giving care to sexual assault survivors and seeking out the expertise of specially trained professionals within networks known as SANE, SAFE, or SART. These networks are critical to providing standardized care to sexual assault patients. Prophylaxis remains a key element for the prevention of sexually transmitted in...
Source: Emergency Medicine Clinics of North America - August 24, 2019 Category: Emergency Medicine Authors: Denise McCormack, Kathryn Koons Source Type: research

Kidney and Ureteral Stones
Renal colic is a common complaint that presents to the emergency department. It is estimated that 13% of men and 7% of women will develop a renal stone. There is a high probability of recurrence, with 50% within 5  years. Computed tomographic scan of the abdomen and pelvis without contrast and the ultrasound of the kidneys, ureters, and bladder are the common diagnostic imaging modalities used for diagnosis. Initial treatment includes analgesics and medical expulsive therapy. Most of the patients will pass t heir stone spontaneously within 3 days. The remaining 20% will require urologic intervention. (Source: Eme...
Source: Emergency Medicine Clinics of North America - August 19, 2019 Category: Emergency Medicine Authors: Jill Corbo, Jessica Wang Source Type: research

Evaluation and Management of Urinary Tract Infection in the Emergency Department
This article reviews the evaluation and management of patients with infections of the urinary tract. Definitions of asymptomatic bacteriuria, uncomplicated UTI, and complicated UTI are presented, as well as techniques for distinguishing them. The pathophysiology and clinical and laboratory diagnoses of UTI are described. Treatment of UTI is reviewed, with attention to bacteriuria and special populations, including pregnant, elderly/geriatric, and spinal cord injury patients. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - August 19, 2019 Category: Emergency Medicine Authors: Sarah B. Dubbs, Sarah K. Sommerkamp Source Type: research

Penile Emergencies
The penis is an organ of enormous importance and is vital for both excretory and reproductive function. The anatomy of the penis itself can lead to many of its emergent conditions and a thorough understanding of the anatomy and physiology is central to recognition of these conditions. Physicians should have a high clinical suspicion for penile emergencies and perform a thorough physical examination to make a proper diagnosis. Prompt diagnosis and proper management are essential for minimizing dysfunction of this vital organ. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - August 16, 2019 Category: Emergency Medicine Authors: Joseph Offenbacher, Andrew Barbera Source Type: research

Urinary Retention
This article provides an overview of the common causes of urinary retention, as well as emergency department evaluation, treatment, and disposition of patients with acute retention. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - August 16, 2019 Category: Emergency Medicine Authors: Michael Billet, Thomas Andrew Windsor Source Type: research

Intracranial Hemorrhage and Intracranial Hypertension
This article reviews the most current evidence regarding blood pressure targets and provides guidance on reversal of anticoagulation for TBI, ICH, and SAH. It also describes the assessment, optimal therapeutic targets, and interventions to treat intracranial hypertension that can result from TBI, ICH, or SAH. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 29, 2019 Category: Emergency Medicine Authors: Evie Marcolini, Christoph Stretz, Kyle M. DeWitt Source Type: research

Mechanical Ventilation Strategies for the Patient with Severe Obstructive Lung Disease
This article addresses key principles when managing these challenging patients: patient-ventilator synchrony, air trapping and auto-positive end-expiratory pressure, and airway pressures. This article provides a practical workflow for the emergency physician responsible for managing these patients. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 29, 2019 Category: Emergency Medicine Authors: Jarrod M. Mosier, Cameron D. Hypes Source Type: research

Mechanical Ventilation in Hypoxemic Respiratory Failure
Acute hypoxemic respiratory failure (AHRF) is a common challenge in emergency medicine. Patient outcomes depend on interventions performed during preintubation, intubation, and postintubation. The article presents recommendations for evidence-based practice to optimally manage patients with AHRF and the acute respiratory distress syndrome. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 29, 2019 Category: Emergency Medicine Authors: Shikha Kapil, Jennifer G. Wilson Source Type: research

Beyond Triage and Resuscitation: Optimizing Care for the Critically Ill Emergency Department Patient
Since the last critical care issue of Emergency Medicine Clinics of North America published in 2014, emergency departments (ED) across the country have continued to experience an increase in critically ill patient volumes, intensive care unit (ICU) boarding times, clinical complexity, and expectations for care. Appropriate management of these patients by emergency medicine (EM) physicians is critical as the trajectory of the critically ill patient is often defined by the early and effective interventions delivered in the ED. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 29, 2019 Category: Emergency Medicine Authors: John C. Greenwood, Tsuyoshi Mitarai Tags: Preface Source Type: research

Beyond Triage and Resuscitation: Optimizing Care for the Critically Ill Emergency Department Patient
During my last shift in the emergency department (ED), I assumed care at sign-out of an intubated patient with an acute asthma exacerbation as well as a patient with cardiogenic pulmonary edema who was receiving noninvasive ventilation. Shortly thereafter, prehospital personnel brought us a patient with respiratory failure due to emphysema who needed to be intubated, followed by a patient having an acute stroke who would receive thrombolytics, followed by a patient with hypotension who would later require pressors for septic shock. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 29, 2019 Category: Emergency Medicine Authors: Amal Mattu Tags: Foreword Source Type: research

Critical Care in the Emergency Department
EMERGENCY MEDICINE CLINICS OF NORTH AMERICA (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 29, 2019 Category: Emergency Medicine Authors: John C. Greenwood, Tsuyoshi Mitarai Source Type: research

Copyright
ELSEVIER (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 29, 2019 Category: Emergency Medicine Source Type: research

Contributors
AMAL MATTU, MD (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 29, 2019 Category: Emergency Medicine Source Type: research

Contents
Amal Mattu (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 29, 2019 Category: Emergency Medicine Source Type: research