急診醫學

該套教材近 50種，主要供臨牀醫學留學生、七年制或八年制醫學生、醫學本科生英語或雙語教學使用。部分教材由我國長期從事醫學留學生教育的教授、學者編寫，其餘大部分教材由清華大學出版社從多家國外出版社引進，改編出版，以適應我國臨牀醫學專業留學生課堂教學和臨牀實習所需。 ^[1] 

SECTION 1

Selected Diagnosic and Therapeutic Techniques of Emergency Medicine Dignostic Techniques

Chapter 1 Emergency Ultrasound ………………… 2

PERSPECTIVE ……………………………………… 2

APPLIED ULTRASOUND PHYSICS AND INSTRUMENTATION………………………… 2

EQUIPMENT AND SAFETY ……………………… 3

INTEGRATION INTO EMERGENCY MEDICINE PRACTICE ………………………………………… 11

Chapter 2

Monitoring the Emergency Patient … 12

PERSPECTIVE …………………………………… 12

NONINVASIVE BLOOD PRESSURE MEASUREMENT …………………………… 12

PULSE OXIMETRY ……………………………… 13

END-TIDAL CARBON DIOXIDE MONITORING ……………………………… 13

CEREBRAL FUNCTION MONITORING ……… 16

MONITOR ALARMS AND LIMITS …………… 16

Therapeutic Techniques Chapter 3 Airway …………………………………… 17

PERSPECTIVE …………………………………… 17

PATHOPHYSIOLOGY …………………………… 17

CLINICAL FEATURES …………………………… 17

MANAGEMENT ………………………………… 21

THERAPEUTIC MODALITIES ………………… 23

PRINCIPLES OF MECHANICAL VENTILATION … 28

MANAGEMENT ………………………………… 31

Chapter 5

Adult Resuscitation …………………… 36

PERSPECTIVE …………………………………… 36

PRINCIPLES OF DISEASE ……………………… 36

CLINICAL FEATURES AND MANAGEMENT … 37

Chapter 6

Brain Resuscitation …………………… 43

PERSPECTIVE …………………………………… 43

PATHOPHYSIOLOGY …………………………… 43

MANAGEMENT ………………………………… 43

CLINICAL OUTCOMES ………………………… 48

Chapter 7

Implantable Cardiac Devices………… 49

PERSPECTIVE …………………………………… 49

INDICATIONS FOR PERMANENT PACEMAKERS AND ANTIARRHYTHMIA DEVICES ……… 49

IMPLANTABLE CARDIOVERTER DEFIBRILLATORS …………………………… 57

Chapter 8

Blood and Blood Components ……… 62

PERSPECTIVE …………………………………… 62

PATHOPHYSIOLOGIC PRINCIPLES ………… 62

MANAGEMENT ………………………………… 64

OUTCOMES ……………………………………… 65

SECTION 2 Medical Emergencies Cardiac Emergencies

Chapter 9

Chest Pain ……………………………… 68

PERSPECTIVE …………………………………… 68

DIAGNOSTIC TABLE …………………………… 74

MANAGEMENT AND DISPOSITION ………… 76

Chapter 10

Acute Coronary Syndrome ………… 80

PERSPECTIVE …………………………………… 80

EPIDEMIOLOGY ………………………………… 80

SPECTRUM OF DISEASE………………………… 80

PATHOPHYSIOLOGY …………………………… 81

CLINICAL FEATURES …………………………… 81

DIAGNOSTIC INVESTIGATIONS ……………… 82

EMERGENCY DEPARTMENT BASED CHEST PAIN CENTERS……………………………… 96

MANAGEMENT OF ACUTE CORONARY SYNDROME…………………………………… 97

Chapter 11

Aortic Dissection ……………………… 102

PERSPECTIVE …………………………………… 102

PRINCIPLES OF DISEASE ……………………… 102

CLINICAL FEATURES …………………………… 104

DIAGNOSTIC STRATEGIES …………………… 105

DIFFERENTIAL CONSIDERATIONS ………… 107

MANAGEMENT ………………………………… 107

DISPOSITION……………………………………… 109

Chapter 12

Pericardial and Myocardial Disease … 110

PERICARDIAL DISEASE (PERICARDITIS) ……… 110

PERSPECTIVE …………………………………… 110

ETIOLOGY ………………………………………… 110

EPIDEMIOLOGY ………………………………… 110

PRINCIPLES OF DISEASE ……………………… 111

PATHOPHYSIOLOGY …………………………… 111

IDIOPATHIC PERICARDITIS …………………… 111

UREMIC PERICARDIAL DISEASE …………… 112

POST-MYOCARDIAL INFARCTION PERICARDITIS ………………………………… 113

POSTINJURY PERICARDITIS …………………… 113

NEOPLASTIC PERICARDIAL DISEASE ……… 114

PERICARDIAL DISEASE RELATED TO CONNECTIVE TISSUE DISORDERS …………… 114

MISCELLANEOUS INFECTIOUS CAUSES OF PERICARDITIS ………………………………… 114

PERICARDIAL EFFUSION ……………………… 115

CARDIAC TAMPONADE ……………………… 115

PURULENT PERICARDITIS …………………… 116

CONSTRICTIVE PERICARDITIS ……………… 117

MYOCARDIAL DISEASES (MYOCARDITIS) …… 117

PERSPECTIVE …………………………………… 117

PRINCIPLES OF DISEASE AND PATHOPHYSI- OLOGY ………………………………………… 118

CLINICAL FEATURES …………………………… 118

DIAGNOSTIC STRATEGIES …………………… 118

DIFFERENTIAL DIAGNOSIS …………………… 119

MANAGEMENT ………………………………… 119

DISPOSITION……………………………………… 119

CARDIOMYOPATHIES AND SPECIFIC HEART MUSCLE DISEASE ……………………………… 119

DILATED CARDIOMYOPATHY ……………… 120

HYPERTROPHIC CARDIOMYOPATHY ……… 121

RESTRICTIVE CARDIOMYOPATHY ………… 122

PERIPARTUM CARDIOMYOPATHY ………… 123

SPECIFIC HEART MUSCLE DISEASES………… 123

Chapter 13 Hypertension…………………………… 125

PERSPECTIVE …………………………………… 125

PRINCIPLES OF DISEASE ……………………… 125

CLINICAL FEATURES …………………………… 127

DIAGNOSTIC STRATEGIES …………………… 128

CONSIDERATION OF DIFFERENTIAL DIAGNOSES…………………………………… 129

MANAGEMENT ………………………………… 129

DISPOSITION……………………………………… 129

Chapter 14 Dysrhythmias ………………………… 130

CARDIAC CELLULAR ELECTROPHYSI- OLOGY ……………………………………… 130

ANATOMY AND CONDUCTION……………… 131

MECHANISMS OF DYSRHYTHMIA FORMATION ……………………………… 132

APPROACH TO DYSRHYTHMIA RECOGNITION AND MANAGEMENT ……………………… 133

SPECIFIC DYSRHYTHMIAS …………………… 135

Chapter 15 Heart Failure ………………………… 148

EPIDEMIOLOGY ………………………………… 148

CELLULAR MECHANISMS …………………… 149

CARDIAC PHYSIOLOGY ……………………… 150

PRIMARY DISEASE PROCESSES RESULTING IN HEART FAILURE ……………………………… 151

COMPENSATORY MECHANISMS IN HEART FAILURE ……………………………………… 152

CLASSIFICATION OF HEART FAILURE ……… 153

CLINICAL EVALUATION OF PATIENTS WITH EPIDEMIOLOGY AND ETIOLOGY …………… 118

SUSPECTED HEART FAILURE……………… 154

TREATMENT OF ACUTE HEART FAILURE … 156

SUMMARY ………………………………………… 161

Pulmonary Emergencies Chapter 16 Dyspnea ………………………………… 162

PERSPECTIVE …………………………………… 162

DIAGNOSTIC APPROACH……………………… 163

DIFFERENTIAL DIAGNOSIS …………………… 168

Chapter 17 Hemoptysis …………………………… 172

PERSPECTIVE …………………………………… 172

DIAGNOSTIC APPROACH……………………… 173

DIAGNOSTIC ALGORITHM …………………… 174

DISPOSITION……………………………………… 175

Chapter 18 Asthma ………………………………… 176

PERSPECTIVE …………………………………… 176

EPIDEMIOLOGY ………………………………… 176

PRINCIPLES OF DISEASE ……………………… 177

CLINICAL FEATURES …………………………… 179

DIAGNOSTIC STRATEGIES …………………… 180

DIFFERENTIAL CONSIDERATIONS (Box 18-2) …………………………………182

MANAGEMENT OF ACUTE EXACERBATIONS… 182

DISPOSITION……………………………………… 188

Chapter 19

Pneumonia……………………………… 190

PERSPECTIVE …………………………………… 190

PRINCIPLES OF DISEASE ……………………… 190

CLINICAL FEATURES …………………………… 192

DIAGNOSTIC STRATEGIES …………………… 194

DIFFERENTIAL DIAGNOSIS CONSIDERATIONS ………………………… 197

MANAGEMENT ………………………………… 197

DISPOSITION……………………………………… 200

ACUTE RESPIRATORY DISTRESS SYNDROME …………………………………201

Chapter 20

Pulmonary Embolism and Deep Vein Thrombosis …………………………… 203

PERSPECTIVE …………………………………… 203

DEEP VEIN THROMBOSIS ……………………… 203

PULMONARY EMBOLISM ……………………… 205

Chapter 21

Nontraumatic Pleural Problems …… 213

SPONTANEOUS PNEUMOTHORAX ………… 213

PLEURAL INFLAMMATION AND EFFUSION …………………………………… 218

Gastrointestinal Emergencies

Chapter 22 Acute

Pancreatitis …………………… 224

BACKGROUND…………………………………… 224

PERSPECTIVE …………………………………… 225

PRINCIPLES OF DISEASE ……………………… 225

CLINICAL FEATURES …………………………… 227

DIAGNOSTIC STRATEGIES …………………… 229

PROGNOSIS ……………………………………… 231

RADIOGRAPHIC STUDIES……………………… 232

DIFFERENTIAL CONSIDERATIONS ………… 232

MANAGEMENT ………………………………… 233

DISPOSITION……………………………………… 234

Chapter 23

Gastrointestinal Bleeding …………… 235

PERSPECTIVE …………………………………… 235

DIAGNOSTIC APPROACH……………………… 235

DIAGNOSTIC ALGORITHM …………………… 238

EMPIRICAL MANAGEMENT ………………… 238

DEFINITIVE MANAGEMENT ………………… 240

DISPOSITION……………………………………… 241

Renal Emergency

Chapter 24

Acute Kidney Injury ………………… 242

PRINCIPLES OF DISEASE ……………………… 242

CLINICAL FEATURES …………………………… 245

DIAGNOSTIC STRATEGY ……………………… 245

MANAGEMENT ………………………………… 246

DISPOSITION……………………………………… 246

Hematologic Emergency

Chapter 25

Disorders of Hemostasis …………… 248

PERSPECTIVE …………………………………… 248

PATHOPHYSIOLOGY …………………………… 248

CLINICAL FEATURES …………………………… 250

DIFFERENTIAL DIAGNOSIS AND MANAGEMENT ……………………………… 252

DISPOSITION……………………………………… 258

Metabolic Emergencies

Chapter 26

Diabetic Emergency ………………… 259

DIABETES MELLITUS …………………………… 259

HYPOGLYCEMIA ………………………………… 260

DIABETIC KETOACIDOSIS……………………… 261

HYPERGLYCEMIC HYPEROSMOLAR STATE … 265

CONTROL OF DIABETES ……………………… 266

Chapter 27

Electrolyte Disorders ………………… 268

PERSPECTIVE …………………………………… 268

HYPERKALEMIA ………………………………… 268

HYPOKALEMIA ………………………………… 271

HYPERNATREMIA ……………………………… 273

HYPONATREMIA………………………………… 274

HYPERCALCEMIA ……………………………… 278

HYPOCALCEMIA ………………………………… 279

HYPERMAGNESEMIA…………………………… 281

HYPOMAGNESEMIA …………………………… 282

HYPERPHOSPHATEMIA ……………………… 283

HYPOPHOSPHATEMIA ………………………… 284

Chapter 28

Acid-Base Disorders ………………… 286

PERSPECTIVE …………………………………… 286

PRINCIPLES OF DISEASE ……………………… 286

DIAGNOSTIC STRATEGIES …………………… 287

RESPIRATORY ACIDOSIS ……………………… 288

RESPIRATORY ALKALOSIS …………………… 289

METABOLIC ACIDOSIS ………………………… 290

METABOLIC ALKALOSIS ……………………… 292

MIXED DISORDERS ……………………………… 293

Neurologic Emergencies

Chapter 29

Acute Meningitis ……………………… 294

DEFINITION ……………………………………… 294

PRINCIPLES OF DISEASE ……………………… 294

CLINICAL FEATURES …………………………… 296

DIAGNOSTIC STRATEGIES …………………… 297

DIFFERENTIAL CONSIDERATIONS ………… 301

MANAGEMENT ………………………………… 301

DISPOSITION……………………………………… 303

Chapter 30

Headache ……………………………… 304

PERSPECTIVE …………………………………… 304

DIAGNOSTIC APPROACH……………………… 304

DIFFERENTIAL

CONSIDERATIONS ………… 308

SPECIAL MANAGEMENT ……………………… 309

PRIMARY HEADACHE DISORDERS ………… 309

SECONDARY HEADACHE DISORDERS……… 314

OTHER HEADACHE DISORDERS AND FACIAL PAIN …………………………………………… 319

Chapter 31 Syncope ………………………………… 320

PERSPECTIVE …………………………………… 320

DIAGNOSTIC APPROACH……………………… 320

DIAGNOSTIC ALGORITHM …………………… 324

EMPIRICAL MANAGEMENT ………………… 326

Chapter 32

Depressed Consciousness and Coma…… 328

PERSPECTIVE …………………………………… 328

CLINICAL EVALUATION ……………………… 329

EMPIRICAL MANAGEMENT ………………… 335

Chapter 33 Seizure ………………………………… 336

PERSPECTIVE …………………………………… 336

DIAGNOSTIC APPROACH……………………… 337

MANAGEMENT ………………………………… 342

DISPOSITION……………………………………… 342

Chapter 34 Stroke …………………………………… 343

PERSPECTIVE …………………………………… 343

PRINCIPLES OF DISEASE ……………………… 345

CLINICAL FEATURES …………………………… 346

DIFFERENTIAL CONSIDERATIONS ………… 350

DIAGNOSTIC STRATEGIES …………………… 351

STROKE MANAGEMENT ……………………… 352

DISPOSITION……………………………………… 356

SECTION 3 Surgical Emergencies

Chapter 35

Acute abdominal pain ……………… 358

PERSPECTIVE …………………………………… 358

DIAGNOSTIC APPROACH……………………… 363

DIFFERENTIAL DIAGNOSIS …………………… 368

EMPIRICAL MANAGEMENT ………………… 368

DISPOSITION……………………………………… 369

Chapter 36

Abdominal Aortic Aneurysm ……… 371

PERSPECTIVE …………………………………… 371

PRINCIPLES OF DISEASE ……………………… 372

CLINICAL FEATURES …………………………… 372

DIAGNOSTIC STRATEGIES …………………… 375

DIFFERENTIAL CONSIDERATIONS ………… 377

MANAGEMENT ………………………………… 377

LATE COMPLICATIONS OF REPAIR ………… 380

DISPOSITION……………………………………… 380

Chapter 37

Acute Disorders of the Small Intestine … 381

SMALL BOWEL OBSTRUCTION ……………… 381

ACUTE MESENTERIC ISCHEMIA……………… 385

Chapter 38

Wound Management Principles …… 389

PERSPECTIVE …………………………………… 389

PRINCIPLES OF DISEASE ……………………… 389

CLINICAL FEATURES AND DIAGNOSTIC STRATEGIES …………………………………… 391

MANAGEMENT ………………………………… 393

DISPOSITION……………………………………… 407

SUMMARY ………………………………………… 408

Chapter 39

Multiple Trauma ……………………… 410

INTRODUCTION ………………………………… 410

PRINCIPLES OF DISEASE ……………………… 410

MANAGEMENT ………………………………… 410

DISPOSITION……………………………………… 415

Chapter 40 Injury

Prevention and Control …… 416

PERSPECTIVE …………………………………… 416

PRINCIPLES OF THE DISEASE OF INJURY … 416

METHODS OF PREVENTION ………………… 418

INJURY CONTROL IN MEDICAL PRACTICE … 419

SECTION 4 Enviroment Emergencies

Chapter 41 Heat Illness …………………………… 422

PERSPECTIVE …………………………………… 422

PRINCIPLES OF DISEASE ……………………… 422

PATHOPHYSIOLOGY …………………………… 423

MINOR HEAT ILLNESS ………………………… 424

HEAT EXHAUSTION …………………………… 425

HEATSTROKE …………………………………… 426

Chapter 42

High-Altitude Medicine……………… 429

EPIDEMIOLOGY ………………………………… 429

DEFINITIONS …………………………………… 429

ENVIRONMENTAL CONSIDERATIONS …… 430

ACCLIMATIZATION …………………………… 430

PATHOPHYSIOLOGY …………………………… 431

ACUTE MOUNTAIN SICKNESS ……………… 433

HIGH-ALTITUDE PULMONARY EDEMA …… 434

HIGH-ALTITUDE CEREBRAL EDEMA ……… 436

HIGH-ALTITUDE RETINAL HEMORRHAGE … 436

ALTITUDE AND UNDERLYING MEDICAL CONDITIONS ………………………………… 437

Chapter 43

Drowning ……………………………… 440

PERSPECTIVE …………………………………… 440

PRINCIPLES OF DISEASE ……………………… 440

CLINICAL FEATURES …………………………… 441

DIFFERENTIAL CONSIDERATIONS ………… 442

DIAGNOSTIC STUDIES ………………………… 442

MANAGEMENT ………………………………… 442

DISPOSITION……………………………………… 443

Chapter 44

Electrical and Lightning Injuries … 444

PERSPECTIVE …………………………………… 444

PRINCIPLES OF DISEASE ……………………… 444

CLINICAL FEATURES …………………………… 448

COMPLICATIONS ……………………………… 450

DIFFERENTIAL CONSIDERATIONS ………… 450

MANAGEMENT ………………………………… 451

DISPOSITION……………………………………… 452

SECTION 5 Toxicology Emergencies

Chapter 45

General Approach to the Poisoned Patient…………………………………… 454

PERSPECTIVE …………………………………… 454

INITIAL APPROACH TO THE POISONED PATIENT ……………………………………… 454

TOXIC SYNDROMES AND ANTIDOTES……… 455

TOXICOLOGY LABORATORY ………………… 459

DECONTAMINATION ………………………… 459

DISPOSITION AND CONSULTATION ……… 460

Chapter 46 Opioids ………………………………… 461

PERSPECTIVE …………………………………… 461

PRINCIPLES OF DISEASE ……………………… 461

CLINICAL FEATURES …………………………… 462

DIAGNOSTIC STRATEGIES …………………… 463

DIFFERENTIAL CONSIDERATIONS ………… 464

MANAGEMENT ………………………………… 464

DISPOSITION……………………………………… 465

Chapter 47

Organophosphorus-poison ………… 466

PERSPECTIVE …………………………………… 466

PRINCIPLES OF DISEASE ……………………… 466

CLINICAL FEATURES …………………………… 467

DIAGNOSTIC STRATEGIES …………………… 468

DIFFERENTIAL DIAGNOSIS …………………… 468

MANAGEMENT ………………………………… 468

DISPOSITION……………………………………… 469

Chapter 48

Sedative Hypnotics Poisoning ……… 470

BARBITURATES ………………………………… 470

BENZODIAZEPINES …………………………… 472

Chapter 49 Toxic Alcohols ………………………… 476

METHANOL ……………………………………… 476

ETHYLENE GLYCOL …………………………… 479

ISOPROPYL ALCOHOL ………………………… 484

SECTION 6 Toxinlogy Emergency

Chapter 50

Venomous Snake Bite ……………… 488

PERSPECTIVE …………………………………… 488

PRINCIPLES OF DISEASE ……………………… 490

CLINICAL FEATURES …………………………… 491

MANAGEMENT ………………………………… 491

DISPOSITION……………………………………… 496

SECTION 7 Other Emergencies

Chapter 51

Shock Syndrome ……………………… 498

PERSPECTIVE …………………………………… 498

CLINICAL FEATURES ………………………… 500

MANAGEMENT ………………………………… 502

Chapter 52 Sepsis Syndromes …………………… 505

PERSPECTIVE …………………………………… 505

PRINCIPLES OF DISEASE ……………………… 506

CLINICAL FEATURES …………………………… 508

DIAGNOSTIC STRATEGIES …………………… 509

DIFFERENTIAL CONSIDERATIONS ………… 510

MANAGEMENT ………………………………… 510

SECTION 8 Pharmacotherapy of selected emergencies

Chapter 53

Antihypertensive medications ……… 516

PERSPECTIVE …………………………………… 516

ACUTE BLOOD PRESSURE CONTROL ……… 517

CHRONIC

ANTIHYPERTENSIVE THERAPY … 521

Chapter 54

Antiarrhythmic Agents ……………… 525

CLASSIFICATION OF ANTIDYSRHYTHMIC DRUGS ………………………………………… 525

Chapter 55 Drug Therapy in Pregnancy………… 529

PERSPECTIVE …………………………………… 529

PRINCIPLES OF DISEASE ……………………… 530

DRUG THERAPY DURING PREGNANCY …… 531

REFERENCES ………………………………………………………………………………………………………………… 553 ^[2]