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Part 2 book “Atlas of pediatric emergency medicine” has contents: Rheumatology, gastrointestinal disorders, endocrinology, environmental emergencies, orthopedics, emergency ultrasound, trauma, orthopedics,… and other contents.
RHEUMATOLOGY Chapter 12 RHEUMATOLOGY Binita R Shah Raynaud phenomenon 453 KAWASAKI DISEASE Clinical Summary Kawasaki disease (KD; also known as mucocutaneous lymph node syndrome) is an immune-mediated disorder of unknown etiology that occurs in genetically predisposed children leading to endothelial cell injury and vasculitis of mainly mediumsized arteries (predilection for coronary arteries) Small arterioles, larger arteries, capillaries, and veins are affected to a lesser extent KD occurs in all ethnic groups; however, incidence is highest in East Asia and in children of Asian descent Clinical and epidemiologic features strongly support an infectious etiology About 80% of patients are 0.5 g/d or 3+ if quantitation not performed, red blood cells and cellular casts in urine) CNS lupus (eg, psychosis, seizures, encephalopathy, myelitis, coma, stroke, peripheral neuropathy, migraines) Hematologic lupus (anemia [hemolytic with positive direct Coombs test or anemia of chronic disease], leukopenia, lymphopenia, thrombocytopenia) 10 Positive antinuclear antibody 11 Immunologic tests (anti-dsDNA, anti-Sm, antiphospholipid antibodies) Other Clinical Features of SLE Alopecia, Raynaud phenomenon, vasculitis with palpable purpura and petechiae, urticaria, angioedema, vesicobullous SLE, deep vein thrombosis, cerebrovascular accidents, digital ulceration, fever, myalgia, arthralgia, poor weight gain, depression, hepatosplenomegaly, lymphadenopathy 460 ■ SYSTEMIC LUPUS ERYTHEMATOSUS (CONTINUED) A B FIGURE 12.10 ■ Systemic Lupus Erythematosus An 8-year-old -male with discoid lesions consisting of purple erythematous plaques with overlying scale are seen on the ear and lateral cheek (A) Malar cheek with scaling and erythema, papules, and coalescing red to purple discoid plaques are seen on the chest Note ulceration of the tongue (B) (Photo contributor: Binita R Shah, MD.) SYSTEMIC LUPUS ERYTHEMATOSUS (CONTINUED) ■ 461 FIGURE 12.11 ■ Systemic Lupus Erythematosus with Serositis Frontal view of the chest shows cardiomegaly that was secondary to a large pericardial effusion in an adolescent patient with SLE requiring sternotomy for a pericardial window (Photo contributor: John Amodio, MD.) Emergency Department Treatment and Disposition Obtain CBC with differential, platelet count, ESR, comprehensive metabolic panel, serum complements C3 and C4 (commonly reduced, especially with renal lupus), and urinalysis If clinically indicated, obtain ECG (pericarditis) and a chest radiograph to look for cardiomegaly due to pericardial effusion or pleural effusion Immunologic tests include ANA, anti-double-stranded DNA (anti-dsDNA), antibodies to Sm nuclear antigen (anti-Sm), and antiphospholipid antibodies Admit all patients with nephritis, pericarditis, central nervous system (CNS)-lupus, and those with complications of therapy such as infection with neutropenia Consult rheumatology and nephrology as appropriate Refer stable patients to a pediatric rheumatologist for long-term management Treatment options include nonsteroidal anti-inflammatory drugs, antimalarial drugs (eg, hydroxychloroquine), and immunosuppressive agents (eg, cyclophosphamide or azathioprine) and systemic corticosteroids Pearls The most common clinical presentations of SLE are cutaneous, renal, and joint Consider SLE in the differential diagnosis of many signs and symptoms ranging from fevers of unknown origin to arthralgia, anemia, and nephritis Psychosis and seizures are the most common CNS manifestations Pericarditis is the most common cardiac manifestation NEONATAL LUPUS Clinical Summary Neonatal lupus (NL) is caused by transplacental passage of maternal autoantibodies to the fetus and is characterized by skin lesions and/or congenital heart block (CHB) (prolongation of PR interval to complete heart block) The majority of antibodies are maternal IgG anti-Ro (also known as SSA) and/or anti-La (also known as SSB) About 50% of mothers with babies with NL have clinical features of either Sjögren syndrome or SLE, whereas 50% of women are asymptomatic Skin lesions occur in about 50% of affected infants and are either present at birth or appear within months of age and may be precipitated by sun exposure Erythematous annular or elliptical macules with slight central atrophy and raised active margins are seen in the periorbital region (most common distribution), scalp, trunk, extremities, neck, and intertriginous areas Lesions disappear in to months (with disappearance of autoantibodies) usually without scarring or atrophy Complete heart block may be diagnosed in utero or at birth and infant may be asymptomatic, may require pacemaker, or develop signs of congestive heart failure Neonatal A carditis and late-onset dilated cardiomyopathy may also develop in these infants Other findings of NL include anemia, leukopenia, thrombocytopenia, hepatomegaly, and cholestatic hepatitis Infants with NL are at risk of developing other autoimmune diseases during childhood or adolescence Emergency Department Treatment and Disposition Obtain CBC with differential and platelet count, chest radiograph, and ECG Additional tests include anti-Ro/SSA (seen in about 95% of NL), anti-La/SSB (seen in 70% of NL), and antinuclear antibody (may be positive) Admit all symptomatic infants (eg, those with CHB or signs of CHF) for further management Refer asymptomatic patients to cardiology for follow-up and to dermatology, if the diagnosis is unclear For cutaneous lesions, sunscreen, protective clothing, and mild topical corticosteroids may be used Refer the mother to a rheumatologist for the workup for SLE or other connective tissue disease B FIGURE 12.12 ■ Neonatal Lupus (NL) (A, B) Characteristic periorbital “owl-eye” appearance with erythematous, scaly, and atrophic changes in different infants with NL (Photo contributor: Binita R Shah, MD.) 462 866 ■ INDEX Nephrology acute poststreptococcal glomerulonephritis (APSGN), 564–565 hematuria, 558–560 hemolytic uremic syndrome (HUS), 568–569 hypertensive emergency, 572–573 minimal change nephrotic syndrome, 561–563 nephrolithiasis, 574–576 nephrotic syndrome, 555f obstructive uropathy, 570–571 proteinuria, 556–557 urinary tract infection (UTI), 566–567 Nephrotic syndrome, 555f Neurocysticercosis, 493–495, 494f albendazole, 494 axial T1 MRI, 495f brain MRI, 493 corticosteroids, 494 emergency department treatment and disposition, 493–494 enzyme-linked immunoelectrotransfer blot (EITB), 494 ring-enhancing cortical lesion, 494f spinal cord, 493 Taenia solium (tapeworm), 493 tapeworms, life cycle, 493f Neurology, 469 altered mental status, 478–481 bacterial meningitis, 470–473 Bell palsy, 496–497 brain tumors, 501–503 febrile seizures, 482–483 Guillain-Barré syndrome (GBS), 511–512 headache, 498–500 hydrocephalus, 504–507 myasthenia gravis (MG), 513–514 neurocysticercosis, 493–495 raised intracranial pressure, 474–477 seizures and epilepsy, 484–486 spinal cord lesions (non-traumatic), 508–510 status epilepticus, 487–489 stroke in children, 490–492 Neurotoxins, 649 Nevi of Ota and Ito, 32–33 blue-gray pigmentation, 32f, 33f vs inflicted bruise, 33f NF See Necrotizing fasciitis (NF) Nitroprusside, use, 649 NL See Neonatal lupus (NL) Nonperforated appendicitis, acute See Acute nonperforated appendicitis Nonsteroidal anti-inflammatory drugs (NSAIDs), 668 use in black widow spider envenomation, 648 Nutritional vitamin D deficiency rickets, 42–45 child abuse, differential, 45f emergency department treatment and disposition, 42–44 knee, anteroposterior (AP) view, 44f parathyroid hormone (PTH), 42 rachitic deformities, 42f–43f O Obstructive sleep apnea syndrome (OSAS) choking/gasping, 216 emergency department treatment and disposition, 217 infectious mononucleosis, 216f laboratory tests, 217t nasopharyngeal airway, 217f neck, lateral view, 216f Obstructive uropathy, 570–571 acute renal failure (ARF), 571 emergency department treatment and disposition, 570–571 right nephrostogram, 571f ureteropelvic junction (UPJ), 570 ureterovesical junction obstruction, 571 Odontoid fractures, 785 Dens fractures, 785f emergency department treatment and disposition, 785 Jefferson fractures, 785 types, 785 OI See Osteogenesis imperfecta (OI) Oncology See Hematology and oncology Operating room (OR) setting., 663 Ophthalmia neonatorum, 320–321 chlamydial ophthalmia, 321f Chlamydia trachomatis, 320 emergency department treatment and disposition, 320 gonococcal ophthalmia, 320f herpes simplex virus (HSV) infection, 321f newborn conjunctivitis, 320 Ophthalmology, 309 acute conjunctivitis, 318–319 chemical burns, 336–337 corneal abrasions, 327 corneal foreign body, 326 corneal ulcer, 328 eyelid lacerations, 333 hordeolum and chalazion, 316–317 hyphema, 330–331 hypopyon, 329 infantile glaucoma, 324–325 leukocoria, 322–323 ophthalmia neonatorum, 320–321 orbital cellulitis, 310–312 preseptal cellulitis, 313–315 ruptured globe, 309f subconjunctival hemorrhage (SH), 332 traumatic globe rupture, 334–335 Orbital cellulitis, 310–312 antibiotics, 312 bony erosion and periosteal reaction, 311f emergency department treatment and disposition, 310–312 left orbital cellulitis with subperiosteal abscess, 311f metastatic neuroblastoma, 311f proptosis, differential diagnosis, 312f rhabdomyosarcoma, 312f severe proptosis, 310f unilateral eye involvement with swelling, 310f Orbital trauma, 770–771 dark-colored iris, 771f emergency department treatment and disposition, 771 orbital floor blow-out fracture, 770f orbital roof fracture, 771f signs and symptoms, 770 INDEX Oropharyngeal herpes simplex virus (HSV), 94–95 emergency department treatment and disposition, 94–95 gingivostomatitis/herpes labialis, differential of, 94 herpes labialis, 95f herpetic gingivostomatitis, 95f herpetic infection, Tzanck smear, 95f recurrent herpes labialis/recurrent erythema multiforme (EM), 94f varicella zoster virus (VZV) infections, 94 Orthopedics Achilles tendon rupture, 731 consultation, 731 emergency department treatment and disposition, 731 positive thompson test, 731f acromioclavicular injuries, 726 AC joint and distal clavicular separation, 726 acromioclavicular separation, 726f emergency department treatment and disposition, 726 ankle dislocation, 720f emergency department treatment and disposition, 720 fracture, 721f ankle fracture/sprain, 706f, 707f complications, 706 emergency department treatment and disposition, 706–707 epiphyseal injuries, 706 nonfractures with clinical ligamentous injury, 707 anterior cruciate ligament (ACL) tears, 729 emergency department treatment and disposition, 729, 729f treatment, 729 anterior/posterior glenohumeral joint dislocations, 716, 716f, 717f emergency department treatment and disposition, 716 Hill-Sachs lesion, 716 Bennett fracture/Rolando fracture, 689 emergency department treatment and disposition, 689 radiograph demonstrating fracture, 689f bone and joint infections: acute osteomyelitis, 736 acute osteomyelitis, 736f C-reactive protein (CRP), 737 emergency department treatment and disposition, 737 Haemophilus influenzae, 736 methicillin-resistant Staphylococcus aureus, 737 pathogens causing osteomyelitis, 737t Boxer’s fracture, 690 anteroposterior (AP)/lateral views, 690 emergency department treatment and disposition, 690 oblique view, 690f volar angulation, 690 calcaneal fracture, 708f Böhler angle, 708 chronic complications, 708 emergency department treatment and disposition, 708 chronic osteomyelitis, 738, 738f, 739f diagnosis, 739 emergency department treatment and disposition, 739 polymicrobial, 738 clavicle fracture dislocation, 700f emergency department treatment and disposition, 700 dislocations: interphalangeal joint dislocation emergency department treatment and disposition, 712 IV antibiotics, 712 metacarpophalangeal (MCP) joint dislocation, 713f proximal interphalangeal (PIP) joint deformity, 712f distal radius fractures, 692f colles fracture, 692 complications, 692 dinner fork deformity, 692 emergency department treatment and disposition, 692 wrist fractures, 692 elbow dislocation emergency department treatment and disposition, 715 lateral, anteroposterior, and oblique views, 715f femur fracture, 702f bilateral femora, anteroposterior view, 703f consultation, 702 emergency department treatment and disposition, 702 flexor tenosynovitis, 735, 735f consultation, 735 emergency department treatment and disposition, 735 Kanavel signs, 735 foreign bodies/penetrating injuries, 732, 732f complications, 732 emergency department treatment and disposition, 732 fractures/fracture classification, 676 avulsion fracture, 680f blunt/penetrating trauma, 676 comminuted fracture, 679f complete fractures, 677f complications, 684t ecchymosis, 676 emergency department treatment and disposition, 676–678 epiphyseal fractures, Salter-Harris classification, 682f, 682t greenstick fracture, 680f incomplete fracture, 678f oblique fracture, 679f, 680f open fractures, 676f pathologic fracture, 681f Salter-Harris type II fracture, 683f Salter-Harris type III fracture, 683f Salter-Harris type IV fracture, 683f with special considerations, 680t spiral fracture, 679f torus fracture, 681f transverse fracture, 678f types of, 677t Galeazzi fracture dislocation, 693f hand infections: paronychia emergency department treatment and disposition, 734 paronychia, 734, 734f radiographic evaluation, 734 hip dislocation, 718 emergency department treatment and disposition, 718 pelvis, anteroposterior view of, 718f proper technique for reduction, 718f humerus fracture, 698 emergency department treatment and disposition, 698 humeral shaft fracture, 698f myositis ossificans, 699f proximal humerus fracture, 698f intra-articular foreign body, 733f ■ 867 868 ■ INDEX Orthopedics (cont.) jones fracture emergency department treatment and disposition, 709 Pseudo-Jones fractures, 709f knee dislocation, 719 anterior and posterior dislocations, 719 emergency department treatment and disposition, 719 tibiofemoral dislocation, 719f Legg-Calvé-Perthes disease, 728, 728f acute complications, 728 emergency department treatment and disposition, 728 lisfranc fracture, 710 emergency department treatment and disposition, 710 lunate/perilunate dislocations consultation, 714 emergency department treatment and disposition, 714 perilunate dislocation, 714f volar dislocations, 714 maisonneuve fracture, 705, 705f emergency department treatment and disposition, 705 tibiofibular syndesmosis, 705 mallet finger dorsal avulsion fractures, 688 emergency department treatment and disposition, 688 image of, 688f Monteggia fracture dislocation, 693f musculoskeletal injuries: Gamekeeper’s thumb, 723 emergency department treatment and disposition, 723 MCP thumb joint, 723 PA radiograph, 723f neonatal osteomyelitis/septic arthritis acute osteomyelitis, 745f antimicrobials, 745 cefotaxime, 745 congenital malformation, 744 diagnosis, 744 emergency department treatment and disposition, 745 sagittal T2-weighted images, 744f skin and soft tissue infection, 744 vancomycin, 745 Nursemaid’s elbow, 724 emergency department treatment and disposition, 724 mechanism of injury, 724 radial head subluxation, 725f temper-tantrum elbow, 724 olecranon fracture, 694 emergency department treatment and disposition, 694 open femur fracture, 675f Osgood-Schlatter disease, 730 emergency department treatment and disposition, 730 knee demonstrates, 730f osteomyelitis, in sickle cell disease, 740f, 741f diagnosis, 741 emergency department treatment and disposition, 741 Salmonella species, 740 patella dislocation complications, 722 consultation, 722 differential diagnosis, 722 emergency department treatment and disposition, 722 lateral patella dislocation, 722f patella fractures, 704 consultation, 704 emergency department treatment and disposition, 704 knee, oblique/lateral views, 704f phalanx fractures, 686f digit, axial loading, 687f distal interphalangeal (DIP) joint, 686 distal phalangeal fractures, 686 emergency department treatment and disposition, 686–687 proximal interphalangeal (PIP) joint, 686 subungual hematoma, 686f Swan-Neck deformity, 687f radial head fracture, 695 elbow, lateral view, 695f emergency department treatment and disposition, 695 type I-II fractures, 695 scaphoid/navicular fractures, 691 anteroposterior radiograph, 691f consultation, 691 emergency department treatment and disposition, 691 forced supination of wrist, 691f scapular fracture, 701, 701f complications, 701 consultation, 701 emergency department treatment and disposition, 701 septic arthritis, 742f coronal image, 743f diagnosis of, 742t diagnostic arthrocentesis, 743f emergency department treatment and disposition, 743 etiologies and diagnosis by age, 742t Legg-Calvé-Perthes disease, 742 microbial invasion, 742 neonatal osteomyelitis, 744 transient synovitis and postinfectious reactive arthritis, 742 slipped capital femoral epiphysis, 727f consultation, 727 emergency department treatment and disposition, 727 slipped capital femoral epiphysis (SCFE), 727 spinal tuberculosis, 746, 747f blood-based assays, 746 emergency department treatment and disposition, 746 progressive bone destruction, 746 respiratory isolation, 746 stress fracture, 711 distribution and frequency, 711f emergency department treatment and disposition, 711 nonsteroidal anti-inflammatory drugs (NSAIDs), 711 supracondylar fracture, 696 anterior/posterior fat pads, 697f clinical picture, 696f consultation, 696 emergency department treatment and disposition, 696 tuft fractures, 685, 685f distal interphalangeal (DIP) joint space, 685 emergency department treatment and disposition, 685 OSAS See Obstructive sleep apnea syndrome (OSAS) Osteogenesis imperfecta (OI) bilateral blue sclera, 47f cracked egg shell, 48f emergency department treatment and disposition, 46–48 INDEX genetic inheritance, 46 lower extremity, radiograph, 48f multiple angular deformities, 46f severe bowing, 48f Osteosarcoma, 407f, 442–445 anteroposterior, 442f biopsy, 443f emergency department treatment and disposition, 444–445 Li-Fraumeni syndrome, 442 osteogenic sarcoma, diagnosis, 443f P53 gene mutations, 442 proximal tibia, and proximal humerus, 442 swelling, 443f T1 MR image, 445 vs lymphedema, 445f Otitis externa (OE), 346–347 acute, 346, 347f bacterial infections, 346 external auditory canal (EAC), 346f neomycin/polymixin B/hydrocortisone suspension, 347 Pseudomonas and Staphylococcus species, 346 Swimmer’s ear, 346f Otitis media, complications, 343–345, 344t acute mastoiditis, 343f acute otitis media with otorrhea, 343f chronic otitis media with cholesteatoma/mastoiditis, 344f complete blood count (CBC), 345 emergency department treatment and disposition, 345 external auditory canal (EAC), 343 facial palsy, 345f mastoid air cell inflammation, 343 mastoiditis, 343 Otolaryngology, 339 acute otitis externa (AOE), 346–347 acute otitis media (AOM) complications, 343–345 diagnosis of, 340–342 acute sinusitis, 361–363 auricular foreign body, 350–351 auricular hematoma, 352–353 chronic sinusitis, 364–366 deep neck space infection, 367–369 epistaxis, 354–357 lemierre syndrome, 372–375 nasal foreign bodies, 358–360 perichondritis, 348–349 peritonsillar abscess (PTA), 370–371 Pott’s puffy tumor, 339f Ovarian torsion, 402–403 acute-onset pelvic pain, 402 emergency department treatment and disposition, 402 left ovary, longitudinal scan, 402f ovarian teratoma, 403f Ovarian tumors, 451–452 chemotherapeutic agents, 452 choriocarcinoma, 451 emergency room treatment and disposition, 451–452 endodermal sinus/yolk sac tumors, 451 α-fetoprotein (AFP) level, 451 human chorionic gonadotrophin (HCG) level, 451 malignant ovarian tumors, 451 mature cystic teratoma, 451f rhabdomyosarcoma, 451 teratoma, 452f teratoma mimicking pregnancy, 452f P Pancreatic injury, 815 Pancreatitis, 649 Pandinus imperator, 649f Paraphimosis, 400–401 balanoposthitis, 401f distal foreskin and glans, 400 emergency department treatment and disposition, 400 foreskin, edema/swelling, 400f glans penis and fingertips, 400f paraphimosis-like presentations, 401f postreduction residual penile edema, 401f Parkland formula, 637, 639 PCECV See Purified chick embryo cell vaccine (PCECV) PD See Perioral/periorificial dermatitis (PD) PE See Pulmonary embolism (PE) Pediatric fractures, 849 cortical bone, 849 distal radius fractures ultrasounds, 849f positioning and technique, 849 posterior fat pad suggesting, 849f ultrasound findings, 849 Pediatric hip ultrasound, 848, 848f positioning and technique, 848 ultrasound findings, 848 Pediatric lung ultrasound, 844–845 hepatization, 844 M-mode image, 845f parenchymal/pleural diseases, 844 positioning and technique, 844 sagittal image, 844f ultrasound findings, 844 Pelvic fractures, 817–818, 817f emergency department treatment and disposition, 817–818 hemorrhagic shock, 817 scrotal hematoma, 818f total blood volume (TBV), 817 trauma surgery and orthopedics, 818 Pelvic inflammatory disease, 138–139 differential diagnosis, 138 emergency department treatment and disposition, 138–139 IM ceftriaxone plus doxycycline, 139 intrauterine device, 139f menstruation, 138 risk of, 138 tubo-ovarian abscess (TOA), 138, 139f Penetrating hand/foot injury, 828, 828f emergency department treatment and disposition, 828 foreign bodies, remove, 828 Penetrating neck injuries, 780–781 anterior, 780, 781f emergency department treatment and disposition, 780–781 management decisions, 781 mechanisms of, 780 trauma, 780f PEP See Postexposure prophylaxis (PEP) ■ 869 870 ■ INDEX Perforated appendicitis, 385 clinical symptoms, 385 computed tomographic image, 385f definitive management, 385 emergency department treatment and disposition, 385 Perianal streptococcal dermatitis (PSD), 50–51 better-tasting preparation, 51 differential diagnosis, 50 emergency department treatment and disposition, 51 group A β-hemolytic Streptococcus (GABHS), 50 rectal culture, 50f, 51f rule out sexual abuse, 50f sexual abuse, evaluation, 51f Pericarditis, acute, 176–177 cardiomegaly and pulmonary edema, 177f ECG, 176 emergency department treatment and disposition, 177 pericardial effusion, 177f Perichondritis, 348–349 acute allergic reaction, ear swelling, 349f cartilage necrosis, 348f dermatitis, 349f differential diagnosis, 349f ear piercing, 348f emergency room treatment and disposition, 348–349 quinolones, 348 Perioral/periorificial dermatitis (PD), 308 emergency department treatment and disposition, 308 erythematous papules and papulopustules, 308, 308f granulomatous periorificial dermatitis, 308 Peripheral cold injuries classification of, 642t clinical pearls, 641–642 clinical signs and symptoms, 642t emergency department treatment and disposition, 640–641 Peritonsillar abscess (PTA), 370–371, 370f amoxicillin-clavulanate, 371 ampicillin, 370 axial CT scan, 371f clindamycin, 370, 371 emergency department treatment and disposition, 370–371 head/neck, suppurative infection, 370 IV antibiotics, 370 oropharynx, examination, 370f physical examination, 370 sulbactam, 370 Pertussis, 194 bilateral subconjunctival hemorrhages, 194f emergency department treatment and disposition, 194 periorbital ecchymosis, 194f respiratory tract, infection, 194 Physalia physalis See Portuguese man-of-war Phytophotodermatitis (PPD), 36–37 Berloque dermatitis, 36 bizarre streaky hyperpigmentation, 36f emergency department treatment and disposition, 37 erythematous rash, 36f hyperpigmentation, 37f Piperacillin, orbital cellulitis, 312 Pityriasis rosea (PR), 260–262 Christmas tree pattern, 262f diagnosis, 261 emergency department treatment and disposition, 261–262 herald patch, 260f nonfluorinated topical corticosteroids, 261 oval-shaped papulosquamous lesions, 260f oval-shaped, salmon colored lesions, 261f presumed viral, 260 scaly oval papules, 261f ultraviolet B (UVB), 262 Pneumonia See Bacterial pneumonia; Viral pneumonia Pneumothorax, 222, 800–801, 801f blunt/penetrating chest trauma, 800 emergency department treatment and disposition, 800 hydropneumothorax, 801f jugular venous distention (JVD), 800 Portuguese man-of-war, 660, 660f background, 660 lidocaine treatment, 660 nematocysts, 660 treatment, 660 Port-wine stain (PWS), 34–35 emergency department treatment and disposition, 34–35 Klippel-Trenaunay Syndrome (KTS), 35f pink-purple macular lesions, 34f Sturge-Weber syndrome, 34f Postexposure prophylaxis (PEP) guidelines for, 652, 652t Pott disease See Spinal tuberculosis Pott’s puffy tumor, 339f PPD See Phytophotodermatitis (PPD) PR See Pityriasis rosea (PR) Prazosin use, 649 Premature ventricular contractions (PVCs), 166–167 benign vs serious, 167t emergency department treatment and disposition, 166 etiology, 167t multifocal premature ventricular contraction, 167f unifocal premature ventricular contraction, 166f Preseptal cellulitis, 313–315 amoxicillin clavulanate, 313 bacitracin ophthalmic ointment/polymyxintrimethoprim drops, 313 dacryocystitis, 315f differential diagnosis, 313, 314f, 315f emergency department treatment and disposition, 313 herpes simplex virus (HSV) infection, 314f hordeolum, 314f intense erythema, eyelid edema, 313f methicillin-resistant Staphylococcus aureus (MRSA), 313 nonimmunized children, 313 orbital anatomy, 313f orbital cellulitis, 314f proptosis, rhabdomyosarcoma, 315f Primary and secondary syphilis condyloma lata, 131f copper-colored papulosquamous nonpruritic characteristic lesions, 130f diffuse papulosquamous esions, 131f emergency department reatment and disposition, 131 rash on penis, 130f T pallidum immunofluorescent antibody, 130 INDEX Primary spontaneous pneumothorax (PSP), 222–223, 223f emergency department treatment and disposition, 222–223 Proptosis differential diagnosis, 312f with fungal sinusitis, 364f Proteinuria, 556–557 emergency department treatment and disposition, 556 hematuria, 556 nephrotic syndrome (NS), 556f, 557f orthostatic, 556 renal biopsy, 557f severe edema, 557f transient, 556 PSD See Perianal streptococcal dermatitis (PSD) Psoriasis, 256–257 bilateral, symmetric plaques, 257f diagnosis, 256 emergency department treatment and disposition, 256 generalized pustular, 257f nail, deep pitting, 256f palmar-plantar, 257f pustular psoriasis, close-up, 257f PSP See Primary spontaneous pneumothorax (PSP) PTA See Peritonsillar abscess (PTA) Pulmonary contusion, 804, 804f clinical presentation, 804 emergency department treatment and disposition, 804 thoracic injury, 804 treatment, 804 Pulmonary embolism (PE), 224–225 chest, CT scans, 225f Doppler sonogram, 225f emergency department treatment and disposition, 224 Pulmonary tuberculosis, 210–213 cavitary, 212f chest, CT scan, 211f chest, frontal/lateral projections, 210f emergency department treatment and disposition, 213 latent tuberculosis infection (LTBI), 210 with lymph node calcifications, 211f with pleural effusion, 213f reactivation, 212f skin test, 210f Purified chick embryo cell vaccine (PCECV), 652 PVCs See Premature ventricular contractions (PVCs) PWS See Port-wine stain (PWS) Pyloric stenosis, 839, 839f nonbilious vomiting, 839 technique, 839 ultrasound findings, 839 Pyogenic granuloma, 317f R Rabies exposure and vaccine prophylaxis, 653f clinical pearls, 653 emergency department treatment and disposition, 652 Rabies immune globulin (RIG), 652 Raccoon eyes, 25f, 38 bleeding disorders, 39f emergency department treatment and disposition, 38 inflicted eye trauma, 39f ■ 871 Raised intracranial pressure, 474–477 See also Intracranial pressure (ICP) brain compression, 474 brain tumor presenting with increased intracranial pressure, 475f causes of, 477t central venous pressure (CVP), 475 cerebral blood flow (CBF), 475 cerebral perfusion pressure (CPP), 475 maximization, 477 clinical signs, 474 emergency department treatment and disposition, 475–477 epidural hematoma with herniation, 474f Glasgow Coma Scale score, 475 hemorrhagic stroke, 474f herniation, 477 hyperventilation, 475 intraventricular drain and hemicraniectomy, 476f mean arterial pressure (MAP), 475 PALS and ATLS guidelines, 475 traumatic subarachnoid hemorrhage, 476f Raynaud phenomenon (RP), 453f, 464–465 acrocyanosis, 464 clinical features, 465t emergency department treatment and disposition, 464–465 nails, 464f physical examination, 464 systemic lupus erythematosus (SLE), 465f Raynaud syndrome See Raynaud phenomenon (RP) Respiratory disorders asthma, 218–221 bacterial pneumonia, 205–207 bacterial tracheitis, 198–199 bronchiolitis, 202–204 croup, 195–197 epiglottitis, 200–201 massive aspiration, 189f miliary tuberculosis (TB), 214–215 obstructive sleep apnea syndrome (OSAS), 216–217 pertussis, 194 primary spontaneous pneumothorax, 222–223 pulmonary embolism (PE), 224–225 pulmonary tuberculosis, 210–213 tracheobronchial foreign bodies, 190–193 viral pneumonia, 208–209 Retained bones, 540–541 chicken bones, 540f emergency department treatment and disposition, 540 fish bones, 541f goat bone, 541f laryngoscopy and Magill forceps, 541f oropharynx and hypopharynx, 540 plain radiographs, 540 Rheumatic carditis acute rheumatic fever (ARF), 180f Rheumatology Kawasaki disease (KD), 454–457 lyme disease, 465–468 neonatal lupus (NL), 462–463 Raynaud phenomenon (RP), 453f, 464–465 systemic lupus erythematosus (SLE), 458–461 872 ■ INDEX Rib fractures clinical pearls, 16–17 emergency department treatment and disposition, 16 Rickets, 14f knee, anteroposterior (AP) view, 44f nutritional vitamin D deficiency, 42–45 RIG See Rabies immune globulin (RIG) Ring incarceration, 819, 819f digit’s blood supply, 819 emergency department treatment and disposition, 819 Rocky mountain spotted fever (RMSF), 86–87 emergency department treatment and disposition, 86–87 erythematous maculopapular eruption, 86f Henoch-Schönlein purpura (HSP), 87f meningococcemia, 87f Roseola infantum, 98–99 diffuse erythematous maculopapular eruptions, 98f, 99f emergency department treatment and disposition, 99 Kawasaki disease, 98 Roseola infantum, 98 RP See Raynaud phenomenon (RP) Rubella, 102–103 congenital rubella syndrome (CRS), 102f coryza, cough, conjunctivitis and sore throat, 102 discrete erythematous rose-pink papular rash, 103f emergency department treatment and disposition, 102–103 S Scabies, 264–267 γ-benzene hexachloride, 265 bullous lesion of ankle, 265f classic lesions on trunk and axilla of infant, 267f contagious skin infestation, 264 emergency department treatment and disposition, 264–267 Norwegian scabies, 267 papulovesicular lesions, 265, 265f on foot, 266f sarcoptes scabiei, 264f scabetic nodule on wrist, 266f Scald burns, 636 Scarlet fever, 60–63 in dark-skinned patients, 61f desquamation sign, 63f emergency department treatment and disposition, 61–63 erythematous scarlatiniform rash, 61f exudative tonsillopharyngitis, 60f hand/foot, desquamation, 63f red strawberry tongue, 62f suppurative cervical lymphadenitis, acute, 60f white strawberry tongue, 62f SCFN See Subcutaneous fat necrosis (SCFN) SCIWORA See Spinal cord injury without radiographic abnormality (SCIWORA) Scorpion envenomation bulbous segment (See Telson) clinical pearls, 649 emergency department treatment and disposition, 649 Scorpionfish, 664–665, 665f Sea anemone, 659f Sea urchin, 663, 663f Seborrheic dermatitis, 246–247 adolescent seborrheic dermatitis, 247f Candida albicans, 246 differential diagnosis, 246 emergency department treatment and disposition, 246 erythematous scaly plaques, 246f greasy papular eruption, 247f greasy plaque, 247f greasy scaling, 246f Second-degree atrioventricular block, 148–149 emergency department treatment and disposition, 148–149 heart block, 149t Mobitz type I atrioventricular heart block (Wenckebach block), 149t Mobitz type II AV block, 149t Second-degree burns, 638f Seizures and epilepsy, 484–486 arteriovenous (AV) malformation, 485f crowe sign/Café au lait spots in neurofibromatosis, 484f emergency department evaluation and disposition, 485–486 neurocysticercosis presenting with new-onset seizure, 484f Sturge-Weber syndrome, 486f Serum sickness/serum sickness–like reactions, 232–233 antitoxins for treatment, 232 crotalidae antivenin, 232 emergency department treatment and disposition, 232 erythematous maculopapular and urticarial edematous plaques, 232f mechanism, 232 morbilliform eruption, 233f Sexual abuse and sexually transmitted diseases See also Child abuse; Gynecology condyloma acuminata, 124f condyloma lata, 121f condylomata acuminata, 120f, 121f, 125f ED with cardiopulmonary arrest, 123f emergency department treatment and disposition, 120–123 genital herpes, 121f gental warts, 121f gonococcal conjunctivitis, 122f herpetic vulvovaginitis, 135f infantile hemangioma mimicking sexual abuse, 123f injuries, 123f Jacquet diaper dermatitis mimicking sexual abuse, 123f STDs for diagnosis and reporting, 120t SH See Subconjunctival hemorrhage (SH) Sharp object foreign body, 544–545 consultations, 544 duodenojejunal junction, perforation, 545f emergency department treatment and disposition, 544 gastroenterology, 544 nail ingestion, 544f needle ingestion, 545f pin ingestion, 544f stomach/proximal duodenum, 544 Sickle cell anemia and acute splenic sequestration crisis, 428–429 abdominal fullness, 428f emergency department treatment and deposition, 428–429 tachycardia, 429f thrombocytopenia, 428 transfusions, 429 INDEX Sickle cell anemia and cerebrovascular disease, 417–419 angiogram, 418 HbSS/sickle β0-thalassemia, 419 hemorrhagic stroke, 417 hyperplasia, 417 magnetic resonance angiography (MRA), 419 strokes, 417f magnetic resonance images, 418f transcranial Doppler ultrasonography (TCD), 417 transient ischemic attacks (TIAs), 417 patients, 419 T2-weighted magnetic resonance imaging (MRI) scan, 417f Sickle cell anemia and transient aplastic crisis, 426–427, 427f emergency department treatment and deposition, 426–427 glucose-6-phosphate dehydrogenase deficiency, 426 hematology consultation, 427 leukoerythroblastosis, 426 Sickle cell anemia with acute chest syndrome (ACS), 414–416 abdominal pain, 414 chest radiograph, 414 Chlamydia pneumoniae, 414 emergency department treatment and disposition, 414–416 fever and abdominal pain, 414f frontal radiograph, 415f Mycoplasma pneumoniae, 414 pallor, 416f transfusion therapy, 414 Sickle cell anemia with acute pain, 410–413 acute pain episodes, 410 codeine, 413 emergency department treatment and disposition, 411–413 jaundice and right-sided abdominal pain, 412 nonpharmacologic interventions, 413 nuclear medicine scans, 410 pain and swelling, 411f patient-controlled analgesia (PCA), 412 radiographs, 410 right upper quadrant (RUQ) syndrome, 412f vaso-occlusive crisis (VOC), 410f Sickle cell anemia with fever, 408–409 antibiotics, 409 complete blood count (CBC), 408 emergency department treatment and disposition, 408–409 hemoglobin SC (HbSC), 408 pain and swelling with erythema, 408f penicillin resistance, 409 Streptococcus pneumoniae sepsis, 408 with transient aplastic crisis, 409f Sickle cell anemia with priapism, 420–421 hydroxyurea therapy, 421 intracorporeal irrigation, 421f ischemia and infarction, 420 lidocaine injection, 420f stilbestrol therapy, 421 Sickle cell anemia with right upper quadrant syndrome, 422–425 cholecystitis, acute, 422f emergency department treatment and disposition, 425 endoscopic retrograde cholangiopancreatography (ERCP), 425 endoscopic ultrasonography, 425 gallbladder, longitudinal images, 423f Gilbert syndrome, 425 ■ glucuronosyl transferase gene, 425 hyperbilirubinemia, 425 magnetic resonance cholangiopancreatography (MRCP), 425 perhaps exchange transfusion, 422 sickle cell hepatopathy, 424f viral/immune hepatitis, 422 Silver sulfadiazine for burns, 636 Sinus tachycardia (ST), 158–159, 159t differential diagnosis, 159f emergency department treatment and disposition, 158 heart rate, 158f sinus node, 158 SJS See Stevens-Johnson syndrome (SJS) Skeletal manifestations of child abuse clinical pearls, 12–14 emergency department treatment and disposition, 11–12 Skull fractures, 18–19, 753, 753f clinical pearls, 19 consultation, 753 emergency department treatment and disposition, 18–19, 753 physical examination, 753 SLE See Systemic lupus erythematosus (SLE) Snake envenomations, 670 antivenom, 672f bite site, radiographs of, 671 clinical pearls, 671–672 clinical presentation, 670–671 coral snake, 672f of Elapidae family, 671f emergency department treatment and disposition, 671 of Viperidae family, 670f Soft coral, 659f Soft tissue trauma, 774–776 Advanced Trauma Life Support (ATLS) protocols, 774 auricular trauma, 775f cheek laceration, 774f emergency department treatment and disposition, 774–775 eyelid lacerations, 774 facial nerve injury, diagnosis, 774, 775 nose laceration, 776f penetrating injury, 776f scalp laceration, 776f scalp trauma, 774 Spinal cord injury without radiographic abnormality (SCIWORA), 790 emergency department treatment and disposition, 790 neurologic syndrome, 790 sagittal T2-weigheted MR image, 790f Spinal cord lesions (non-traumatic), 508–510 abdominal mass with intraspinal extension, 510f acute disseminated encephalomyelitis, 509 Chiari malformation, 508 emergency department treatment and disposition, 509 epidural abscess with spinal cord compression, 509f idiopathic acute transverse myelitis, 509 intramedullary spinal cord tumor, 510f intravenous immune globulin (IVIG), 509 longitudinally extensive transverse myelitis (LETM), 508f neuromyelitis optica (NMO), 508f, 509 Potts disease, 508 873 874 ■ INDEX Spinal cord lesions (non-traumatic) (cont.) sensory disturbances, 508 spinal cord tumors, 508 Spinal process (Clay Shoveler’s) fracture, 794, 794f emergency department treatment and disposition, 794 neurologic deficits, 794 Spinal tuberculosis, 746, 747f Splenic injuries, 812–813 blunt abdominal trauma, 812 emergency department treatment and disposition, 812 grading scale, 812t splenic lacerations, 813f Sponges antibiotics use, 662 background, 662 brown tube sponge, 662f clinical features, 662 clinical pearls, 662 emergency department treatment and disposition, 662 SSSS See Staphylococcal scalded skin syndrome (SSSS) ST See Sinus tachycardia (ST) Stabbing marine animals: cone shells (family Conidae), 667 clinical pearls, 667 emergency department treatment and disposition, 667 treatment in, 667 Stabbing marine animals: starfish, sea urchins, and crown-of-thorns starfish, 663 clinical pearls, 663 emergency department treatment and disposition, 663 Stabbing marine animals: stingray clinical pearls, 666 emergency department treatment and disposition, 666 treatment, 666 Stabbing marine animals: stonefish and scorpionfish (family Scorpaenidae) clinical pearls, 664–665 emergency department treatment and disposition, 664 toxin components, 664 Staphylococcal scalded skin syndrome (SSSS), 78–81 emergency department treatment and disposition, 79–81 exfoliating skin, 78f febrile infant, 81f palm/dorsal foot, superficial desquamation, 81f pustular lesions with cellulitis, 79f radial sunburst crusting and fissuring, 78f Ritter disease, 78, 80f vs toxic epidermal necrolysis (TEN), 81t Staphylococcus aureus, 69 Starfish, 662f, 663, 663f Status epilepticus, 487–489 autoimmune encephalitis, 489f CNS infections, 487 cortical malformations, 488f emergency department evaluation and disposition, 487–488 guidelines for management, 488t herpes encephalitis, 488f Sturge-Weber syndrome Port-Wine stain (PWS) and intracranial calcification, 487f Stevens-Johnson syndrome (SJS), 236–239 complications, 236 emergency department treatment and disposition, 237 erosive stomatitis, 236f erythematous and purpuric macules, 236f hypersensitivity disorders, 236 penicillin for pharyngitis, 236f targetoid lesions, 237f toxic epidermal necrolysis, 238f, 239f Stinging marine animals: box jellyfish, true jellyfish, and portuguese man-of-war, 660 clinical pearls, 661 emergency department treatment and disposition, 660–661 Stinging marine animals: corals, sea anemones, hydroids, and fire coral, 658 Stinging marine animals: sponges (phylum Poriphera) antibiotics use, 662 background, 662 brown tube sponge, 662f clinical features, 662 clinical pearls, 662 emergency department treatment and disposition, 662 starfish, 662f Stingrays, 666, 666f Stomach and lower gastrointestinal tract foreign bodies, 542–543 abdomen, frontal view, 542f cylindrical battery ingestions, 542f emergency department treatment and disposition, 543 foreign body (FB) ingestion, 542 GI tract, 542 hand-held metal detectors, 543 nail ingestion, 543f pencil ingestion, 543f stuffing drug packets, 542 swallowed FB, history, 542 toxicity, signs of, 543 Stonefish, 664–665, 665f Straddle injuries, 56–57 differential diagnosis, 56 emergency department treatment and disposition, 57 scrotal hematoma, 57f self-inserted foreign bodies, 56 unilateral scrotal swelling, 57f Streptococcal pharyngitis, 60–63 in dark-skinned patients, 61f emergency department treatment and disposition, 61–63 erythematous scarlatiniform rash, 61f exudative tonsillopharyngitis, 60f hand/foot, desquamation, 63f red strawberry tongue, 62f scarlet fever, desquamation, 63f suppurative cervical lymphadenitis, acute, 60f white strawberry tongue, 62f Stroke in children, 490–492 acute cerebellar infarct, 492f cerebrospinal fluid examination in sub arachnoid hemorrhage, 492f CT angiography, 490 cyanotic heart disease, 490 dystonia, 490 Ehler-Danlos syndrome, 490 emergency department treatment and disposition, 490–491 ischemic stroke, 491f middle cerebral artery (MCA) infarct, 491f right facial palsy, 490f risk factors, 490 INDEX subarachnoid hemorrhage with communicating hydrocephalus, 492f thrombolytic agents, 491 Subconjunctival hemorrhage (SH), 332 emergency department treatment and disposition, 332 episcleral and conjunctival blood vessels burst, 332 ocular examination, 332f severe subconjunctival hemorrhage, 332f valsalva maneuver, 332 Subcutaneous fat necrosis (SCFN), 305 emergency department treatment and disposition, 305 hypercalcemia, 305 of newborn, 305, 305f Subdural hematoma, acute See Acute subdural hematoma Subgaleal hematoma, 3f Subungual hematoma, 822–823, 823f digital blocks, 822 drain (trephinate) symptomatic painful hematomas, 822 emergency department treatment and disposition, 822 Sudden infant death syndrome See Infanticide vs sudden infant death syndrome Sulbactam, orbital cellulitis, 312 Supraventricular tachycardia (SVT), 160–163 with aberrancy, 161f adenosine and supraventricular tachycardia, 163t two-hand/two-syringe technique, 162f differential diagnosis, 162t ECG, 160f emergency department treatment and disposition, 160–163 heart rate, 160 Wolff-Parkinson-White (WPW) syndrome, 161f Surgery and genitourinary acute nonperforated appendicitis, 383–384 congenital imperforate hymen with hematometrocolpos, 398–399 epididymo-orchitis, 394–395 hypertrophic pyloric stenosis, 382 incarcerated inguinal hernia, 386–387 intussusception, 371f, 378–381 malrotation and volvulus, 404 ovarian torsion, 402–403 paraphimosis, 400–401 perforated appendicitis, 385 testicular torsion, 388–391 testicular trauma, 392–393 torsion of appendix testis, 396 umbilical granuloma, 405 umbilical hernia, 406 vaginal foreign body in prepubertal child, 397 SVT See Supraventricular tachycardia (SVT) Syncope, 155–157 cardiac tumor, 156f emergency department treatment and disposition, 155–157 etiology, 157t feeling tired, 156f paced rhythm, 155f seizures, differential diagnosis, 157t Systemic lupus erythematosus (SLE), 458–461 anti-double-stranded DNA (anti-dsDNA), 461 antimalarial drugs, 461 arthritis of, 458f butterfly rash, 458f ■ central nervous system (CNS)-lupus, 461 clinical features, 459t emergency department treatment and disposition, 461 multisystem autoimmune disease, 458 nonblanching lesions, 459f oral contraceptive pills/hormone replacement therapy, 458 purple erythematous plaques, discoid lesions consisting, 460f Raynaud phenomenon (RP), 465f with serositis, 461f T TAPVR See Total anomalous pulmonary venous return (TAPVR) Tazobactam, orbital cellulitis, 312 TBTI See Tracheobronchial tree injury (TBTI) TDR See Traumatic diaphragm rupture (TDR) Telson, 649 TEN See Toxic epidermal necrolysis (TEN) Tension pneumothorax, 800–801, 801f See also Pneumothorax blunt/penetrating chest trauma, 800 emergency department treatment and disposition, 800 hydropneumothorax, 801f jugular venous distention (JVD), 800 pneumothorax, 800 Testicular torsion, 388–391 acute pediatric scrotum, differential diagnosis, 391t bell-clapper deformity, 388, 388f cellulitis with acute scrotal swelling, 390f emergency department treatment and disposition, 388 erythematous scrotal swelling, 388f hydrocele, 390f left-sided scrotal enlargement, 389f Prehn sign, 388 spectral Doppler images, 389f transverse color Doppler image, 389f transverse sonogram of scrotum, 390f vs acute epididymitis, differential diagnosis, 391t Testicular trauma, 392–393 birth trauma, scrotal edema, 393f blunt scrotal trauma, 392 coronal color Doppler image, 392f emergency department treatment and disposition, 392 left testicle, sagittal sonogram, 393f scrotal ultrasound, 393f Tetanus in cat bite, 654 prophylaxis, 649, 657 Tetralogy of fallot (TOF), 168–171 boot-shaped heart, 169f clubbing/cyanotic nail beds, 168f cyanotic congenital heart disease, 168f, 170f, 170t egg on string appearance, 169f emergency department treatment and disposition, 168–170 hypercyanotic spell, 168–171 of tetralogy of fallot, 171t total anomalous pulmonary venous return (TAPVR), 169f tricuspid atresia, 170f Thermal burns classification of, 638t clinical pearls, 639 emergency department treatment and disposition, 636–639 875 876 ■ INDEX Third-degree atrioventricular block, 150–151 complete heart block, 150f emergency department treatment and disposition, 150 heart block, 151t Stokes-Adams attack, 150 Thoracic trauma chest physiotherapy, 799 chest radiograph, 799 emergency department treatment and disposition, 798 flail chest, 798 rib fractures, 798–799, 798f, 799f Thyroid storm and thyrotoxicosis, 528–530 cardiac complication, 528 congestive heart failure (CHF), 528 emergency department treatment and disposition, 528–530 exophthalmos, 529f goiter, 528f, 529f Graves disease, 529f hashitoxicosis presenting with goiter, 529f life-threatening condition, 528 multinodular goiter presenting with thyrotoxicosis, 529f supraventricular tachycardia, 530f thyroid-stimulating hormone (TSH), 528 Thyrotoxicosis See Thyroid storm and thyrotoxicosis Tinea capitis, 270–273 antidandruff medications, 272f bacterial culture, 270 diagnosis, 270 discrete scaly plaques on scalp, 271f emergency department treatment and disposition, 270–273 griseofulvin, 270 hair loss, 270 kerion, inflammatory, 273f noninflammatory, 271f prednisone therapy, 270 pustular, 273f round scaly plaque, 270f seborrheic, 272f Trichophyton tonsurans lesions, 272 Tinea corporis, 274–275 allylamines, 275 emergency department treatment and disposition, 274–275 griseofulvin, 275 imidazoles, 275 Majocchi granuloma, 275 Microsporum canis, 274 naphthiomates, 275 ringworm, 274f tinea faciei, 274f Tinea cruris, 276–277 bilateral, irregular, half moonshaped, 276f differential diagnosis, 275, 277f econazole cream, 276 emergency department treatment and disposition, 276–277 erythematous plaque, 276 intertrigo, 277f microscopic examination, 275 Tinea pedis, 278–279 Burow solution, 278 dermatophyte test media, 278 emergency department treatment and disposition, 278–279 hyperkeratotic diffuse, 278 interdigital infection, 278 maceration and scale, 278f with secondary bacterial infection, 279f toe web space with macerated scale and inflammation, 279f Tinea unguium, 280–281 Candida albicans, 280 emergency department treatment and disposition, 281f Epidermophyton floccosum, 280 KOH preparation, 280 nail infection, 280 onychomycosis of nail, 280f oral antifungal agents, 281 Schiff stain, 280 symptomatic dystrophic nails, nonsurgical avulsion, 281 Trichophyton species, 280 Tinea versicolor, 268–269, 268f emergency department treatment and disposition, 268–269 hyperpigmented scaly plaques, 268f, 269f Ketoconazole, 269 KOH preparation, 269f Malassezia furfur, 268 Pityrosporum orbicular, 268 Pityrosporum ovale, 268 spaghetti-and-meatballs, 269f wood lamp examination, 268 TNPM See Transient neonatal pustular melanosis (TNPM) Toddler’s fracture, 11f TOF See Tetralogy of fallot (TOF) Tongue laceration, 778, 778f anterior split tongue, 778 emergency department treatment and disposition, 778 Torsion of appendix testis, 396 differential diagnosis, 396 emergency department treatment and disposition, 396 intrascrotal appendages, location/incidence, 396f swiss cheese appearance, 396f Total anomalous pulmonary venous return (TAPVR), 169f Toxic epidermal necrolysis (TEN), 236–239, 238f, 239f complications, 236 emergency department treatment and disposition, 237 erosive stomatitis, 236f erythematous and purpuric macules, 236f hypersensitivity disorders, 236 penicillin for pharyngitis, 236f targetoid lesions, 237f vs staphylococcal scalded skin syndrome (SSSS), 81t Toxicology abuse, prescription drugs, 624 acetaminophen/salicylate toxicity, 624 benzodiazepines, 624, 625f emergency department treatment and disposition, 624–625 opioids, 624 acute acetaminophen toxicity acetaminophen (APAP), 585, 585f acetaminophen toxicity nomogram, 586f complete blood count (CBC), 585 emergency department treatment and disposition, 585–587 gastrointestinal (GI) symptoms, 585 Rumack-Matthew nomogram, 586f INDEX acute isoniazid neurotoxicity, mechanisms of, 606f acute salicylate toxicity, 588 acetylsalicylic acid (ASA), 588 acute lung injury (ALI), 588 acute respiratory distress syndrome (ARDS), 588 arterial blood gases (ABG), 588 clinical findings, 588 differential diagnosis, 588 emergency department treatment and disposition, 588–589 GI decontamination, 589 positive ferric chloride reaction with salicylate-containing topical cream, 599f salicylates, household agents, 588f serum salicylate level, 588 anticholinergic drug/plant toxicity, 604 emergency department treatment and disposition, 604–605 jimson weed, 604f physostigmine, 604 sympathomimetics, comparison, 605t symptoms, 604 beta-blockers/calcium channel blocker toxicity, 626, 626f antihypertensive medications, 626 bradycardia, 626f differential diagnosis, 626 diltiazem and verapamil, 626 emergency department treatment and disposition, 626–627 gastric decontamination, 626 hemodialysis, 626 pharmacokinetics, 626 verapamil, 627f camphor toxicity camphor cube, 608f clinical symptoms, 608 emergency department treatment and disposition, 608 gastric lavage, 608 serum camphor levels, 608 castor bean/rosary pea ingestion, 600–601 Abrus precatorius, 600 bracelet made with castor bean seeds, 600f differential diagnosis, 600 emergency department treatment and disposition, 601 Ricinus communis, 600 rosary pea, 600f caustics burns, 577f, 633f dribble burns, 633 emergency department treatment and disposition, 634 functional and histologic damage, 633 GI burns, endoscopic grading systems, 634 Hamman’s crunch, 633 lye stricture, 634f physical injury, 633 clonidine toxicity, 628 differential diagnosis, 628 emergency department treatment and disposition, 628 formulations, 628f naloxone, 628 cocaine toxicity, 594 cocaine packets, 595f cocaine washout syndrome, 594 ■ emergency department treatment and disposition, 595 head/neck examination, 594 nasal insufflation and intravenously, 594 neuroleptic malignant syndrome, 594 nontoxicologic etiologies, 594 pulmonary complication related to crack cocaine inhalation, 594f radiopaque packets with body packing, 595f cyclic antidepressants (CAs), 629 attention deficit hyperactivity disorder (ADHD), 629 cardiovascular effects, 629 consultation, 630 differential diagnosis, 630 emergency department treatment and disposition, 630 GABA antagonism, 629 sodium bicarbonate, 630 tricyclic antidepressants, 629, 629f, 630f dextromethorphan toxicity dextromethorphan (DXM), 615f emergency department treatment and disposition, 615 GI decontamination, 615 NMDA antagonists, 615 various formulations containing dextromethorphan, 615f differential diagnosis, 607 ecstasy toxicity, 612, 612f emergency department evaluation and management, 612–613 hyponatremia, 612 methamphetamine toxicity, 613f 3,4-methylenedioxymethamphetamine (MDMA) effects, 612 ethanol toxicity acetaminophen, 623 common sources, 622f differential diagnosis, 622 emergency department treatment and disposition, 622–623 ethanol abuse, 622 GI decontamination, 623 metabolism interferes with gluconeogenesis, 622 supportive care, 623 tonic-clonic seizures, 622 ethylene glycol toxicity, 618 antifreeze, 618 calcium oxalate cystals, 619f differential diagnosis, 618 emergency department treatment and disposition, 618–619 ethylene glycol, 618 metabolism of, 618f pyridoxine, 619 signs and symptoms, 618 thiamine, 619 hydrocarbon/naphthalene toxicity, 609 acute hemolytic anemia in child With G6PD deficiency, 610f bagging hydrocarbon (HC) abuse, 610f candy look-alikes, 611f differential diagnosis, 609 emergency department treatment and disposition, 610–611 hematologic effects, 609 hydrocarbon pneumonitis, 609f myocardial irritation, 609 paradichlorobenzene (PDB), 609 pulmonary aspiration, 609 877 878 ■ INDEX Toxicology (cont.) iron toxicity, 590 consultation, 591 deferoxamine, 591 differential diagnosis, 590 emergency department treatment and disposition, 591 GI symptoms, 590 iron poisoning, 591f kidney, ureters, and bladder (KUB), 590f prothrombin time (PT)/partial thromboplastin time (PTT), 591 radiopaque tablets in iron poisoning, 590f vin rose urine, 591f isoniazid (INH), 606 ketamine toxicity, 614 emergency department treatment and disposition, 614 nonopioid anesthetic, 614 pharmaceutical ketamine, 614f Kussmaul respirations, 606 lead toxicity, 631 emergency department treatment and disposition, 631–632 GI symptoms, 631 IV edetate calcium disodium, 631 kidneys, 631 knees, single anteroposterior view, 631f potential household sources, 632f Marijuana toxicity acute symptoms, 616 cannabis plant, 616 Cannabis sativa, 616f emergency department treatment and disposition, 616–617 incense, 617f K2 Spice/JWH-018, 616f organic material resembling, 617f methanol toxicity CNS depression, 620 differential diagnosis, 620 emergency department treatment and disposition, 620–621 folic acid, 621 metabolism of, 621f methanol-containing household products, 620f methanol ingestion, 621 signs and symptoms, 620 toxic alcohol, 620 methemoglobin (MetHb), 596 chocolate brown blood, 596 chocolate-colored blood in methemoglobinemia, 597f CO poisoning, differential diagnosis, 596 emergency department treatment and disposition, 596–597 methemoglobinemia, 596f methylene blue, 597f NADPH-methemoglobin reductase, 597 opioid toxicity cardiopulmonary depression, 593 central nervous system (CNS), 592 consultation, 593 emergency department treatment and disposition, 592–593 heroin packet, 592f naloxone, 593 sedative-hypnotic toxicity, comparison, 593t skin popping, 593 therapeutic and toxic doses, 592 uses, 592 organophosphate/carbamate exposures, 598 atropine, 599 clinical presentation, 598 CNS signs and symptoms, 598 differential diagnosis, 598 emergency department treatment and disposition, 599 intermediate syndrome, 598 physical examination, 598 pralidoxime, 599 serum electrolytes, 598 severity and extent, 598 phenothiazine toxicity acute dystonic reactions, 603 atrioventricular (AV) block, 602 consultation, 603 differential diagnosis, 602 diphenhydramine, 603 dystonic reaction, 602f emergency department treatment and disposition, 603 extrapyramidal side effects, 602 IV diphenhydramine, 602f liver function tests, 602 neuroleptic malignant syndrome (NMS), 602 neuroleptics, 602 rhabdomyolysis, 602 poisoned patient: general approach and gastrointestinal decontamination, 578 acetaminophen, 578 activated charcoal administration, 582f airway, breathing, and circulation (ABCs), 582 antidotes, prophylactic use of, 584 blood urea nitrogen (BUN), 581 chest radiographs, 582 clonidine toxicity, 583f emergency department treatment and disposition, 582–584 frequently nontoxic household products, 578 history, 578 household products, 578f medications and poisons, 582f medications and toxins, 583t motor seizures, 583 pediatric poisoning, 578 physical examination, 578–582 poisonings/toxidromes, mnemonics, 580–581 polyethylene glycol electrolyte solution (PEG ELS), 584 sinus bradycardia, 583f toxicologic clues and tests, 579t, 580t whole bowel irrigation (WBI), 584 pyridoxine (vitamin B6 ), 607, 607f Rifamate, 606 serum chemistries, 607 Toxic shock syndrome (TSS), 74–77 emergency department treatment and disposition, 74–77 Kawasaki disease, 74 staphylococcal, 76f clinical case definition, 77t Staphylococcus aureus, 74 INDEX streptococcal, 74f cellulitis, 75f clinical case definition, 77t desquamation, 75f Tracheobronchial foreign bodies, 190–193 cardiopulmonary arrest, 190f chest, frontal view, 191f emergency department treatment and disposition, 191–193 food products, aspiration/asphyxiation, 190f larynx and glottis, 190 radiolucent foreign body aspiration, 191f, 192f radiopaque foreign body aspiration, 193f Tracheobronchial tree injury (TBTI), 808, 808f emergency department treatment and disposition, 808 high-resolution CT, 808 Transient neonatal pustular melanosis (TNPM), 304, 304f diagnosis, 304 differential diagnosis, 304 emergency department treatment and disposition, 304 Giemsa-/Wright-stained smear, 304 Traumas, 834–836 abdominal trauma, 809–811 acute subdural hematoma, 756–757 anterior flexion fractures, 788 anterior subluxation, 793 aortic disruption, 806 atlanto-occipital dislocation, 789 basilar skull fractures (BSFs), 754–755 bilateral facet dislocation, 791 cerebral concussion, 760 cerebral contusion, 759 cervical spine injuries, 782–783 degloving/avulsion injuries, 826–827 dental caries/dentoalveolar abscess, 795 dental trauma, 796–797 digital amputation, 824–825 epidural hematoma, 758 extension teardrop fracture, 787 findings, 834–836 fishhook removal, 830 focused assessment with sonography for trauma (FAST), 834 head abusive, 20–21 trauma, 750–752 hemoperitoneum, 834 hemothorax, 802–803 hepatic injuries, 814 intra-abdominal trauma including seatbelt injuries, 815–816 Jefferson fractures, 784 Knife wound, 749f lip laceration, vermilion border, 777 mandible fractures, 764–766 midfacial fractures, 767–769 nail bed injury, 820–821 nasal fractures, 762–763 nasal septal hematoma, 761 odontoid fractures, 785 orbital trauma, 770–771 pelvic fractures, 817–818 penetrating anterior neck injuries, 780–781 penetrating hand/foot injury, 828 pneumothorax and tension pneumothorax, 800–801 pulmonary contusion, 804 ring incarceration, 819 skull fractures, 753 soft tissue trauma, 774–776 spinal cord injury without radiographic abnormality (SCIWORA), 790 spinal process (clay shoveler’s) fracture, 794 splenic injuries, 812–813 subungual hematoma, 822–823 technique, 834–835 thoracic trauma rib fractures and flail chest, 798–799 tongue laceration, 778 tracheobronchial tree injury, 808 traumatic airway obstruction, 805 traumatic diaphragm rupture, 807 traumatic extremity amputation, 829 traumatic spondylolisthesis of C2, 786 traumatic temporomandibular joint dislocation, 779 unilateral facet dislocation, 792 zipper injury, 831 zygomatic complex/zygomatic arch, fractures, 772–773 Traumatic airway obstruction, 805, 805f cervical spine injury, 805 cyanosis, 805 emergency department treatment and disposition, 805 lower face, tissues avulsion, 805f Traumatic diaphragm rupture (TDR), 807, 807f clinical presentation, 807 diaphragmatic herniation, 807 emergency department treatment and disposition, 807 Traumatic extremity amputation, 829, 829f emergency department treatment and disposition, 829 replantation, 829 Staphylococcus aureus with penicillin G, 829 types, 829 Traumatic globe rupture, 334–335 Bacillus species, 334 conjunctival laceration, 335f differential diagnosis, 334 eight-ball hyphema filling, 335f emergency department treatment and disposition, 334 IV antibiotics, 334 neuroimaging, 334 ocular ultrasound, 334 teardrop pupil with subconjunctival hemorrhage, 335f tetanus toxoid, 334 traumatic ruptured globe, 334f wound, 335f Traumatic spondylolisthesis of C2, 786 emergency department treatment and disposition, 786 Hangman’s fracture, 786, 786f spinal cord injury, 786 Traumatic temporomandibular joint dislocation, 779, 779f emergency department treatment and disposition, 779 temporomandibular joint (TMJ), 779 ■ 879 880 ■ INDEX Trichomonas vaginalis infection See Trichomoniasis Trichomoniasis, 126, 126f AFFIRM VP III, 126 emergency department treatment and disposition, 126 PCR assay, 126 TSS See Toxic shock syndrome (TSS) Tuberculosis (TB) See Miliary tuberculosis; Pulmonary tuberculosis U Ultrasound emergency abscesses and cellulitis, 846–847 appendicitis, 837 appendix, 833f biliary ultrasound, 840–841 first trimester pregnancy, 842–843 fluid, 833f intussusception, 838 pediatric fractures, 849 pediatric hip ultrasound, 848 pediatric lung ultrasound, 844–845 pyloric stenosis, 839 trauma, 834–836 findings, 837 Umbilical granuloma, 405 differential diagnosis, 405, 405f emergency department treatment and disposition, 405 GI/genitourinary anomalies, 405 umbilical polyps, 405 Umbilical hernia, 406, 406f emergency department management and disposition, 406 umbilical ring, 406 Unilateral facet dislocation, 792 cervical spine, 792f emergency department treatment and disposition, 792 Urethral prolapse, 54–55 blood-stained underwear, 54f painless bleeding/spotting, 54f vaginal introitus, 55f Urinary tract infection (UTI), 558, 566–567 ceftriaxone/cefotaxime/cefazolin/gentamicin, 566 cloudy urine, 566f differential diagnosis, 566 emergency department treatment and disposition, 566 IV antibiotics, 566 and kidneys, 566 multicystic dysplastic kidney, 567f oral antibiotics, 566 renal scarring, 567f urethral catheterization, 566 vesicourethral reflux (VUR), 567f Urticaria/hives, 228–229 acute urticaria with chemosis, 228f anaphylaxis, 228f dermographism, 229f emergency department treatment and disposition, 228 etiology of lesions, 229f UTI See Urinary tract infection (UTI) V Vaginal foreign body in prepubertal child, 397 anteroposterior radiograph, 397f emergency department treatment and disposition, 397 frog-leg/kneechest position, 397 prepubertal children, 397f vaginal irritation/dysuria, 397 Vancomycin, orbital cellulitis, 312 Venomous marine animals clinical pearls, 659 emergency department treatment and disposition, 658–659 fire coral, 659f hard coral, 658f hydroid injury, 658f Indo-Pacific varieties, 658 sea anemone, 659f soft coral, 659f stabbing marine animals: starfish, sea urchins, and crown-of-thorns starfish, 663 stabbing marine animals: stingray, 666 stabbing marine animals: stonefish and scorpionfish (family Scorpaenidae), 664 stinging marine animals: box jellyfish, true jellyfish, and portuguese man-of-war, 660 stinging marine animals: corals, sea anemones, hydroids, and fire coral, 658 stinging marine animals: sponges (phylum Poriphera), 662 Viral pneumonia, 208f emergency department treatment and disposition, 208 foreign body aspiration, 209f influenza, 209f RSV and parainfluenza viruses, 208 Virus–neutralizing antibody, 652 W Warts, 282–283 differential diagnosis, 282 emergency department treatment and disposition, 282–283 flat warts, 282f HPVs causing nongenital warts, 282 hyperpigmented papules, 282f mucous membrane, 282 multiple warts on thumb, 283f solitary verrucous papule, 283f Whooping cough See Pertussis Wound care basic principles of, 650, 654, 656 Z Zipper injury, 831, 831f emergency department treatment and disposition, 831 penile skin, 831 physical restraint, 831 Zygomatic arch See Zygomatic complex/zygomatic arch, fractures Zygomatic complex/zygomatic arch, fractures, 772–773 emergency department treatment and disposition, 772–773 facial fractures, 772 midface fractures, 772 tripod fracture, 773f zygomatic arch, 773 zygomaticomaxillary complexes (ZMCs), 772 ... (eds) Saunders Manual of Pediatric Practice, 2nd ed WB Saunders, Philadelphia, 20 02, p 1151 480 ■ ALTERED MENTAL STATUS (CONTINUED) TABLE 13.6 ■ COMMON CAUSES OF ALTERED LEVEL OF CONSCIOUSNESS Commonly... fourth day of illness (H) Cervical adenopathy (I) Desquamation of the fingers on the 12th day of illness (Photo contributor: Binita R Shah, MD.) 456 ■ KAWASAKI DISEASE (CONTINUED) Emergency Department... Binita R Shah, MD.) TABLE 12. 3 ■ CLINICAL FEATURES OF SYSTEMIC LUPUS ERYTHEMATOSUS The American College of Rheumatology classification of SLE requires presence of of the following 11 criteria