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The scope of Emergency Medicine is extremely broad; it covers the care of the neonate through the geriatric, surgical, and medical patients, and encompasses all organ systems. Emergency Medicine is rapidly evolving to reflect our increasing experience, knowledge, and research. Procedural skills must supplement our cognitive skills. Achieving proficiency in procedural skills is essential for the daily practice of Emergency Medicine. In this textbook, we have produced a clear, complete, and easy-to-understand guide to procedures. It will provide all practitioners, from the medical student to the seasoned Emergentologist, with a single procedural reference on which to base their clinical practices and technical skills.

The primary purpose of this text is to provide a detailed, step-by-step approach to procedures performed in the Emergency Department—and it is expressly about procedures. While well referenced, it is not meant to be a comprehensive reference but an easy-to-use and clinically useful text that should be at hand in every Emergency Department. The content and information are complete. The book is organized and written for ease of access and use. The detail is sufficient to allow the reader to gain a thorough understanding of each procedure. When available, alternative techniques or hints are presented. Each chapter provides the reader with clear and specific guidelines for performing every procedure. Although some may use this text as a library reference, its real place is in the Emergency Department where the procedures are performed. Despite its size, we hope that this book will find its way to the bedside to be used by medical students, residents, and practicing clinicians.

This book will satisfy the needs of physicians with a variety of backgrounds and training. While it is primarily written for Emergentologists, many other practitioners will find this a valuable reference. This book is written for those who care for people with acute illnesses or injuries. Medical students and residents will find this an authoritative work on procedural skills. Medical students, residents, and practitioners with limited experience will find all the information in each chapter to learn a complete procedure. Family Physicians, Internists, and Pediatricians will find this text useful to review procedures infrequently performed in the clinic, office, or urgent care center. Intensivists and Surgeons involved in the care of acutely ill patients will also find this book a wonderful resource. Experienced clinicians can get a quick refresher on the procedure while enhancing their knowledge and skills. Physicians actively involved in the education of medical students and residents will find this text an easy-to-understand and well illustrated source of didactic material.

The text has 15 sections containing 173 chapters. The contents are organized into sections, each representing an organ system, an area of the body, or a surgical specialty. Each chapter is devoted to a single procedure. This should allow quick access to complete information. Most of the chapters follow a similar format, thus allowing information to be retrieved as quickly and as efficiently as possible. There are often several acceptable methods to perform a procedure. While alternative techniques are described in many chapters, we have not exhaustively included all alternative techniques. Key information, cautions, and important facts are highlighted throughout the text in bold type.

Each chapter, with a few exceptions, follows a standard format. The relevant anatomy and pathophysiology are discussed, followed by the indications and contraindications for the procedure. A list of the necessary equipment is provided. Preparation of the patient—including consent, anesthesia, and analgesia—is addressed. The procedure is then described step by step. Cautions are placed where problems commonly occur. Alternative techniques and helpful hints for each procedure are presented. Aftercare and follow-up are discussed. Any potential complications are described, including the methods to reduce and care for the complications. Finally, a summary contains a review of any critical or important information.

This book covers a wide variety of procedures. We have made an effort to think of most procedures that may be performed in a rural or urban Emergency Department and have incorporated them into this text. This includes procedures performed routinely or rarely. It also includes procedures that are often performed in the acute care, clinic, and office setting. Some of the procedures in this book may be performed frequently in the daily practice of Emergency Medicine, such as laceration repair or endotracheal intubation. Other procedures, such as cricothyroidotomy, are seldom to rarely performed but critical to the practice of Emergency Medicine. While many of the procedures are well known to the Emergentologist, some are uncommon and may not be so widely known. This gives the reader an opportunity to acquire new information that may be converted, with proper practice and training, into a useful skill. A few of the procedures are performed only by Surgeons. They are included to promote understanding by those who may later see the patients in the Emergency Department and have to provide emergent care for a complication.

We have drawn on a wide variety of authors. The majority of authors are residency-trained, board-certified, practicing Emergentologists. We have the honor of having many contributors from outside the field of Emergency Medicine who are experts in their own specialties. Many of them are from Cook County Hospital, including the trauma surgeons. The authors do have biases because of differences in education, experience, and training. We have tried to base all recommendations on sound clinical and scientific data. However, we have not excluded personal experience or preferences when appropriate. In these cases, the authors also present alternative techniques.

Hopefully, this book will grow and change with time. Suggestions from you, the reader, would be most appreciated. Let us know what additional procedures should be included or excluded in future editions.

Eric F. Reichman, PhD, MD
Robert R. Simon, MD



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