Preface

The scope of Emergency Medicine is extremely broad and covers the neonate through the geriatric, surgical, and medical, 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. We have produced a clear, complete, and easy-to-understand textbook of Emergency Medicine procedures. This text will provide all practitioners, from the medical student to the seasoned Emergentologist, with a single procedural reference on which to base clinical practices and technical skills.

The primary purpose of this text is to provide a detailed and step-by-step approach to procedures performed in the Emergency Department. 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 procedure book that should be in every Emergency Department. The contents and information are complete. It is organized and written for ease of access and usability. 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 the 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 this text 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 illness or injury. Medical students and residents will find this an authoritative work on procedural skills. Medical students, residents, nurse practitioners, physician's assistants, and practitioners with limited experiences will find all the information in each chapter to learn the 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. The experienced clinician 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 16 sections containing 195 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. The chapters have a similar format to allow 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, has a standard format. The relevant anatomy and pathophysiology are discussed followed by the indications and contraindications for the procedure. A list is provided of the necessary equipment. The patient preparation, including consent, anesthesia, and analgesia, is addressed. The procedure is then described in a step-by-step format. Cautions are placed where problems commonly occur. Alternative techniques and helpful hints for each procedure are presented. The 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 it 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 a 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 known to the reader. This provides 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. This edition has added chapters to cover additional procedures, especially the Respiratory section. A few chapters of seldom used procedures have been eliminated.

We have drawn on a wide variety of authors. The majority of authors are residency-trained, board-certified, and practicing Emergentologists. We have the honor of having many contributors from outside the field of Emergency Medicine, who are experts in their own specialty. 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 has grown and changed with this second edition. Suggestions from you, the reader, would be most appreciated. Let us know what additional procedures should be included or excluded in the future.

Eric F. Reichman, PhD, MD