Textbook of Adult Emergency Medicine 5th Edition

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Textbook of
ADULT
EMERGENCY
MEDICINE
This page intentionally left blank

     
Textbook of
ADULT
EMERGENCY
MEDICINE
Fifth Edition

EDITED BY

Peter Cameron MBBS MD FACEM

Professor of Emergency Medicine, Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Victoria, Australia; Emergency Physician, Emergency and Trauma Centre,
The Alfred Hospital, Melbourne, Victoria, Australia

Mark Little MBBS FACEM MPH&TM DTM&H IDHA

Emergency Physician and Clinical Toxicologist, Department of Emergency Medicine, Cairns Hospital,
Cairns, Queensland, Australia; Clinical Toxicologist, New South Wales Poisons Information Service,
New South Wales, Australia

Biswadev Mitra MBBS MHSM PhD FACEM

Emergency Physician, Alfred Hospital Emergency and Trauma Centre; Professor, Critical Care Research,
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

Conor Deasy MB DCH Dip IMC Dip Tox FRCEM PhD

Clinical Lead and Consultant in Emergency Medicine, Cork University Hospital, Cork, Ireland; Senior Lecturer,
Emergency Medicine, University College Cork, Cork, Ireland; Deputy Medical Director, National Ambulance
Service, Dublin, Ireland; Associate Adjunct Professor, School of Primary Care, Monash University,
Melbourne, Victoria, Australia

For additional online content visit ExpertConsult.com

EDINBURGH LONDON NEW YORK OXFORD PHILADELPHIA ST LOUIS SYDNEY 2020

© 2020, Elsevier Ltd. All rights reserved.

First edition 2000

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Third edition 2009
Fourth edition 2015
Fifth edition 2020

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This book and the individual contributions contained in it are protected under copyright by the Publisher (other than
as may be noted herein).

Chapter 26.2 Exotic snakebite © Julian White. All rights reserved. Published with permission of Julian White.
Chapter 29.3 Medical issues in disasters © 2020 World Health Organization. All rights reserved. Published with
­permission of the World Health Organization.

Notice

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using
any information, methods, compounds or experiments described herein. Because of rapid advances in the medical
sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest
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Printed in China
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 Contents

Preface xi 2.8 Anaphylaxis 59

Contributors xiii Anthony F.T. Brown SECTION 4
Acknowledgements xxi Orthopaedic
Introduction xxiii emergencies 147
Editor: Conor Deasy
SECTION 3
SECTION 1 Trauma 67 4.1 Injuries of the shoulder 147
Editor: Peter Cameron
Resuscitation 1 Crispijn van den Brand
Editor: Conor Deasy
3.1 Trauma overview 67 4.2 Dislocations of the elbow 151
Peter Cameron, Gerard O’Reilly Timothy H. Rainer, Raymond Chi
1.1 Basic life support 1 Hung Cheng
Sameer A. Pathan 3.2 Neurotrauma 72
Gerard O’Reilly, Peter Cameron 4.3 Fractures of the humerus 152
1.2 Advanced life support 5 Raymond Chi Hung Cheng,
Sameer A. Pathan 3.3 Spinal trauma 76 Timothy H. Rainer
Pieter van Driel
4.4 Fractures of the forearm and
3.4 Facial trauma 88 carpal bones 156
SECTION 2 Mark Putland, Kiran Veera Crispijn van den Brand
Critical care 12 3.5 Abdominal trauma 92 4.5 Hand injuries 161
Editor: Conor Deasy
Garry Wilkes Arthur Hennessy
2.1 Airway and ventilation 3.6 Chest trauma 96 4.6 Pelvic injuries 165
management 12 Mark Fitzgerald, Jeremy Stevens, Stephen Cusack
Christopher Groombridge, Robert Gocentas
Amit Maini, Peter Fritz 4.7 Hip injuries 169
3.7 Limb trauma 101 Stephen Cusack
2.2 Oxygen therapy 21 Amit Maini, Christopher
David R. Smart Groombridge 4.8 Femoral injuries 173
Stephen Cusack
2.3 Haemodynamic monitoring 30 3.8 Radiology in major
Craig Hore trauma 107 4.9 Knee injuries 174
Anthony P. Joseph, Brett Lurie Michael Baker, Dean Fulford
2.4 Shock overview 35
Gerard McCarthy 3.9 Trauma in pregnancy 122 4.10 Tibial and fibular injuries 180
Steven Troupakis Michael Baker, Dean Fulford
2.5 Sepsis and septic shock 43
Alan Watts 3.10 Wound care and repair 125 4.11 Ankle joint injuries 183
Gim Tan Michael Baker, Dean Fulford
2.6 Arterial blood gases 48
Anthony D. Holley 3.11 Burns 137 4.12 Foot injuries 186
Gerard O’Reilly, Biswadev Mitra Michael Baker, Dean Fulford
2.7 Cerebral resuscitation after cardiac
arrest 55 3.12 Massive transfusion 141 4.13 Osteomyelitis 190
Stephen A. Bernard Biswadev Mitra Arthur Hennessy

v
CONTENTS

6.5 Chronic obstructive pulmonary

SECTION 5 disease 285 SECTION 8
Cardiovascular emergencies 193 Katie Walker, Christine Jackman Neurology emergencies 352
Editor: Conor Deasy Editor: Conor Deasy
6.6 Pneumothorax 290
5.1 Chest pain 193 Anne-Maree Kelly 8.1 Headache 352
Rohan Laging 6.7 Pleural effusion 294 Anne-Maree Kelly
5.2 Acute coronary syndromes 199 Shammi Ramlakhan 8.2 Stroke and transient ischaemic
Rohan Laging 6.8 Haemoptysis 298 attacks 356
Katie Walker, Christine Jackman Philip Aplin, Mark Morphett
5.3 Assessment and management of
acute pulmonary oedema 205 8.3 Subarachnoid haemorrhage 364
David Lightfoot Íomhar O’Sullivan
SECTION 7
5.4 Arrhythmias 209 8.4 Altered conscious state 368
Marcus Ong Eng Hock, Desmond Digestive emergencies 301 Ruth Hew
Editor: Biswadev Mitra
Mao, Gayathri Devi Nadarajan
8.5 Seizures 374
5.5 Pulmonary embolism 223 7.1 Dysphagia 301 Garry Wilkes
David Mountain Graeme Thomson 8.6 Syncope and vertigo 379
5.6 Pericarditis, cardiac tamponade 7.2 Approach to abdominal pain 302 Rosslyn Hing
and myocarditis 230 Rebecca Day, James Fordyce 8.7 Weakness 383
C. Geraldine McMahon
7.3 Bowel obstruction 309 Tim Green, Eileen M. Rogan
5.7 Heart valve emergencies 237 Kim Yates
Kevin K.C. Hung, Colin A. Graham
7.4 Hernia 312
5.8 Peripheral vascular disease 245 Neil A. Goldie SECTION 9
Kevin K.C. Hung, Colin A. Graham Infectious disease
7.5 Gastroenteritis 314 emergencies 390
5.9 Hypertension 250 Arun Ilancheran Editor: Peter Cameron
Francis O’Keeffe
7.6 Haematemesis and melaena 318
5.10 Aortic dissection 254 Kevin K.C. Hung, Colin A. Graham 9.1 Approach to undifferentiated
Eoin Fogarty fever in adults 390
7.7 Peptic ulcer disease and Arun Ilancheran
5.11 Aneurysms 259 gastritis 323
Adrian Murphy Win Sen Kuan, Shirley Ooi 9.2 Meningitis 395
Andrew Singer
7.8 Biliary tract disease 327
Stacy Turner 9.3 Septic arthritis 400
SECTION 6 Christopher Carman
Respiratory emergencies 262 7.9 Acute pancreatitis 330
Kenneth Heng 9.4 Urinary tract infections 402
Editor: Biswadev Mitra
Sean Arendse
7.10 Acute appendicitis 333
6.1 Upper respiratory tract 262 Ashis Banerjee 9.5 Skin and soft-tissue
Kenneth Ooi infections 409
7.11 Inflammatory bowel Cecil S. Johnny
6.2 Asthma 267 disease 336
Anne-Maree Kelly Kim Yates, Louise Finnel 9.6 Hepatitis 415
Helen E. Stergiou, Biswadev Mitra
6.3 Community-acquired 7.12 Acute liver failure 339
pneumonia 272 John M. Ryan, John J. Cronin 9.7 Human immunodeficiency virus
Mark Putland, Karen and acquired immune deficiency
Robins-Browne 7.13 Haematochezia 343 syndrome 420
Francis Chun-Yue Lee Carl Luckhoff
6.4 Influenza and emerging
respiratory infections 282 7.14 Perianal conditions 348 9.8 Sexually transmitted
Michelle van den Driesen, Michael R. Augello infections 427
Nicola Walsham Jane Terris

vi
CONTENTS

9.9 Antibiotics in the emergency

department 433 SECTION 13 SECTION 16
John Vinen Haematology Ocular emergencies 549
emergencies 497 Editor: Peter Cameron
9.10 Needlestick injuries and
Editor: Mark Little
related blood and body fluid 16.1 Ocular emergencies 549
exposures 443 Mark J. Walland, R.C. Andrew
13.1 Anaemia 497
Sean Arendse Symons, James K. Galbraith,
Mark Little
9.11 Tropical infectious David V. Kaufman
13.2 Neutropaenia 503
diseases 448
Mark Little
Sander Manders
13.3 Thrombocytopaenia 505 SECTION 17
Mark Little Dental emergencies 557
SECTION 10 13.4 Haemophilia 508 Editor: Peter Cameron
Genitourinary Sean Arendse
emergencies 457 17.1 Dental emergencies 557
13.5 Blood and blood products 511 Ian Hewson
Editor: Biswadev Mitra
Sean Arendse, Biswadev Mitra
10.1 Acute kidney injury 457
Nicholas Adams SECTION 18
SECTION 14
10.2 The acute scrotum 466 Ear, nose and throat
Gino Toncich
Rheumatology and emergencies 561
musculoskeletal Editor: Peter Cameron
10.3 Renal colic 469 emergencies 517
Sean Arendse Editor: Conor Deasy 18.1 Ear, nose and throat
emergencies 561
14.1 Rheumatological Carmel Crock, Nadine de Alwis
SECTION 11 emergencies 517
Endocrine emergencies 472 Michelle C. Papandony,
Editor: Mark Little Michael J. Gingold, SECTION 19
Flavia M. Cicuttini
Obstetrics and gynaecology
11.1 Diabetes mellitus and 14.2 Monoarthritis 523 emergencies 567
hypoglycaemia: an Michelle C. Papandony, Editor: Biswadev Mitra
overview 472 Michael J. Gingold,
Anthony F.T. Brown Flavia M. Cicuttini 19.1 Pelvic pain 567
11.2 Diabetic ketoacidosis and 14.3 Polyarthritis 526 Anusch Yazdani
hyperosmolar, hyperglycaemic Michelle C. Papandony, 19.2 Pelvic inflammatory disease 571
state 474 Shom Bhattacharjee, Erica Kreismann, Gar Ming Chan
Anthony F.T. Brown Flavia M. Cicuttini
19.3 Abnormal vaginal bleeding in the
11.3 Thyroid and adrenal 14.4 Musculoskeletal and soft-tissue non-pregnant patient 573
emergencies 478 emergencies 533 Erica Kreismann, Gar Ming Chan
Andrew Maclean Anthony Tzannes
19.4 Ectopic pregnancy and bleeding
in early pregnancy 576
SECTION 12 Gim Tan
SECTION 15
Metabolic emergencies 484 Dermatology 19.5 Bleeding after the first trimester
Editor: Mark Little emergencies 540 of pregnancy 579
Editor: Biswadev Mitra
Fatima Rahman
12.1 Acid–base disorders 484 19.6 Pre-eclampsia and eclampsia 581
Alan Gault 15.1 Emergency dermatology 540 Marian Lee
12.2 Electrolyte disturbances 488 Ryan De Cruz, Vanessa Morgan,
George Varigos 19.7 Emergency delivery and
John Pasco complications 584
Stephen Priestley
vii
CONTENTS

SECTION 20 SECTION 22 SECTION 25

Psychiatric emergencies 595 Pain relief 660 Toxicology emergencies 731
Editor: Biswadev Mitra Editor: Conor Deasy Editor: Mark Little

20.1 Mental state assessment 595 22.1 General pain management 660 25.1 Approach to the poisoned
Blair Hobbs Adrian Murphy patient 731
Alan Gault
20.2 Distinguishing medical from 22.2 Local anaesthesia 665
psychiatric causes of mental Anthony F.T. Brown 25.2 Cardiovascular drugs 737
disorder presentations 600 Betty S.H. Chan, Angela L. Chiew
22.3 Emergency department
David Spain
procedural sedation 671 25.3 Antipsychotic drugs 744
20.3 Deliberate self-harm/ Anthony J. Bell, Greg Treston, Dino Druda
suicide 604 Adam Michael
25.4 Antidepressant drugs 748
Jennie Hutton, Grant Phillips,
Shaun Greene
Peter Bosanac
SECTION 23 25.5 Lithium 753
20.4 Depression 610
Jessamine Soderstrom
Evan Symons Emergency imaging 678
Editor: Biswadev Mitra 25.6 Paracetamol 756
20.5 Psychosis 618
Andis Graudins, Anselm Wong
Evan Symons
23.1 Emergency department
25.7 Salicylate 760
20.6 Pharmacological management of ultrasound 678
Andis Graudins, Digby Green
the aroused patient 624 James Rippey, Adrian Goudie
John C. Spencer 25.8 Antidiabetic drugs 763
23.2 Computed tomography
Jason Armstrong
scanning in emergency
medicine 689 25.9 Colchicine 766
SECTION 21 Stephen J. Dunjey, Swithin Song Dushan Jayaweera, Mark Salter
Challenging situations 628 23.3 Magnetic resonance imaging in 25.10 Theophylline and caffeine 768
Editor: Biswadev Mitra
emergency medicine 694 Gopi Mann, Satish Mitter,
James Rippey Naren Gunja
21.1 Death and dying 628
William Lukin, Carol Douglas 25.11 Iron 770
Zeff Koutsogiannis,
21.2 Sexual assault 631 SECTION 24 Yit Hung Leang
Jeremy Stevens
Environmental emergencies 700 25.12 Drugs of abuse 773
21.3 Family violence 635 Editor: Mark Little
Kerry A. Hoggett
Evan Symons, De Villiers Smit,
Kellie Muir, Catherine Smith 24.1 Heat-related illness 700 25.13 Cyanide 778
Ian Rogers George Braitberg
21.4 Alcohol-related illness 638
Ioana Vlad 24.2 Hypothermia 702 25.14 Hydrofluoric acid 781
Ian Rogers Andis Graudins, Sam Alfred
21.5 The challenging
patient 645 24.3 Dysbarism 706 25.15 Pesticides 784
Georgina Phillips, David R. Smart Darren M. Roberts, Matthew Bode
Kirsten Cassidy
24.4 Radiation incidents 713 25.16 Herbicides 789
21.6 End-of-life decision Paul D. Mark Katherine Isoardi, Geoffrey
making and palliative Isbister, Darren M. Roberts
24.5 Drowning 719
care 653
David Mountain 25.17 Ethanol and other ‘toxic’
William Lukin, Ben White,
alcohols 792
Carol Douglas 24.6 Electric shock and lightning
David McCoubrie,
injury 724
21.7 Organ and tissue Mohan Raghavan
Daniel M. Fatovich
donation 656
25.18 Carbon monoxide 798
Martin J. Dutch, 24.7 Altitude illness 728
Nicholas Buckley
David Pilcher Ian Rogers

viii
CONTENTS

25.19 Anticonvulsants 801 27.5 Postgraduate emergency medicine 29.6 Emergency department short
Joe-Anthony Rotella, teaching and simulation 854 stay units 911
Anselm Wong Victoria Brazil Carl Luckhoff
25.20 Hymenoptera stings 804 29.7 Overcrowding 914
Annabel Somerville Drew Richardson
SECTION 28
25.21 Toxidromes 806 29.8 Rapid response systems and the
Emergency medicine and
Nazila Jamshidi, emergency department 916
the law 858
Andrew H. Dawson Julie Considine, Daryl A. Jones
Editor: Biswadev Mitra
25.22 Chloroquine 812 29.9 Public health and emergency
Michael A. Downes 28.1 Mental health and the law: medicine 920
the Australian, NZ and UK Diana Egerton-Warburton, Jennie
25.23 Opioids 814
perspectives 858 Hutton, Peter Aitken, Hilary Tyler
Angela L. Chiew, Therese Becker
Georgina Phillips,
25.24 Oral anticoagulants 816 Matthew Warden
Robert Dowsett SECTION 30
28.2 The coroner: the Australian, NZ
and UK perspectives 866 Administration 923
Biswadev Mitra, Jane Terris Editor: Peter Cameron
SECTION 26
28.3 Consent and competence—
Toxinology emergencies 819 30.1 Emergency department
the Australian, NZ and UK
Editor: Mark Little staffing 923
perspectives 872
Julie Considine, Sue Ieraci
Jane Terris, George Braitberg
26.1 Snakebite 819
30.2 Emergency department
Geoffrey Isbister 28.4 Privacy and confidentiality 877
layout 926
Biswadev Mitra, De Villiers Smit
26.2 Exotic snakebite 824 Matthew W.G. Chu
Julian White 28.5 Ethics in emergency
30.3 Quality assurance and quality
medicine 880
26.3 Spider bite 827 improvement 930
Michael W. Ardagh
Geoffrey Isbister Kim Hansen
26.4 Marine injury, envenomation and 30.4 Business planning 932
poisoning 831 SECTION 29 De Villiers Smit
Jamie Seymour, Peter Pereira
Emergency and medical 30.5 Accreditation, specialist training
systems 887 and recognition in Australia 935
Editor: Peter Cameron James Collier, Barry Gunn
SECTION 27
30.6 Specialist training and recognition
Academic emergency 29.1 Pre-hospital emergency
in emergency medicine in the
medicine 835 medicine 887
United Kingdom 938
Editor: Biswadev Mitra Stephen A. Bernard,
Jason Long
Paul A. Jennings
27.1 Research methodology 835 30.7 Complaints 941
29.2 Retrieval 891
David McD. Taylor Fatima Rahman
Marcus Kennedy
27.2 Writing for publication 842 30.8 Patient safety 946
29.3 Medical issues in disasters 896
Anne-Maree Kelly Peter Sprivulis
Jonathan Abrahams, David A.
27.3 Principles of medical Bradt, Richard J. Brennan 30.9 Wellness, resilience and
education 845 performance in emergency
29.4 Triage 904
Debbie Paltridge medicine 948
Drew Richardson
Bethany Boulton, Melanie Rule,
27.4 Teaching medical students
29.5 Emergency care in a humanitarian Alex Markwell
emergency medicine 850
crisis 907
Geoffrey A. Couser
Angela Jackson, Mark Little Index 951

ix
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 Preface

The discipline of emergency medicine contin- covers the complex organizational issues for interested can still access more detailed infor-
ues to grow, and the subspecialties continue disaster planning and response, humanitarian mation. We have also moved many images
to expand in breadth and number. Since emergencies and refugee medicine. and photos online to reduce printed matter.
the first edition of this book 20 years ago, A further feature of this book is that gover- The additional material can be found in the
there has been enormous change in the way nance, training, research and organizational free e-book that comes with the printed ver-
emergency care is delivered. This has occurred subjects are covered, to give the reader some sion—see inside front cover.
both in countries where emergency medicine frameworks to understand the complexity of In a book of this size and complexity,
originally developed and in those where it managing major emergency systems of care. there are many people to thank—more than
was originally felt that it might not have a role The clinical subjects in this edition have 200 contributing authors from around the
because it was a ‘first-world’ specialty, limited all been extensively reviewed and updates world, and their family and friends who were
in application because of cost. The World provided. There have been major updates in deprived of their company whilst writing the
Health Organization is now completely chang- some of the clinical chapters, such as airway, chapters! The production staff from Elsevier
ing this view and regards emergency medicine shock and sepsis, because guidelines have was extremely helpful, especially Fiona Conn
as the cornerstone of response to acute illness, changed rapidly. The imaging chapters have for overall coordination. A special thanks to
even in countries with very limited resources. also evolved with changing practice, improved Angela Hodges, for assisting the editors and
An emergency medicine program provides technology and evidence for inclusion of authors to complete the book in a reasonable
essential structure to develop a response to emergency physician interpretation of imag- timeframe.
disasters, epidemics and humanitarian crises. ing becomes more robust.
The importance of emergency medicine in Despite the rapid escalation of topics and Peter Cameron
ensuring an appropriate response to all acute depth of potential content, we have tried to Mark Little
medical problems is also becoming more keep the book to a manageable length, to Biswadev Mitra
obvious. This edition covers not only specific ensure accessibility for readers. As part of Conor Deasy
medical emergencies such as cardiac, neuro- this process, we have moved many of the
logical and respiratory emergencies, it also references online, so that readers who are

xi
 Contributors

Jonathan Abrahams, MPH BSc Michael R. Augello, MBBS FACEM Matthew Bode, MBChB FACEM
Grad Dip (Population Health) Cert. Emergency Physician, Emergency Department, Emergency Physician, St Vincent’s Hospital
(Emergency Management) St Vincent’s Hospital, Melbourne; H ­ onorary and Sutherland Hospital, Sydney, New South
Country Health Emergency Preparedness and ­Fellow, Department of Medicine, The University Wales, Australia
International Health Regulations, World Health of Melbourne, Melbourne, Victoria, Australia
Organization, Geneva, Switzerland Peter Bosanac, MBBS MMed
Michael Baker, MBBS (Hons) FACEM (Psychiatry) MD FRANZCP Grad Dip MH
Nicholas Adams, MBBS (PEM) DipCH Science (Clinical Hypnosis)
Emergency Physician, Alfred Health, Mel- Emergency Physician, Sir Charles Gairdner Director Clinical Services, Mental Health,
bourne, Victoria, Australia Hospital and Princess Margaret Hospital for St Vincent’s Hospital, Melbourne, Victoria,
Children, Perth, Western Australia, Australia Australia
Peter Aitken, MBBS FACEM EMDM
MClinEd DrPH Ashis Banerjee, MBBS MRCS LRCP MS Bethany Boulton, BPharm Grad Cert Int
Senior Director, Health Disaster Manage- FRCS (Eng) FRCS (Edin) FCEM DTM&H Health MBBS (Hons) FACEM
ment Unit, Queensland Health, Brisbane, (Lond) Senior Staff Specialist, Department of Emer-
Queensland, Australia Consultant/Royal Free London NHS Founda- gency Medicine, Sunshine Coast Hospital and
tion Trust, London; Honorary Senior lecturer Health Service, Queensland; Senior Lecturer,
Sam Alfred, MBBS FACEM Dip Tox in Emergency Medicine, University of Hert- Coast Clinical Unit, University of Queensland,
Emergency Physician and Clinical Toxicolo- fordshire, Hatfield, United Kingdom Brisbane, Queensland, Australia
gist, Royal Adelaide Hospital, Adelaide, South
Australia, Australia Therese Becker, BSc MBBS FACEM David A. Bradt, MD MPH FACEM
Emergency Physician and Clinical Toxicologist, FAFPHM FACEP DTM&H
Philip Aplin, MBBS FACEM Prince of Wales Hospital, Sydney, New South Johns Hopkins University, Baltimore,
Emergency Physician, Emergency Depart- Wales, Australia Maryland, United States
ment, Flinders Medical Centre, Adelaide, South
Australia, Australia Anthony J. Bell, MBBS FACEM MBA George Braitberg, AM MBBS
MPH FRACMA FACEM FACMT FRACMA MBioethics
Michael W. Ardagh, ONZM PhD MBChB Director of Medical Services, The Wesley Hos- MHlthServMt Dip Epi Biostats
DCH FACEM pital, Brisbane, Queensland, Australia Executive Director of Strategy, Quality and
Professor of Emergency Medicine, University Improvement, Melbourne Health; Professor
of Otago, Christchurch, New Zealand Stephen A. Bernard, MD of Emergency Medicine, Head Emergency
Senior Staff Specialist, The Alfred Hospital, Stream, Centre for Critical Care Medicine, The
Sean Arendse, BSc MBBS FACEM PG Dip Melbourne; Medical Director, ­A mbulance University of Melbourne, Melbourne, Adjunct
(Clin Derm) AKC Victoria, Melbourne, Victoria, Australia Professor Health Sciences Unit, Monash Uni-
Senior Emergency Physician, The Alfred Hos- versity, Melbourne, Victoria, Australia
pital, Melbourne, Victoria, Australia Shom Bhattacharjee, MBBS FRACP
Consultant Rheumatologist, The Alfred Hospi- Crispijn van den Brand, MD
Jason Armstrong, MBChB FACEM tal, Melbourne, Victoria, Australia Emergency Physician, Emergency Medicine,
Emergency Physician and Clinical Toxicologist, Haaglanden Medisch Centrum, The Hague,
Sir Charles Gairdner Hospital, Perth; Medical Netherlands
Director, WA Poisons Information Centre,
Perth, Western Australia, Australia
xiii
CONTRIBUTORS

Victoria Brazil, MBBS FACEM MBA Gar Ming Chan, MD FACEM John J. Cronin, MB, BCh, BAO, FRCEM,
Professor of Emergency Medicine, Fac- Staff Specialist in Emergency Medicine, Calvary AFRCSI, FFSEM, DCH
ulty of Health Sciences and Medicine, Bond Hospital, Lenah Valley, Tasmania, Australia Consultant in Emergency Medicine, St Vin-
­University, Gold Coast Health, Gold Coast, cent’s University Hospital, Dublin, Ireland
Queensland, Australia Raymond Chi Hung Cheng, MBChB
MRCSEd FHKCEM FHKAM (Emergency Stephen Cusack, MB BSc FRCSI FRCEM
Richard J. Brennan, MBBS MPH FACEM Medicine) Professor of Emergency Medicine, University
FIFEM Consultant, Accident and Emergency Depart- College Cork, Cork; Consultant in Emergency
Director, Department of Emergency Manage- ment, Prince of Wales Hospital, Shatin, Hong Medicine, Cork University Hospital, Cork,
ment Operations, World Health Organization, Kong Ireland
Geneva, Switzerland
Angela L. Chiew, BSci (Med) MBBS FACEM Andrew H. Dawson, MBBS FRACP FRCP
Anthony F.T. Brown, AM, FRCP FRCSEd Emergency Physician and Clinical Toxicologist, FCCP
FRCEM FACEM Prince of Wales Hospital, Randwick, Sydney, Professor of Clinical Toxicology, Royal Prince
Senior Staff Specialist, Emergency and NSW, Australia; Clinical Toxicologist, NSW Poi- Alfred Hospital, Sydney, New South Wales,
Trauma Centre, Royal Brisbane and Women’s sons Information Centre, The Children’s Hos- Australia
Hospital, Brisbane; Professor of Emergency pital Westmead, New South Wales, Australia
Medicine, Discipline of Anaesthesiology and Rebecca Day, MBBS MRCS FACEM
Critical Care, Faculty of Medicine, University Matthew W.G. Chu, MBBS (Hons) Co-Director of Emergency Medicine, Royal
of Queensland, Queensland, Brisbane; Peer FACEM Darwin Hospital, Darwin, Northern Territory,
Support Examiner, Senior Court of Examiners, Senior Specialist, Emergency Department Australia
Australasian College for Emergency Medicine, Director, Medical Assessment Unit Director,
Australia Prevocational Education and Training Can- Nadine de Alwis, MBBS BSci Dip Anat
terbury Hospital, Sydney, New South Wales, ENT Surgeon, Royal Victorian Eye and Ear
Nicholas Buckley, MD FRACP Australia Hospital, Melbourne; Consultant ENT Surgeon,
Professor of Clinical Pharmacology, University Cairns Hospital, Cairns, Queensland, Australia
of Sydney, Sydney; VMO clinical toxicologist, Flavia M. Cicuttini, MBBS (Hons) PhD
The Children’s Hospital at Westmead, Sydney, DLSHTM FRACP FAFPHM Ryan De Cruz, MBBS (Hons) BMedSci
New South Wales, Australia Head, Rheumatology Unit, The Alfred Hos- FACD
pital, Melbourne; Professor and head of Specialist Dermatologist, The Royal Melbourne
Peter Cameron, MBBS MD FACEM
Musculoskeletal Unit, School of Public Health Hospital, Melbourne, Victoria, Australia
Professor of Emergency Medicine, Depart-
and Preventive Medicine, Monash University,
ment of Epidemiology and Preventive Medi-
Melbourne, Victoria, Australia Carol Douglas, MBChB FRACGP FAChPM
cine, Monash University, Melbourne, Victoria,
Director Palliative and Supportive Care Ser-
Australia; Emergency Physician, Emergency
James Collier, MBBS FACEM vice, Royal Brisbane and Women’s Hospital,
and Trauma Centre, The Alfred Hospital, Mel-
Co-Director, Department of Emergency Medi- Brisbane, Queensland, Australia
bourne, Victoria, Australia
cine, Princess Alexandra Hospital, Brisbane,
Queensland, Australia Michael A. Downes, MBChB FACEM
Christopher Carman, MBBS
Emergency Physician and Clinical Toxicologist,
PGDipSurgAnat
Julie Considine, RN RM BN PhD Calvary Mater Newcastle Hospital, Waratah,
Emergency Registrar, The Alfred Emergency
Professor of Nursing, Deakin University School New South Wales, Australia
and Trauma Centre, Melbourne, Victoria,
of Nursing and Midwifery and Centre for Quali-
Australia
ty and Patient Safety Research – Eastern Health Robert Dowsett, BMBS GDipClinEd
Partnership, Melbourne, Victoria, Australia FACEM
Kirsten Cassidy, MBChB DRCOG MRCGP
Visiting Medical Officer, Emergency Medicine,
FACEM
Geoffrey A. Couser, MBBS FACEM MEd Calvary Hospital, Bruce, Canberra; Visiting
Emergency Physician, Emergency Depart-
Senior Staff Specialist, Emergency Department Medical Officer, New South Wales Poisons
ment, St Vincent’s Hospital, Fitzroy, Victoria,
Royal Hobart Hospital, Hobart; Clinical Associ- Information Centre, The Childrens Hospital
Australia
ate Professor, School of Medicine, University at Westmead, Sydney, New South Wales,
of Tasmania, Hobart, Tasmania, Australia Australia
Betty S.H. Chan, MBBS FACEM PhD
Head of Clinical Toxicology Unit & Emergency
Carmel Crock, MBBS FACEM BLitt Pieter van Driel, MD DEMT FNVSHA
Physician, Prince of Wales Hospital, Sydney;
Director, Emergency Department, Royal Emergency Physician, Elisabeth-TweeSteden
Clinical Toxicologist, New South Wales
Victorian Eye and Ear Hospital, Melbourne, ziekenhuis (ETZ) Tilburg, Netherlands
Poisons Information Centre, The Children’s
Australia; Senior Lecturer, University of Mel-
Hospital at Westmead, Sydney, New South
bourne, Victoria, Australia
Wales, Australia
xiv
CONTRIBUTORS

Michelle van den Driesen, MBBS FACEM Eoin Fogarty, FRCEM FACEM Colin A. Graham, MBChB MPH MD FRCP
DTMH MPH MHML Emergency Physician, Cork University Hospi- FRCS FIMCRCSEd FCCP FRCEM FHKCEM
Emergency Physician, Royal Melbourne Hos- tal, Cork, Ireland FHKAM (Emergency Medicine)
pital, Melbourne, Victoria, Australia Professor of Emergency Medicine, Chinese
James Fordyce, MBBS MPH FACEM University of Hong Kong; Honorary Consult-
Dino Druda, BMedSi (Hons) MBBS GradCertSpMed ant in Emergency Medicine, Prince of Wales
FACEM FRCP (Edin) Emergency Physician, Monash Health, Mel- Hospital, Shatin, Hong Kong; Editor-in-Chief,
Emergency Physician and Clinical Toxicologist, bourne, Victoria, Australia European Journal of Emergency Medicine,
Monash Health, Melbourne, Victoria, Australia London, United Kingdom
Peter Fritz, MBBS (Hons) FACEM
GCHPE Andis Graudins, MBBS (Hons) PhD
Stephen J. Dunjey, MBBS FACEM DDU
Emergency Physician, The Alfred Hospital, FACEM FACMT
Consultant in Emergency Medicine, Royal
Melbourne; Adjunct Lecturer, Monash Univer- Professor of Emergency Medicine and Clini-
Perth Hospital, Perth; Professor of Emergency
sity, Melbourne, Victoria, Australia cal Toxicology Research, Monash University,
Medicine, St John of God Hospital, Murdoch,
Western Australia, Australia Melbourne; Consultant Emergency Physician
Dean Fulford, MBChB BSc (Hons) MRCS and Clinical Toxicologist, Monash Dandenong,
(Eng) PgCert (Med Ed) Melbourne; Visiting Consultant Clinical Toxi-
Martin J. Dutch, BMedSci (Hons) MBBS Emergency Medicine Registrar, Sir Charles
(Hons) MPH&TM FACEM O.StJ. cologist, New South Wales Poisons Informa-
Gairdner Hospital, Perth, Western Australia, tion Centre, The Children’s Hospital at The
Emergency Physician, Royal Melbourne Hos- Australia
pital, Melbourne; Medical Donation Specialist, Children’s Hospital at Westmead, Sydney; Vis-
DonateLife, Melbourne, Victoria, Australia iting Consultant Clinical Toxicologist, Victorian
James K. Galbraith, MBBS FRANZCO Poisons Information Centre, Austin Hospital,
FRACS Heidelberg, Victoria, Australia
Diana Egerton-Warburton, MBBS Ophthalmic Surgeon, Royal Melbourne Hos-
FACEM MClinEpi MPH CCPU pital, Melbourne, Victoria, Australia Digby Green, BSc MBChB FACEM
Director of Emergency Medicine Research,
Emergency Physician, Cairns Hospital,
Monash Medical Centre, Monash Health, Alan Gault DipClinTox, FACEM MBChB Queensland, Australia
Melbourne; Professor, School of Clinical Sci- BAO BA (HSc)
ences at Monash Health, Monash University, Emergency Medicine Staff Specialist and Tim Green, MBBS FACEM
Melbourne, Victoria, Australia Clinical Toxicologist, Western Australia Poi- Senior Staff Specialist, Royal Prince Alfred Hos-
son I­nformation Centre, Sir Charles Gairdner pital, Sydney; Clinical Senior Lecturer, Sydney;
Daniel M. Fatovich, MBBS FACEM PhD Hospital, Perth; New South Wales Poisons Medical School, University of Sydney, Sydney,
Professor of Emergency Medicine, Royal Information Centre, The Children’s Hospital New South Wales, Australia
Perth Hospital, University of Western Australia, at Westmead, Sydney, New South Wales,
Perth; Head, Centre for Clinical Research Australia Shaun Greene, MBChB MSc FACEM
in Emergency Medicine, Harry Perkins FACMT
­Institute of Medical Research, Perth; D
­ irector Michael J. Gingold, BMedSc (Hons) Emergency Physician, Austin Health, Mel-
of ­Research, Royal Perth Hospital, Perth, MBBS (Hons) FRACP bourne; Clinical Toxicologist, Victorian Poisons
­Western Australia, Australia Consultant Rheumatologist, Monash Health, Information Service, Melbourne, Victoria,
Melbourne, Victoria, Australia Australia
Louise Finnel, MBChB FACEM
PGDipClinEd GDipBHL Robert Gocentas, MBBS DipClinEpi Christopher Groombridge, MBBS MA
Emergency Medicine Specialist, Middlemore FACEM (Cantab) MSc DOHNS (RCSEng) DRTM
Emergency Department, Counties Manu- Emergency Physician, Emergency & Trauma (RCSEd) DIMC (RCSEd) MRCS FACEM
kau District Health Board, Auckland, New Centre, Alfred Health, Melbourne, Victoria, Emergency Physician, The Alfred Hospital,
Zealand Australia Melbourne; Adjunct Lecturer, Monash Univer-
sity, Melbourne, Victoria, Australia
Mark Fitzgerald, MBBS MD Neil A. Goldie, MBBS FACEM
Director, Trauma Service, The Alfred Hospi- Service Director – Emergency Medicine, Naren Gunja, MBBS MSc (ForTox)
tal, Melbourne; Director, National Trauma Monash Health, Melbourne, Victoria, Australia FACEM FACMT
Research Institute, Melbourne; Professor, Clinical & Forensic Toxicologist, Western
Department of Surgery, Central Clinical Adrian Goudie, BMedSci (Hons) MBBS ­Sydney Health, NSW; Clinical Toxicologist,
School, Monash University, Melbourne; Medi- FACEM DDU NSW Poisons Information Centre, Sydney,
cal Adviser, Ambulance Victoria, Melbourne, Emergency Physician, Fiona Stanley Hospital, NSW; Clinical Associate Professor, Sydney
Victoria, Australia Perth, Western Australia, Australia Medical School, New South Wales, Australia

xv
CONTRIBUTORS

Barry Gunn, MBBS FACEM Anthony D. Holley, BSc MBBCh Christine Jackman, MBBS FACEM MPHE
Emergency Physician, Western Health, Mel- DipPaeds DipDHM FACEM FCICM Senior Emergency Physician, Cabrini Hospi-
bourne, Victoria, Australia Senior Staff Specialist, Royal Brisbane and tal, Cabrini Health, Victoria; Senior Lecturer
Women’s Hospital, Brisbane; Senior Lecturer, Monash University, Eastern Health Clinical
Kim Hansen, MBBS (Hons) MBA FACEM School of Medicine, University of Queensland, School, Box Hill, Victoria, Australia
Director of Emergency Services, St Andrew’s Brisbane, Queensland, Australia
War Memorial Hospital, Brisbane; Senior Staff Angela Jackson, RN RM NP. B Nurs, Dip
Specialist, Emergency Department, The Prince Craig Hore, MBBS FACEM FCICM MHPol Nurs, Crit Care Cert, MPH&TM LLB Dip
Charles Hospital, Brisbane; Senior Lecturer, Clinical Director of Intensive Care, Port Mac- Law, M Nursing (NP), IDHA
Faculty of Medicine, University of Queensland, quarie Base Hospital, Port Macquarie; Conjoint Emergency Nurse Practitioner, Department of
Brisbane, Queensland, Australia Senior Lecturer, Faculty of Medicine, Rural Clin- Emergency Medicine, Cairns Hospital, Cairns,
ical School, University of New South Wales, Queensland, Australia
Kenneth Heng, MBBS FRCS (A&E) Edin Port Macquarie, New South Wales, Australia
FAMS MPHEd Nazila Jamshidi, BPharm (Hons) PhD
Senior consultant Tan Tock Seng Hospital Kevin K.C. Hung, MBChB MPH EMDM MBBS
Singapore, Adj Assoc Professor LKC School MRCSEd FRCEM FHKCEM FHKAM Clinical pharmacology/Addiction and General
of Medicine, Singapore (Emergency Medicine) Medicine Advanced Trainee, Drug Health Ser-
Assistant Professor in Emergency Medicine, vices, Royal Prince Alfred Hospital, Sydney,
Arthur Hennessy, MB BCh BAO Dip Chinese University of Hong Kong; Honorary New South Wales, Australia
Med Tox MRCSI FRCEM Specialist in Emergency Medicine, Prince of
Consultant in Emergency Medicine, St. Wales Hospital, Shatin, Hong Kong Dushan Jayaweera, MBBS (Hons)
James’s Hospital, Dublin, Ireland FACEM DipTox
Jennie Hutton, MBChB MPH FACEM Emergency Physician and Clinical Toxicologist,
Ruth Hew, MBBS BA MSc (ClinEpi) Emergency Physician, St Vincent’s Hospital, Conjoint Senior Lecturer, Western Sydney
FACEM Melbourne, Victoria, Australia Health, New South Wales Poisons Information
Emergency Physician, Sunshine Hospital, Centre, The Children’s Hospital at Westmead,
Melbourne, Victoria, Australia Sue Ieraci, MBBS FACEM School of Medicine, Western Sydney Univer-
sity, Sydney, New South Wales, Australia
Ian Hewson, BDSc FRACDS MRACDS Arun Ilancheran, MBBS (Hons) FACEM
Director of Dental Services, The Alfred Hospi- Emergency Physician, The Alfred Emergency Paul A. Jennings, BN GradCertAdvNsg
tal, Melbourne, Victoria, Australia and Trauma Centre, Melbourne, Victoria, MClinEpi PhD
Australia Clinical Manager, Ambulance Victoria,
Rosslyn Hing, BSc (Med) MBBS FACEM ­M elbourne, Australia; Adjunct Associate
Emergency Physician, Staff Specialist, Royal Geoffrey Isbister, BSc MBBS FACEM MD Professor, Community Emergency Health
Prince Alfred Hospital, Sydney, New South Senior Staff Specialist, Department of Clinical and Paramedic Practice, Monash University,
Wales, Australia Toxicology and Pharmacology, Calvary Mater Melbourne, Victoria, Australia
Newcastle Hospital, Newcastle; Professor,
Blair Hobbs, B.Sc.P.N, PostGradDip
School of Medicine and Public Health, Uni- Cecil S. Johnny, MBBS MS (Gen Surg)
ACN, MANP (NP), MACMHN
versity of Newcastle, Newcastle; Consultant, FACEM
Team Leader/Nurse Practitioner, Consulta-
New South Wales Poisons Information Centre, Consultant, The Alfred Emergency and Trauma
tion Liaison and Emergency Psychiatry
The Children’s Hospital at Westmead, Sydney, Centre, Melbourne, Victoria, Australia
Service, Alfred Mental and Addiction Health,
New South Wales, Australia
The Alfred Hospital, Melbourne, Victoria,
Australia
Daryl A. Jones, BSc (Hons) MBBS
Katherine Isoardi, BMed FACEM FRACP FCICM MD PhD
GradDip ClinTox Consultant Intensive Care Specialist, Austin
Kerry A. Hoggett, MBBS GCertClinTox
Emergency Physician and Clinical Toxicologist, Health, Melbourne; Associate Professor
FACEM
Princess Alexandra Hospital, Brisbane; Clinical SPHPM Monash University, Melbourne; Ad-
Emergency Physician and Clinical Toxicologist,
Toxicologist, Queensland Poisons Informa- junct Associate Professor, The University of
Royal Perth Hospital, Perth; Clinical Toxicolo-
tion Centre, Lady Cilento Children’s Hospital, Melbourne, Melbourne; Medical Director Criti-
gist, New South Wales Poisons Information
Brisbane, Queensland, Australia cal Care, Outreach Austin Hospital, Melbourne,
Centre, The Children’s Hospital at Westmead,
Victoria, Australia
Sydney, New South Wales, Australia

xvi
CONTRIBUTORS

Anthony P. Joseph, MBBS FACEM Yit Hung Leang, MBBS FACEM PGDip Gerard McCarthy, MBBCh BAO FRCSI
Senior Staff Specialist and Director of Trauma, (Med.Tox.) FRCSEd (A&E) FRCEM
Royal North Shore Hospital, Sydney; As- Emergency Physician & Clinical Toxicology Consultant in Emergency Medicine, Cork Uni-
sociate Professor, Sydney Medical School, Fellow, Austin Health & Victorian Poison Infor- versity Hospital, Cork; Clinical Lead, National
University of Sydney, Sydney, New South mation Centre, Melbourne, Victoria, Australia Emergency Medicine Programme, Clinical
Wales, Australia Strategy and Programmes Division, Health
Francis Chun-Yue Lee, MBBS (S’pore) Service Executive, Dublin, Ireland
David V. Kaufman, MBBS FRANZCO FRCSEd (A&E) FAMS
FRACS Senior Consultant, Acute & Emergency Care David McCoubrie, MBBS FACEM
Ophthalmic Surgeon, Epworth Freemasons Centre, Khoo Teck Puat Hospital, Singapore; Emergency Physician and Clinical Toxicolo-
Hospital, Melbourne, Victoria, Australia Adjunct Associate Professor, Lee Kong Chian gist, Royal Perth Hospital, Perth; VMO Clinical
School of Medicine; Adjunct Assistant Profes- Toxicologist, New South Wales Poisons Infor-
Anne-Maree Kelly, MBBS MD MClinEd sor, Yong Loo Lin School for Medicine mation Centre, The Children’s Hospital at West-
FACEM FCCP mead, Sydney, New South Wales, Australia
Director, Joseph Epstein Centre for Emer- Marian Lee, MBBS DCH FACEM MHA
gency Medicine Research, Western Health, Emergency Physician, Prince of Wales Hospi- C. Geraldine McMahon, MB BAO BCh
Melbourne; Professorial Fellow, Joseph tal, Sydney, New South Wales, Australia BSCAnat FRCSEd FRCPI FRCEM PhD
Epstein Centre for Emergency Medicine Re- Professor of Emergency Medicine, Trinity
search, Western Health, St Albans, Victoria; David Lightfoot, BSc (Med) MBBS College, Dublin; Clinical Associate, St. James’s
Department of Medicine, Melbourne Medical FACEM Hospital, Dublin, Ireland
School – Western Precinct, The University Emergency Physician, Monash Medical Centre,
of Melbourne, St. Albans, Victoria; Adjunct Monash Health, Melbourne, Victoria, Australia Andrew Maclean, MBBS FACEM
Professor, School of Public Health, Queens- Director of Emergency Services, Box Hill
land University of Technology, Brisbane, Mark Little, MBBS FACEM MPH&TM Hospital, Melbourne; Adjunct Senior ­Lecturer,
Queensland, Australia DTM&H IDHA Eastern Health Clinical School, Monash
Emergency Physician and Clinical Toxicologist, University Faculty of Medicine, Melbourne,
Marcus Kennedy, MBBS FACEM FRACGP Department of Emergency Medicine, Cairns Victoria, Australia
DA (UK) DipIMC (RCSEd) MHlth ServMt Hospital, Cairns, Queensland, Australia; Clini-
GAICD cal Toxicologist, New South Wales Poisons In- Amit Maini, MBBS BSc FACEM
Director, Adult Retrieval Victoria, Melbourne, formation Service, New South Wales, Australia Emergency Physician, The Alfred Hospital,
Victoria, Australia Melbourne; Adjunct Senior Lecturer, Monash
Jason Long, MBChB FRCEM FRCP DRTM University, Melbourne, Victoria, Australia
Zeff Koutsogiannis, MBBS FACEM GCert DipMedEd
Clin Tox Dean, Royal College of Emergency Medicine, Sander Manders, MD FACEM FRCEM
Emergency Physician & Clinical Toxicologist, London; Consultant in Emergency Medicine, Emergency Physician, Royal Darwin Hospital,
Austin Health & Victorian Poison Information Queen Elizabeth University Hospital, Glasgow, Darwin; Medical Retrieval Consultant, Care-
Centre, Melbourne, Victoria, Australia United Kingdom Flight, Darwin, Northern Territory, Australia

Erica Kreismann, MD FACEM Carl Luckhoff, MBChB FACEM GCEH Gopi Mann, MBChB MSc(MedTox)
Director & Staff Specialist in Emergency Medicine, (Aeromed) FACEM
Calvary Hospital, Lenah Valley, Tasmania; Special- Emergency Physician, The Alfred Emergency Emergency Physician & Clinical Toxicolo-
ist in Aeromedical and Retrieval Medicine, Am- and Trauma Centre, Alfred Health, Melbourne, gist, Western Sydney Health, NSW; Clinical
bulance Tasmania, Hobart, Tasmania, Australia Victoria, Australia Toxicologist, NSW Poisons Information Centre,
Sydney, New South Wales, Australia
Win Sen Kuan, MBBS MRCSEd (A&E) William Lukin, MBBS FACEM FAChPM
MCI FAMS Senior Staff Specialist, Emergency Depart- Desmond Mao, MBBS MCEM MMed
Senior Consultant, Emergency Medicine ment, Royal Brisbane and Women’s Hospital, (Emergency Medicine)
Department, National University Hospital, Brisbane; Staff Specialist in Palliative Care, Consultant, Acute and Emergency Care Depart-
Singapore; Assistant Professor, Department Metro North Hospital and Health Service, ment, Khoo Teck Puat Hospital, Singapore
of Surgery, Yong Loo Lin School of Medicine, Brisbane, Queensland, Australia
National University of Singapore, Singapore
Brett Lurie, MBBS BSc (Med) RANZCR
Rohan Laging, MBBS (Hons) FACEM Staff Specialist Radiologist, Royal North Shore
Emergency Physician, Emergency and Trauma Hospital, Sydney, New South Wales, Australia
Centre, The Alfred Hospital, Melbourne; Clini-
cal Director Emergency Department, Cabrini
Hospital, Melbourne, Victoria, Australia
xvii