TABLE OF CONTENTS &
CONTRIBUTORS
Preface—Using This
Book
.............................................................................. iii
About The Authors
............................................................................................
iv
Foreword
.............................................................................................................v
A Two Step Approach to
Avoid “Bouncebacks” .......................................... xv
Michael B. Weinstock, MD
Clinical Assistant Professor, Division of Emergency Medicine
The Ohio State University, College of Medicine,
Columbus, Ohio
Attending ED physician, Director of Medical Education
Mt. Carmel St. Ann’s Emergency Department, Westerville,
Ohio
Ryan Longstreth, MD,
FACEP
Attending ED Physician
Mt. Carmel St. Ann’s
Emergency Department, Westerville, Ohio
Assistant ED Director, St. Ann’s Emergency Department
Case by Case Commentary
Gregory L. Henry, MD,
FACEP
CEO, Medical Practice Risk Assessment, Inc., Ann Arbor,
Michigan
Clinical Professor, Department of Emergency Medicine
University of Michigan Medical School, Ann Arbor,
Michigan
Past President, American College of Emergency
Physicians (ACEP)
Case 1: 18 Year Old Male
with Left Hand Pain ...............................................1
Wesley P. Eilbert, MD,
FACEP
Clinical Associate Professor and Resident Research
Director
Department of Emergency Medicine, University of
Illinois College of Medicine
Director of Undergraduate Education, Department of
Emergency Medicine
Mercy Hospital and Medical Center, Chicago, Illinois
Case 2: 33 Year Old Male
with Abdominal Pain............................................ 13
Scott W. Melanson, MD,
FACEP
Associate Program Director, Emergency Medicine
Residency
Chair, Disaster Committee, St. Luke’s Hospital,
Bethlehem, Pennsylvania
Clinical Associate Professor, Temple University,
Philadelphia, Pennsylvania
Case 3: 71 Year Old Male
with Back Pain ...................................................... 27
M. Jacob Ott, MD
Ohio Chapter, American College of Emergency Physicians
Ultrasound Instructor
Attending ED physician & ED Ultrasound Director
Mt. Carmel St. Ann’s Emergency Department, Westerville,
Ohio
Case 4: 37 Year Old
Female with Headache & Flu-Like Symptoms ........... 45
Andy Jagoda, MD, FACEP
Professor and Vice Chair
Department of Emergency Medicine
Mount Sinai School of Medicine, New York, New York
Chair, ACEP Clinical Policies Committee
Chair, ACEP Clinical Policy Subcomittee on Acute
Headache
Editor-in-Chief, Emergency Medicine Practice
John Bruns, Jr., MD
Assistant Professor
Department of Emergency Medicine
Mount Sinai School of Medicine, New York, New York
Case 5: 17 Year Old Male
with Fever & Headache ........................................63
Ann Dietrich, MD, FAAP,
FACEP
Attending, ED physician, Columbus Children’s Hospital
Associate Professor, The Ohio State University College
of Medicine, Columbus, Ohio
Editor-in-chief, Pediatric Emergency Medicine Reports
Editor-in-chief, Trauma Reports
ACEP, Pediatric Emergency Medicine Committee
Case 6: 24 Year Old Male
with Abdominal Pain............................................ 77
Stephen A. Colucciello,
MD, FACEP
Associate Chair, Department of Emergency Medicine
Carolinas Medical Center, Charlotte, North Carolina
Adjunct Professor, Department of Emergency Medicine
University of North Carolina at Chapel Hill, Chapel
Hill, North Carolina
Former Member, ACEP Clinical Policies Committee
Former Member, ACEP Clinical Policies Subcommittee on
Abdominal Pain
Chair (1998-2000), ACEP Clinical Policies Subcommittee
on Syncope
Case 7: 38 Year Old Male
with Chest Pain .................................................... 91
Amal Mattu, MD, FAAEM,
FACEP
Associate Professor and Residency Director
Emergency Medicine Residency Program
University of Maryland School of Medicine, Baltimore,
Maryland
Author, ECG’s for the Emergency Physician
Consulting Editor, Emergency Medicine Clinics of North
America
Section Editor for Best Practices in Emergency
Medicine, Journal of Emergency Medicine
American Academy of Emergency Medicine (AAEM) Young
Educator of the Year, 2002
Case 8: 38 Year Old
Female with Abdominal Pain ..................................... 107
William Mallon, MD,
FACEP, FAAEM
Associate Professor of Clinical Emergency Medicine
Keck School of Medicine at USC
Director, Division of International Emergency Medicine
Los Angeles County + USC Medical Center, Los Angeles,
California
American Academy of Emergency Medicine (AAEM) Program
Director of the Year, 2004
Jan M. Shoenberger, MD,
FAAEM
Assistant Professor of Clinical Emergency Medicine
Director of Medical Student Education
Assistant Program Director
Keck School of Medicine at USC
Los Angeles County + USC Medical Center, Los Angeles,
California
Case 9: 34 Year Old Male
with Leg Pain ....................................................... 121
Jeffrey A. Kline, MD,
FACEP
Research and Fellowship Director, Department of
Emergency Medicine
Carolinas Medical Center
Adjunct Professor of Biology, Faculty, PhD Program,
Biomedicine and Biotechnology
University of North Carolina, Charlotte, North Carolina
Member ACEP Subcommittee on Suspected Pulmonary
Embolism
Member ACEP Subcommittee on Suspected Lower-Extremity
DVT
Member ACEP Subcommittee on MI and Unstable Angina
Board of Directors, Society for Academic Emergency Medicine
Case 10: 50 Year Old
Male with Gallbladder Inflammation........................ 137
Jud E. Hollander, MD,
FACEP
Professor of Medicine, University of Pennsylvania,
Philadelphia, Pennsylvania
Past member, Society of Academic Emergency Medicine
(SAEM) Board of Directors
Past Chair of Scientific Review Committee ACEP
Past Chair of SAEM Program Committee
Deputy Editor, Annals of Emergency Medicine, Reviewer
for JAMA, NEJM, JACC,
Academic Emergency Medicine, American Journal of
Emergency Medicine
ACEP Award for Outstanding Contribution in Research,
2001
Esther H. Chen, MD
Assistant Professor, Department of Emergency Medicine
University of Pennsylvania, School of Medicine,
Philadelphia, Pennsylvania
Case 11: 37 Year Old
Male with Headache .................................................. 151
Michael Para, MD
Pomerene Professor of Infectious Diseases
Associate Dean of Clinical Research
The Ohio State University College of Medicine,
Columbus, Ohio
Case 12: 42 Year Old
Female with Headache .............................................. 165
Stephen Karas, Jr., MD,
FACEP
Clinical Professor at UCSD in Emergency Medicine, San
Diego, California
Member, ACEP Clinical Policy Committee, 1991–2000
Author of ACEP publications: Guidelines for Cost
Containment in Emergency
Medicine and Cost Effective Diagnostic Testing in
Emergency Medicine
Case 13: 71 Year Old
Female with Bipolar Disease & Shoulder Pain........ 181
Stephen F. Pariser, MD
Professor of Clinical Psychiatry
Professor of Clinical Obstetrics and Gynecology
The Ohio State University College of Medicine,
Columbus, Ohio
Douglas A. Rund, MD,
FACEP
Professor and Chair
Department of Emergency Medicine
Associate Dean, College of Medicine and Public Health
President, Ohio State University Physicians
The Ohio State University College of Medicine,
Columbus, Ohio
Past President, American Board of Emergency Medicine
Editor-in-Chief, Textbook Essentials in Emergency
Medicine, 2nd Edition
ACEP Award for Outstanding Contribution in Education,
1992
Case 14: 55 Year Old
Male with LUQ Abdominal Pain S/P MVA .................... 193
Tom Lukens, MD, PhD,
FACEP
Operations Director, Emergency Department, MetroHealth
Medical Center
Associate Professor, Case Western University School of
Medicine
Cleveland, Ohio
Member, ACEP Clinical Policies Committee
Member, ACEP Clinical Policy Subcommittee on Blunt
Abdominal Trauma
Case 15: 45 Year Old
Male with Cough & Sore Throat ............................... 207
Michael B. Weinstock, MD
Clinical Assistant Professor, Division of Emergency
Medicine
The Ohio State University, College of Medicine,
Columbus, Ohio
Attending ED physician, Director of Medical Education
Mt. Carmel St. Ann’s Emergency Department, Westerville,
Ohio
Case 16: 46 Year Old
Male with Neck & Upper Back Pain ......................... 225
Ed Boudreau, DO, FACEP,
FAAEM
Vice President, Medical Affairs
Chief Medical Officer
Attending Physician Emergency Department
Mount Carmel St. Ann’s Hospital, Westerville, Ohio
Case 17: 82 Year Old
Female with Generalized Weakness ......................... 239
Ryan Longstreth, MD,
FACEP
Attending ED Physician
Mt. Carmel St. Ann’s Emergency Department, Westerville,
Ohio
Assistant ED Director, St. Ann’s Emergency Department
Case 18: 10 Year Old
Male with Eye Pain .................................................... 255
Grace J. Kim, MD, FAAP
Assistant Professor, Attending Physician
Pediatric Emergency Medicine
Loma Linda University Medical Center, Loma Linda,
California
Lance Brown, MD, MPH,
FACEP, FAAEM
Chief, Division of Pediatric Emergency Medicine
Associate Professor of Emergency Medicine and
Pediatrics
Loma Linda University Medical Center and Children’s
Hospital, Loma Linda, California
Editor-in-Chief, Pediatric Emergency Medicine Practice
Speaker of the Year—2004 USC Essentials of
Emergency Medicine
Associate Editor, Canadian Journal of Emergency
Medicine
Member, ACEP Pediatric Emergency Medicine Committee
Case 19: 57 Year Old
Male with Heart Fluttering & Lightheadedness ...... 269
Sandy Craig, MD, FACEP
Adjunct Assistant Professor, Department of Emergency
Medicine
University of North Carolina at Chapel Hill
Associate Program Director, Department of Emergency
Medicine, Carolinas Medical Center
Charlotte, North Carolina
Case 20: 76 Year Old
Female with Syncope ................................................. 285
Wyatt Decker, MD, FACEP
Chair, Department of Emergency Medicine, Mayo Clinic
Jacksonville, Florida and Mayo Clinic, Rochester,
Minnesota
Associate Professor of Emergency Medicine
Mayo Clinic College of Medicine
Member ACEP Clinical Policies Committee
Member ACEP Subcommittee on MI and Unstable Angina
Case 21: 47 Year Old
Female with Flank Pain .............................................. 299
Patrick Pettengill, MD
Attending ED physician, Department of Emergency
Medicine
Beaumont Hospital, Royal Oak, MI
Case 22: 28 Year Old
Pregnant Female with Shortness of Breath ........... 313
Ryan Longstreth, MD,
FACEP
Attending ED Physician
Mt. Carmel St. Ann’s Emergency Department, Westerville,
Ohio
Assistant ED Director, St. Ann’s Emergency Department
Case 23: 51 Year Old
Male with Back Pain ................................................... 329
Michael B. Weinstock, MD
Clinical Assistant Professor, Division of Emergency
Medicine
The Ohio State University, College of Medicine,
Columbus, Ohio
Attending ED physician, Director of Medical Education
Mt. Carmel St. Ann’s Emergency Department, Westerville,
Ohio
Case 24: 48 Year Old
Male with Back Pain & Fevers .................................. 347
Frank Orth, DO, FACEP
Past Physician Facilitator for Performance Improvement
of the Emergency
Care Center
President of Medical Staff at Mount Carmel St. Ann’s
Hospital
Past President, Immediate Health Associates
Attending ED physician
Mt. Carmel St. Ann’s Emergency Department, Westerville,
Ohio
Case 25: 6 Year Old Male
with Abdominal Pain .......................................... 367
Ann Dietrich, MD, FAAP,
FACEP
Attending ED physician, Columbus Children’s Hospital
Associate Professor, The Ohio State University College
of Medicine, Columbus, Ohio
Editor-in-chief, Pediatric Emergency Medicine Reports
Editor-in-chief, Trauma Reports
ACEP, Section Affairs Emergency Medicine Committee
Case 26: 53 Year Old
Female with Headache & Eye Pain .......................... 379
Frank J. Weinstock, MD,
FACS
Professor of Ophthalmology, Northeastern Ohio
University College of Medicine
Past President, Society of Geriatric Ophthalmology
Recipient Lifetime Achievement Award 2000, American
Academy of Ophthalmology
Editorial Board, Geriatric Ophthalmology, Journal of
Refraction, Review of Ophthalmology,
and the Ohio State Medical Journal
Ophthalmologist, Canton Ophthalmology Associates,
Canton, Ohio
Michael B. Weinstock, MD
Clinical Assistant Professor, Division of Emergency
Medicine
The Ohio State University, College of Medicine, Columbus,
Ohio
Attending ED physician, Director of Medical Education
Mt. Carmel St. Ann’s Emergency Department, Westerville,
Ohio
Case 27: 30 Year Old
Pregnant Female with Abdominal Pain .................. 393
Robert Dart, MD, FACEP
Chief, Emergency Services, Quincy Medical Center,
Quincy, Massachusetts
Associate Professor, Boston University
Vice-Chair, Department of Emergency Medicine
Boston University School of Medicine, Boston,
Massachusetts
Case 28: 36 Year Old
Male with Fever & Myalgias ...................................... 405
David Hill, MD
Attending ED physician
Mt. Carmel St. Ann’s Emergency Department, Westerville,
Ohio
Case 29: 29 Year Old
Female with Chest Pain ............................................. 421
Raymond Jackson MD, MS,
FACEP
Research Director, William Beaumont Hospital, Royal
Oak, Michigan
Clinical Professor, Wayne State University College of
Medicin, Detroit, Michigan
Case 30: 5 Month Old
Male with a Cough & Easy Bruising ...................... 439
Sharon E. Mace, MD,
FACEP, FAAP
Clinical Director, Observation Unit
Director, Pediatric Education/Quality Improvement
Cleveland Clinic Foundation, Cleveland, Ohio
Author, Pain Management and Sedation: Emergency
Department Management
Legal Considerations: So
You Want to be Sued for Malpractice ............. 453
Thomas R. Himmelspach,
Esq.
Richard S. Milligan,
Esq.
Jeffrey D. Weinstock,
Esq.
Buckingham, Doolittle & Burroughs, LLP
Appendix: Answers to
cases and titles of discussion sections............................... 467
(Note: Don’t read before
reading cases!)
Personal Notes of
Authors
............................................................................ 473
Index
.................................................................................................................
477
