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Ron M,Walls ' Robert Hockber / ^ er Marianne Geu&che-HNI DIGITAL VERSION Timothy EL Erickson Busan Wilcox Kutherj ' it Uwjn Brewi Mi Dv.- cl Firc '^ n,.i ^ n.vl’.in D'v A rr -^i ' JD£OA,.' J _ V j .l LCrtll FJl'Chlii, JO££$lhA. Tc'lhUI MK. |- ^ vfanRorr/ rn Toth Edition ROSEN’S Emergency Medicine Concepts arc! Clinical Practice IIMV.IK Voltimc i
Emergency Medicine Concepts and Clinical Practice 10th Edition ROSEN’S Katie Bakes, MD Rocky Mountain Regional VA Medical Center Professor of Emergency Medicine and Pediatrics University of Colorado School of Medicine Denver, Colorado Calvin A. Brown III, MD Department of Emergency Medicine Brigham and Women’s Hospital; Associate Professor of Emergency Medicine Harvard Medical School Boston, Massachusetts David F.M. Brown, MD MGH Trustees Endowed Professor Department of Emergency Medicine Harvard Medical School; President Massachusetts General Hospital Boston, Massachusetts Jonathan Davis, MD Professor and Academic Chair Department of Emergency Medicine Georgetown University and MedStar Health Washington, DC Andy Jagoda, MD, FACEP Professor and Chair Emeritus of Emergency Medicine Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York, New York Amy H. Kaji, MD, PhD Interim Chair Department of Emergency Medicine Harbor-UCLA Medical Center Torrance, California; Professor of Emergency Medicine David Geffen School of Medicine at UCLA Los Angeles, California; Attending Physician Department of Emergency Medicine Long Beach Memorial Medical Center Long Beach, California León D. Sánchez, MD, MPH Chief Department of Emergency Medicine Brigham and Women’s Faulkner Hospital Associate Professor of Emergency Medicine Harvard Medical School Boston, Massachusetts J. Adrian Tyndall, MD, MPH Executive Vice President for Health Affairs Professor and Dean Morehouse School of Medicine Atlanta, Georgia Michael VanRooyen, MD, MPH Chair Department of Emergency Medicine Brigham and Women’s Hospital Massachusetts General Hospital; Enterprise Chief of Emergency Medicine Mass General Brigham; J. Stephen Bohan Professor of Emergency Medicine Harvard Medical School Boston, Massachusetts Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP Clinical Pharmacy Manager Emergency Medicine, Pediatric, and Overnight Services Massachusetts General Hospital; Associate Professor Department of Emergency Medicine Division of Medical Toxicology Interim Director Graduate Pharmacy Education Harvard Medical School; Immediate Past-President American Board of Applied Toxicology (ABAT) Boston, Massachusetts Robert S. Hockberger, MD Chair Emeritus Emergency Medicine Harbor-UCLA Medical Center Torrance, California; Emeritus Professor of Emergency Medicine David Geffen School of Medicine at UCLA Westwood, California Marianne Gausche-Hill, MD Medical Director Los Angeles County EMS Agency; Professor of Clinical Emergency Medicine and Pediatrics David Geffen School of Medicine at University of California, Los Angeles Los Angeles, California; Clinical Faculty Departments of Emergency Medicine and Pediatrics Harbor-UCLA Medical Center Torrance, California Timothy B. Erickson, MD, FACEP, FACMT, FAACT Department of Emergency Medicine Brigham and Women’s Hospital; Chief, Division of Medical Toxicology Mass General Brigham; Associate Professor of Emergency Medicine Harvard Medical School Boston, Massachusetts Susan R. Wilcox, MD Chief, Division of Critical Care Department of Emergency Medicine Massachusetts General Hospital; Associate Professor of Emergency Medicine Harvard Medical School Associate Chief Medical Officer Boston MedFlight Boston, Massachusets Ron M. Walls, MD Neskey Family Professor of Emergency Medicine Department of Emergency Medicine Harvard Medical School; Chief Operating Officer Mass General Brigham Boston, Massachusetts Editor-in-Chief Senior Editors Editors Content Editor— Pharmacology
Elsevier 1600 John F. Kennedy Blvd. Ste 1600 Philadelphia, PA 19103-2899 ROSEN’S EMERGENCY MEDICINE: CONCEPTS AND CLINICAL PRACTICE, TENTH EDITION ISBN: 978-0-323-75789-8 VOLUME 1 ISBN: 978-0-323-75847-5 VOLUME 2 ISBN: 978-0-323-75848-2 Copyright © 2023 by Elsevier, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). 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 extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Senior Content Strategist: Kayla Wolfe Content Development Specialist: Kristen Helm Publishing Services Manager: Catherine Jackson Senior Project Manager: Kate Mannix Design Direction: Patrick Ferguson Printed in Canada Last digit is the print number: 9 8 7 6 5 4 3 2 1
v ACKNOWLEDGMENTS Never has family meant so much. To my wife, Barb; my children, Andrew, Blake, and Alexa; and their spouses and children, thank you for reminding me why this work is so important. I was inspired and profoundly moved by the response of our specialty, and our colleagues across the healthcare spectrum, to this pandemic scourge. We embrace a brighter future, with a deep and unwavering look to the past, and with enormous gratitude. To Peter and John, thanks again, for all of it. RMW It has been both an honor and a pleasure to serve as an editor of this book for 10 editions, and I would like to express my appreciation to those who made this career-spanning journey for me both profession- ally fulfilling and personally rewarding. To Peter, John, and Ron for their vision and leadership as editors-in-chief, and for their friendship over the years, in good times and bad; to the 28 other leaders in our discipline who gave generously of their time and talent to serve as edi- tors on different editions of the book; to the Elsevier staff (particularly Laura, Kathy, Stephanie, Kate, and Dee) for the support and encourage- ment they provided over the years; and to my wife Patty for bringing color, perspective, and broader meaning to my life. RSH I would like to thank my family for their continued understanding of my work to improve emergency care. My husband, David, and our three children, Katie, Jeremiah, and Sarah, provide the love, joy, and encour- agement that makes participation on endeavors as important as this text worthwhile. Finally, I would like to thank my editor colleagues for their leadership and willingness to work through the pandemic to create a truly state-of-the-art textbook. MGH I would like to thank my incredible husband, Peter—I love you more each day—and our three amazing daughters, Sam, Jessie, and Avery— being your mom has been the joy of my life. I would also like to thank Denver Health’s humanistic, incredibly talented, and brave Emergency Medicine residents—you are the hope for the future of medicine. And finally, I am deeply indebted to our patients, who allow us to witness their most vulnerable moments, and in doing so, offer us a chance to connect through our shared humanity. KB Thanks to my family for their understanding and support of all that pulls me away from time to time. Many thanks to Ron, Bob, Marianne, Tim, and Susan for the opportunity to work on this critical resource for our specialty. It has been an honor and a wonderful learning experience. CAB Forged during the scourge of the COVID-19 pandemic, this edition was for me a personal tribute to Peter Rosen, whose voice I can still hear and whose wisdom I still need. Looking forward to a brighter, kinder, safer, and more just future for all we serve, including those most dear to me: Deborah, Jacob, Sally, and Jaylin. DFMB With sincerest gratitude to Ron for the opportunity to contribute to this humbling body of work, to Bob, Marianne, Tim, and Susan for their sage wisdom and guidance throughout the process, and to Chris- tine, Marisa, and Matthew—you are a source of perpetual strength, grounding, and encouragement that forever reminds me of the really important things in life. JED I extend my heartfelt thanks to Valerie, Camille, Isabelle, Celeste, Julian, and my parents, Robert and Gladys. I also give full credit to my mentors and colleagues in Emergency Medicine, Toxicology, Wilderness Medicine, and Global Humanitarian Health. Special thanks (with deep reverence) to the scientists who helped lay the foundation for us all: Paracelsus, Alice Hamilton, Rosalind Franklin, and Percy Lavon Julian. TBE To all the faculty, residents, and staff at the Mount Sinai Department of Emergency Medicine—their commitment to excellence in clinical care, teaching, and research inspires me every day. To Silvana, my wife and clos- est colleague, for her support and for keeping me focused on the important things in life. To Ron for being a mentor throughout my career; and to John and Peter, who live forever in our hearts and in the soul of our specialty. ASJ I am grateful to Ron, Bob, Marianne, Tim, and Susan for their incredible mentorship and patience with me, and to our Elsevier team for their edi- torial guidance. I also want to thank all the faculty, fellows, and residents at Harbor-UCLA Medical Center for inspiring me to always be the better teacher, learner, faculty member, and physician. Thank you! AHK To my wife Ami, thank you for your boundless patience. To all the resi- dents I have played a role in training, I hope you have learned from me as much as I have from you. LDS I am grateful to my family who put up with late nights, early morn- ings and weekends, understanding this labor of love. To the authors for incredible work, and to my senior editors, Bob, Marianne, Tim, and Susan for their tremendous guidance. To Ron, for his incredi- ble leadership and artful mentorship and for bringing me on. To the Elsevier team for first class support. To my late mother, Belle Patricia Tyndall, a teacher of English, who made this all possible for me. JAT With love and thanks to my wife, Julie, and my three wonderful kids, Izzy, Jack, and Alex, to my family, ever patient and ever supportive, and to my friends and mentors who continue to advance this critical field. This book is more important than ever as our specialty forms the front line of medicine and faces the most challenging clinical and social issues of our time. I remain inspired by all of the emergency providers every- where who strive to provide expert care to every patient, every day; thank you. And especially to my daughter, Isabella VanRooyen, who is striving toward a career in medicine. May she be as fortunate as I was to find wonderful colleagues, inspiring mentors, and generous patients to lead her into a fulfilling career in a field that she loves. MVR I would like to thank Ron for the opportunity to work with this incomparable team of authors and coeditors. I have learned from each of you. I also want to thank my residents. Over the years, I have been fortunate to work with gifted EM residents who push me each day to be a better physician. Their asking the “why” behind the medicine, wanting to know the evidence, and insisting upon excel- lence from themselves have elevated my knowledge and practice. I am deeply indebted to you all. SRW

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