**Meet the editor**

Upon graduation from medical school, Dr. Blaivas entered an emergency medicine residency at the University of Michigan Medical Center. He went on to attend the only emergency ultrasound fellowship in existence at that time and after fellowship progressed to become a pioneer of emergency ultrasound. He has published over 140 peer reviewed articles on emergency ultra-

sound, edited several books and created multiple multi-media educational products. Along with his research interests Dr. Blaivas has been active in multiple medical societies and is a founding member of the World Interactive Network For Critical Ultrasound (WINFOCUS) and Society of Ultrasound in Medical Education (SUSME), having served as president of both. Dr. Blaivas is active in building educational and policy-making relationships between societies in a variety of medical specialties through the world.

Contents

**Preface IX** 

Savas Ozsu

Xiang-Yu Hou

Ernest E. Wang

Jiri Pokorny

Chapter 7 **Medical Instructions of** 

Chapter 8 **Considerations in Mass Casualty** 

Chapter 1 **Intensive Care Management** 

Chapter 2 **Lumbar Puncture: Techniques,** 

Chapter 3 **Delays in the Diagnosis of Pulmonary** 

Chapter 4 **Emergency Medicine in China 73** 

**of the Traumatic Brain Injury 3**  Akarsu Ayazoglu Tülin and Özden Nihan

**Complications and CSF Analyses 17** 

**Thromboembolism and Risk Factors 63** 

Chapter 5 **Emergent Procedure Training in the 21st Century 95** 

**the Apparently Dead: Rescuing the Drowned** 

Flavia Petrini, Maurizio Menarini and Elena Bigi

**to Define the Origins of the Emergency Medicine 121**  Silvia Marinozzi, Giuliano Bertazzoni and Valentina Gazzaniga

Chapter 6 **Emergency Medicine in the Czech Republic 109** 

**the XVIII Century to Resuscitate** 

**and Disaster Management 143**  Peter Aitken and Peter Leggat

Chapter 9 **Prehospital Airway Management 183** 

Ali Moghtaderi, Roya Alavi-Naini and Saleheh Sanatinia

## Contents

#### **Preface XI**


Flavia Petrini, Maurizio Menarini and Elena Bigi

X Contents

#### Chapter 10 **Procedural Sedation and Analgesia in Emergency Department 199**  Balwinder Singh, Akhilesh Kumar Tiwari, Sanjay Kumar Verma, Pedro Whatts, Dipti Agarwal and Subhash Chandra

#### Chapter 11 **Traumatic Brain Injury 209**  Zahra Gardezi

## Preface

Emergency medicine is, by its nature, borne out of necessity and through painful lessons that specialized care is required for many patients presenting to hospital "ERs" with complaints ranging from minor ailments to life threatening illness and even in peri-arrest states. While individual medical specialists can often provide care for a specific disease process, none are able to one minute treat a poly-trauma patient by intubating them and placing a chest tube and then move on to treating a patient with myocardial infarction, diagnose an ectopic pregnancy or resuscitate a septic shock patient. It is this diversity that makes emergency medicine exiting for its practitioners and also creates challenges for the field as it develops in the midst of established older specialties all of whom have to interact with emergency patients as well. In fact, it is exactly this fact that weighs on many students who are in the process of making decisions about their future in the final year of medical school. Like many students, I was interested in multiple different fields. Surgery was exciting and active, internal medicine and its sub-specialties required rigorous thought and analysis, anesthesiology allowed control of patients' pain and vital functions, while radiology held the capability to look within the body without penetrating it.

The common theme that attracts many to emergency practice is an interested in all of the most exciting aspects of each major specialty but a reluctance to giving up on what other specialties offered at the same time. Emergency medicine, unlike any other field, combines all of these aspects for its practitioners. However, while offering a combination of skills and knowledge found nowhere else, it offers unusual challenges at the same time. There are few opportunities to develop long term relationships with patients and the need to be ready to meet any challenge from psychiatric to surgical or medical disasters can be stressful while at the same time stimulating. Thus a broad core knowledge of anatomy, pathophysiology, pharmacology and a variety of noninvasive and invasive procedures is critical.

Having watched emergency medicine develop in the United States over the last twenty years I realize how much I have seen of the foundation a major new specialty and what a critical role it plays. In addition, over the last decade I have had the privilege of being involved with a multitude international colleagues. This has been one of the most eye opening and professionally inspiring experiences I have had. The diverse nature of emergency practice and growth around the world highlights the

#### X Preface

basic principle of emergency medicine, any time, anything and for many this also includes anywhere. Multiple specialists practice emergency medicine around the globe and in some cases are asked to provide care that would challenge and inspire colleagues in North America, the birthplace of emergency medicine.

This book is unique among its peers as it offers a broad international perspective and discusses practice approaches from around the globe. In addition, key elements of emergency medicine practice are covered for the reader discussing historical and cutting edge approaches and their scientific basis. The chapters that make up this textbook should be of interest to any reader who treats or is interested in the treatment of the emergency patient whether the patient is located in the pre-hospital, emergency department or in-hospital settings.

> **Dr. Michael Blaivas** Department of Emergency Medicine, Northside Hospital Forsyth Atlanta, Georgia

X Preface

basic principle of emergency medicine, any time, anything and for many this also includes anywhere. Multiple specialists practice emergency medicine around the globe and in some cases are asked to provide care that would challenge and inspire

This book is unique among its peers as it offers a broad international perspective and discusses practice approaches from around the globe. In addition, key elements of emergency medicine practice are covered for the reader discussing historical and cutting edge approaches and their scientific basis. The chapters that make up this textbook should be of interest to any reader who treats or is interested in the treatment of the emergency patient whether the patient is located in the pre-hospital, emergency

**Dr. Michael Blaivas**

Georgia

Department of Emergency Medicine, Northside Hospital Forsyth Atlanta,

colleagues in North America, the birthplace of emergency medicine.

department or in-hospital settings.

**1** 

*Turkey* 

**Intensive Care Management** 

**of the Traumatic Brain Injury** 

Akarsu Ayazoglu Tülin1 and Özden Nihan2

*Specialized Education and Training Hospital İstanbul 2Göztepe Education and Training Hospital Istanbul* 

Traumatic brain injury has been major cause of mortality and morbidity worldwide, especially in children and young adults and it has been continuing a difficult problem in

Brain trauma can be caused by a direct impact or by acceleration alone. In addition to the damage caused at the moment of injury, brain trauma causes secondary injury, a variety of

Secondary brain injury is attributable to a decrease in cerebral oxygen delivery as a result of hypertension, hypoxia, cerebral oedema, intracranial hypertension or abnormalities in cerebral blood flow. Although the severity of primary brain injury cannot be reduced, secondary brain injury can be minimised if appropriate therapies are implemented in time. The main aim in the traumatic brain injured patients must be to maintain a good result from

The second aim must be to prevent secondary brain injury caused by as results of the complications. The basic principle in the care and treatment of traumatic brain injury is to describe and begin the treatment these complications that worsen the primary injury and

1. Maintain the cerebral energy metabolism by maintaining needed systemic support,

The intensive care for traumatic brain injury should consist beside the control of ICP, respiratory system, central nervous system, and cirulatory system, it should also consist monitoring of metabolism especially glucose metabolism, temperature and electrolite balance in short intervals. With these invasive and noninvasive monitoring, all the

events that take place in that minutes and/or days following the injury

primary injury caused by trauma and/or as a result of direct effect of trauma.

2. Maintain cerebral perfusion pressure (CPP) in normal limits,

**1. Introduction** 

intensive care units.

lead to secondary brain injury.

The main targets in these aims are:

3. Maintain ICP in normal limits as possible.

precausions for the problems should be ready.

*1Chief Asistant Kartal Kosuyolu Highly* 
