, THIRD EDITION
CASE FILES®
Emergency Medicine
Eugene C. Toy, MD Katrin Y. Takenaka, MD
Vice Chair of Academic Affairs and Assistant Professor, Clerkship Director
Residency Program Director Assistant Residency Program Director
Department of Obstetrics and Department of Emergency Medicine
Gynecology University of Texas Medical School at
The Methodist Hospital Houston
Houston, Texas Houston, Texas
The John S. Dunn Senior Academic Chair
St Joseph Medical Center, Houston Terrence H. Liu, MD, MHP
Clinical Professor and Professor of Clinical Surgery
Clerkship Director University of California San Francisco
Department of Obstetrics and School of Medicine
Gynecology San Francisco, California
University of Texas Medical School Program Director, University of
at Houston California San Francisco
Houston, Texas East Bay Surgery Residency
Associate Clinical Professor Attending Surgeon, Alameda County
Weill Cornell College of Medicine Medical Center
Oakland, California
Barry C. Simon, MD
Chairman, Department of Emergency Adam J. Rosh, MD, MS
Medicine Assistant Professor
Clinical Professor of Medicine Residency Director
Alameda County Medical Department of Emergency Medicine
Center/Highland Campus Wayne State University School of Medicine
University of California, San Francisco Detroit Receiving Hospital
Oakland, California Detroit, Michigan
New York Chicago San Francisco Lisbon London Madrid Mexico City Milan
New Delhi San Juan Seoul Singapore Sydney Toronto
,Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved. Except as permitted under
the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in
any form or by any means, or stored in a database or retrieval system, without the prior written permission
of the publisher.
ISBN: 978-0-07-177082-8
MHID: 0-07-177082-8
The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-176854-2,
MHID: 0-07-176854-8.
All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every
occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the
trademark owner, with no intention of infringement of the trademark. Where such designations appear in
this book, they have been printed with initial caps.
McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales
promotions, or for use in corporate training programs. To contact a representative please e-mail us at
.
Previous edition copyright © 2009, 2004 by The McGraw-Hill Companies, all rights reserved.
Case Files® is a registered trademark of The McGraw-Hill Companies, Inc. All rights reserved.
Notice
Medicine is an ever-changing science. As new research and clinical experience broaden our
knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work
have checked with sources believed to be reliable in their efforts to provide information that is complete
and generally in accord with the standard accepted at the time of publication. However, in view of the
possibility of human error or changes in medical sciences, neither the editors nor the publisher nor any
other party who has been involved in the preparation or publication of this work warrants that the
information contained herein is in every respect accurate or complete, and they disclaim all responsibility
for any errors or omissions or for the results obtained from use of the information contained in this work.
Readers are encouraged to confirm the information contained herein with other sources. For example and
in particular, readers are advised to check the product information sheet included in the package of each
drug they plan to administer to be certain that the information contained in this work is accurate and that
changes have not been made in the recommended dose or in the contraindications for administration. This
recommendation is of particular importance in connection with new or infrequently used drugs.
TERMS OF USE
This is a copyrighted work and The McGraw-Hill Companies, Inc. (“McGraw-Hill”) and its licensors
reserve all rights in and to the work. Use of this work is subject to these terms. Except as permitted under
the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile,
disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute,
disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill’s prior consent.
You may use the work for your own noncommercial and personal use; any other use of the work is strictly
prohibited. Your right to use the work may be terminated if you fail to comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO
GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR
COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY
INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR
OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED,
INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR
FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill and its licensors do not warrant or
guarantee that the functions contained in the work will meet your requirements or that its operation will be
uninterrupted or error free. Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for
any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom.
McGraw-Hill has no responsibility for the content of any information accessed through the work. Under
no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special,
punitive, consequential or similar damages that result from the use of or inability to use the work, even if
any of them has been advised of the possibility of such damages. This limitation of liability shall apply to
any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise.
, DEDICATION
(1921-2008)
Case Files®: Emergency Medicine was the last planned book in the Clinical Case Files
series, and now is in its third edition. It is fitting that we take this opportunity to
dedicate this series to the memory of a great physician, Dr Joseph A. Lucci Jr, who
has had a tremendous impact on the practice and education in medicine in Houston,
particularly at CHRISTUS St Joseph Hospital. Dr Lucci was born in Morrone del
Sannio, a province of Campobasso in Italy on August 21, 1921. “Dr Joe” arrived in
the United States in 1930 at the age of 9 years. He obtained his medical degree from
the Medical College of Wisconsin in 1946. After finishing his internship in 1947, he
served as an Air Force base surgeon in Germany. He then received residency train-
ing for 2 years at the Margaret Hague Maternity Hospital in Jersey City, New Jersey.
Upon his arrival to Houston, Dr Lucci received his further training in gynecologic
surgery at the MD Anderson Cancer Center. He was appointed as the first academic
chair over the department of obstetrics/gynecology at St Joseph Hospital, and had
academic appointments at the MD Anderson Cancer Center, UTMB Galveston
Medical School, and later at the University of Texas Houston Medical School. During
his 31 years as academic chair, Dr Joe trained more than 100 excellent residents,
revolutionized the education of gynecologic surgery, developed innovative surgical
techniques, reduced maternal mortality to practically zero, and helped to coordinate
medical education throughout the Houston/Galveston region. He and his wife Joan
have five children: Joe, Joan Marie, Jacqueline, Regina Marie, and James, and nine
grandchildren. “Dr Joe” was academic chief emeritus of the CHRISTUS St Joseph
Hospital Obstetrics-Gynecology Residency. He has been a true pioneer in many
aspects of medicine, touching the lives of thousands of people. We are greatly indebted
to this extraordinary man and saddened by his death, which occurred peacefully on
November 21, 2008 in the presence of his entire family.
CASE FILES®
Emergency Medicine
Eugene C. Toy, MD Katrin Y. Takenaka, MD
Vice Chair of Academic Affairs and Assistant Professor, Clerkship Director
Residency Program Director Assistant Residency Program Director
Department of Obstetrics and Department of Emergency Medicine
Gynecology University of Texas Medical School at
The Methodist Hospital Houston
Houston, Texas Houston, Texas
The John S. Dunn Senior Academic Chair
St Joseph Medical Center, Houston Terrence H. Liu, MD, MHP
Clinical Professor and Professor of Clinical Surgery
Clerkship Director University of California San Francisco
Department of Obstetrics and School of Medicine
Gynecology San Francisco, California
University of Texas Medical School Program Director, University of
at Houston California San Francisco
Houston, Texas East Bay Surgery Residency
Associate Clinical Professor Attending Surgeon, Alameda County
Weill Cornell College of Medicine Medical Center
Oakland, California
Barry C. Simon, MD
Chairman, Department of Emergency Adam J. Rosh, MD, MS
Medicine Assistant Professor
Clinical Professor of Medicine Residency Director
Alameda County Medical Department of Emergency Medicine
Center/Highland Campus Wayne State University School of Medicine
University of California, San Francisco Detroit Receiving Hospital
Oakland, California Detroit, Michigan
New York Chicago San Francisco Lisbon London Madrid Mexico City Milan
New Delhi San Juan Seoul Singapore Sydney Toronto
,Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved. Except as permitted under
the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in
any form or by any means, or stored in a database or retrieval system, without the prior written permission
of the publisher.
ISBN: 978-0-07-177082-8
MHID: 0-07-177082-8
The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-176854-2,
MHID: 0-07-176854-8.
All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every
occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the
trademark owner, with no intention of infringement of the trademark. Where such designations appear in
this book, they have been printed with initial caps.
McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales
promotions, or for use in corporate training programs. To contact a representative please e-mail us at
.
Previous edition copyright © 2009, 2004 by The McGraw-Hill Companies, all rights reserved.
Case Files® is a registered trademark of The McGraw-Hill Companies, Inc. All rights reserved.
Notice
Medicine is an ever-changing science. As new research and clinical experience broaden our
knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work
have checked with sources believed to be reliable in their efforts to provide information that is complete
and generally in accord with the standard accepted at the time of publication. However, in view of the
possibility of human error or changes in medical sciences, neither the editors nor the publisher nor any
other party who has been involved in the preparation or publication of this work warrants that the
information contained herein is in every respect accurate or complete, and they disclaim all responsibility
for any errors or omissions or for the results obtained from use of the information contained in this work.
Readers are encouraged to confirm the information contained herein with other sources. For example and
in particular, readers are advised to check the product information sheet included in the package of each
drug they plan to administer to be certain that the information contained in this work is accurate and that
changes have not been made in the recommended dose or in the contraindications for administration. This
recommendation is of particular importance in connection with new or infrequently used drugs.
TERMS OF USE
This is a copyrighted work and The McGraw-Hill Companies, Inc. (“McGraw-Hill”) and its licensors
reserve all rights in and to the work. Use of this work is subject to these terms. Except as permitted under
the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile,
disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute,
disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill’s prior consent.
You may use the work for your own noncommercial and personal use; any other use of the work is strictly
prohibited. Your right to use the work may be terminated if you fail to comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO
GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR
COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY
INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR
OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED,
INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR
FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill and its licensors do not warrant or
guarantee that the functions contained in the work will meet your requirements or that its operation will be
uninterrupted or error free. Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for
any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom.
McGraw-Hill has no responsibility for the content of any information accessed through the work. Under
no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special,
punitive, consequential or similar damages that result from the use of or inability to use the work, even if
any of them has been advised of the possibility of such damages. This limitation of liability shall apply to
any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise.
, DEDICATION
(1921-2008)
Case Files®: Emergency Medicine was the last planned book in the Clinical Case Files
series, and now is in its third edition. It is fitting that we take this opportunity to
dedicate this series to the memory of a great physician, Dr Joseph A. Lucci Jr, who
has had a tremendous impact on the practice and education in medicine in Houston,
particularly at CHRISTUS St Joseph Hospital. Dr Lucci was born in Morrone del
Sannio, a province of Campobasso in Italy on August 21, 1921. “Dr Joe” arrived in
the United States in 1930 at the age of 9 years. He obtained his medical degree from
the Medical College of Wisconsin in 1946. After finishing his internship in 1947, he
served as an Air Force base surgeon in Germany. He then received residency train-
ing for 2 years at the Margaret Hague Maternity Hospital in Jersey City, New Jersey.
Upon his arrival to Houston, Dr Lucci received his further training in gynecologic
surgery at the MD Anderson Cancer Center. He was appointed as the first academic
chair over the department of obstetrics/gynecology at St Joseph Hospital, and had
academic appointments at the MD Anderson Cancer Center, UTMB Galveston
Medical School, and later at the University of Texas Houston Medical School. During
his 31 years as academic chair, Dr Joe trained more than 100 excellent residents,
revolutionized the education of gynecologic surgery, developed innovative surgical
techniques, reduced maternal mortality to practically zero, and helped to coordinate
medical education throughout the Houston/Galveston region. He and his wife Joan
have five children: Joe, Joan Marie, Jacqueline, Regina Marie, and James, and nine
grandchildren. “Dr Joe” was academic chief emeritus of the CHRISTUS St Joseph
Hospital Obstetrics-Gynecology Residency. He has been a true pioneer in many
aspects of medicine, touching the lives of thousands of people. We are greatly indebted
to this extraordinary man and saddened by his death, which occurred peacefully on
November 21, 2008 in the presence of his entire family.
