Primary Care for Emergency Physicians

Preface
Contents
Contributors
1: Headache
	1.1	 Introduction
	1.2	 Classification and Differential Diagnosis
	1.3	 Pathophysiology
	1.4	 Epidemiology
	1.5	 Evaluation
	1.6	 Treatment
	Appendix
	References
2: Eye Issues
	2.1	 Introduction
	2.2	 Differential Diagnosis
	2.3	 History
	2.4	 Physical Exam
		2.4.1	 Periorbital Exam
		2.4.2	 Extraocular Movements
		2.4.3	 Conjunctival and Sclera Evaluation
		2.4.4	 Pupil Exam
		2.4.5	 Corneal Examination
		2.4.6	 Intraocular Pressure
		2.4.7	 Slit Lamp Examination
		2.4.8	 Funduscopic Exam
	2.5	 Specific Conditions and Their Management
		2.5.1	 Eyelid/Periorbital Conditions
			2.5.1.1	 Blepharitis
			2.5.1.2	 Hordeolum and Chalazion
			2.5.1.3	 Dacryoadenitis and Dacryocystitis
			2.5.1.4	 Preseptal (Periorbital) and Orbital Cellulitis
		2.5.2	 Intrinsic Orbit Conditions: Traumatic Injuries
			2.5.2.1	 Globe Rupture
			2.5.2.2	 Hyphema
			2.5.2.3	 Subconjunctival Hemorrhage
			2.5.2.4	 Corneal Abrasions
			2.5.2.5	 Corneal Foreign Body
			2.5.2.6	 Chemical Burns
		2.5.3	 Intrinsic Orbit Conditions: Atraumatic Conditions
			2.5.3.1	 Acute Angle-Closure Glaucoma
			2.5.3.2	 Conjunctivitis
			2.5.3.3	 Corneal Ulcer
			2.5.3.4	 Endophthalmitis
			2.5.3.5	 Episcleritis and Scleritis
			2.5.3.6	 Keratitis
			2.5.3.7	 Iritis (Anterior Uveitis)
			2.5.3.8	 Herpes Zoster Ophthalmicus
			2.5.3.9	 Pterygium
		2.5.4	 Loss of Vision: Painful
			2.5.4.1	 Giant Cell Arteritis (Temporal Arteritis)
			2.5.4.2	 Optic Neuritis
		2.5.5	 Loss of Vision: Painless
			2.5.5.1	 Central Retinal Artery Occlusion (CRAO)
			2.5.5.2	 Retinal Detachment
	References
3: Ear Pain + Cerumen Impaction
	3.1	 Introduction
	3.2	 Differential Diagnosis
	3.3	 History
	3.4	 Physical Examination
	3.5	 Important Primary Otalgia Etiologies and Treatment
		3.5.1	 Acute Otitis Media
		3.5.2	 Otitis Media with Effusion
		3.5.3	 Acute Otitis Externa
		3.5.4	 Necrotizing (Malignant) Otitis Externa
		3.5.5	 Acute Mastoiditis
		3.5.6	 Foreign Bodies
		3.5.7	 Traumatic Tympanic Membrane Perforation
		3.5.8	 Cerumen Impaction
	References
4: Sore Throat, Dental Pain, and Other Oral Issues
	4.1	 Introduction
	4.2	 History
	4.3	 Physical
	4.4	 Specific Etiologies
		4.4.1	 Sore Throat
			4.4.1.1	 Viral Pharyngitis
			4.4.1.2	 Streptococcal Pharyngitis
			4.4.1.3	 Centor Criteria
			4.4.1.4	 Mononucleosis
			4.4.1.5	 Epiglottitis
			4.4.1.6	 Peritonsillar Abscess
			4.4.1.7	 Retropharyngeal Abscess
			4.4.1.8	 Diphtheria
			4.4.1.9	 Salivary Gland Disease
			4.4.1.10	 Parotitis
			4.4.1.11	 Dental Issues
			4.4.1.12	 Periodontal Disease
			4.4.1.13	 Post-extraction Pain
	References
5: Demystifying the Enigma of the Pediatric Viral Upper Respiratory Infection
	5.1	 Introduction
	5.2	 Presentation
	5.3	 Diagnostic Workup
	5.4	 Special Considerations in Pediatric Viral URI
		5.4.1	 Acute Otitis Media
		5.4.2	 Conjunctivitis
		5.4.3	 Croup
		5.4.4	 Sinusitis
	5.5	 Management
	References
6: Sinonasal Diseases
	6.1	 Allergic Rhinitis
		6.1.1	 Epidemiology
		6.1.2	 Pathophysiology
		6.1.3	 Diagnosis
		6.1.4	 Management
	6.2	 Sinusitis
		6.2.1	 Epidemiology
		6.2.2	 Pathophysiology
		6.2.3	 Diagnosis
		6.2.4	 Management
	References
7: Neck Pain
	7.1	 Introduction
	7.2	 Risk Factors for Neck Pain
	7.3	 Differential Diagnosis
	7.4	 Red Flags of Neck Pain
	7.5	 History
	7.6	 Physical Examination
	7.7	 Introduction to Treatment
	7.8	 Pharmacologic Treatment
	References
8: Dysphagia and Odynophagia
	8.1	 Dysphagia
		8.1.1	 Pathophysiology
		8.1.2	 History
		8.1.3	 Physical Exam
		8.1.4	 Further Studies
		8.1.5	 Management
	8.2	 Odynophagia
		8.2.1	 Etiology
	References
9: Noncardiac Chest Pain (Including Chest Wall Pain)
	9.1	 Introduction
	9.2	 Risk Factors for Chest Pain
	9.3	 Differential Diagnosis
	9.4	 History
	9.5	 Physical Examination
	9.6	 Introduction to Treatment
	9.7	 Pharmacologic Treatment
		9.7.1	 Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
		9.7.2	 Opioid Analgesics
		9.7.3	 Proton Pump Inhibitors (PPIs)
		9.7.4	 H2 Receptor Antagonists (H2 Blockers)
		9.7.5	 Benzodiazepines
		9.7.6	 Antidepressants
	References
10: Hypertension in the Emergency Department
	10.1	 Introduction
	10.2	 Definitions
		10.2.1	 Hypertension
		10.2.2	 Severe Hypertension, Urgency, and Emergency
	10.3	 Etiology and Risk Factors
	10.4	 Differential Diagnosis of Underlying Causes [12]
	10.5	 History
	10.6	 Physical Exam
	10.7	 Diagnostic Testing
	10.8	 Treatment and Disposition of Patients with Hypertension
		10.8.1	 Asymptomatic Hypertension
		10.8.2	 Hypertensive Urgency [17]
		10.8.3	 Evidence-Based Dosing for Antihypertensive Drugs*
	10.9	 Hypertensive Emergency
	References
11: Gastroesophageal Reflux Disease (GERD)
	11.1	 Introduction
	11.2	 History
	11.3	 Risk Factors for GERD
	11.4	 Symptoms (Red Flags*)
	11.5	 Physical Exam
	11.6	 Differential Diagnosis
	11.7	 Treatment
	11.8	 Treatment Failures
	References
12: Dyspnea
	12.1	 Introduction
	12.2	 Differential Diagnosis
	12.3	 History
	12.4	 Physical
	12.5	 Specific Relevant Etiologies
		12.5.1	 Asthma
		12.5.2	 COPD Exacerbations
	12.6	 Chronic Management
		12.6.1	 Hyperventilation
		12.6.2	 Croup
		12.6.3	 Pulmonary Embolism
		12.6.4	 Pneumonia
	References
13: Hemoptysis
	13.1	 Introduction
	13.2	 Pathophysiology
	13.3	 Risk Factors
	13.4	 Differential Diagnosis
	13.5	 History
	13.6	 Physical Examination
	13.7	 Diagnosis
	13.8	 Management Approaches
		13.8.1	 Massive Hemoptysis
		13.8.2	 Non-massive Hemoptysis
	References
14: Abdominal Pain
	14.1	 Introduction
	14.2	 Special Populations
		14.2.1	 Women
		14.2.2	 Older Adults
		14.2.3	 Immunocompromised and Immunosuppressed Patients
	14.3	 Evaluation
	14.4	 Differential Diagnosis
	14.5	 Physical Examination
	14.6	 Diagnostic Workup
	14.7	 Management
	14.8	 Disposition
	References
15: Irritable Bowel Syndrome
	15.1	 Introduction
	15.2	 Diagnostic Criteria
		15.2.1	 Rome IV Criteria
	15.3	 History and Physical Examination
	15.4	 Differential Diagnosis
	15.5	 Treatment of IBS
	15.6	 Pharmacologic Treatment
		15.6.1	 Over-the-Counter Fiber or Laxatives
		15.6.2	 Over-the-Counter Antidiarrheal Medications
		15.6.3	 Prosecretory Agents
		15.6.4	 Antidepressants
		15.6.5	 Antispasmodics
	15.7	 Medications to Avoid
		15.7.1	 Over the Counter
		15.7.2	 Prescription Drugs
	References
16: Bloating
	16.1	 Introduction
	16.2	 Pathophysiology
		16.2.1	 Intestinal Gas Production
		16.2.2	 Impairment of Gas Transit
		16.2.3	 Impaired Evacuation
		16.2.4	 Other Potential Causes
	16.3	 Risk Factors
	16.4	 Differential Diagnosis
	16.5	 History
	16.6	 Physical Examination
	16.7	 Diagnosis
	16.8	 Introduction to Treatment
		16.8.1	 Education
		16.8.2	 Pharmacologic Treatment
			16.8.2.1	 Over-the-Counter Medications
			16.8.2.2	 Probiotics
	16.9	 Introduction to Prescription Medications
		16.9.1	 Antibiotics
		16.9.2	 Antispasmodics
		16.9.3	 Tricyclic Antidepressants
			16.9.3.1	 Prokinetic Agents: Neostigmine
			16.9.3.2	 Prokinetic Agents: Metoclopramide
		16.9.4	 Osmotic Laxatives
	References
17: Constipation
	17.1	 Introduction
	17.2	 Primary Constipation
	17.3	 Secondary Constipation: Wide Array of Sources [8–10]
	17.4	 Diagnosis [11]
	17.5	 Treatment
	References
18: Diarrhea
	18.1	 Introduction
		18.1.1	 Pathophysiology
	18.2	 Risk Factors for Diarrhea
	18.3	 Differential Diagnosis
		18.3.1	 Acute
		18.3.2	 Chronic
		18.3.3	 Common Complaints and Red Flags of Acute Diarrhea
	18.4	 Common Complaints and Red Flags of Chronic Diarrhea
	18.5	 History
	18.6	 Physical Examination
	18.7	 Diagnostic Testing
		18.7.1	 Specific Tests
	18.8	 Introduction to Treatment
	18.9	 Pharmacologic Treatment
		18.9.1	 Antibiotics
		18.9.2	 Treatment of Clostridium difficile
		18.9.3	 Antidiarrheal Agents
		18.9.4	 Probiotics
		18.9.5	 Zinc
	References
19: Hemorrhoids
	19.1	 Introduction
	19.2	 Differential
	19.3	 Physical Exam
	19.4	 Labs
	19.5	 Treatment
	References
20: Acute Pelvic Pain
	20.1	 Introduction
	20.2	 Differential Diagnosis
		20.2.1	 Gynecologic (Premenopausal)
		20.2.2	 Gynecologic (Postmenopausal)
		20.2.3	 Gastrointestinal
		20.2.4	 Genitourinary
		20.2.5	 Musculoskeletal
		20.2.6	 Obstetric
		20.2.7	 Others
		20.2.8	 Psychiatric
		20.2.9	 Vascular
	20.3	 History
	20.4	 Physical Examination
	20.5	 Laboratory Testing
	20.6	 Imaging
	20.7	 Treatment
		20.7.1	 Surgical Intervention
		20.7.2	 Ovarian Cysts
		20.7.3	 Infections
		20.7.4	 Endometriosis
	References
21: Dysmenorrhea
	21.1	 Introduction
	21.2	 Risk Factors for Dysmenorrhea
	21.3	 Differential Diagnosis
	21.4	 Common Complaints and Red Flags
	21.5	 History
	21.6	 Physical Examination
	21.7	 Introduction to Treatment
	21.8	 Pharmacologic Treatment
		21.8.1	 NSAIDS: First-Line Therapy
		21.8.2	 Hormonal Contraceptives: Second-Line Therapy
	21.9	 Nonpharmacologic Treatment
		21.9.1	 Abdominal Heat Wrap: First-Line Therapy
		21.9.2	 Exercise [5]
	21.10	 Alternative Medicine/Treatments [5]
	References
22: Back Pain
	22.1	 Introduction
	22.2	 Risk Factors for Low Back Pain [4]
	22.3	 History and Differential Diagnosis
	22.4	 Physical Exam
	22.5	 Diagnostic Workup
	22.6	 Introduction to Treatment
	References
23: Nonemergency Skin Problems in the Emergency Department
	23.1	 Introduction
	23.2	 Topical Glucocorticoids
	23.3	 Eczematous Eruptions
		23.3.1	 Xerosis (Dry Skin) [3–9]
		23.3.2	 Atopic Dermatitis (Eczema)
		23.3.3	 Contact Dermatitis
		23.3.4	 Seborrheic Dermatitis
		23.3.5	 Urticaria
	23.4	 Parasite and Infestation Reactions
		23.4.1	 Scabies
		23.4.2	 Bedbugs [22]
		23.4.3	 Pediculosis (Lice) [22]
	23.5	 Fungal Disorders
		23.5.1	 Dermatophytes, “Tinea” [22]
		23.5.2	 Candidiasis, Intertrigo [22]
	23.6	 Closing Remarks
	References
24: Anxiety
	24.1	 Introduction
	24.2	 Risk Factors for Anxiety
	24.3	 Differential Diagnosis
	24.4	 Types of Anxiety Disorders [3]
	24.5	 History
	24.6	 Physical Exam
	24.7	 Labs and Imaging
	24.8	 Introduction to Treatment
	24.9	 Pharmacologic Treatment
		24.9.1	 Antidepressant Agents
		24.9.2	 Benzodiazepines
	References
25: Depression
	25.1	 Introduction
	25.2	 Risk Factors
	25.3	 Diagnostic Criteria
	25.4	 Differential Diagnosis
	25.5	 History
	25.6	 Physical Exam
	25.7	 Red Flags
	25.8	 Treatment
	25.9	 Other Treatment Modalities
		25.9.1	 Lifestyle Changes
		25.9.2	 Pharmacotherapy
	25.10	 Pitfalls in Treating Depressed Patients in the ED
	References
Index