EMERGENCY MEDICINE Best Practices at CMC (EMAC)
EMERGENCY MEDICINE Best Practices at CMC (EMAC)
Second Edition
Editor KPP Abhilash MD (General Medicine) PDF (Emergency Medicine)
Professor and Head Department of Emergency Medicine Christian Medical College Hospital
Vellore, Tamil Nadu, India
Foreword
K Prasad Mathews MD FRACP (Geriatrics)
EMAC
A Compendium for
Emergency Department Registrars
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Emergency Medicine: Best Practices at CMC (EMAC)
First Edition: 2016
Second Edition: 2019
9789352702466
Printed at
Dr Shubhanker Mitra (1981–2016) who was a fantastic colleague and friend, an outstanding clinician and researcher. Born on January 16, 1981, he joined Christian Medical College, Vellore, Tamil Nadu, India in the year 2000. He completed MD in General Medicine in 2010 and joined the department of General medicine and later Emergency department as a faculty. He lived his life with joyful exuberance, reckless investigation, legendary neologisms, irrepressible mischief, a penchant for drama and touching mindfulness for those around him. Many will vouch for his diligence in the process of diagnosis, commitment to true hands-on personal care, and willingness to teach others as he learnt. His work ethic, devotion to his patients, and drive towards self-improvement, was exemplary and an example to all his colleagues. As a teacher, he was instrumental in spurring many into research fields, if not into plain pure inquisitiveness. Over the last five years, he had been instrumental in resurrecting the culture of undergraduate research. He was the force behind Cognitio: CMC's undergraduate research conference. Our undergraduates have since gone on to be regular features in conferences, winning awards at several conferences. He would certainly be missed by all those who had the privilege to know and work with him.
- Debasis Das Adhikari
- DCh DNB (Pediatrics) FAEM FAPEM
- Department of Pediatric Emergency
- Christian Medical College
- Vellore, Tamil Nadu, India
- Reginald Alex DipNB (General Medicine)
- Department of Emergency Medicine
- Christian Medical College
- Vellore, Tamil Nadu, India
- TS Ravi Kumar MSc (Nursing)
- Department of Emergency Medicine
- Christian Medical College
- Vellore, Tamil Nadu, India
- David Vincent FAEM
- Department of Emergency Medicine
- Christian Medical College
- Vellore, Tamil Nadu, India
- Gautham Raja FAEM MRCEM
- Department of Emergency Medicine
- Christian Medical College
- Vellore, Tamil Nadu, India
- Vineet Subodh FAEM
- Department of Emergency Medicine
- Christian Medical College
- Vellore, Tamil Nadu, India
- Moses Kirubairaj
- DipNB Family Medicine, FAEM
- Department of Emergency Medicine
- Christian Medical College
- Vellore, Tamil Nadu, India
- Priya G MD (Anesthesiology)
- Department of Emergency Medicine
- Christian Medical College
- Vellore, Tamil Nadu, India
- Tina George MD (General Medicine)
- Department of General Medicine
- Christian Medical College
- Vellore, Tamil Nadu, India
- Mohammed Sadiq MD (General Medicine)
- Department of General Medicine
- Christian Medical College
- Vellore, Tamil Nadu, India
- Anne George MD (Obstetrics and Gynecology)
- Department of Community Medicine
- Christian Medical College
- Vellore, Tamil Nadu, India
- Surendra Kumar FAEM
- Department of Emergency Medicine
- Christian Medical College
- Vellore, Tamil Nadu, India
- Sisha Liz Abraham
- MS DipNB (Otorhinolaryngology) FHNS
- Department of ENT
- Christian Medical College
- Vellore, Tamil Nadu, India
- Suma Mary Thampi MD (Anesthesiology)
- Department of Anesthesia
- Christian Medical College
- Vellore, Tamil Nadu, India
- Deepu David MD DM (Gastroenterology)
- Department of Gastroenterology
- Christian Medical College
- Vellore, Tamil Nadu, India
- Roshna Rose Paul MS (Otorhinolaryngology)
- Department of ENT
- Christian Medical College
- Vellore, Tamil Nadu, India
- Subrangshu Dey MD DM (Cardiology)
- Department of Cardiology
- Christian Medical College
- Vellore, Tamil Nadu, India
- Esther Paul BSc (Nursing)
- Department of Emergency Medicine
- Christian Medical College
- Vellore, Tamil Nadu, India
- Jeyalinda Christopher MSc (Nursing)
- Department of Emergency Medicine
- Christian Medical College
- Vellore, Tamil Nadu, India
- Sri Ranjani BSc (Nursing)
- Department of Emergency Medicine
- Christian Medical College
- Vellore, Tamil Nadu, India
I am very happy to write the foreword for the Second Edition of the Emergency Medicine: Best Practices at CMC (EMAC). Emergency Medicine is an emerging specialty in India. Christian Medical College, Vellore, Tamil Nadu has been at the forefront of emergency medicine in India and has been conducting the course on “Early management of Trauma” from 1998.
The department of Emergency Medicine has grown exponentially over the years. The volume and variety of patients managed has increased dramatically. The number of faculty and staff has increased accordingly. Training for all doctors in emergency medicine through standardized protocols written in this book has greatly helped in improving the quality of patient care. Early trauma management and the art of making a quick diagnosis are essential for the quick recovery of the patient. This manual provides a valuable resource in emergency medicine for doctors working in all settings.
I wish the Emergency Medical team, all the very best in their efforts to educate more doctors and paramedical workers in this important specialty.
K Prasad Mathews
MD FRACP (Geriatrics)
Medical Superintendent
Christian Medical College
Vellore, Tamil Nadu, India
Preface
There has been a perceived need to have comprehensive guidelines for all acute medical and surgical emergencies presenting to the Emergency Department (ED) of Christian Medical College (CMC), Vellore, Tamil Nadu, India. This book is a compilation of all management guidelines and protocols followed in our ED. Since the ED of CMC was formed 22 years ago, there have been various changes in the structure and concept of emergency care.
Our adult ED is one of the largest in the country with 54 beds and an average patient load of 220 per day. The ED registrars are exposed to a wide spectrum of disease conditions. Through this book an attempt has been made to cover the basics of all the commonly seen medical and surgical conditions in our ED and the emergency management principles in a simplified manner. Many newer concepts have replaced the traditional management practices. Every effort has been taken to incorporate the latest evidence-based recommendations in the Emergency Medicine: Best Practices at CMC (EMAC).
I hope that this book would serve the purpose of achieving the goal of protocol-based evaluation and evidence-based management of the common emergencies. If this book helps to provide better patient care and stimulates interest in emergency medicine among medical, nursing and paramedic students, our efforts will indeed have been worthwhile.
All comments and constructive suggestions are welcome for further editions of the EMAC.
Wishing all the readers the very best.
KPP Abhilash
MD (General Medicine) PDF (Emergency Medicine)
Acknowledgments
I acknowledge all the contributions who helped prepare the first and second editions of this textbook of emergency medicine. The final product is the result of intensive work put in by these contributors.
Dr Debasis Das Adhikari for his input into the chapters on pediatric emergencies which is a new addition to the second edition of EMAC.
Mr Senthil for his secretarial work in putting it all together.
The Emergency department registrars for all their suggestions and comments.
The patients in the emergency department who teach us something new every day.
To my parents Dr KPA Chandrasekhar and Mrs KLT Priyadarshini, brother, sister-in-law, my niece and friends for their everlasting support.
We especially appreciate the constant support and encouragement of Mr Jitendar P Vij (Group Chairman) and Mr Ankit Vij (Managing Director) of Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India in publishing this textbook and also their associates particularly Ms Chetna Malhotra Vohra (Associate Director—Content Strategy) and Ms Payal (Senior Manager—Professional Publishing) who have been prompt, efficient and most helpful.
Advice to the Readers
- Treat the patient's symptoms. Do not treat the monitors or laboratory investigations.
- DO NOT start your workup by looking at outside investigations. Your diagnosis will be totally biased.
- HISTORY is the most vital component needed to make a diagnosis. A wrong history will always lead you to the wrong diagnosis.
- NEVER IGNORE abnormal vital signs. They are more accurate in assessing the severity of the illness than your visual assessment of the patient.
- Develop your clinical skills. Never depend on the laboratory to make a clinical diagnosis. Train your brain to be better than a machine.
- History, examination findings, clinical diagnosis and the laboratory investigations should be internally consistent. Otherwise, something is wrong somewhere. It is most probably a lab error (if your brain is smart enough).
- It is good to follow guidelines, but that should not limit your thinking process.
- Learn to make a list of differential diagnoses after history taking and clinical examination, NOT after viewing the results of blood investigations or imaging.