bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender Differences in Pain
Authors: Carpenter Gregory , Patil Meenal
Published: March 2017

Epidemiologic and clinical findings demonstrate that women are at increased risk for chronic pain, experience greater pain-related distress, and show heightened sensitivity for pain compared to men. There are differences in analgesic responses to pain and to both opioid and non-opioid medications as well as for endogenous analgesic processes. Many stress-related disorders, such as fibromyalgia and chronic pain, are more prevalent in women. Studies of experimentally induced pain show that women exhibit greater pain sensitivity, enhanced pain facilitation, and reduced pain inhibition compared to men. Mechanisms that implicated in the underlying sex differences include biological involvement of estrogen and progesterone versus testosterone. Sex-related differences in pain may also reflect differences in the endogenous opioid system. Other mechanisms include steroid action differences in adulthood, modulation of various biological systems such as the cardiovascular and inflammatory pathways, and sociocultural differences
Pharmacology
Authors: Nobles Ryan
Published: March 2017

This chapter focuses on principles of pharmacokinetics, pharmacodynamics, adverse effects, drug interactions, and common indications with regard to opioids, nonsteroidal anti-inflammatory agents, acetaminophen, anticonvulsants, and antidepressants. The questions are formulated to focus on the most relevant topics that may be tested on the listed medications, but it is not a comprehensive review. The information provided should be supplemented with additional study of the cited literature in the Further Reading section for each question.
Pain Management Techniques
Authors: McClenahan Maureen F. , Beckman William
Published: March 2017

This chapter provides a broad review of various interventional pain management procedures with a focus on indications, anatomy, and complications. Specific techniques reviewed include transforaminal epidural steroid injection, lumbar sympathetic block, stellate ganglion block, cervical and lumbar radiofrequency ablation, gasserian ganglion block, sacroiliac joint injection, celiac plexus block, lateral femoral cutaneous nerve block, ilioinguinal block, lumbar medial branch block, obturator nerve block, ankle block, occipital nerve block, superior hypogastric plexus block, spinal cord stimulation, and intrathecal drug delivery systems. The chapter reviews contrast agents, neurolytic agents, botulinum toxin use, corticosteroids, and ziconotide pharmacology and side effects in addition to diagnosis and management of local anesthetic toxicity syndrome. It also discusses indications for neurosurgical techniques including dorsal root entry zone lesioning. In addition, information on radiation safety and the use of anticoagulants with neuraxial blocks is covered.
Work Rehabilitation
Authors: Yang Robert
Published: March 2017

Pain has wide-ranging effects on physical function, emotional well-being, and the ability to fulfill social roles. When pain affects patients’ ability to work, restoring patients to their optimal function may require more than healing of the initial injury. Although a pain physician may not be managing a patient’s work rehabilitation, understanding the importance of multidisciplinary treatment and rehabilitation optimizes comprehensive and integrated treatment. Patients who are unable to work often become involved with disability or the workers’ compensation system. A pain physician should have an appreciation of medicolegal aspects of work rehabilitation because these issues can affect the treatment, and such understanding can help the physician advocate more effectively for patients in this system.
Cervical Radicular Pain
Authors: Horowitz Joshua
Published: March 2017

Cervical radicular pain is a common reason for patients in pain to seek care from a pain physician. Differing from low back pain and lumbar radiculopathy, cervical radicular pain is often not related to disc protrusion alone but, rather, a combination of disc and degenerative pathologies, such as uncovertebral hypertrophy and spondylosis. Likewise, the natural history is quite favorable if no treatments are applied, mandating greater safety for the treatments applied. Indeed, the most recent American Society of Anesthesiologists closed claims database report suggests that adverse occurrences from procedural therapies for cervical radicular pain are increasing. This chapter broadly discusses the anatomy, pathophysiology, and various approaches to treatment of these disorders.
Orofacial Pain
Authors: Sobey Christopher
Published: March 2017

Management of orofacial pain in the general population can be a challenging and demanding undertaking due to the complex neurological anatomy and close proximity to vital structures. Differentiating various syndromes and origins of pain can prove difficult; thus, specific emphasis on establishing the correct diagnosis is of the utmost importance in formatting a successful treatment plan. The questions in this chapter delve into the presentations, physical exam findings, diagnostic testing, psychological effects, and evidence-based medical and interventional treatment algorithms of both common and less common craniofacial pain disorders. This chapter covers pathophysiology of the neurological, biomechanical, and central causes of facial pain.
Epidemiology and Public Policy
Authors: Molina Carlos E.
Published: March 2017

This chapter reviews topics on epidemiology, biostatistics and research design. In addition, topics on mental health systems, evidence-based practice and health care economics will be reviewed. Topics on public policy and law and psychiatry will be reviewed in this chapter
Diagnostic Procedures
Authors: Shah Ajay , Penumetcha Varma , Tampi Rajesh R. , Ahmed Mohsina , Mansoor Rabeea , Marwaha Raman , Young Juan
Published: March 2017

In this chapter, topics that are reviewed include psychiatric interviews, mental status examinations, psychological testing, neuropsychological testing, diagnostic assessments, rating scales and laboratory monitoring
Neural Development Through the Life Cycle
Authors: Tampi Rajesh R. , Young Juan , Ahmed Mohsina , Marwaha Raman
Published: March 2017

This chapter reviews topics on neural development from infancy to late life. Topics reviewed include brain development, physical development and environmental influences on neural development
Basic Neurosciences
Authors: Tampi Rajesh
Published: March 2017

In this chapter the topics that will be reviewed include neuroanatomy, neurobiology, neuropathology, genetics, neurochemistry, neurophysiology, chronobiology, neuroendocrinology, neuroimmunology and epidemiology
Somatic Symptom Disorders and Factitious Disorders
Authors: Singh Harvinder , Young Juan , Michna Isabella
Published: March 2017

In this chapter topics on somatoform disorders will be reviewed including conversion disorder and hypochondriasis/somatic symptom disorder
Diagnostic Procedures
Authors: Bachu Anil
Published: March 2017

In this chapter important aspects of diagnostic procedures are reviewed including psychiatric interview, mental status examination, psychological testing, neuropsychological testing, diagnostic assessments and rating scales, laboratory monitoring, imaging studies, EEG and sleep studies
Treatment of Psychiatric Disorders
Authors: Singh Harvinder , Kang Miyun , de Asis Sarah , Radhakrishnan Rajiv , Tampi Rajesh R. , Sharma Esha , Manikkara Geetha , Balachandran Silpa , Kolli Mahitha , Cherlopalle Suneela
Published: March 2017

In this chapter the treatment of psychiatric disorders are reviewed including antidepressants, mood stabilizers, antianxiety agents, antipsychotics, psychostimulants, hypnotics, sedatives, electroconvulsive therapy, vagal nerve stimulation, psychotherapy, repetitive transcranial nerve stimulation (rTMS), vagal nerve stimulation and self-help groups
Interpersonal and Communication Skills
Authors: Challagolla Deepti
Published: March 2017

In this chapter various aspects of interpersonal and communication skills are reviewed including interview techniques, management of difficult patients, relationships with other professionals, role of physician attitudes in therapy and professionalism
Factors Affecting Prognosis or Complicating Treatment
Authors: Chawla Jatinder , Gupta Swapnil
Published: March 2017

In this chapter factors affecting prognosis or complicating treatment will be reviewed including genetics, chronicity of illness, insight, adherence to treatment, physical health, primary support group, social environment, economics, access to care and the legal system
Clinical Vignette
Authors: Hussain Filza
Published: March 2017

This chapter includes a clinical vignette on Delirium, with accompanying questions.
Clinical Vignette
Authors: Jillani Sarah
Published: March 2017

This chapter includes a clinical vignette on Mood Disorder (with suicidal ideation), with accompanying questions.
Mechanisms of HIV Transmission
Authors: Nambiar Puja , Short William R.
Published: March 2017

HIV is a sexually transmitted infection. Most new HIV infections in the United States are the result of sex, but it is rare for HIV to be transmitted through oral sex. The risk of HIV transmission to a receptive partner remains higher than that to an insertive one; however, both are at risk. Anything that compromises the integrity of mucous membranes, such as sexually transmitted infections, may increase the risk of transmission. Although not 100% effective, keeping an infected partner’s viral load low reduces the risk of transmission to an HIV-negative partner. Maternal transmission is a larger concern in developing countries due to lack of access to perinatal treatment with antiretroviral drugs.
HIV Testing and Counseling
Authors: Delgado Alejandro , Mazur William P.
Published: March 2017

It is estimated that approximately 14% of people living with HIV are unaware of their diagnosis. Thus, HIV testing should be offered as part of routine medical care to all patients. In 2013, the US Preventive Services Task Force formally recommended that clinicians screen all patients between the ages of 15 and 65 years. Testing in younger and older patients should be offered when special circumstances deem this appropriate. All persons screened for HIV should be counseled regarding risk-reduction strategies regardless of test result. All pregnant women should be screened for HIV at the earliest instance possible. HIV screening should be voluntary and undertaken only with the patient’s knowledge and understanding.
Laboratory Testing Strategies
Authors: Young Thomas P.
Published: March 2017

Laboratory confirmation of HIV infection is primarily through the detection of HIV antibodies in an individual. Using the current immunoassays and confirmatory testing, false-positive results are exceedingly rare. However, providers should use clinical judgment when interpreting test results and consider additional follow-up testing when appropriate. False-negative immunoassays are also exceedingly rare except for individuals who are early in their infection and have yet to produce HIV antibodies that are detectable by current assays. Rapid HIV tests have similar testing accuracies as compared to those of currently available immunoassays and can be useful testing options for settings such as health fairs, nonclinical locations, and other situations in which quickly receiving preliminary test results would be beneficial.
Issues in Specific Patient Populations
Authors: Spinner Gary F. , Anderson Jean R. , Church Joseph A. , Arrington-Sanders Renata , Sangarlangkarn Aroonsiri , DenOuden Paul W. , Deutsch Madeline B. , Wlodarczyk Daniel , Zevin Barry , Prosser Rachel A. , Dahya Vishal
Published: March 2017

It is estimated that 61% of new HIV infections are transmitted by patients who have either dropped out of care or are not taking their medications. In order to improve patient adherence and retention-in-care, efforts to enhance trust in health care providers require a broader understanding of the diversity and cultures of many different groups of patients with HIV. Children, adolescents, women, older patients, transgender patients, incarcerated patients, homeless patients, and rural and migrant patients represent special populations the care of which requires cultural competency and awareness of their special needs. Becoming competent in developing a clinician–patient relationship across cultural differences is very important.
Palliative Care and End-of-Life Support
Authors: DenOuden Paul W. , Appelbaum Jonathan S.
Published: March 2017

Hospice and palliative care are part of the active care continuum. Hospice care involves an interdisciplinary approach to diagnosing and managing suffering and addressing the physical, psychosocial, and spiritual needs of patients and their families. Hospice care should be considered when no further interventions or treatments can cure or prolong the life of a terminally ill patient with an estimated life expectancy of 6 months or less. Making the decision for hospice care is often challenging for the patient, family, and clinicians alike in the antiretroviral therapy era of HIV treatment. Evaluation and treatment of terminal syndromes such as delirium, pain, dyspnea, nausea, and dry mouth are reviewed in this chapter.
HIV-1 Resistance to Antiretroviral Drugs
Authors: Thu Ye , Nassar Naiel
Published: March 2017

Numerous epidemiologic studies of antiretroviral resistance in both treatment-experienced and treatment-naive individuals have been performed in the potent combination antiretroviral therapy (ART) era. The development of antiretroviral resistance depends on previous antiretroviral exposure, compliance with the medication, and availability of a fully active antiretroviral regimen for the individual patient. The previous exposure to ART medications plays significant role in developing drug resistance, especially in patients who are noncompliant with medications. Drug resistance testing should be done in the setting of treatment failure because it can help achieve better virologic response. There is extensive cross-resistance with first-generation non-nucleoside reverse transcriptase inhibitors and first-generation integrase strand inhibitors.
Immunosuppressants and Antiretroviral Therapy in HIV-Positive Transplant Patients
Authors: Kramer Carolyn , Blumberg Emily
Published: March 2017

Protease inhibitors (PIs), especially ritonavir, are inhibitors of CYP3A4 and P-gp1 and can significantly increase levels of calcineurin inhibitors and mammalian target of rapamycin (mTOR) inhibitors. Cobicistat is an inhibitor of CYP3A4, and its effect on levels of calcineurin inhibitors and mTOR inhibitors is likely to be similar to that of ritonavir. Efavirenz may result in lower concentrations of calcineurin inhibitors and mTOR inhibitors. Dose reduction and careful attention to monitoring drug levels are critical to avoid toxicity and maintain therapeutic immunosuppressive concentrations when PIs or cobicistat are coadministered with calcineurin inhibitors or mTOR inhibitors. Although there is no formalized recommendation for the ideal antiretroviral therapy regimen in HIV-positive transplant recipients, a regimen consisting of two nucleoside reverse transcriptase and an integrase inhibitor minimizes the risk of drug–drug interactions and simplifies dosing of immunosuppressive agents while maintaining a high barrier to resistance.
Understanding the Use of Antiretroviral Drugs in the Aging Patient
Authors: Samson Brandon H. , Scott James D.
Published: March 2017

The prevalence of HIV infection is increasing in the older population. Because of other comorbidities, older patients infected with HIV may be taking multiple medications, which increases the risk of drug–drug interactions. Treatment of HIV in aging patients is based on the consideration of adverse effects associated by antiretroviral therapy (ART) with regard to renal, hepatic, cardiovascular, metabolic, and bone health, as well as the potential for increased drug–drug interactions. Because ART is associated with both beneficial and deleterious effects, health care providers should weigh the negative effects against the positive effects of viral suppression. Health care providers should routinely review patients’ medication lists to search for significant drug–drug interactions and perform drug interaction checks using available resources.
Psychiatric Illness and Treatment in HIV Populations
Authors: David Elizabeth
Published: March 2017

The interaction between HIV and mental illness is complex. For many individuals, the psychiatric condition is a preexisting one, predisposing to HIV infection through behavioral factors and risk environment. The risk factors for HIV are well established and involve blood/bodily fluid contact with infected individuals: unprotected sexual behaviors, needle sharing, multiple sexual partners, and fetal/natal exposure. Individuals with preexisting psychiatric illness often engage in risky behaviors with little thought or fear of consequences. This relates to increased emotional immaturity and impulsivity, poor contact with reality, denial and disinhibition, cognitive dysfunction, active thoughts of self-harm, and victimization or impaired judgment. Barriers to treatment, such as distrust of authority, poor communication skills, limited access, lack of motivation, and unstructured lifestyle, result in poor overall health care and delayed diagnosis of all health issues. Diagnosis of mental health issues is frequently challenging, and adherence to treatment is frequently impacted by these same factors.
HIV/Hepatitis Co-infection
Authors: Barnett Ben J. , Hoffman-Terry Margaret
Published: March 2017

Hepatitis B virus (HBV) infection is common in people living with HIV, and all patients with HIV should be screened for HBV infection. The most common route of transmission worldwide is through perinatal or early childhood exposure, but adult transmission of HBV is often by routes similar to those for HIV, including sexual contact and injection drug use. Although it varies by exposure route, approximately 10% of HIV-positive patients also have chronic HBV infection, and up to 90% have serologic evidence of past exposure to HBV. Long-term complications of HBV infection can include cirrhosis, end-stage liver disease, and hepatocellular carcinoma.
Cardiovascular Disease
Authors: Wohl David A. , Kirchner Jeffrey T.
Published: March 2017

There is a growing body of evidence that HIV-infected persons are at increased risk for cardiovascular disease (CVD) and associated complications, including myocardial infarction and stroke. Autopsy studies have noted premature atherosclerosis in HIV-infected adults, and epidemiological studies demonstrate higher rates of CVD among HIV-infected compared to HIV-uninfected patients. These findings are in part due to chronic inflammation and immune activation associated with HIV infection. Traditional CVD risk factors, including hypertension, hyperlipidemia, and cigarette smoking, also play keys roles. There is additional evidence from observational cohort studies that some antiretroviral drugs, including protease inhibitors and nucleoside reverse transcriptase inhibitors, may increase the risk of myocardial infarction. Treatment interventions to reduce the risk of CVD include diet, exercise, smoking cessation, lipid-lowering agents, and antihypertensive medications. For select patients, changing antiretroviral therapy to improve lipid profiles may be appropriate but should not compromise virologic or immunologic control.
Renal Complications
Authors: Fine Derek M. , Waheed Sana
Published: March 2017

Renal disease in persons with HIV has been a major cause of morbidity and mortality since the onset of the epidemic. HIV nephropathy (HIVAN) was the most common form of kidney disease initially seen, but in the post-antiretroviral therapy (ART) era it is much less common. Other renal conditions associated with HIV infection include immune complex disease and classic focal segmental glomerulosclerosis. The pathologic spectrum of renal disease in patients with HIV is extensive. Some conditions, including HIVAN, improve following treatment of the virus with ART. Acute kidney injury is much more common in HIV-infected patients and is associated with a sixfold increase in mortality. Patients with HIV are also much more likely to require renal replacement therapy, including dialysis and renal transplantation. ART may also contribute to renal disease in patients with HIV.
Sexually Transmitted Diseases
Authors: Vigil Karen J.
Published: March 2017

Sexually transmitted diseases (STDs) are common in HIV-infected patients. Education and counseling on changes in sexual behaviors of patients with STDs and their sexual partners, identification of asymptomatic infection, and effective diagnosis and treatment are the cornerstone for prevention. HIV-infected patients with syphilis should have a detailed neurologic examination. Penicillin is the treatment of choice for syphilis. Gonococcal infection is an important cause of urethritis, cervicitis, pharyngitis, and proctitis in HIV-infected sexually active patients. Dual therapy for gonorrhea and chlamydia is recommended. Most Chlamydia trachomatis infections are asymptomatic and thus detected only by routine, periodic screening. Human papillomavirus is the most common STD in the United States.
HIV-Associated Lipodystrophy and Lipoatrophy
Authors: Sekhar Rajagopal V.
Published: March 2017

Patients with HIV have been seen to manifest unusual changes in body habitus that constitute variable combinations of peripheral fat loss ( lipoatrophy), central fat accumulation (lipohypertrophy), and the condition known as HIV-associated lipodystrophy (HAL). Although the origins of HAL are unclear, several factors have been linked to it. Because better antiretroviral therapy (ART) drug regimens have led to increased longevity, it is possible that the natural evolution of metabolic complications of HIV is the lipodystrophic phenotype. The specific effects of antiretroviral medications have also been implicated, and the initial usage of ART in the 1990s was accompanied by multiple reports of abnormalities in body fat distribution variously termed the “protease paunch,” “crixivan belly,” among others. Other factors include immune phenomenon and effects mediated directly by the HIV virus. Despite intensive research to understand the mechanistic underpinnings of HIV lipodystrophy and lipoatrophy, the answers remain elusive.
Legal Issues
Authors: Schouten Jeffrey T.
Published: March 2017

One-time routine screening of all adults and adolescents as well as annual screening of high-risk individuals and all pregnant women are recommended without the need for pretest counseling or written consent. HIV is a reportable disease to the Centers for Disease Control and Prevention in all 50 states and the District of Columbia. Partner notification remains a key component of HIV prevention. Health care providers may be obligated to assist in notification or HIV disclosure in select instances. HIV stigma and discrimination remain problematic in many areas of the United States and globally, but laws have been progressively enacted to limit these problems and protect persons living with HIV disease. Confidentiality of HIV status and health-related issues is protected under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Advance care planning is an important component of comprehensive care for adults living with HIV/AIDS.
Research Design and Analysis
Authors: Ramers Christian B.
Published: March 2017

Accurate interpretation of research literature is important as advances are made in the diagnosis and treatment of HIV and its complications. Because of inherent differences in approach, the on-treatment analysis will frequently report better outcomes than will the intent-to-treat analysis. The concept of time-to-loss of virologic response has been replaced by SNAPSHOT analysis as the preferred method of efficacy analysis by the US Food and Drug Administration. New antiretroviral therapy regimens are usually compared to existing standard-of-care regimens using a type of statistical comparison called a non-inferiority analysis. A common error in reporting clinical trial results is not correctly distinguishing between clinical and statistical significance.
Cytogenetic Technologies and Test Issues
Authors: Dolan Michelle , Hirsch Betsy
Published: March 2017

Cytogenetic testing is ordered in a wide range of clinical settings. The primary purpose is to evaluate for constitutional abnormalities. This chapter describes cytogenetic testing methodologies, such as microarray analysis, chromosome analysis, prenatal genetic testing, and fluorescence in situ hybridization, identifying their strengths and limitations, and details specimen processing. It summarizes commonly used nomenclature according to the International System for Human Cytogenetic Nomenclature. The chapter also discusses the criteria that laboratory genetic counselors use for reporting uncertain, novel, or ambiguous results.
Test Development and Validation
Authors: Catalano Lisa , Tanner Alice K.
Published: March 2017

The process of developing a genetic test starts with an initial assessment of need and utility, followed by the development and validation of the chosen testing method. Several factors must be taken into account during test development, including existing technology, financial requirements, personnel resources, and market share. This chapter reviews the steps involved in the development and the validation/verification of clinical genetic testing. It discusses the factors that are addressed by clinical genetic testing laboratories during the design and implementation phases of test development. The role of the laboratory genetic counselor in this process is highlighted throughout.
Ethical Considerations in the Genetic Testing Laboratory
Authors: Groepper Daniel , Bower Matt
Published: March 2017

Ethical dilemmas are commonly encountered by genetic counselors, whether in the clinical or laboratory setting. This chapter describes common ethical dilemmas, conflicts, and challenges encountered in genetic testing laboratories. These situations include genetic testing of minors for adult-onset conditions, prenatal testing, the ethical impacts of incidental findings and unexpected test results, and conflicts of interest. This chapter also explores the genetic counselor’s role in addressing ethical issues. Resources are provided for managing these ethical dilemmas within the laboratory.
Considering a Laboratory Genetic Counseling Position
Authors: Butler Elizabeth , Hagen Vickie Matthias
Published: March 2017

Genetic counselors who are thinking about pursuing a laboratory position should consider multiple factors, including the work environment, the specific roles of the position, perceptions of possible conflict of interest, and other factors that may influence job satisfaction. Genetic counseling training programs provide the foundation for the necessary scientific knowledge and communication skills used in a laboratory setting. Opportunities exist for internships, additional training, and networking to help refine these skills. Genetic counselors who seek to establish a new position must be prepared to provide financial justification. They will likely be offered opportunities to expand the position’s roles and responsibilities over time.
Immunology of the vessel wall
Authors: Hansson Göran K.
Published: March 2017

This chapter provides an overview of the vascular wall and its cells from an immunological point of view, discusses the capacity of vascular cells to promote and regulate immune responses, and outlines interactions between the vasculature and the immune system in health and disease. The role of immune mechanisms in vascular diseases is discussed, with a focus on atherosclerosis, a chronic inflammatory vascular disease.
Biology of vascular wall dilation and rupture
Authors: Michel Jean-Baptiste
Published: March 2017

Arterial pathologies, important causes of death and morbidity in humans, are closely related to modifications in the circulatory system during evolution. With increasing intraluminal pressure and arterial bifurcation density, the arterial wall becomes the target of interactions with blood components and outward convection of plasma solutes and particles, including plasma zymogens and leukocyte proteases. Abdominal aortic aneurysms of atherothrombotic origin are characterized by the presence of an intraluminal thrombus (ILT), a major source of proteases, including plasmin, MMP-9, and elastase. Saccular cerebral aneurysms are characterized by the interaction of haemodynamics and arterial bifurcation defects, of either genetic or congenital origin. They also develop an intrasaccular thrombus, implicated in rupture. Aneurysms of the ascending aorta (TAAs) are not linked to atherothrombotic disease, and do not develop an ILT. The most common denominator of TAAs, whatever their aetiology, is the presence of areas of mucoid degeneration, and increased convection and vSMC-dependent activation of plasma zymogens within the wall, causing extracellular matrix proteolysis. TAA development is also associated with an epigenetic phenomenon of SMAD2 overexpression and nuclear translocation, potentially linked to chronic changes in mechanotransduction. Aortic dissections share common aetiologies and pathology (areas of mucoid degeneration) with TAAs, but differ by the absence of any compensatory epigenetic response. There are main experimental animal models of aneurysms, all characterized by the cessation of aneurysmal progression after interruption of the exogenous stimuli used to induce it. These new pathophysiological approaches to aneurysms in humans pave the way for new diagnostic and therapeutic tools.
Upper limb
Authors: Harrison Mark
Published: March 2017

This chapter describes the anatomy of the upper limb as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the muscles, joints, nerves, and movements of the pectoral region, axilla, breast, shoulder, anterior arm, posterior arm, forearm, and wrist and hand. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Natural and innate immunity
Authors: Harrison Mark
Published: March 2017

This chapter describes the microbiology of natural and innate immunity as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of barriers to infection, normal bacterial flora, and phagocytes and complement. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Pseudomonas
Authors: Harrison Mark
Published: March 2017

This chapter describes the microbiology of Pseudomonas as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the basis of infection, clinical features, basis of diagnosis, principles of treatment, and implications within a hospital setting for Pseudomonas. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Herpes simplex and zoster
Authors: Harrison Mark
Published: March 2017

This chapter describes the microbiology of herpes simplex and zoster as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the clinical features, basis of diagnosis, treatment, and prevention, of herpes simplex and zoster, including herpes encephalitis, chicken pox, and shingles. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
HIV
Authors: Harrison Mark
Published: March 2017

This chapter describes the microbiology of HIV as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the epidemiology, pathogenesis, clinical features, basis of diagnosis, AIDS-defining illness, and basis of management of HIV. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Measles, mumps, rubella
Authors: Harrison Mark
Published: March 2017

This chapter describes the microbiology of measles, mumps, and rubella as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the epidemiology, and clinical features of measles, mumps, and rubella, also covering the MMR injection. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Basic cellular physiology
Authors: Harrison Mark
Published: March 2017

This chapter describes basic cellular physiology as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of homeostasis, compartments and fluid spaces, cell structure and function, vessel fluid dynamics, blood flow, neurological action potential, generated action potential, parasympathetic nervous systems, and muscle physiology. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Gastrointestinal system
Authors: Harrison Mark
Published: March 2017

This chapter describes the pharmacology of the gastrointestinal system as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of antacids, alginates, antispasmodics, ulcer-healing drugs, acute diarrhoea, chronic bowel disorders, and laxatives. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Respiratory system
Authors: Harrison Mark
Published: March 2017

This chapter describes the pharmacology of the respiratory system as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of bronchodilators, corticosteroids antihistamines, and oxygen. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Endocrine system
Authors: Harrison Mark
Published: March 2017

This chapter describes the pharmacology of the endocrine system as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of diabetes, thyroid disease, and corticosteroids. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Immunological products and vaccines
Authors: Harrison Mark
Published: March 2017

This chapter describes the pharmacology of immunological products and vaccines as they apply to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of active immunity, passive immunity, specific vaccines and preparations (including BCG, diphtheria, Hib, hepatitis A and B, MMR, meningococcal vaccines, pertussis, poliomyelitis, rabies, and tetanus), and immunoglobulins. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Anaesthesia
Authors: Harrison Mark
Published: March 2017

This chapter describes the pharmacology of anaesthesia as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of intravenous agents, inhalational agents, sedatives and analgesics, muscle relaxants, antagonist agents, and local anaesthesia. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Respiratory
Authors: Harrison Mark
Published: March 2017

This chapter describes the pathophysiology of the respiratory system as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the control of ventilation, reflexes, pressure, chemical, and irritant receptors, J receptors, pulmonary stretch receptors, Golgi tendon organs, muscle spindles, lung volumes, pulmonary mechanics, oxygen and carbon dioxide transport, DO2/VO2 relationships, carbon monoxide, pulse oximetry, effects of altitude, and dysbarism. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Immune response
Authors: Harrison Mark
Published: March 2017

This chapter describes the pathology of immune response as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of normal and abnormal responses. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Infection
Authors: Harrison Mark
Published: March 2017

This chapter describes the pathology of infection as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the causes, pathological processes, and investigations of respiratory tracts infections (upper and lower including pneumonia), meningitis and encephalitis, myocarditis and endocarditis, hepatitis, gastroenteritis, urinary tract infection, STD, pelvic inflammatory disease, cellulitis, infection of bones and joints, AIDS, pyrexia of unknown origin, malaria, and fungal infection. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Haematology
Authors: Harrison Mark
Published: March 2017

This chapter describes the pathology of haematology as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the classification, causes, and investigation of anaemia, leukaemia, lymphoma and myeloma, and coagulation. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Types of trials
Authors: Harrison Mark
Published: March 2017

This chapter describes types of trials as applied to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details and advantages and disadvantages of case reports, case series, cohort studies, case–control studies, randomized controlled trials, crossover trials, systematic reviews, and meta-analysis. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Blinding
Authors: Harrison Mark
Published: March 2017

This chapter describes blinding as applied to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details and methods involved with blinding trials. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Normal distribution
Authors: Harrison Mark
Published: March 2017

This chapter describes normal distribution as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the bell-shaped curve, standard deviation, and confidence intervals. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Resuscitation and Stabilization
Authors: Nadkarni Vinay , Sutton Robert M. , Berg Robert A.
Published: March 2017

The authors provide essential information on providing care during the four phases of cardiac arrest and cardiopulmonary resuscitation (CPR): (1) prearrest, (2) no flow (untreated cardiac arrest), (3) low flow (CPR), and (4) postresuscitation. They discuss the most common precipitating events for out-of-hospital and in-hospital cardiac arrests in children and the how to deliver high-quality CPR. Medications used to treat cardiac arrest are presented (specifically vasopressors, including epinephrine; antiarrhythmics, including lidocaine, amiodarone, and magnesium sulfate; calcium; and sodium bicarbonate), along with the clinical indications and rationale for their use. Appropriate goals for care after return of spontaneous circulation are delineated, with guidelines for targeted temperature management and blood pressure.
Extracorporeal Life Support
Authors: Dalton Heidi J. , Davidson Mark , Roeleveld Peter P.
Published: March 2017

Extracorporeal membrane oxygenation (ECMO) can provide support as a bridge to recovery or a bridge to more definitive therapy for patients with severe respiratory or cardiorespiratory disease. In this chapter, the criteria for ECMO are discussed and a practical decision tree for mode of ECMO (venovenous or venoarterial) is presented. A stepwise approach to initiation and management of ECMO for the patient is described, including flow rate goals, ventilator management, anticoagulation, blood product replacement, identification of recovery, weaning procedures, and specific issues relating to the two different modes of ECMO.
Transport of the Critically Ill Child
Authors: Felmet Kathryn , Orr Richard
Published: March 2017

This chapter provides essential information about risks and therapeutic opportunities related to interfacility and intrafacility transport of critically ill children. Background information regarding US regulation of the transfer of patients via the Consolidated Omnibus Budget Reconciliation Act is provided. Also discussed is information crucial to making decisions about mode of transport (ground vs. air, helicopter vs. fixed wing), including presentations of specific risks related to each (vibration, noise, cold, changes in barometric pressure affecting oxygenation and volume of gas in enclosed patient cavities). Options for team composition (via emergency medical services, local emergency department providers, or pediatric specialized transport teams) are described. Finally, the concept of “the golden hour” is reviewed along with pitfalls when it is applied inappropriately to critically ill children who would benefit from more aggressive efforts at stabilization than rapid transfer without such efforts.
Procedures
Authors: Pasala Sanjiv , Ocal Eylem , Schexnayder Stephen M.
Published: March 2017

This chapter describes the most common invasive bedside procedures used to facilitate the treatment of critically ill infants and children. These procedures provide invasive monitoring, support organ function, deliver therapies, and aid in diagnostic and therapeutic interventions. The authors include the indications, equipment needed, the required technique, and complications that must be considered for endotracheal intubation, arterial and central venous catheter placement, tube thoracostomy, abdominal paracentesis, pericardiocentesis, and ventriculoperitoneal shunt tap.
Basic Pediatric Hemodynamic Monitoring
Authors: Sainz Jorge G. , Fuhrman Bradley P.
Published: March 2017

Physiological monitoring using a variety of technological advances supplements, but does not replace, our ability to distinguish normal from abnormal physiology traditionally gleaned from physical examination. Pulse oximetry uses the wavelengths of saturated and unsaturated hemoglobin to estimate arterial oxygenation noninvasively. Similar technology included on vascular catheters provides estimation of central or mixed venous oxygenation and helps assess the adequacy of oxygen delivered to tissues. End-tidal carbon dioxide measurements contribute to the assessment of ventilation. Systemic arterial blood pressure and central venous pressure measurements help evaluate cardiac performance, including the impact of ventilatory support. Intra-abdominal pressure may increase as a result of intraluminal air or fluid, abnormal fluid collections within the peritoneal cavity, or abnormal masses. Increased pressure may impede venous return to the heart and compromise intra-abdominal organ perfusion. Pressure measurement guides related management decisions.
Sedation and Analgesia
Authors: Ivanova Iskra I. , Martin Lynn D.
Published: March 2017

This chapter on sedation and analgesia provides essential information on how to achieve and monitor the comfort of patients safely in the pediatric intensive care unit. Included is succinct information about dosing, pharmacodynamics, and pharmacokinetics of benzodiazepines, opiates, and other sedatives (propofol, etomidate, ketamine, dexmedetomidine, and nonsteroidal anti-inflammatory agents), as well as the antagonists naloxone and flumazenil. Information is also provided about the use and dosage of both depolarizing and nondepolarizing neuromuscular blocking agents (muscle relaxants) and American Society of Anesthesiologists guidelines for fasting (i.e., nothing by mouth) times before elective endotracheal intubation. The chapter also includes key information regarding the recognition and treatment of malignant hyperthermia.
Fluids and Electrolytes
Authors: Bohn Desmond
Published: March 2017

This chapter provides essential information on the distribution of body water and key electrolytes (sodium and potassium) in children, including the extracellular and intracellular components of total body water. Guidelines are provided for the composition and volume of fluids needed to maintain homeostasis, including maintenance intravenous fluids and fluids needed for specific circumstances, such as postoperatively. Water and electrolyte compositions of commonly used intravenous fluids and electrolytes in body fluids are provided in table format. Approaches are also given for disorders of fluid and electrolyte balance, including etiology and treatment of those related to antidiuretic hormone secretion, hyponatremia, hypernatremia, hypokalemia, and hyperkalemia.
Diagnosis and Management of Renal Disorders in the Pediatric Intensive Care Unit
Authors: Fuhrman Dana Y. , Moritz Michael L.
Published: March 2017

Renal disorders can occur in the pediatric intensive care unit (PICU) either as a primary diagnosis or secondary to other diagnoses. This chapter serves as a guide to the diagnosis and management of the more common renal disorders encountered in the PICU. A practical approach to patients presenting with hypernatremia, hyponatremia, and hyperkalemia is provided, including etiologies as well as treatment approaches to these electrolyte disturbances. The diagnosis and management of hypertensive emergencies are discussed as well. Important considerations in the evaluation and treatment of patients with acute kidney injury are reviewed. In addition, modalities for renal replacement therapy are described as well as factors that should be considered when choosing a dialysis treatment modality.
Hematology and Oncology
Authors: Spinella Philip C. , Bednarski Jeffrey J.
Published: March 2017

Coagulopathy, thrombosis, and other hematological abnormalities are common in the pediatric intensive care unit . Current guidelines recommend red blood cell transfusion for a hemoglobin concentration less than 7 g/dL in critically ill, hemodynamically stable patients; platelets for a concentration less than 10,000 in nonbleeding patients; and cryoprecipitate in bleeding patients for fibrinogen values less than 100 to 150 mg/dL. Massive transfusion protocols that push blood products to the bedside are more practical than reactive protocols. Transfusion reactions include transfusion-associated acute lung injury and transfusion-associated circulatory overload. Hematologic crises in the PICU are commonly complications of other primary disorders. Sickle cell disease may lead to acute chest syndrome, sequestration crisis, and stroke, and require aggressive intervention. Oncological diseases produce hyperleukocytosis, tumor lysis syndrome, veno-occlusive disease, graft-versus-host disease, and sepsis in association with leukopenia. A relatively newly recognized disorder, hemophagocytic lymphohistiocytosis, requires early recognition and treatment to avoid adverse outcomes.