Diagnostic Imaging for the Emergency Physician E-Book , livre ebook

Diagnostic Imaging for the Emergency Physician

Joshua Broder, MD, FACEP
Associate Professor, Associate Residency Program Director, Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina
Saunders
Front Matter
Diagnostic Imaging for the Emergency Physician
Joshua Broder, MD, FACEP
Associate Professor, Associate Residency Program Director, Division of Emergency Medicine Duke University Medical Center, Durham, North Carolina
Copyright

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DIAGNOSTIC IMAGING FOR THE EMERGENCY PHYSICIAN ISBN: 978-1-4160-6113-7
Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Notices
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Dedication
To my family
Acknowledgments
This book would not have been possible without the aid of my mentors, colleagues, and loving family.
Many thanks to Amal Mattu, David Jerrard, Michael Witting, and the entire teaching faculty at the University of Maryland Department of Emergency Medicine for the outstanding training they provided to me in residency and for the mentorship and encouragement they continue to provide.
I also owe much to the faculty and residents of the Duke University Division of Emergency Medicine. They inspire me every day with their dedication to quality patient care and their enthusiasm for evidence-based medicine.
Thanks to Ryan Martiniuk for his work in cataloging and preparing images for the extremity chapter. Ryan, you have a great future in medicine.
My thanks also to Robert Preston, with whom I have had the pleasure of working for many years. Rob's passion for emergency medicine is evident to all who know him.
My parents, Michael and Susan Broder, are responsible for so many wonderful things in my life. My father is a board-certified radiologist who introduced me to diagnostic imaging and also to emergency medicine. He dedicated his career to the patients of my hometown of Thomasville, North Carolina, and inspired me to share with others the lessons I have learned. My mother is a human geneticist whose greatest experiments were my sister, my brother, and me. The three of us benefited enormously from her intelligence and unfailing belief that we would achieve any goal we undertook. Thank you for all of your support through the development of this book and for everything you have done for me.
My sister, Elena, and brother, Daniel, were also essential to this book. Both set a remarkable standard through their work in law and software engineering, making difficult tasks appear easy. Their humor and love helped me to continue when the job seemed to have no end in sight.
My wife, Pek, and sons, Spencer and Isaac, have borne the greatest burden during the development of this book. My deadline was Spencer's birth; 18 months later, Pek sternly reminded me that I had better be done before Isaac was born. Thank you for your love and devotion and for the joy the three of you bring me.
Finally, thank you to patients—people—whose suffering from disease and injury is visible throughout this book. I hope that readers will provide better care through the lessons you have taught.

Joshua Broder
Foreword
It is often said that a picture is worth a thousand words. Although this quote originated in the advertising industry, it certainly applies to the field of medicine as well. Visual findings are the cornerstone of diagnosis for many medical conditions. One might argue, in fact, that the field of radiology was borne out of the need to look beyond a patient's external findings—essentially, internal visual diagnosis—without the need for surgical exploration.
The first x-ray of the human body was performed in 1895 and allowed the first noninvasive look inside the body. Since that first x-ray was performed, advances in technology have produced incredible developments in radiologic imaging. Modern radiologic techniques allow cancers that were once diagnosable only after metastasis to now be detected at stages when most are still localized and treatable. Appendicitis, a condition that had always been ruled out only by exploratory laparotomy, is now routinely excluded by computed tomography (CT). Coronary artery disease, the major cause of death in Western societies, had always been diagnosed by cardiac catheterization, but now noninvasive methods such as CT-angiography are routinely used to stratify a patient's risk of disease. Even the stethoscope, the primary diagnostic tool of physicians for more than 100 years, is slowly being pushed aside by portable ultrasound (US) machines.
Radiographic imaging has certainly become an intrinsic part of the field of emergency medicine. Almost all of the major journals in emergency medicine routinely include research publications focused on emergency imaging, and recently an entire journal dedicated to emergency imaging was initiated. All of the major educational and research conferences in emergency medicine include sessions focused on emergency radiology, and residency training programs in emergency medicine universally include some training in use and interpretation of imaging studies. However, there remains a significant shortcoming in the current level of radiology knowledge that most emergency physicians possess. All too often we find ourselves dependent on radiologists for diagnoses of life-threatening diseases. Often the radiologists are not immediately available, and the result is that patient care is compromised. Given the frequency with which emergency physicians depend on radiologic tests for diagnoses, it stands to reason that we should be more knowledgeable about interpreting these tests on our own.
Thankfully, there are certain members of our specialty who have committed their academic careers to becoming experts at emergency radiology and teaching this skill to the rest of us. Dr. Joshua Broder is one of those physicians. Dr. Broder is one of the brightest and most talented educators in emergency medicine, having won numerous local and national teaching awards. The majority of his academic work has been focused on the study and teaching of emergency radiology. He routinely teaches at national conferences on this topic, and he always finds a way of making the most complicated concepts simple and understandable. He has now turned his enormous talent toward writing, and the result lies before you: arguably the best textbook on the topic of emergency radiology ever written for our specialty.
Dr. Broder's textbook covers every aspect of imaging, from head to toe; and from x-ray to CT to magnetic resonance imaging to US. His writing style, much like his teaching style, is simple, practical, and understandable. Although there are several other textbooks on the market focused on emergency radiology, there are notable characteristics of this text that set it apart from the rest. First and foremost, the images in this text are truly outstanding in quality. These images tell the complete story. The reader will note that the images themselves contain text, arrows, highlights—all the usual features that other textbooks relegate to hard-to-read legends. These im