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This text defines the breadth of academic and clinical emergency medicine and the enormous technical skill and intellectual responsibility required by each emergency physician. These chapters are written by emergency physicians and other physicians working closely with emergency patients who have highly specialized knowledge in particular aspects of emergency medicine. Almost a third of these authors are new contributors to this edition. A reevaluation of the clinical and academic roles of the emergency physician has led to the refinement of this Fourth Edition.

Akkadian cuneiform inscriptions, which appear to have adapted an ancient Sumerian icon of a flaming brazier to denote both fever and the local warmth of inflammation in a single ideogram. Clinical thermometry was introduced by Sanctorius in 1625. Mercury column thermometers were introduced by Fahrenheit in 1714. Although their routine use was supported by Boerhaave, thermometry was not established as routine clinical practice until the 1870s. [9] 4 TABLE 1-1 -- Normal Values for Vital Signs of Infants and Children (Mean ± SD) Age Parameter 0–2 mo 3–12 mo 1–6 yr 7–12 yr 13–18 yr Breaths/min —* —* 24 ± 3 19 ± 2 17 ± 3 Pulse/min 126 ± 20 131 ± 20 88 ± 9 70 ± 8 64 ± 7 Systolic BP† 72 ± 10 95 ± 15 93 ± 13 100 ± 10 112 ± 12 Diastolic BP 51 ± 9 53 ± 10 55 ± 10 63 ± 10 67 ± 10 *For data on children 0 to 36 months, see Table 1-2 .

The current section discusses indirect blood pressure monitoring. Discussions of the specific use of the Doppler device for pulse and blood pressure measurement and the measurement of orthostatic blood pressure and pulse changes follow this section. As noted earlier, despite an association between the absence of a radial pulse (or the absence of both radial and femoral pulses) with hypotension, in the setting of trauma, the variability in individual response prohibits the use of this parameter as an absolute gauge of blood pressure.

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