eMedicine Specialties > Emergency Medicine > Gastrointestinal

Rectus Sheath Hematoma: Treatment & Medication

Author: Wan-Tsu Chang, MD, Staff Physician, Department of Emergency Medicine, University of Cincinnati
Coauthor(s): William A Knight IV, MD, Assistant Professor, Department of Emergency Medicine, University of Cincinnati School of Medicine; Steven G Werdehoff, MD, Consulting Staff, Department of Emergency Medicine, Huntsville Emergency Physicians Group; Andra L Blomkalns, MD, Associate Professor, Vice Chair - Academic Affairs, Department of Emergency Medicine, University of Cincinnati School of Medicine
Contributor Information and Disclosures

Updated: Jul 1, 2009

Treatment

Emergency Department Care

Once rectus sheath hematoma (RSH) is diagnosed, the patient's clinical condition determines appropriate treatment and disposition. Treatment may be either conservative or invasive.

  • Conservative treatment is appropriate for patients who are hemodynamically stable and have small nonexpanding hematomas in which symptoms are mild and the diagnosis is certain. Conservative treatment of rectus sheath hematoma includes rest; analgesics; hematoma compression; ice packs; treatment of predisposing conditions; and if necessary, more aggressive therapies of intravenous fluid resuscitation, reversal of anticoagulation, and transfusion. Care must be taken in applying a conservative approach because even a relatively small hematoma has been reported to cause hypotension and death in a patient who is debilitated. Conversely, in 2000, Berna et al's case series of 12 patients with rectus sheath hematoma who were all undergoing anticoagulant therapy and treated conservatively had no reported mortality even though 7 of the patients initially had hemodynamic instability and anemia. These patients demonstrated improvement in their general condition 3-5 days after diagnosis.4
    • Anticoagulation reversal: Patients who are undergoing invasive procedures and those with hemodynamic instability, expanding hematomas, or symptomatic anemia should be considered for anticoagulation reversal. For patients taking oral anticoagulation, reversal can be achieved with phytonadione plus fresh frozen plasma (FFP). The patient's clinical condition determines the aggressiveness of anticoagulation reversal.
      • Intravenous phytonadione can be administered at a dose of 1-10 mg. Intravenous phytonadione is associated with rare but well-documented cases of anaphylactoid reactions; thus, it must be administered with care at a rate no greater than 1 mg/min, with frequent (every 15 min, 30 min, and 1 h) vital sign measurements. A patient given a dose of 10 mg of intravenous phytonadione may be refractory to Coumadin for several weeks, making 2.5 mg or 5 mg a better dose in all but the most severe RSHs.
      • Subcutaneous phytonadione is associated with an unpredictable therapeutic response and is not recommended.
      • Oral phytonadione has a time to onset that is too slow for a patient who is actively bleeding.
      • FFP is administered in a volume of 15 mL/kg and provides coagulation factors for as long as 8 hours. FFP may have to be administered with diuretics if volume overload is a concern.
      • Patients on heparin can have coagulation reversed by protamine at a dose of 1 mg per 100 U of heparin. Heparin has a half-life of 60 minutes. A dose of protamine reverses all of the heparin administered in the past hour, one half of the heparin of the previous hour, and one fourth of the heparin given 2 hours previously, assuming that no recent bolus has been administered.
      • Patients on LMWHs can have their anticoagulation partially reversed by protamine, although refractory heparinoid fractions are present.
    • Transfusion: The decision to transfuse is made depending on the patient's need for fluid resuscitation; the presence of comorbid conditions, such as active coronary ischemia; the degree of anemia; and the need for an operative procedure for control of bleeding. In 1988, Zainea reported the transfusion of blood in 4 of 8 patients in a case series, although none of the patients were hemodynamically unstable.7 In Berna's case series of 12 anticoagulated patients in 2000, all 5 patients with type III hematomas required transfusion and had alterations in hemodynamic variables.4 Transfusion requirements are generally 2-6 U of packed red blood cells.
  • Two main modalities exist for invasive control of active bleeding in rectus sheath hematoma: (1) therapeutic angiography with embolization of the bleeding vessel and (2) operative therapy with clot evacuation, ligation of bleeding vessels, and closed-suction drainage. Invasive treatment should be considered in patients with enlarging hematomas, hemodynamic instability unresponsive to fluid resuscitation, peritoneal signs, pain not well controlled with analgesics, and persistent gastrointestinal or urinary symptoms. Patients with significant comorbidities may not be candidates for invasive therapy.
    • Arterial embolization: In 1980, Levy first described the transcatheter Gelfoam embolization technique in the treatment of rectus sheath hematoma.13 This invasive therapy can produce hemostasis, reduce the size of the hematoma, decrease the need for blood product transfusion, and prevent rupture into the abdomen. Embolization with thrombin, Gelfoam, or coil is an alternative to surgery for conditions not responding to conservative management.
    • Operative exploration: Surgical treatment includes evacuation of the hematoma, ligation of bleeding vessels, repair of the rectus sheath, drainage (when indicated), and closure of the abdominal wall. Recurrences following surgical therapy have not been reported.
  • The decision to admit a patient with rectus sheath hematoma depends on the clinical data regarding hemodynamic status and comorbid conditions as well as the size of the hematoma. Patients on anticoagulation therapy should be admitted to ensure that the hematoma is not expanding and to plan restarting anticoagulation as appropriate. In general, patients with type I hematomas do not require hospitalization. Patients with type II and type III hematomas usually do require hospitalization. Patients with type II hematomas can be admitted to the floor during the first 24-48 hours to evaluate evolution of the hematoma. Patients with type III hematomas often present with hemodynamic instability requiring fluid resuscitation and blood transfusion that is best managed in the intensive care unit setting.
  • Postdischarge care includes rest, analgesics, hematoma compression, ice packs, and treatment of predisposing conditions. Type I hematomas resolve after approximately 1 month. Type II hematomas require 2-4 months, and type III hematomas require more than 3 months and as long as a year for complete resolution.

Consultations

All patients who are admitted for rectus sheath hematoma (RSH) should have a surgical consultation, either general or vascular, depending on the institution. The diagnosing clinician should also consider surgical or primary care consultation for discharged patients and provide follow-up evaluation and long-term pain control.

Medication

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Anticoagulation reversal agents

Patients on warfarin can have their anticoagulation reversed with phytonadione.


Phytonadione (Mephyton, Konakion, AquaMEPHYTON)

Vitamin K is a necessary cofactor for gamma carboxylation in the synthesis of factors II, VII, IX, and X in the liver. Used therapeutically in RSH to treat warfarin-induced hypoprothrombinemia.

Adult

1-10 mg IV slow (<1 mg/min); IM and SC routes are not recommended because response is unpredictable and may be delayed; a dose of 10 mg IV is associated with prolonged warfarin resistance but is the recommended dose by the American College of Chest Physicians for major or life-threatening bleeding in the anticoagulated patient on warfarin

Pediatric

Not established

Broad-spectrum antibiotics, quinidine, quinine, and salicylates may increase phytonadione requirements

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

IV form has been associated with rare anaphylactoid reactions and death, even when care has been taken to administer the drug slowly; transient flushing sensations and peculiarities of taste have been reported following vitamin K injection


Protamine sulfate

Protamine forms a complex with heparin to create a nonreactive salt. Heparin is neutralized within 5 min of protamine administration. The duration of effect is 2 h. The half-life of protamine is less than heparin; therefore, multiple dosing may be required. LMWHs can be partially reversed with protamine.
The half-life of heparin is 60 min. Therefore, enough protamine should be administered to reverse all of the heparin administered in the last 30 min, one half of the heparin administered the previous hour, and one fourth of the heparin administered the hour before that, assuming no recent bolus.

Adult

1 mg IV per 100 U of heparin to be neutralized; not to exceed 50 mg with a maximum rate of 5 mg/min

Pediatric

Not established

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Upon metabolism, the salt complex may liberate heparin, causing heparin rebound and requiring multiple dosing of protamine; protamine sulfate has its own anticoagulant effect, which may become apparent if administered in doses larger than necessary to inactivate heparin

Analgesia

RSHs are very painful conditions that often mimic or present as an acute abdomen. The clinician should have a low threshold for narcotic analgesia. The clinician should also recognize the theoretic complication of platelet inhibition with nonsteroidal anti-inflammatory analgesics.


Hydrocodone and acetaminophen (Lorcet-HD, Vicodin, Lortab)

Drug combination indicated for moderate to severe pain.

Adult

1-2 tab or cap PO q4-6h prn pain

Pediatric

<12 years: 10-15 mg/kg/dose acetaminophen PO q4-6h prn; not to exceed 2.6 g/d acetaminophen
>12 years: 750 mg acetaminophen PO q4h; not to exceed 10 mg hydrocodone bitartrate per dose or 5 doses/24 h

Coadministration with phenothiazines may decrease analgesic effects; toxicity increases with CNS depressants or tricyclic antidepressants

Documented hypersensitivity; high altitude cerebral edema (HACE) or elevated intracranial pressure (ICP)

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Tab contain metabisulfite, which may cause hypersensitivity; caution in patients dependent on opiates since this substitution may result in acute opiate-withdrawal symptoms; caution in severe renal or hepatic dysfunction


Oxycodone and acetaminophen (Percocet, Roxicet, Roxilox, Tylox)

Drug combination indicated for the relief of moderate to severe pain.

Adult

1-2 tab or cap PO q4-6h prn pain

Pediatric

0.05-0.15 mg/kg/dose oxycodone PO; not to exceed 5 mg/dose of oxycodone q4-6h prn

Phenothiazines may decrease analgesic effects of this medication; toxicity increases with coadministration of either CNS depressants or tricyclic antidepressants

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Duration of action may increase in elderly patients; be aware of total daily dose of acetaminophen patient is receiving (do not exceed 4,000 mg/24 h of acetaminophen; higher doses may cause liver toxicity)

More on Rectus Sheath Hematoma

Overview: Rectus Sheath Hematoma
Differential Diagnoses & Workup: Rectus Sheath Hematoma
Treatment & Medication: Rectus Sheath Hematoma
Follow-up: Rectus Sheath Hematoma
Multimedia: Rectus Sheath Hematoma
References
[ CLOSE WINDOW ]

References

  1. Teske JM. Hematoma of the rectus abdominis muscle: report of a case and analysis of 100 cases from the literature. Am J Surg. 1946;71:689-95.

  2. Berna JD, Garcia-Medina V, Guirao J, Garcia-Medina J. Rectus sheath hematoma: diagnostic classification by CT. Abdom Imaging. Jan-Feb 1996;21(1):62-4. [Medline].

  3. Klingler PJ, Wetscher G, Glaser K, et al. The use of ultrasound to differentiate rectus sheath hematoma from other acute abdominal disorders. Surg Endosc. Nov 1999;13(11):1129-34. [Medline].

  4. Berna JD, Zuazu I, Madrigal M, et al. Conservative treatment of large rectus sheath hematoma in patients undergoing anticoagulant therapy. Abdom Imaging. May-Jun 2000;25(3):230-4. [Medline].

  5. Fothergill WE. Hematoma in the abdominal wall simulating pelvic new growth. Br Med J. 1926;1:941-2.

  6. Kaftori JK, Rosenberger A, Pollack S, Fish JH. Rectus sheath hematoma: ultrasonographic diagnosis. AJR Am J Roentgenol. Feb 1977;128(2):283-5. [Medline].

  7. Zainea GG, Jordan F. Rectus sheath hematomas: their pathogenesis, diagnosis, and management. Am Surg. Oct 1988;54(10):630-3. [Medline].

  8. Fukuda T, Sakamoto I, Kohzaki S, et al. Spontaneous rectus sheath hematomas: clinical and radiological features. Abdom Imaging. Jan-Feb 1996;21(1):58-61. [Medline].

  9. Unger EC, Glazer HS, Lee JK, Ling D. MRI of extracranial hematomas: preliminary observations. AJR Am J Roentgenol. Feb 1986;146(2):403-7. [Medline].

  10. Herzan FA. Roentgenologic diagnosis of rectus sheath hematoma. Am J Roentgenol Radium Ther Nucl Med. Oct 1967;101(2):397-405. [Medline].

  11. Monsein LH, Davis M. Radionuclide imaging of a rectus sheath hematoma caused by insulin injections. Clin Nucl Med. Aug 1990;15(8):539-41. [Medline].

  12. Osinbowale O, Bartholomew JR. Rectus sheath hematoma. Vasc Med. Nov 2008;13(4):275-9. [Medline].

  13. Levy JM, Gordon HW, Pitha NR, Nykamp PW. Gelfoam embolization for control of bleeding from rectus sheath hematoma. AJR Am J Roentgenol. Dec 1980;135(6):1283-4. [Medline].

  14. Denard PJ, Fetter JC, Zacharski LR. Rectus sheath hematoma complicating low-molecular weight heparin therapy. Int J Lab Hematol. Jun 2007;29(3):190-4. [Medline].

  15. Humphrey R, Carlan SJ, Greenbaum L. Rectus sheath hematoma in pregnancy. J Clin Ultrasound. Jun 2001;29(5):306-11. [Medline].

  16. Adeonigbagbe O, Khademi A, Karowe M, et al. Spontaneous rectus sheath hematoma and an anterior pelvic hematoma as a complication of anticoagulation. Am J Gastroenterol. Jan 2000;95(1):314-5. [Medline].

  17. Barry TL, Butt J, Awad ZT. Spontaneous rectus sheath hematoma and an anterior pelvic hematoma as a complication of anticoagulation. Am J Gastroenterol. Nov 2000;95(11):3327-8. [Medline].

  18. Bene J, Lassman D, Solomon SA. Rectus sheath haematoma in elderly patients: a diagnostic challenge. Age Ageing. Jul 1998;27(4):512-4. [Medline].

  19. Brotzman GL. Rectus sheath hematoma: a case report [corrected]. J Fam Pract. Aug 1991;33(2):194-7. [Medline].

  20. Casey RG, Mahmoud M, Carroll K, Hurley M. Rectus sheath haematoma: an unusual diagnosis. Ir Med J. May 2000;93(3):90-2. [Medline].

  21. Cervantes J, Sanchez-Cortazar J, Ponte RJ, Manzo M. Ultrasound diagnosis of rectus sheath hematoma. Am Surg. Oct 1983;49(10):542-5. [Medline].

  22. Chatzipapas IK, Magos AL. A simple technique of securing inferior epigastric vessels and repairing the rectus sheath at laparoscopic surgery. Obstet Gynecol. Aug 1997;90(2):304-6. [Medline].

  23. Chi CH, Chen KW, Shin JS, Wu MH. Spontaneous rectus sheath hematoma: ED diagnosis and management. Am J Emerg Med. Nov 1995;13(6):671-3. [Medline].

  24. Cordero OC, Baldonado RT, Conte SJ, Lopez FA. Rectus sheath hematoma: cause of pelvic pseudotumor. Urology. May 1974;3(5):577-80. [Medline].

  25. Costello J, Wright J. Rectus sheath haematoma: 'a diagnostic dilemma?'. Emerg Med J. Jul 2005;22(7):523-4. [Medline].

  26. Cullen TS. Hemorrhage into or beneath the rectus muscle simulating an acute abdominal condition. Bull Johns Hopkins Hosp. 1937;61:317-48.

  27. Ducatman BS, Ludwig J, Hurt RD. Fatal rectus sheath hematoma. JAMA. Feb 18 1983;249(7):924-5. [Medline].

  28. Edlow JA, Juang P, Margulies S, Burstein J. Rectus sheath hematoma. Ann Emerg Med. Nov 1999;34(5):671-5. [Medline].

  29. Gocke JE, MacCarty RL, Foulk WT. Rectus sheath hematoma: diagnosis by computed tomography scanning. Mayo Clin Proc. Dec 1981;56(12):757-61. [Medline].

  30. Graham JM, Kozak JA, Reardon MJ. Rectus sheath hematoma after anterior lumbar fusion. Spine. Dec 1991;16(12):1377. [Medline].

  31. Hamilton JV, Flinn G Jr, Haynie CC, Cefalo RC. Diagnosis of rectus sheath hematoma by B-mode ultrasound: a case report. Am J Obstet Gynecol. JUN 15 1976;125(4):562-5. [Medline].

  32. Hildreth DH. Anticoagulant therapy and rectus sheath hematoma. Am J Surg. Jul 1972;124(1):80-6. [Medline].

  33. Hopper KD, Smazal SF Jr, Ghaed N. CT and ultrasonic evaluation of rectus sheath hematoma: a complication of anticoagulant therapy. Mil Med. May 1983;148(5):447-9. [Medline].

  34. Hough DR, Schneider HE. Rectus sheath hematoma with pain relief after ultrasound: case report. Mil Med. Nov 1983;148(11):885-6. [Medline].

  35. James RF. Rectus sheath haematoma. Lancet. May 21-27 2005;365(9473):1824. [Medline].

  36. Khan MI, Medhat O, Popescu O. Rectus sheath haematoma (RSH) mimicking acute intra-abdominal pathology. N Z Med J. 2005;118:1217. [Medline].

  37. Klingler PJ, Oberwalder MP, Riedmann B, DeVault KR. Rectus sheath hematoma clinically masquerading as sigmoid diverticulitis. Am J Gastroenterol. Feb 2000;95(2):555-6. [Medline].

  38. Lee TM, Greenberger PA, Nahrwold DL, Patterson R. Rectus sheath hematoma complicating an exacerbation of asthma. J Allergy Clin Immunol. Aug 1986;78(2):290-2. [Medline].

  39. Linsk JA. Rectus sheath hematoma. Mayo Clin Proc. May 1982;57(5):329. [Medline].

  40. Lohle PN, Puylaert JB, Coerkamp EG, Hermans ET. Nonpalpable rectus sheath hematoma clinically masquerading as appendicitis: US and CT diagnosis. Abdom Imaging. Mar-Apr 1995;20(2):152-4. [Medline].

  41. Luhmann A, Williams EV. Rectus sheath hematoma: a series of unfortunate events. World J Surg. Nov 2006;30(11):2050-5. [Medline].

  42. Luyx C, Vanpee D, Douala C, Gillet JB. Acute dyspnea in a woman with swelling of the left leg treated with low molecular weight heparine. Am J Emerg Med. May 2001;19(3):223-4. [Medline].

  43. Maharaj D, Ramdass M, Teelucksingh S, et al. Rectus sheath haematoma: a new set of diagnostic features. Postgrad Med J. Dec 2002;78(926):755-6. [Medline].

  44. Manier JW. Rectus sheath hematoma. Am J Gastroenterol. May 1972;57(5):443-52. [Medline].

  45. Moreno Gallego A, Aguayo JL, Flores B, et al. Ultrasonography and computed tomography reduce unnecessary surgery in abdominal rectus sheath haematoma. Br J Surg. Sep 1997;84(9):1295-7. [Medline].

  46. Noseda A, Bellens R, Van Gansbeke D, Gangji D. Rectus sheath hematoma mimicking acute splenic disease. Am J Gastroenterol. Sep 1983;78(9):566-8. [Medline].

  47. Perry CW, Phillips BJ. Rectus sheath hematoma: review of an uncommon surgical complication. Hosp Physician. 2001;37:35-7.

  48. Richardson SB. Rupture of the right rectus abdominis muscle from muscular efforts: operation and recovery, with remarks. Am J Med Sci. 1857;33:41-5.

  49. Rimola J, Perendreu J, Falco J, Fortuno JR, Massuet A, Branera J. Percutaneous arterial embolization in the management of rectus sheath hematoma. AJR Am J Roentgenol. Jun 2007;188(6):W497-502. [Medline].

  50. Scott WW Jr, Fishman EK, Siegelman SS. Anticoagulants and abdominal pain. The role of computed tomography. JAMA. Oct 19 1984;252(15):2053-6. [Medline].

  51. Sheehan V. Spontaneous haematoma of the rectus abdominis muscle in pregnancy. Br Med J. Nov 10 1951;4740:1131-2. [Medline].

  52. Thia EWH, Low JJH, Wee HY. Rectus Sheath Haematoma Mimicking An Ovarian Mass. The Internet Journal of Gynecology and Obstetrics. 2003;2:1.

  53. Titone C, Lipsius M, Krakauer JS. "Spontaneous" hematoma of the rectus abdominis muscle: critical review of 50 cases with emphasis on early diagnosis and treatment. Surgery. Oct 1972;72(4):568-72. [Medline].

  54. Torpin R. Hematoma of the rectus abdominis muscle in pregnancy. Am J Obstet Gynecol. 1943;46:557-66.

  55. Trias A, Boctor M, Echave V. Ultrasonography in the diagnosis of rectus abdominis hematoma. Can J Surg. Sep 1981;24(5):524-5. [Medline].

  56. Vanpee D, Gillet JB. Rectus sheath hematoma. Ann Emerg Med. Jul 2000;36(1):78-9. [Medline].

  57. Wyatt GM, Spitz HB. Ultrasound in the diagnosis of rectus sheath hematoma. JAMA. Apr 6 1979;241(14):1499-500. [Medline].

  58. Young JR, Cressman M, O'Hara PJ. Rectus sheath hematoma: diagnosis by computed tomography. Arch Intern Med. May 1981;141(6):820. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

rectus sheath hematoma, abdominal wall hematoma, epigastric artery rupture, rectus muscle, rectus muscle tear, rectus sheath hematoma symptoms, rectus sheath hematoma treatment, rectus sheath hematoma, causes, pelvic pseudotumor, RSH, abdominal pain, hypovolemic shock, hematoma, anticoagulation 

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Wan-Tsu Chang, MD, Staff Physician, Department of Emergency Medicine, University of Cincinnati
Wan-Tsu Chang, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

William A Knight IV, MD, Assistant Professor, Department of Emergency Medicine, University of Cincinnati School of Medicine
William A Knight IV, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Emergency Medicine Residents Association, Society for Academic Emergency Medicine, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Steven G Werdehoff, MD, Consulting Staff, Department of Emergency Medicine, Huntsville Emergency Physicians Group
Steven G Werdehoff, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Andra L Blomkalns, MD, Associate Professor, Vice Chair - Academic Affairs, Department of Emergency Medicine, University of Cincinnati School of Medicine
Andra L Blomkalns, MD is a member of the following medical societies: American College of Emergency Physicians, American Heart Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Jerry Balentine, DO, Professor of Emergency Medicine, New York College of Osteopathic Medicine; Executive Vice President, Chief Medical Officer, Attending Physician in Department of Emergency Medicine, St. Barnabas Hospital
Jerry Balentine, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American College of Physician Executives, American Osteopathic Association, and New York Academy of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Fred Harchelroad, MD, FACMT, FAAEM, FACEP, Chair, Department of Emergency Medicine, Director of Medical Toxicology - Allegheny General Hospital, Associate Professor, Department of Emergency Medicine, Drexel University College of Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center
Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.