Acute Medicine: Management of Medical Emergencies

Acute Medicine offers an accessible and concise guide to the practical management of all acute medical problems likely to be encountered in the emergency department, ambulatory care centre, acute medical unit or on the wards.

Reflecting the maturation of acute medicine as a separate specialty, the book is divided into common presentations, specific problems and procedures. New to the fifth edition is a chapter on bed-side ultrasonography; throughout, emphasis is placed on patient safety, and the use of flow diagrams, tables and figures ensures that key information is quickly accessible.

Thoroughly revised by experts in the subject, and updated to reflect current approaches to diagnosis and management, Acute Medicine is an excellent companion for the trainee as well as an aide-mémoire for the more experienced physician.

Table of Contents

Contributors, xi

Preface, xix

Evolution of acute medicine: the development of ambulatory emergency care, xxi

Section 1: Presentations in Acute Medicine, 1

General, 2

۱ The critically ill patient, 3

۲ Hypotension and shock, 9

۳ Reduced conscious level, 16

۴ Delirium, 23

۵ Falls in older people, 30

Cardiorespiratory, 34

۶ Cardiac arrest in hospital, 35

۷ Acute chest pain, 46

۸ Palpitations, 53

۹ Transient loss of consciousness, 60

۱۰ Acute breathlessness, 68

۱۱ Acute respiratory failure, 73

۱۲ Pleural effusion, 79

۱۳ Cough and haemoptysis, 85

Neurological, 91

۱۴ Neurological diagnosis in acute medicine, 92

۱۵ Acute headache, 98

۱۶ Seizures and epilepsy, 103

۱۷ Weakness and paralysis, 110

۱۸ Acute sensory symptoms, 117

۱۹ Loss of vision, 123

Abdominal, 132

۲۰ Acute vomiting, 133

۲۱ Acute abdominal pain, 138

۲۲ Acute diarrhoea, 144

۲۳ Acute jaundice, 150

۲۴ Ascites, 155

۲۵ Acute kidney injury, 160

Skin and Musculoskeletal, 170

۲۶ Acute rash, 171

۲۷ Urticaria and angioedema, 177

۲۸ Acute arthritis, 183

۲۹ Acute spinal pain, 187

۳۰ Acute limb pain, 190

Miscellaneous, 194

۳۱ Comprehensive geriatric assessment, 195

۳۲ Acute medical problems in pregnancy, 199

۳۳ Fever on return from abroad, 207

۳۴ Acute medical problems in the HIV-positive patient, 215

Section 2: Syndromes and Disorders, 223

General, 224

۳۵ Sepsis, 225

۳۶ Poisoning, 233

۳۷ Acid-base disorders, 246

۳۸ Anaphylaxis, 252

Cardiovascular, 258

۳۹ Acute arrhythmias: general principles of management, 259

۴۰ Regular broad complex tachycardia, 263

۴۱ Irregular broad complex tachycardia, 268

۴۲ Narrow complex tachycardia, 272

۴۳ Atrial fibrillation and flutter, 279

۴۴ Bradycardia and atrioventricular block, 283

۴۵ Acute coronary syndromes (1): ST-segment elevation, 289

۴۶ Acute coronary syndromes (2): Non-ST-segment elevation, 298

۴۷ Acute pulmonary oedema, 305

۴۸ Acute heart failure and decompensated chronic heart failure, 311

۴۹ Cardiogenic shock, 317

۵۰ Aortic dissection and other acute aortic syndromes, 321

۵۱ Heart valve disease and prosthetic heart valves, 328

۵۲ Infective endocarditis, 333

۵۳ Acute pericarditis, 340

۵۴ Cardiac tamponade, 344

۵۵ Severe hypertension, 347

۵۶ Deep vein thrombosis, 353

۵۷ Pulmonary embolism, 358

۵۸ Problems with pacemakers and other cardiac devices, 366

Respiratory, 371

۵۹ Upper airway obstruction, 372

۶۰ Acute asthma, 378

۶۱ Exacerbation of chronic obstructive pulmonary disease (COPD), 384

۶۲ Community-acquired pneumonia, 390

۶۳ Hospital-acquired pneumonia, 396

۶۴ Pneumothorax, 399

Neurological, 402

۶۵ Stroke, 403

۶۶ Transient ischaemic attack, 412

۶۷ Subarachnoid haemorrhage, 418

۶۸ Bacterial meningitis, 422

۶۹ Encephalitis, 428

۷۰ Spinal cord compression, 432

۷۱ Guillain-Barré syndrome, 436

۷۲ Raised intracranial pressure, 442

Abdominal, 446

۷۳ Acute upper gastrointestinal bleeding, 447

۷۴ Acute lower gastrointestinal bleeding, 455

۷۵ Acute oesophageal disorders, 459

۷۶ Inflammatory bowel disease flare, 462

۷۷ Acute liver failure and decompensated chronic liver disease, 467

۷۸ Alcoholic hepatitis, 476

۷۹ Biliary tract disorders and acute pancreatitis, 478

۸۰ Urinary tract infection, 481

Metabolic, 487

۸۱ Hypoglycaemia, 488

۸۲ Hyperglycaemic states, 491

۸۳ Diabetic ketoacidosis, 495

۸۴ Hyperosmolar hyperglycaemic state, 499

۸۵ Disorders of plasma sodium concentration, 501

۸۶ Disorders of plasma potassium concentration, 508

۸۷ Disorders of plasma calcium concentration, 514

۸۸ Disorders of plasma magnesium concentration, 518

۸۹ Disorders of plasma phosphate concentration, 521

۹۰ Acute adrenal insufficiency, 525

۹۱ Thyrotoxic storm, 530

۹۲ Myxoedema coma, 534

۹۳ Pituitary apoplexy, 537

۹۴ Paraganglioma (phaeochromocytoma) crisis, 540

Skin and Musculoskeletal, 543

۹۵ Cellulitis and necrotizing fasciitis, 544

۹۶ Erythroderma and toxic epidermal necrolysis, 549

۹۷ Acute gout and pseudogout, 555

۹۸ Septic arthritis, 558

۹۹ Acute vasculitis, 561

Haematology and Miscellaneous, 568

۱۰۰ Interpretation of full blood count and film, 569

۱۰۱ Pancytopenia and febrile neutropenia, 577

۱۰۲ Bleeding disorders, 584

۱۰۳ Management of anticoagulation, 589

۱۰۴ Acute painful sickle cell crisis, 601

۱۰۵ Complications of cancer, 605

۱۰۶ Alcohol-related problems in acute medicine, 612

۱۰۷ Hypothermia, 615

۱۰۸ Drowning, 619

۱۰۹ Electrical injury, 623

۱۱۰ Palliative and end-of-life care, 625

۱۱۱ Medicolegal issues in acute medicine, 632

Section 3: Techniques and Procedures in Acute Medicine, 639

۱۱۲ Airway management, 641

۱۱۳ Non-invasive ventilation, 646

۱۱۴ Ultrasonography in acute medicine, 651

۱۱۵ Reading a chest X-ray, 657

۱۱۶ Central vein cannulation, 665

۱۱۷ Arterial blood sampling and cannulation, 673

۱۱۸ Arterial blood gases, oxygen saturation and oxygen therapy, 677

۱۱۹ Temporary cardiac pacing, 681

۱۲۰ Pericardial aspiration (pericardiocentesis), 687

۱۲۱ DC cardioversion, 692

۱۲۲ Insertion of an intercostal chest drain, 696

۱۲۳ Lumbar puncture, 704

۱۲۴ Aspiration of the knee joint, 709

۱۲۵ Insertion of a Sengstaken-Blakemore tube, 712

Index, 715