Textbook of Adult Emergency Medicine

Description

Since the first edition of Textbook of Adult Emergency Medicine was published twenty years ago, there has been enormous change in the way emergency care is delivered. This has occurred both in countries where emergency medicine was originally developed and in those where its application was limited because of cost. Emergency medicine is now perceived as the cornerstone of response to acute illness regardless of resources. This fully revised Fifth Edition provides clear and consistent coverage of this constantly evolving specialty. Building on the success of previous editions it covers all the major topics relevant to the practice of emergency medicine. The book will prove invaluable to professionals working in this setting – including nurse specialists and paramedics – who require concise, highly practical guidance, incorporating the latest best practice and evidence-based guidelines. This edition comes with an enhanced electronic version with video and self-assessment content, providing a richer learning experience and making rapid reference easier than ever before, anytime, anywhere. A comprehensive textbook of adult emergency medicine for trainee doctors - covers all the problems likely to present to a trainee in the emergency department. Chapters are highly readable and concise – boxes summarise chapter key points and highlight controversial areas of treatment. The content is highly practical, clinically orientated and thoroughly updated in all the core subjects There have been major updates in topics such as airway, shock and sepsis where guidelines have changed rapidly. The imaging chapters have also evolved with changing practice and improved technology, to be concordant with evidence on the importance of image interpretation by emergency clinicians. There are major sections on other skills and issues of key importance to today’s advanced emergency medicine practitioner, such as staffing, overcrowding, triage, patient safety and quality measures. In addition, difficult topics such as death and dying, the challenging patient, ethics, giving evidence and domestic violence are covered. Governance, training, research and organisational subjects such as disaster planning and response, humanitarian emergencies and refugee medicine are included to give the reader a framework to understand the complexity of managing major emergency systems of care. Front Cover......Page 1 IFC......Page 2 Textbook of ADULT EMERGENCY MEDICINE......Page 3 Textbook of ADULT EMERGENCY MEDICINE......Page 5 Copyright......Page 6 Contents......Page 7 Preface......Page 13 Contributors......Page 14 Acknowledgements......Page 22 Introduction......Page 23 Development of protocols......Page 25 Check for response and send for help......Page 26 Airway obstruction manoeuvres A number of manoeuvres have been proposed to clear the airway if it is completely obstructed by a .........Page 27 Basic life support summary......Page 28 International Liaison Committee on Resuscitation......Page 29 Manual external defibrillator......Page 30 Automated external defibrillators......Page 31 The 4Ts......Page 32 Amiodarone......Page 33 Arterial blood gases......Page 34 Prognosis for survival after cardiac arrest......Page 35 Non-invasive ventilation......Page 36 Apnoeic oxygenationThe continuous provision of oxygen through a patent airway in the form of high flow nasal oxygen is called ‘a.........Page 37 Ketamine......Page 38 Airway plan......Page 40 Front of neck access......Page 41 Airway trauma......Page 42 Audit and education......Page 43 Credentialing......Page 44 Pulmonary gas exchange......Page 46 Variable-performance oxygen delivery systems......Page 47 Face-masks (e.g. Hudson, Edinburgh, Medishield)......Page 48 Advantages......Page 49 Advantages......Page 50 Transfer of patients on oxygen therapy......Page 51 Controlled titration of oxygen dose in chronic obstructive pulmonary disease......Page 52 Hyperbaric oxygen treatment......Page 53 Oxygen toxicity......Page 54 Practical use of monitoring......Page 55 Blood pressure monitoring......Page 56 Invasive blood pressure measurement......Page 57 The pulse-induced contour cardiac output system of arterial waveform monitoring......Page 58 Future developments......Page 59 Pump dysfunction—cardiogenic (see Box 2.4.4)......Page 60 Clinical features......Page 61 Emergency department investigations......Page 62 Complications of fluid therapy......Page 63 Titration targets......Page 64 Management of specific shock syndromes......Page 65 Aetiology......Page 66 Emergency department therapy......Page 67 Definitions......Page 68 Apply vasopressors if patient is hypotensive during or after fluid resuscitation to maintain mean arterial pressure at or above .........Page 70 Corticosteroids......Page 71 Post-sepsis syndrome......Page 73 Collection and handling......Page 75 Pathophysiology of hypoxaemic respiratory failure......Page 76 Hypoventilation......Page 77 Acid–base disorders......Page 78 Venous blood gases......Page 81 Oxygenation after resuscitation......Page 82 Targeted temperature management......Page 84 Summary......Page 85 Aetiology......Page 86 Latex-induced anaphylaxis......Page 87 Fatal anaphylaxis......Page 88 Cutaneous and generalized allergic reactions......Page 89 Histamine......Page 90 H1 and H2 antihistamines......Page 91 Allergist/immunologist referral......Page 92 IgE skin testing, in vitro testing and challenge testing......Page 93 The trauma system—background......Page 95 Preparation......Page 96 Airway......Page 97 Exposure......Page 98 Trauma in developing countries......Page 99 Intracranial haematoma......Page 101 Primary survey......Page 102 Moderate/severe traumatic brain injury......Page 103 Disposition......Page 104 Associated injuries......Page 105 In-line protection of the spine......Page 106 Circulation......Page 107 Head and neck......Page 108 Sensory function......Page 109 HyperextensionAnterior widening of disc spaces, prevertebral swelling, avulsion of a vertebral body by the anterior longitudinal.........Page 110 Spinal shock......Page 111 Acute central cervical cord syndrome......Page 112 Documentation conventions......Page 113 Airway......Page 117 Imaging......Page 118 Orbital fractures......Page 119 Conclusion......Page 120 Abdominal examination......Page 122 Abdominal computed tomography......Page 123 Future directions......Page 124 Support of pulmonary function......Page 126 Fractured sternum......Page 127 Pneumothorax......Page 128 Thoracic aortic transection......Page 129 Conclusion......Page 130 Fractures......Page 131 History and examination......Page 133 Management......Page 134 Disposition......Page 135 Crush syndrome......Page 136 Immobilization......Page 137 The trauma series......Page 139 Head......Page 141 Classification of intracranial haemorrhage......Page 142 Cervical spine......Page 143 Thoraco-lumbar spine......Page 144 Chest trauma......Page 145 Thoracic computed tomography scan......Page 147 Visceral angiography and embolization......Page 148 Computed tomography scan of the pelvis......Page 149 Extremity injury......Page 151 Conclusion......Page 153 Respiratory......Page 154 X-rays......Page 159 Prevention......Page 160 Wound cleansing......Page 161 Wound-healing mechanisms......Page 163 Needles......Page 164 Basic suture technique......Page 165 Special sites and situations......Page 166 The ‘dog-ear’......Page 167 Dressings......Page 168 Disposal/removal......Page 170 Likely developments over the next 5 to 10 years......Page 172 Examination......Page 174 Pre-hospital......Page 175 Fluid Resuscitation7......Page 176 Disposition......Page 177 What is a massive transfusion......Page 178 Predicting massive transfusion......Page 180 Circulatory management......Page 181 Calcium......Page 182 Acute traumatic coagulopathy......Page 183 Future directions......Page 184 Fractures of the clavicle......Page 185 Fractures of the scapula......Page 186 Anterior dislocation......Page 187 Inferior dislocation (luxatio erecta)......Page 188 Treatment......Page 189 Disposition......Page 190 Treatment......Page 191 Clinical assessment......Page 192 Treatment and disposition......Page 193 Complications......Page 194 Monteggia fracture dislocation......Page 195 Colles fracture......Page 196 Scaphoid fracture......Page 197 TreatmentAll wrist dislocations require orthopaedic consultation and prompt reduction......Page 198 Examination......Page 199 Fingertip injuries......Page 200 Middle phalangeal injuries......Page 201 Prognosis......Page 202 Young and Resnik classification......Page 203 Haemorrhage......Page 204 Laparotomy with pelvic packing......Page 205 Management of isolated stable fractures......Page 206 Garden I:Incomplete, impacted or stress fractures that are stable. Trabeculae of the inferior neck are still intact and, althoug.........Page 207 ComplicationsSurvival is directly related to the patient’s age and pre-existing medical conditions......Page 208 Closed reduction......Page 209 Complications......Page 210 Reduction and splinting......Page 211 Complications......Page 212 Tibial plateau fracture......Page 213 Mechanism......Page 214 Management......Page 215 RadiologyX-rays may reveal avulsion of the posterior tibial spine but, as with ACL injuries, MRI demonstrates over 90% sensitivi.........Page 216 Management......Page 217 Clinical assessment......Page 218 Osgood-Schlatter disease (traction apophysitis of the tibial tubercle)......Page 219 Maisonneuve fracture......Page 220 Ottawa ankle rules......Page 221 Open dislocations......Page 222 Management......Page 223 Mechanism and classification......Page 224 Management......Page 225 Radiology......Page 226 Management......Page 227 Laboratory tests......Page 228 Prognosis......Page 229 Prevention......Page 230 Differential diagnosis and approach......Page 231 Clinical features......Page 232 Clinical investigations......Page 234 Prognosis......Page 236 Introduction......Page 237 Clinical features......Page 239 Clinical investigations......Page 240 Reperfusion therapy......Page 241 Complications of therapy......Page 242 Primary and secondary prevention......Page 243 History......Page 245 Treatment......Page 246 Furosemide......Page 247 Hypotensive patients......Page 248 Triggered activity......Page 249 Sick sinus syndrome (bradycardia-tachycardia syndrome)......Page 251 Second-degree Mobitz type ll atrioventricular block......Page 252 Ventricular tachycardias 10......Page 253 Treatment 1......Page 254 Right ventricular outflow tract ventricular tachycardia Right ventricular outflow tract VT has a typical LBBB inferior axis morp.........Page 255 Sinus tachycardia......Page 256 Paroxysmal supraventricular tachycardia......Page 257 Treatment3 Emergency management depends on the chronicity of the condition, haemodynamic stability, the ventricular response rat.........Page 258 Right bundle branch block......Page 259 Atrial ectopics......Page 260 Brugada syndrome9......Page 261 Aetiology, pathogenesis and pathology......Page 264 Electrocardiography......Page 266 Computed tomographic pulmonary angiography and venography......Page 267 Risk stratification......Page 268 Thrombolysis......Page 269 Disposition......Page 270 Blood tests......Page 271 Criteria for diagnosis......Page 272 Clinical management and treatment......Page 273 History......Page 274 Drainage procedures......Page 275 First-line clinical Investigations......Page 276 Prognosis......Page 277 Pathology and pathogenesis......Page 278 Clinical features......Page 279 Diagnosis......Page 280 Echocardiography......Page 281 Treatment......Page 282 Practice points......Page 283 Clinical features......Page 284 Mechanical valves......Page 285 5.8 Peripheral vascular disease......Page 286 Clinical features......Page 288 Venous disease: lower limb......Page 289 Treatment......Page 290 Likely developments over the next 5 to 10 years......Page 291 Epidemiology......Page 292 Bedside tests......Page 293 Renal emergencies......Page 294 Developments in the next 5 to 10 years......Page 295 Epidemiology, pathophysiology and classification......Page 296 Electrocardiography......Page 297 Magnetic resonance imaging......Page 298 Treatment of type B aortic dissection......Page 299 Disposition......Page 300 History......Page 301 Introduction......Page 302 Future developments......Page 303 Upper airway obstruction......Page 304 Treatment......Page 305 Imaging......Page 306 Epidemiology and pathology......Page 307 Treatment......Page 308 6.2 Asthma......Page 309 Severe or life-threatening asthma......Page 310 Oxygen......Page 311 Disposition......Page 313 Epidemiology......Page 314 Streptococcus pneumoniae......Page 315 Other important organisms......Page 316 Full blood count......Page 317 Urinary antigen testing......Page 318 CORB......Page 319 General supportive care......Page 320 Antibiotic treatment......Page 321 Pneumonia in tropical areas......Page 322 Likely developments over the next 5 to 10 years......Page 323 Avian and other zoonotic influenzas......Page 324 Microbiology......Page 325 Influenza preparedness......Page 326 6.5 Chronic obstructive pulmonary disease......Page 327 Examination......Page 328 Other tests......Page 329 Invasive ventilation......Page 330 Prognosis......Page 331 Aetiology, genetics, pathogenesis and pathology......Page 332 Size estimation......Page 333 Catheter drainage......Page 334 Other issues......Page 335 Physical examination......Page 336 Thoracocentesis......Page 337 Treatment and prognosis......Page 339 Clinical features......Page 340 Other......Page 341 Other approaches......Page 342 Clinical features......Page 343 Disposition......Page 344 Patient history......Page 345 Associated symptoms......Page 346 Limitations of the abdominal examination......Page 347 Laboratory tests......Page 348 The elderly......Page 349 Antibiotics......Page 350 Introduction and pathophysiology......Page 351 General measures......Page 353 Surgical therapy......Page 354 Complications......Page 355 Surgical repair......Page 356 Epidemiology......Page 358 Differential diagnosis......Page 359 Clinical investigations......Page 360 Treatment......Page 361 Prevention......Page 362 Endoscopy......Page 363 Proton pump inhibitors The PPIs are the most common class of drugs used for peptic ulcer disease based on their profound and per.........Page 364 Transjugular intrahepatic portosystemic stent-shunt......Page 365 Likely developments over the next 5 to 10 years......Page 366 Epidemiology......Page 367 Treatment......Page 368 Haemorrhage......Page 369 Likely developments over the next 5 to 10 years......Page 370 History......Page 371 Disposition......Page 372 Pathology......Page 373 Treatment......Page 374 Severe pancreatitis scoring systems......Page 375 Chronic pancreatitis......Page 376 Aetiology, pathogenesis and pathology......Page 377 Imaging......Page 378 Likely developments over the next 5 to 10 years......Page 379 Examination......Page 380 Medical therapy......Page 381 Prognosis......Page 382 Clinical features......Page 383 Criteria for diagnosis......Page 384 Lamivudine and nucleoside analogues......Page 385 Prognosis......Page 386 Introduction......Page 387 Aortoenteric fistula......Page 388 Risk Assessment......Page 389 Colonoscopy......Page 390 Surgery......Page 391 Treatment......Page 392 Prolapsed irreducible haemorrhoids......Page 393 Injuries and foreign bodies in the perianal region......Page 394 Other anorectal conditions......Page 395 Aetiology, pathophysiology and pathology......Page 397 Classification and clinical features......Page 398 Treatment......Page 399 Temporal (giant cell) arteritis......Page 400 Ischaemic strokes......Page 401 Risk factors for transient ischaemic attack/stroke and prevention......Page 402 Posterior circulation ischaemia......Page 403 General investigations......Page 404 Imaging in stroke......Page 405 Transient ischaemic attacks......Page 406 Clot retrievalA number of similar studies (MR Clean, ESCAPE, SWIFT PRIME, EXTEND 1A and REVASCAT) have shown that in patients wi.........Page 407 Medical Treatment......Page 408 Epidemiology and pathology......Page 409 Differential diagnosis......Page 411 Lumbar puncture......Page 412 Prevention of delayed cerebral ischaemia......Page 413 Introduction......Page 414 Clinical assessment......Page 416 Examination......Page 417 Microbiology......Page 418 Prognosis......Page 419 Management principles......Page 421 Electroencephalography......Page 422 Non-convulsive seizures......Page 423 Drug-related seizures......Page 424 Future directions......Page 425 Differential diagnosis......Page 426 Clinical features......Page 427 Treatment......Page 428 Differential diagnosis......Page 430 Treatment and prognosis......Page 431 Multiple sclerosis......Page 433 Amyotrophic lateral sclerosis (motor neuron disease)......Page 434 Tetanus......Page 435 Envenomations......Page 436 Introduction......Page 437 Step 3: look for the ‘at-risk’ patient......Page 438 Clinical pointers: exposure history......Page 439 Step 4: a final caveat......Page 440 Future research directions......Page 441 Epidemiology......Page 442 History......Page 443 Computed tomography scan......Page 444 Prognosis......Page 445 Prevention......Page 446 Epidemiology......Page 447 Suggested initial empiric regimen12......Page 448 Epidemiology......Page 449 Ageing......Page 451 Nitrites......Page 452 Frequency dysuria syndrome: presumed simple cystitis......Page 453 Pregnancy......Page 454 Complicated urinary tract infection......Page 455 Prognosis......Page 456 Epidemiology and aetiology......Page 457 Antibiotic therapy......Page 458 Cellulitis......Page 459 Necrotizing fasciitis......Page 460 Animal bites......Page 461 Diabetic foot infections......Page 462 Introduction......Page 463 Prevention and immunization......Page 465 Management......Page 466 Natural history......Page 467 Future directions......Page 468 Pathogenesis......Page 469 Previously undiagnosed HIV infection......Page 470 Previously diagnosed HIV infection7......Page 471 Difficult or painful swallowing......Page 472 Other presentations......Page 473 Antiretrovirals in the management ofHIV infection......Page 474 References......Page 475 Introduction......Page 476 Practices......Page 477 Chlamydia......Page 478 Gonorrhoea......Page 479 Lymphogranuloma venereum......Page 480 Follow-up......Page 481 Microorganism susceptibility......Page 482 Host factors......Page 485 Route of administration......Page 486 Bacterial resistance to penicillins......Page 487 Classification and uses......Page 488 Bacterial resistance......Page 489 Co-trimoxazole......Page 490 Colistin Link Parenteral......Page 491 Treatment......Page 492 Recent updates from the medical literature......Page 493 Prevention of needlestick injuries......Page 494 Counselling of exposed worker......Page 496 Hepatitis C......Page 497 Human immunodeficiency virus......Page 498 Pre-exposure prophylaxis......Page 499 References......Page 495 References......Page 500 Clinical features......Page 501 Schistosomiasis (bilharzia)......Page 502 African trypanosomiasis (sleeping sickness)......Page 503 Helminths (worms)......Page 504 Viral haemorrhagic fevers......Page 505 Introduction......Page 506 Cholera......Page 507 Investigations......Page 508 Management......Page 509 Pre-renal acute kidney injury......Page 510 Renal acute kidney injury......Page 511 Clinical features......Page 512 Evaluation of prerenal (intravascular volume) status......Page 513 Serum biochemistry......Page 514 Full blood examination......Page 515 Potassium......Page 516 Fluid overload......Page 517 Prognosis......Page 518 Traps in the clinical diagnosis......Page 519 Urine testing......Page 520 Penetrating......Page 521 Investigations......Page 523 Management......Page 524 Conclusion......Page 525 Diabetes secondary to other conditions......Page 526 Management of hypoglycaemic coma......Page 527 Epidemiology and aetiology......Page 528 Diabetic ketoacidosis......Page 529 Potassium replacement......Page 530 Miscellaneous issues......Page 531 Clinical features......Page 532 General supportive measures......Page 533 Administration of thyroid hormones......Page 534 Laboratory findings......Page 535 Treatment......Page 536 Metabolic acidosis......Page 538 Alkalaemia......Page 539 Respiratory alkalosis (Box 12.1.6)......Page 540 Lactate gap......Page 541 Euvolaemic hyponatraemia......Page 542 Treatment......Page 543 Pathophysiology......Page 544 Pathophysiology......Page 545 Treatment......Page 546 Chronic asymptomatic hypocalcaemia......Page 547 Inhibition of bone resorption......Page 548 Treatment......Page 549 Aetiology......Page 551 Treatment......Page 552 Other causes of decreased red cell production......Page 553 Sickle cell anaemia......Page 554 Haemolytic uraemic syndrome and thrombotic thrombocytopaenic purpura......Page 555 Other causes of haemolysis......Page 556 Pathophysiology and aetiology......Page 557 Prognosis......Page 558 Drug-related thrombocytopaenia......Page 559 Massive blood transfusion and thrombocytopenia......Page 560 Disposition......Page 561 Treatment......Page 562 Treatment of bleeding......Page 563 Contacts......Page 564 WA......Page 565 Packed red blood cells......Page 566 Effect of storage on red blood cells......Page 567 Immediate......Page 568 Red-cell alloimmunization When antibodies are formed against foreign antigens from an individual’s own species, the process is t.........Page 569 Platelets......Page 570 Refusal of blood and blood product transfusion......Page 571 Cervical spine involvement......Page 572 Renal disease......Page 573 Giant cell (temporal) arteritis......Page 574 Investigations and diagnosis......Page 575 Biological disease-modifying antirheumatic drugs......Page 576 Allopurinol hypersensitivity syndrome......Page 577 Blood tests......Page 578 Colchicine......Page 579 Investigations......Page 580 Haemophilia or other bleeding diathesis......Page 581 Diagnosis......Page 582 Prognosis......Page 583 Investigations......Page 584 Prognosis......Page 585 Hepatitis A, B and C viruses......Page 586 Diagnosis and clinical features......Page 587 History......Page 588 Management......Page 590 General management of non-arthritic joint and soft-tissue disorders......Page 591 Diagnosis and management......Page 592 Management......Page 593 Investigations......Page 594 Management......Page 595 Painful arc of the shoulder......Page 596 Clinical features......Page 598 Erythema multiforme......Page 599 Complications of erythroderma......Page 600 Bullous pemphigoid......Page 601 Investigations for vasculitis......Page 602 Investigations for pruritus......Page 603 Eczema herpeticum......Page 604 Skin cancer......Page 605 Management......Page 606 Visual acuity testing......Page 607 Penetrating injury......Page 608 Acute infectious keratitis......Page 609 Acute iritis......Page 610 Clinical assessment......Page 611 Central retinal artery occlusion......Page 612 Giant cell arteritis......Page 613 Optic neuritis......Page 614 Periodontal emergencies......Page 615 Management......Page 616 Dental nomenclature......Page 617 Perichondritis......Page 619 Acute facial (seventh) nerve palsy......Page 620 Epistaxis......Page 621 Fractured nose......Page 622 Oesophageal foreign body......Page 623 History......Page 625 Laboratory investigations......Page 626 Intra-ovarian haemorrhage......Page 627 Primary dysmenorrhoea......Page 628 Risk factors......Page 629 Sexually acquired pelvic inflammatory disease......Page 630 Physiological uterine bleeding......Page 631 Laboratory investigations......Page 632 Other drug treatments......Page 633 Disposition......Page 634 Haemodynamically unstable patient......Page 635 Disposition......Page 636 Examination......Page 637 Investigations......Page 638 Clinical features......Page 639 Prevent further seizure......Page 640 Summary......Page 641 History......Page 642 Transferring the patient......Page 643 Second stage......Page 644 Apgar score......Page 645 Management of breech delivery......Page 646 Treatment of shoulder dystocia......Page 647 Management of postpartum haemorrhage......Page 648 Other surgical causes......Page 649 Positive-pressure ventilation......Page 650 Meconium-stained liquor......Page 651 Neonatal transfer......Page 652 Epidemiology......Page 653 Aims of the mental health assessment......Page 654 Presenting complaint......Page 655 Appearance, attitude and behaviour......Page 656 Conclusion......Page 657 General approach......Page 659 History......Page 660 Diagnostic formulation......Page 661 Conclusion......Page 662 Repeated episodes of deliberate self-harm......Page 663 Social and cultural factors......Page 664 Assessment......Page 665 Use of scales......Page 666 Definitive treatment and disposition......Page 667 Conclusion......Page 668 Introduction......Page 669 Symptoms......Page 671 Signs......Page 672 Differential diagnosis......Page 673 Mood disorder due to psychoactive substance use......Page 674 Assessment......Page 675 Medications......Page 676 Severe depressive episodes......Page 677 Epidemiology and prognosis......Page 679 Acute and chronic schizophrenia......Page 680 Substance-induced psychosis......Page 681 Risk assessment......Page 682 Management in the emergency department......Page 683 Acknowledgements......Page 684 Risks of rapid tranquillization......Page 686 Dexmedetomidine and clonidine......Page 687 Maintenance therapy......Page 688 Acknowledgements......Page 689 Introduction......Page 691 Breaking bad news......Page 692 Professional issues......Page 693 Barriers to care......Page 694 Forensic history, examination and evidence collection (MCQ 3)......Page 695 The risk of genital infection after sexual assault (MCQ 4)......Page 696 Conclusion......Page 697 Elderly......Page 699 Economic cost......Page 700 Documentation......Page 701 Conclusion......Page 702 Coagulopathy and encephalopathy Coagulopathy results from the failure of hepatic synthesis of coagulation factors, thus parenter.........Page 703 Alcohol withdrawal seizures Around 3% to 5% of those with severe alcohol use disorder experience withdrawal seizures within 48 h.........Page 704 Diabetic ketoacidosis......Page 705 Important illnesses to be excluded that mimic alcohol intoxication......Page 706 ‘Hangover’......Page 707 Pharmacotherapy for alcohol use disorder......Page 708 Definition and epidemiology......Page 709 Clinical features......Page 711 Prevention......Page 712 Management......Page 713 Violence......Page 714 Definition and epidemiology......Page 715 Management......Page 716 Administrative issues......Page 717 Expected legal knowledge of medical practitioners......Page 719 Resuscitation and not-for-resuscitation orders......Page 720 Anticipating the end of life and diagnosing the dying......Page 721 The dying......Page 722 Identification of potential organ donors......Page 724 Best practice in raising organ donation......Page 725 Eye and tissue donation......Page 726 Nociceptor function......Page 728 Use of intravenous opioids......Page 729 Tapentadol Tapentadol is a centrally acting opioid analgesic with a dual mode of action as an agonist of the μ-opioid receptor a.........Page 730 Pain relief in pregnancy......Page 731 Likely developments over the next 5 to 10 years......Page 732 Management of systemic toxicity......Page 734 Ulnar nerve wrist block (lateral approach)......Page 735 Saphenous nerve The saphenous nerve is blocked by injecting 3 to 5 mL of 1% lignocaine subcutaneously above the medial malleolus.........Page 736 Technique......Page 737 Guidelines......Page 740 Past medical history......Page 741 Sedative hypnotics......Page 742 Ketamine......Page 743 Sedation scoring......Page 744 Postprocedure considerations......Page 745 Basic physics of ultrasound2......Page 749 Extended focused assessment with sonography for trauma3–6......Page 750 Clinical implications and utility......Page 751 Technique......Page 752 Right upper quadrant/gallbladder14......Page 753 Technique......Page 754 Emergency echocardiography......Page 755 Clinical indications and utility......Page 756 Technique......Page 757 Scrotal ultrasound......Page 758 Training and credentialling1......Page 759 Development science......Page 760 Artefacts......Page 762 Unstable patients......Page 763 Overuse......Page 764 Advances in CT scanning......Page 765 Components......Page 766 Angiography and gadolinium......Page 767 Monitoring patients in the magnetic resonance imaging......Page 768 Soft tissue musculoskeletal injury......Page 769 Noise......Page 770 Conclusion......Page 771 Epidemiology and pathophysiology......Page 772 Prognosis and disposition......Page 773 Epidemiology and pathophysiology......Page 774 Rewarming therapies......Page 775 Prognosis and disposition......Page 777 Diving physics and physiology......Page 778 Clinical features......Page 779 Pathophysiology3......Page 780 Clinical features......Page 781 Recompression......Page 782 Prognosis after treatment......Page 783 UK......Page 784 Terrorism......Page 785 Clinical features......Page 786 Treatment......Page 787 Scene management......Page 788 Decontamination process......Page 789 Likely developments over the next 10 years......Page 790 Definitions and terminology......Page 791 Airways/lungs......Page 792 History......Page 793 Prognosis......Page 794 Disposition......Page 795 Resistance......Page 796 Pre-hospital......Page 797 Introduction and epidemiology......Page 798 Prognosis and disposition......Page 799 Prevention......Page 800 High-altitude pulmonary oedema......Page 801 25.1 Approach to the poisoned patient......Page 803 Pathophysiology and clinical features......Page 804 Resuscitation, supportive care and monitoring......Page 805 Enhanced elimination......Page 807 Disposition......Page 808 Pathophysiology......Page 809 Treatment......Page 811 Clinical investigations......Page 812 Clinical features......Page 813 Disposition......Page 814 Pharmacology......Page 816 Chlorpromazine......Page 817 Neuroleptic malignant syndrome......Page 818 Treatment......Page 819 Clinical investigations......Page 820 Treatment......Page 821 Clinical features......Page 822 Treatment......Page 823 Disposition......Page 824 Chronic lithium toxicity......Page 825 Chronic lithium toxicity......Page 826 Disposition and prognosis......Page 827 Pharmacokinetics and pathophysiology......Page 828 Assessment of risk of hepatotoxicity......Page 829 The staggered acute overdose......Page 830 Massive ingestions of paracetamol......Page 831 Pharmacology and pathophysiology......Page 832 Treatment......Page 833 Disposition......Page 834 Treatment......Page 835 Pharmacology and pathophysiology......Page 836 Disposition......Page 837 Clinical features......Page 838 Prognosis......Page 839 Clinical features......Page 840 Caffeine......Page 841 Systemic effects......Page 842 Differential diagnosis......Page 844 Prognosis......Page 845 Introduction......Page 846 Pharmacology and pathophysiology......Page 847 Clinical features......Page 848 Clinical investigations......Page 849 Treatment......Page 850 Clinical investigations......Page 851 Antidote treatment principles......Page 852 Dicobalt edetate (Kelocyanor)......Page 853 Pathophysiology......Page 854 Treatment......Page 855 Disposition......Page 856 Primary exposures......Page 857 Criteria for diagnosis......Page 858 Mild poisoning and dermal exposures......Page 860 Oximes......Page 861 Immunosuppression......Page 862 How to perform the urinary diothonite test......Page 863 Prognosis......Page 864 Treatment......Page 865 Ethanol withdrawal syndrome......Page 866 Ethanol withdrawal......Page 867 Wernicke encephalopathy......Page 868 Disposition......Page 869 Toxicology......Page 870 Haemodialysis......Page 871 Aetiology, pathophysiology and pathology......Page 872 Electrocardiogram......Page 874 Other treatments......Page 875 Treatment......Page 876 Clinical features......Page 878 Clinical features......Page 879 Treatment......Page 880 Venom immunotherapy......Page 881 Compounds......Page 882 Monitoring......Page 883 Monitoring......Page 884 Tachycardia/hypertension......Page 885 General notes......Page 886 Muscarinic toxicity......Page 887 Generic management......Page 888 Other therapies......Page 890 Management......Page 891 Fentanyl......Page 892 Introduction......Page 893 Warfarin......Page 894 Disposition......Page 895 Epidemiology......Page 897 Neurotoxicity......Page 898 Further management......Page 899 Administration of antivenom......Page 900 Disposition......Page 901 Antivenom use......Page 903 Non-antivenom treatments......Page 905 An approach to the patient with spider bite......Page 906 Clinical features......Page 907 Supportive treatment......Page 908 Necrotic arachnidism......Page 909 First aid......Page 910 Scorpaenidae: stonefish, bullrout, lionfish, scorpionfish......Page 911 Ciguatera poisoning......Page 912 Tetrodotoxin poisoning......Page 913 Assembling the research team......Page 914 Case-control studies......Page 915 Validity and repeatability of the study methods......Page 916 Designing a survey......Page 917 Confounding......Page 918 Database design......Page 919 Informed consent......Page 920 Readability......Page 921 Discussion......Page 922 Social media......Page 923 Adult learning principles......Page 924 Learner-centred education......Page 925 ‘Trolley-side’ teaching......Page 926 Simulation......Page 927 Likely developments over the next 5 to 10 years......Page 928 Curriculum and discipline development......Page 930 Methods of teaching emergency medicine......Page 931 Tutorials and small-group learning......Page 932 Future directions......Page 933 Learning and teaching methods in emergency medicine......Page 934 Training for providers of simulation-based learning......Page 935 Continuing professional development......Page 936 Introduction......Page 938 Advance directives The Act makes provision for advance directives to be made at a time when the patient has capacity. These dire.........Page 939 New Zealand......Page 940 Involuntary admission......Page 941 Tasmania......Page 942 Emergency treatment and surgery......Page 943 Deaths......Page 944 Reportable deaths......Page 946 A coronial inquest......Page 947 Coronial findings......Page 948 Reportable deaths......Page 949 Post-mortems......Page 950 Inquest......Page 951 Consent......Page 952 Competence......Page 954 Mentally ill......Page 955 The emergency patient......Page 956 Physical privacy......Page 958 Australian Privacy Principle 3......Page 959 New Zealand......Page 960 28.5 Ethics in emergency medicine......Page 961 An ethics tool kit for the emergency department......Page 962 Tool 1: The four principles (Box 28.5.2)......Page 963 Tool 4: reassurance about competence (Box 28.5.5)......Page 964 Tool 6: Stopping resuscitation (see Box 28.5.8)......Page 965 Summary......Page 966 Dispatch......Page 968 Intravenous fluid......Page 969 Acute coronary syndromes......Page 970 Acute agitation......Page 971 Retrieval systems......Page 973 Crew......Page 974 Equipment......Page 975 Environmental impacts......Page 976 Highly specialized retrieval......Page 977 Introduction......Page 978 Definitions and classification......Page 979 Epidemiology......Page 980 Comprehensive approach......Page 981 Domestic emergency response activities......Page 982 Prehospital mass casualty management......Page 983 Health facility management......Page 984 Likely developments......Page 985 Origins of triage......Page 986 Other triage scales......Page 988 Military and disaster triage......Page 989 29.5 Emergency care in a humanitarian crisis......Page 990 Emergency Medical Teams......Page 991 Shelter and site planning......Page 992 Past problems......Page 993 Introduction......Page 994 Other uses of an observation ward......Page 995 Conclusions......Page 996 Causes of overcrowding......Page 997 Future research......Page 998 Introduction and definitions......Page 999 Hospital admission......Page 1000 Emergency-department-based rapid response systems......Page 1001 Future developments......Page 1002 Disease and injury surveillance......Page 1004 Health of Indigenous people and cultural safety......Page 1005 Cultural safety and competency......Page 1006 Estimating medical workload......Page 1007 Allied health, clerical and other support staff......Page 1008 Optimizing work practices......Page 1009 Size and composition of the emergency department......Page 1010 Acute mental health area......Page 1011 Reception/triage area......Page 1012 Likely developments over the next 5 to 10 years......Page 1013 Definitions......Page 1014 Quality standards......Page 1015 Introduction......Page 1016 Budget......Page 1017 Business plan implementation and monitoring......Page 1018 Provisional training......Page 1019 Accreditation......Page 1020 Accreditation outcomes......Page 1021 Future directions......Page 1022 Medical training initiative......Page 1023 Training in emergency medicine in the United Kingdom......Page 1024 Incidence......Page 1025 Administration......Page 1026 Determining the issues......Page 1027 Catastrophic adverse events......Page 1028 Summary......Page 1029 Common safety problems encountered in emergency departments......Page 1030 Conclusion......Page 1031 Compassion fatigue and compassion satisfaction......Page 1032 Mentorship and peer support......Page 1033 A......Page 1035 B......Page 1038 C......Page 1039 D......Page 1042 E......Page 1044 F......Page 1045 G......Page 1046 H......Page 1047 I......Page 1049 L......Page 1050 M......Page 1051 N......Page 1052 O......Page 1053 P......Page 1054 R......Page 1057 S......Page 1058 T......Page 1061 U......Page 1062 W......Page 1063 Z......Page 1064