acute medicine

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Acute Medicine 2nd edition 2018 Half Title Other Titles Full Title Copyright Contents Preface Abbreviations 01 - Resuscitation 1.1 - Introduction 1.2 - Initiating resuscitation 1.3 - Basic Iife support: UK Guidelines 2015 1.4 - Advanced life support: UK Guidelines 2015 1.5 - Treatment of shockable rhythms (VF/pulseless VT) 1.6 - Treatment of non-shockable rhythms (asystole/PEA) 1.7 - Reversible causes of cardiac arrest 1.8 - Resuscitation issues 1.9 - Drugs for cardiac arrest 1.10 - Special cases in resuscitation 1.11 - Return of spontaneous circulation (ROSC) 1.12 - Bradycardia management: be prepared to pace 1.13 - Tachycardia management: be prepared to DC shock 1.14 - Emergency DC cardioversion 1.15 - Emergency pericardiocentesis 1.16 - Automated implantable cardioverter defibrillator (AICD) 1.17 - Adult choking algorithm 02 - The acutely ill patient 2.1 - Levels of care 2.2 - National early warning scores 2.3 - Clinical risk and response 2.4 - ABCDE assessment 2.5 - Getting senior help: advice before you call for advice 2.6 - Phone protocols 2.7 - Advanced airways management 2.8 - Tracheostomy/laryngectomy emergencies 2.9 - Assessing and managing fluid balance 2.10 - Fluid replacement regimens 2.11 - Venous access: choosing a venous cannula 2.12 - Acid–base balance and blood gas interpretation 2.13 - Assessment of shocked patient 2.14 - Immediate actions in a shocked patient 2.15 - Quick review of different forms of shock 2.16 - Acute heart failure/cardiogenic shock 2.17 - Vasopressors and inotropes 2.18 - Anaphylactic/anaphylactoid shock 2.19 - Toxic shock syndrome 2.20 - Hypovolaemic shock 2.21 - Systemic inflammatory response syndrome/sepsis/severe sepsis 2.22 - Haemorrhagic shock 2.23 - Massive transfusion protocol 03 - Cardiology emergencies 3.1 - Anatomy and physiology 3.2 - Chest pain assessment 3.3 - Chest pain differentials 3.4 - Palpitations 3.5 - Syncope and transient loss of consciousness (TLOC) 3.6 - Differentials of syncope/transient loss of consciousness (TLOC) 3.7 - Sudden cardiac death 3.8 - Acute coronary syndrome 3.9 - Stable angina 3.10 - Arrhythmias 3.11 - Tachyarrhythmias 3.12 - Monomorphic ventricular tachycardia 3.13 - Polymorphic ventricular tachycardia (torsades de pointes) 3.14 - Supraventricular tachycardia 3.15 - Symptomatic bradycardia 3.16 - Atrial fibrillation 3.17 - Aortic dissection 3.18 - Acute myocarditis 3.19 - Acute pericarditis 3.20 - Pericardial effusion/tamponade 3.21 - Severe (malignant) hypertension 3.22 - Infective endocarditis 3.23 - Cardiomyopathy 04 - Respiratory emergencies 4.1 - Pathophysiology 4.2 - Oxygen therapy 4.3 - Acute breathlessness 4.4 - Acute stridor 4.5 - Acute respiratory failure 4.6 - NIV protocol and settings 4.7 - Invasive ventilation 4.8 - Massive haemoptysis 4.9 - Acute respiratory distress syndrome (ARDS) 4.10 - Acute exacerbation of COPD 4.11 - Acute severe asthma 4.12 - Pneumothorax 4.13 - Pleural effusion 4.14 - Pneumonia 4.15 - Pneumocystis pneumonia 4.16 - Empyema 4.17 - Pulmonary embolism and deep vein thrombosis 4.18 - Lung ‘white out’ 4.19 - Lung abscess 05 - Endocrine and diabetic emergencies 5.1 - Primary hypoadrenalism (Addisonian crisis) 5.2 - Hypoglycaemia 5.3 - Hyperkalaemia 5.4 - Hypokalaemia 5.5 - Hypercalcaemia 5.6 - Hypocalcaemia 5.7 - Myxoedema coma 5.8 - Thyroid storm/thyrotoxic crisis 5.9 - Pituitary apoplexy 5.10 - Hyponatraemia 5.11 - Hypernatraemia 5.12 - Hypophosphataemia 5.13 - Hyperphosphataemia 5.14 - Hypomagnesaemia 5.15 - Hypermagnesaemia 5.16 - Lactic acidosis 5.17 - Acute porphyria 5.18 - Diabetic ketoacidosis 5.19 - Hyperosmolar hyperglycaemic state (HHS) 5.20 - Diabetic foot infections 5.21 - Diabetes and surgery 5.22 - Variable rate intravenous insulin infusion 5.23 - Diabetes care in emergencies 06 - Gastroenterology emergencies 6.1 - Acute diarrhoea 6.2 - Constipation 6.3 - Dyspepsia 6.4 - Upper gastrointestinal bleeding 6.5 - Lower gastrointestinal bleeding 6.6 - Acute abdomen 6.7 - Acute abdomen – surgical causes 6.8 - Acute abdomen – medical causes 6.9 - Gastric outlet obstruction/pyloric stenosis 6.10 - Acute severe colitis 6.11 - Clostridium difficile colitis 6.12 - Intestinal obstruction 6.13 - Acute colonic pseudo-obstruction 6.14 - Acute bowel ischaemia 6.15 - Acute diverticulitis 6.16 - Re-feeding syndrome 6.17 - Ingested foreign bodies and food impactions 07 - Hepatobiliary emergencies 7.1 - Jaundice 7.2 - Acute liver failure 7.3 - Viral hepatitis 7.4 - Alcoholic hepatitis 7.5 - Alcoholic ketoacidosis 7.6 - Alcohol abuse 7.7 - Zieve’s syndrome 7.8 - Delirium tremens/alcohol withdrawal 7.9 - Decompensated cirrhosis, ascites and spontaneous bacterial peritonitis 7.10 - Hepatorenal syndrome 7.11 - Hepatic encephalopathy 7.12 - Chronic liver disease 7.13 - Liver abscess 7.14 - Gallstone disease and local complications 7.15 - Acute cholangitis 7.16 - Acute pancreatitis 08 - Haematological emergencies 8.1 - Anaemia 8.2 - Severe thrombocytopenia 8.3 - Heparin-induced thrombocytopenia 8.4 - Disseminated intravascular coagulation 8.5 - Sickle cell crisis 8.6 - Haemolytic uraemic syndrome 8.7 - Thrombotic thrombocytopenic purpura 8.8 - Bleeding disorders and reversal of anticoagulation 8.9 - Bleeding on warfarin 8.10 - Bleeding on heparin 8.11 - Bleeding on direct oral anticoagulants 8.12 - Bleeding on/after thrombolysis 8.13 - Blood transfusion and blood products 8.14 - Which blood/plasma product? 8.15 - Cross-matching 8.16 - Acute transfusion reactions 8.17 - Indications for irradiated blood 8.18 - Immunocompromised patients 8.19 - Plasmapheresis/plasma exchange (PLEX) 09 - Infectious disease emergencies 9.1 - Pyrexia of unknown origin 9.2 - Assessment of the febrile traveller 9.3 - Falciparum malaria 9.4 - Traveller’s diarrhoea 9.5 - Tick typhus 9.6 - Rocky Mountain Spotted fever 9.7 - Schistosomiasis (Katayama fever) 9.8 - Dengue 9.9 - Viral haemorrhagic fever 9.10 - Chikungunya 9.11 - Plague/tularaemia 9.12 - Brucellosis 9.13 - Pseudomonas infection 9.14 - Q fever 9.15 - Anthrax 9.16 - Leptospirosis 9.17 - Listeriosis 9.18 - Botulism 9.19 - Clostridial infection 9.20 - Acute bacterial sepsis 9.21 - Measles 9.22 - Chickenpox/varicella zoster virus (Shingles) 9.23 - Mumps infection 9.24 - Herpes simplex 1 and 2 9.25 - Infectious mononucleosis 9.26 - Cytomegalovirus 9.27 - Influenza 9.28 - Severe acute respiratory syndrome 9.29 - Middle Eastern respiratory syndrome 9.30 - Zika virus infection 9.31 - Needlestick injury 9.32 - Tuberculosis (Mycobacterium tuberculosis) 9.33 - HIV/acquired immunodeficiency syndrome 9.34 - Syphilis 9.35 - Oropharyngeal bacterial infections 9.36 - Diphtheria 9.37 - Lemierre’s syndrome (Fusobacterium necrophorum) 9.38 - Meticillin sensitive/resistant Staph. aureus 9.39 - Bacterial resistance: VRE, ESBL, CRE/CRO 9.40 - Gastroenteritis and similar infections 9.41 - E. coli infections 9.42 - Staphylococcal food poisoning 9.43 - Shigella dysenteriae 9.44 - Enteric fever (typhoid/paratyphoid) 9.45 - Bacillus cereus 9.46 - Cholera 9.47 - Giardiasis 9.48 - Amoebiasis 9.49 - Neurocysticercosis 9.50 - Tetanus 9.51 - Lyme disease 10 - Renal and urological emergencies 10.1 - Pathophysiology 10.2 - Haematuria 10.3 - Reduced urinary output (anuria/oliguria) 10.4 - Acute kidney injury 10.5 - Chronic kidney disease 10.6 - Urinary tract infection 10.7 - Renal obstruction (obstructive uropathy) 10.8 - Nephrolithiasis 10.9 - Ischaemic priapism 11 - Neurological emergencies 11.1 - Neuroscience and neuroanatomy 11.2 - Clinical assessment 11.3 - Patterns of weakness 11.4 - Coma 11.5 - Acute headache 11.6 - Primary headaches 11.7 - Secondary headaches 11.8 - Acute delirium/confusion 11.9 - Viral encephalitis 11.10 - Rabies 11.11 - Acute bacterial meningitis 11.12 - Acute viral (aseptic) meningitis 11.13 - Cerebral abscess 11.14 - Septic cavernous sinus thrombosis 11.15 - Idiopathic intracranial hypertension 11.16 - Seizures: status epilepticus 11.17 - Non-convulsive status epilepticus 11.18 - Neuroleptic malignant syndrome 11.19 - Cerebrovascular disease 11.20 - Transient ischaemic attacks 11.21 - Ischaemic stroke 11.22 - Haemorrhagic stroke 11.23 - Subarachnoid haemorrhage 11.24 - Cerebral hyperperfusion syndrome 11.25 - Subdural haematoma 11.26 - Epidural haematoma/head trauma 11.27 - Guillain–Barré syndrome 11.28 - Myasthenia gravis 11.29 - Acute cord injury 11.30 - Acute transverse myelitis 11.31 - Acute dystonic reactions 11.32 - Acute vertigo 11.33 - Bell’s palsy/Ramsay Hunt syndrome 11.34 - Acute demyelination 11.35 - Acute peripheral mononeuropathy 11.36 - Motor neurone disease (amyotrophic lateral sclerosis) 11.37 - Dementias 11.38 - Acute hydrocephalus and shunts 11.39 - Managing raised intracranial pressure 11.40 - Cerebral oedema 11.41 - Neurosurgical options 12 - Rheumatological emergencies 12.1 - Septic arthritis 12.2 - Osteomyelitis 12.3 - Reactive arthritis 12.4 - Acute gout and pseudogout 12.5 - Rheumatoid arthritis 12.6 - Trauma and fractures in elderly 12.7 - Proximal femoral fracture 12.8 - Fractured pubic ramus 13 - Ophthalmological emergencies 13.1 - Acute visual loss 13.2 - Red eye 13.3 - Neuro-ophthalmology 13.4 - Giant cell (temporal) arteritis 14 - Toxicology emergencies 14.1 - Reduce absorption or increase excretion/elimination of toxins 14.2 - Supportive management of specific issues 14.3 - Intralipid therapy 14.4 - (High dose) Insulin–glucose euglycaemic therapy 14.5 - Amphetamine (‘speed’) and 3,4 MDMA (‘ecstasy’) toxicity 14.6 - Beta-blocker toxicity 14.7 - Benzodiazepine toxicity 14.8 - Calcium channel blocker toxicity 14.9 - Sodium valproate toxicity 14.10 - Carbon monoxide toxicity 14.11 - Cocaine toxicity 14.12 - Local anaesthetic toxicity 14.13 - Cyanide toxicity 14.14 - Digoxin toxicity 14.15 - Ethanol (C2H5OH) toxicity 14.16 - Ethylene glycol toxicity 14.17 - Methanol toxicity 14.18 - Gamma hydroxybutyrate (GHB) toxicity 14.19 - Insulin toxicity 14.20 - Iron (ferrous sulphate) toxicity 14.21 - Lithium toxicity 14.22 - Monoamine oxidase inhibitors toxicity 14.23 - Neuroleptics toxicity 14.24 - Direct (novel) oral anticoagulants toxicity 14.25 - Non-steroidal anti-inflammatory drugs (NSAIDs) toxicity 14.26 - Opioid/opiate toxicity 14.27 - Organophosphate/carbamates toxicity 14.28 - Paracetamol (acetaminophen) toxicity 14.29 - Paraquat toxicity 14.30 - Chloroquine/quinine toxicity 14.31 - Salicylate toxicity 14.32 - SSRI/SNRI toxicity 14.33 - Tricyclic antidepressant toxicity 14.34 - Theophylline toxicity 14.35 - Body packers (‘mules’) 14.36 - Cannabis toxicity 14.37 - Sulphonylurea toxicity 14.38 - Methaemoglobinaemia 14.39 - Phenobarbital toxicity 14.40 - Carbamazepine toxicity 14.41 - Lead, arsenic, mercury, thallium (heavy metal) toxicity 15 - Medical emergencies in pregnancy 15.1 - Medical problems in pregnancy 15.2 - Pharmacology in pregnancy 15.3 - Amniotic fluid embolism 15.4 - Hypertension in pregnancy 15.5 - Eclampsia and pre-eclampsia 15.6 - Diabetes in pregnancy 15.7 - Acute hepatobiliary disease in pregnancy 15.8 - Diagnoses and management of liver disease in pregnancy 15.9 - Pulmonary embolism and pregnancy 15.10 - Acute severe asthma in pregnancy 15.11 - Status epilepticus in pregnancy 15.12 - Cardiac disease in pregnancy 15.13 - Inflammatory bowel disease and pregnancy 16 - Oncological emergencies 16.1 - Malignancy-related hypercalcaemia 16.2 - Tumour lysis syndrome 16.3 - Hyperviscosity syndrome 16.4 - Brain tumour 16.5 - Neutropenic sepsis 16.6 - Malignant superior vena caval obstruction 16.7 - Severe nausea and vomiting 16.8 - Malignant spinal cord compression 17 - Miscellaneous emergencies 17.1 - Abnormal gaits 17.2 - Falls with no altered consciousness 17.3 - Fat embolism 17.4 - Air embolism 17.5 - Refeeding syndrome 17.6 - Accidental hypothermia 17.7 - Malignant hyperpyrexia 17.8 - Acute rhabdomyolysis 17.9 - Painful leg 17.10 - Acute limb ischaemia 17.11 - Abdominal aortic aneurysm 18 - Dermatological emergencies 18.1 - Introduction 18.2 - Toxic epidermal necrolysis/Stevens–Johnson syndrome 18.3 - Cellulitis/erysipelas, bites, surgery 18.4 - Erythroderma (exfoliative dermatitis) 18.5 - Severe (erythrodermic/pustular) psoriasis 18.6 - Necrotising fasciitis 18.7 - Other important rashes for acute physicians 19 - General management 19.1 - Enteral feeding 19.2 - Parenteral feeding 19.3 - Pain management 19.4 - WHO pain ladder 19.5 - Using opiates and other analgesics 19.6 - Venous thromboembolism prevention 19.7 - Duties of a doctor 19.8 - Medical errors, harm and duty of candour 19.9 - Never events – events that should ‘never’ occur 19.10 - Risk management and risk register 19.11 - Duty of candour 19.12 - Discharging patients safely 19.13 - Self-discharge 19.14 - Suicidal patients 19.15 - Common law and Mental Health Act 19.16 - Mental capacity 19.17 - Managing opiate addicts 19.18 - Driving and disease 19.19 - Do not attempt cardiopulmonary resuscitation (DNACPR) 19.20 - End of life care 19.21 - Palliative care drugs 19.22 - Roles and responsibilities after death 19.23 - Death certification 19.24 - Managing inpatients with pressure sores and ulcers 19.25 - Rehabilitation, function and discharge 19.26 - Drains and tubes 19.27 - Surgical problems and referrals 20 - Procedures 20.1 - Checks before any procedure 20.2 - Venepuncture 20.3 - Chest drain insertion 20.4 - Central venous line insertion 20.5 - Lumbar puncture 20.6 - Abdominal paracentesis 20.7 - Arterial blood gas 20.8 - Nasogastric tube insertion 21 - Normal laboratory values 21.1 - Clinical chemistry values 21.2 - Haematology values 21.3 - CSF values 22 - Emergency drugs (use with BNF) 22.1 - Prescribing and side effects abbreviations 22.2 - Antibiotic prescribing advice 22.3 - Commonly used and emergency drugs 22.4 - Important drug interactions and metabolism 22.5 - Potentially fatal drug errors 22.6 - Prescribing warfarin 22.7 - Steroids Index