Acute Medicine A Practical Guide to the 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.

David Sprigings, Consultant Physician 1993-2016, Northampton General Hospital, Northampton, UK.

John B. Chambers, Professor of Clinical Cardiology and Consultant Cardiologist, Guy's and St Thomas' Hospitals, London, UK.

Contributors, xi

Preface, xix

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

Section 1: Presentations in Acute Medicine, 1

General, 2

1 The critically ill patient, 3

2 Hypotension and shock, 9

3 Reduced conscious level, 16

4 Delirium, 23

5 Falls in older people, 30

Cardiorespiratory, 34

6 Cardiac arrest in hospital, 35

7 Acute chest pain, 46

8 Palpitations, 53

9 Transient loss of consciousness, 60

10 Acute breathlessness, 68

11 Acute respiratory failure, 73

12 Pleural effusion, 79

13 Cough and haemoptysis, 85

Neurological, 91

14 Neurological diagnosis in acute medicine, 92

15 Acute headache, 98

16 Seizures and epilepsy, 103

17 Weakness and paralysis, 110

18 Acute sensory symptoms, 117

19 Loss of vision, 123

Abdominal, 132

20 Acute vomiting, 133

21 Acute abdominal pain, 138

22 Acute diarrhoea, 144

23 Acute jaundice, 150

24 Ascites, 155

25 Acute kidney injury, 160

Skin and Musculoskeletal, 170

26 Acute rash, 171

27 Urticaria and angioedema, 177

28 Acute arthritis, 183

29 Acute spinal pain, 187

30 Acute limb pain, 190

Miscellaneous, 194

31 Comprehensive geriatric assessment, 195

32 Acute medical problems in pregnancy, 199

33 Fever on return from abroad, 207

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

Section 2: Syndromes and Disorders, 223

General, 224

35 Sepsis, 225

36 Poisoning, 233

37 Acid-base disorders, 246

38 Anaphylaxis, 252

Cardiovascular, 258

39 Acute arrhythmias: general principles of management, 259

40 Regular broad complex tachycardia, 263

41 Irregular broad complex tachycardia, 268

42 Narrow complex tachycardia, 272

43 Atrial fibrillation and flutter, 279

44 Bradycardia and atrioventricular block, 283

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

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

47 Acute pulmonary oedema, 305

48 Acute heart failure and decompensated chronic heart failure, 311

49 Cardiogenic shock, 317

50 Aortic dissection and other acute aortic syndromes, 321

51 Heart valve disease and prosthetic heart valves, 328

52 Infective endocarditis, 333

53 Acute pericarditis, 340

54 Cardiac tamponade, 344

55 Severe hypertension, 347

56 Deep vein thrombosis, 353

57 Pulmonary embolism, 358

58 Problems with pacemakers and other cardiac devices, 366

Respiratory, 371

59 Upper airway obstruction, 372

60 Acute asthma, 378

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

62 Community-acquired pneumonia, 390

63 Hospital-acquired pneumonia, 396

64 Pneumothorax, 399

Neurological, 402

65 Stroke, 403

66 Transient ischaemic attack, 412

67 Subarachnoid haemorrhage, 418

68 Bacterial meningitis, 422

69 Encephalitis, 428

70 Spinal cord compression, 432

71 Guillain-Barré syndrome, 436

72 Raised intracranial pressure, 442

Abdominal, 446

73 Acute upper gastrointestinal bleeding, 447

74 Acute lower gastrointestinal bleeding, 455

75 Acute oesophageal disorders, 459

76 Inflammatory bowel disease flare, 462

77 Acute liver failure and decompensated chronic liver disease, 467

78 Alcoholic hepatitis, 476

79 Biliary tract disorders and acute pancreatitis, 478

80 Urinary tract infection, 481

Metabolic, 487

81 Hypoglycaemia, 488

82 Hyperglycaemic states, 491

83 Diabetic ketoacidosis, 495

84 Hyperosmolar hyperglycaemic state, 499

85 Disorders of plasma sodium concentration, 501

86 Disorders of plasma potassium concentration, 508

87 Disorders of plasma calcium concentration, 514

88 Disorders of plasma magnesium concentration, 518

89 Disorders of plasma phosphate concentration, 521

90 Acute adrenal insufficiency, 525

91 Thyrotoxic storm, 530

92 Myxoedema coma, 534

93 Pituitary apoplexy, 537

94 Paraganglioma (phaeochromocytoma) crisis, 540

Skin and Musculoskeletal, 543

95 Cellulitis and necrotizing fasciitis, 544

96 Erythroderma and toxic epidermal necrolysis, 549

97 Acute gout and pseudogout, 555

98 Septic arthritis, 558

99 Acute vasculitis, 561

Haematology and Miscellaneous, 568

100 Interpretation of full blood count and film, 569

101 Pancytopenia and febrile neutropenia, 577

102 Bleeding disorders, 584

103 Management of anticoagulation, 589

104 Acute painful sickle cell crisis, 601

105 Complications of cancer, 605

106 Alcohol-related problems in acute medicine, 612

107 Hypothermia, 615

108 Drowning, 619

109 Electrical injury, 623

110 Palliative and end-of-life care, 625

111 Medicolegal issues in acute medicine, 632

Section 3: Techniques and Procedures in Acute Medicine, 639

112 Airway management, 641

113 Non-invasive ventilation, 646

114 Ultrasonography in acute medicine, 651

115 Reading a chest X-ray, 657

116 Central vein cannulation, 665

117 Arterial blood sampling and cannulation, 673

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

119 Temporary cardiac pacing, 681

120 Pericardial aspiration (pericardiocentesis), 687

121 DC cardioversion, 692

122 Insertion of an intercostal chest drain, 696

123 Lumbar puncture, 704

124 Aspiration of the knee joint, 709

125 Insertion of a Sengstaken-Blakemore tube, 712

Index, 715

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