BOOK
Textbook of Adult Emergency Medicine E-Book
Peter Cameron | Mark Little | George Jelinek | Anne-Maree Kelly | Anthony F. T. Brown
(2014)
Additional Information
Book Details
Abstract
Now fully revised and updated, Textbook of Adult Emergency Medicine provides clear and consistent coverage of this rapidly evolving specialty. Building on the success of previous editions, it covers all the major topics that present to the trainee doctor in the emergency department. It will also prove invaluable to the range of other professionals working in this setting - including nurse specialists and paramedics - who require concise, highly practical guidance, incorporating latest best practices and current guidelines.
For the first time, this edition now comes with access to addtional ancillary meterial, including practical procdure videos and self-assessment material.
- Updates throughout reflect latest practice developments, curricula requirements and essential guidelines
- Key point boxes highlight topic ‘essentials’ as well as controversial areas of treatment
- An expanded list of leading international contributors ensures comprehensive coverage and maximizes worldwide relevance
- New and enhanced coverage of important and topical areas - including latest imaging in emergency medicine; organ donation; massive transfusion protocols; medico legal issues; patient safety and quality measures
- All new accompanying electronic ancillariy material, including procedure videos and self-assessment materials to check your understanding and aid exam preparation
- Expansion of administration section - especially patient safety
- New and enhanced coverage of important and topical areas - including latest imaging in emergency medicine; organ donation; massive transfusion protocols; medico legal issues; patient safety and quality measures
- All new accompanying electronic ancillary materials - including practical procedures videos and self-assessment materials
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Textbook of Adult Emergency Medicine | iii | ||
| Copyright Page | iv | ||
| Contents | v | ||
| Preface to Fourth Edition | xi | ||
| Contributors | xiii | ||
| International Advisory Board | xxiii | ||
| Introduction | xxv | ||
| Definition | xxv | ||
| The development of emergency medicine | xxv | ||
| Scope of practice | xxvi | ||
| The future | xxvi | ||
| 1 Resuscitation | 1 | ||
| 1.1 Basic Life Support | 1 | ||
| Introduction | 1 | ||
| Development of protocols | 1 | ||
| DRSABCD approach to Basic Life Support | 2 | ||
| Management | 3 | ||
| Defibrillation | 4 | ||
| Basic Life Support (BLS) summary | 5 | ||
| References | 5 | ||
| 1.2 Advanced Life Support | 6 | ||
| Introduction | 6 | ||
| Aetiology and incidence of cardiac arrest | 6 | ||
| Advanced Life Support guidelines and algorithms | 6 | ||
| Initiation of ALS | 7 | ||
| Attachment of the defibrillator-monitor and rhythm recognition | 7 | ||
| Defibrillation | 8 | ||
| CPR ‘Code Blue’ process | 9 | ||
| Other ALS interventions | 10 | ||
| Drug therapy in ALS | 11 | ||
| Haemodynamic monitoring during CPR | 12 | ||
| Post-resuscitation care | 12 | ||
| When to discontinue ALS | 12 | ||
| Prognosis for survival after cardiac arrest | 13 | ||
| 2 Critical Care | 14 | ||
| 2.1 Airway and ventilation management | 14 | ||
| Introduction | 14 | ||
| Non-invasive ventilation | 14 | ||
| Endotracheal intubation | 15 | ||
| Difficult intubation | 18 | ||
| Laryngeal mask airway | 18 | ||
| Video-laryngoscope assisted intubation | 19 | ||
| Cricothyroidotomy | 19 | ||
| Mechanical ventilation | 20 | ||
| Extubation in the emergency department | 20 | ||
| 2.2 Oxygen therapy | 21 | ||
| Introduction | 21 | ||
| Physiology of oxygen | 22 | ||
| Oxygen delivery systems | 23 | ||
| Variable-performance systems | 24 | ||
| Fixed-performance systems | 24 | ||
| 100% oxygen delivery systems | 25 | ||
| Helium and oxygen mixtures | 27 | ||
| Measurement of oxygenation | 27 | ||
| Paediatric considerations in oxygen therapy | 27 | ||
| Transfer of patients on oxygen therapy | 28 | ||
| Oxygen therapy in specific circumstances | 28 | ||
| Goal-directed oxygen therapy | 30 | ||
| Special delivery systems | 30 | ||
| Complications of oxygen therapy | 31 | ||
| 2.3 Haemodynamic monitoring | 32 | ||
| Introduction | 32 | ||
| Historical background | 32 | ||
| Overview of cardiovascular physiology | 32 | ||
| Role of haemodynamic monitoring in the emergency department | 33 | ||
| Clinical assessment | 33 | ||
| Blood pressure monitoring | 34 | ||
| Other non-invasive monitoring methods for cardiac output | 34 | ||
| Invasive devices | 35 | ||
| Conclusion | 37 | ||
| Future developments | 37 | ||
| 2.4 Shock overview | 38 | ||
| Introduction | 38 | ||
| Aetiology and epidemiology | 38 | ||
| Pathophysiology | 39 | ||
| Clinical features | 40 | ||
| Initial management of shock | 40 | ||
| Guidance for interventions and treatments | 41 | ||
| Interventions in shock | 42 | ||
| Effects of shock on other interventions | 44 | ||
| Management of specific shock syndromes | 44 | ||
| Conclusion | 47 | ||
| 2.5 Sepsis and septic shock | 48 | ||
| Introduction | 48 | ||
| Aetiology and pathophysiology | 48 | ||
| Clinical features | 48 | ||
| Clinical investigations | 49 | ||
| Treatment | 49 | ||
| 2.6 Arterial blood gases | 52 | ||
| Introduction | 52 | ||
| Technical aspects of arterial blood gas analysis | 52 | ||
| Interpretation | 53 | ||
| Pathophysiology of hypoxaemic respiratory failure | 54 | ||
| Acid–base balance | 55 | ||
| Venous blood gases | 58 | ||
| 2.7 Cerebral resuscitation after cardiac arrest | 59 | ||
| Introduction | 59 | ||
| Definition | 59 | ||
| Pathophysiology of cerebral ischaemia | 59 | ||
| Reperfusion injury | 59 | ||
| Cerebral haemodynamics after reperfusion | 59 | ||
| Pharmacological interventions | 60 | ||
| Therapeutic hypothermia | 60 | ||
| Hyperoxia compared with normoxia after resuscitation | 61 | ||
| Other interventions | 61 | ||
| Outcome prediction | 61 | ||
| 2.8 Anaphylaxis | 62 | ||
| Introduction | 62 | ||
| Definition | 62 | ||
| Aetiology | 63 | ||
| Epidemiology | 64 | ||
| Pathophysiology | 65 | ||
| Clinical features | 66 | ||
| Differential diagnosis | 66 | ||
| Clinical investigations | 67 | ||
| Management | 67 | ||
| Disposition | 69 | ||
| Discharge policy | 69 | ||
| 3 Trauma | 71 | ||
| 3.1 Trauma overview | 71 | ||
| Epidemiology | 71 | ||
| Initial management | 73 | ||
| Trauma audit | 75 | ||
| Trauma in developing countries | 75 | ||
| 3.2 Neurotrauma | 77 | ||
| Introduction | 77 | ||
| Pathogenesis | 77 | ||
| Epidemiology | 78 | ||
| Prevention | 78 | ||
| Clinical features | 78 | ||
| Clinical investigations | 79 | ||
| Treatment | 79 | ||
| Disposition | 80 | ||
| Prognosis | 81 | ||
| 3.3 Spinal trauma | 82 | ||
| Introduction | 82 | ||
| Pathophysiology | 82 | ||
| Autonomic nervous system effects of spinal cord damage | 83 | ||
| Pre-hospital issues | 83 | ||
| Immobilization of the spine | 83 | ||
| First treatment options | 84 | ||
| Clearing the spine | 85 | ||
| Secondary survey, referral-disposition and definitive treatment | 86 | ||
| Specific conditions | 87 | ||
| Documentation conventions | 91 | ||
| 3.4 Facial trauma | 95 | ||
| Introduction | 95 | ||
| History | 95 | ||
| Examination | 95 | ||
| Radiographic examination | 96 | ||
| Immediate management in the emergency department | 96 | ||
| Specific injuries | 97 | ||
| Penetrating injuries to the face | 98 | ||
| Conclusion | 98 | ||
| 3.5 Abdominal trauma | 99 | ||
| Introduction | 99 | ||
| Primary and secondary surveys | 100 | ||
| Penetrating injuries | 102 | ||
| Disposition | 103 | ||
| Future directions | 103 | ||
| 3.6 Chest trauma | 104 | ||
| Introduction | 104 | ||
| Principles of initial management | 104 | ||
| Indications for emergency thoracotomy | 105 | ||
| Thoracic injuries | 105 | ||
| Tracheobronchial injury | 107 | ||
| Likely developments | 109 | ||
| Conclusion | 109 | ||
| 3.7 Limb trauma | 110 | ||
| Introduction | 110 | ||
| Fractures | 110 | ||
| Associated injuries | 110 | ||
| Presentation | 111 | ||
| Investigations | 111 | ||
| Management | 112 | ||
| Management of the mangled extremity | 113 | ||
| Hyperbaric oxygen therapy | 114 | ||
| Disposition | 114 | ||
| Complications | 114 | ||
| Immobilization | 116 | ||
| 3.8 Radiology in major trauma | 117 | ||
| Emergency department reception | 117 | ||
| Hazards of radiation | 117 | ||
| The trauma series | 117 | ||
| Specific regional radiology | 118 | ||
| Chest trauma | 126 | ||
| Abdomen/pelvis | 128 | ||
| Extremities | 132 | ||
| Conclusion | 133 | ||
| 3.9 Trauma in pregnancy | 134 | ||
| Introduction | 134 | ||
| Anatomical and physiological changes in pregnancy | 134 | ||
| Epidemiology | 135 | ||
| Specific injuries | 135 | ||
| Presentation | 135 | ||
| Investigations | 136 | ||
| Management | 136 | ||
| Disposition | 136 | ||
| Prognosis | 137 | ||
| Prevention | 137 | ||
| 3.10 Wound care and repair | 138 | ||
| Introduction | 138 | ||
| Clinical presentation | 138 | ||
| Wound cleansing | 139 | ||
| Tetanus prophylaxis | 140 | ||
| Wound-healing mechanisms | 141 | ||
| Suture types | 141 | ||
| Needles | 142 | ||
| Basic suture technique | 143 | ||
| Special sites and situations | 145 | ||
| Special suture techniques | 148 | ||
| The ‘dog-ear’ | 148 | ||
| Wound drainage | 148 | ||
| Dressings | 148 | ||
| Immobilization | 149 | ||
| Disposal/removal | 150 | ||
| Likely developments over the next 5 to 10 years | 150 | ||
| 3.11 Burns | 151 | ||
| Introduction | 151 | ||
| Pathophysiology | 151 | ||
| Classification | 151 | ||
| Thermal burns | 152 | ||
| Presentation | 152 | ||
| Examination | 152 | ||
| Evaluation of burn area | 152 | ||
| Management | 152 | ||
| Burn shock | 154 | ||
| Inhalation injury | 155 | ||
| Disposition | 155 | ||
| Chemical burns | 155 | ||
| Specific chemicals | 156 | ||
| 3.12 Massive transfusion | 157 | ||
| What is a massive transfusion? | 157 | ||
| Predicting massive transfusion | 157 | ||
| Preparation | 158 | ||
| Reception | 158 | ||
| History | 158 | ||
| Examination | 158 | ||
| Investigations | 159 | ||
| Circulatory management | 159 | ||
| Massive transfusion guidelines | 159 | ||
| Acute traumatic coagulopathy | 161 | ||
| Future directions | 161 | ||
| 4 Orthopaedic Emergencies | 163 | ||
| 4.1 Injuries of the shoulder | 163 | ||
| Fractures of the clavicle | 163 | ||
| Acromioclavicular joint injuries | 164 | ||
| Sternoclavicular subluxation and dislocation | 164 | ||
| Fractures of the scapula | 165 | ||
| Supraspinatus tendon injuries | 165 | ||
| Dislocation of the shoulder | 165 | ||
| 4.2 Fractures of the humerus | 167 | ||
| Introduction | 167 | ||
| Fractures of the proximal humerus | 167 | ||
| Fractures of the shaft of humerus | 169 | ||
| Fractures of the distal humerus | 170 | ||
| 4.3 Dislocations of the elbow | 171 | ||
| Introduction | 171 | ||
| Clinical assessment | 171 | ||
| Clinical investigations | 171 | ||
| Treatment | 171 | ||
| Disposition | 172 | ||
| 4.4 Fractures of the forearm \nand carpal bones | 173 | ||
| Radial head fractures | 173 | ||
| Shaft fractures | 174 | ||
| Fractures of the distal radius and ulna | 175 | ||
| Carpal fractures and dislocations | 177 | ||
| 4.5 Hand injuries | 178 | ||
| Introduction | 178 | ||
| Clinical features | 178 | ||
| Clinical investigations | 179 | ||
| Treatment | 179 | ||
| Fingertip injuries | 180 | ||
| Digital nerve injuries | 180 | ||
| Nailbed injuries | 180 | ||
| Distal interphalangeal joint injuries | 181 | ||
| Middle phalangeal injuries | 181 | ||
| Proximal interphalangeal joint injuries | 181 | ||
| Proximal phalangeal injuries | 181 | ||
| Metacarpophalangeal joint injuries | 181 | ||
| Metacarpal injuries | 181 | ||
| Dorsal hand injuries | 182 | ||
| Palmar hand injuries | 182 | ||
| Disposition | 182 | ||
| Prognosis | 182 | ||
| Prevention | 182 | ||
| 4.6 Pelvic injuries | 183 | ||
| Anatomy | 183 | ||
| Classification of pelvic fractures | 183 | ||
| Clinical assessment | 184 | ||
| Injuries associated with pelvic fractures | 184 | ||
| Management of the unstable pelvic fracture | 185 | ||
| Open pelvic fracture | 185 | ||
| Acetabular fractures | 185 | ||
| Stable fracture of the pelvis | 186 | ||
| 4.7 Hip injuries | 187 | ||
| Anatomy | 187 | ||
| Classification of hip fractures | 187 | ||
| Hip dislocation | 189 | ||
| 4.8 Femur injuries | 191 | ||
| Femoral shaft fracture | 191 | ||
| 4.9 Knee injuries | 192 | ||
| Anatomy | 192 | ||
| Clinical assessment | 192 | ||
| Fractures around the knee joint | 193 | ||
| Dislocations around the knee joint | 195 | ||
| Soft-tissue knee injuries | 196 | ||
| 4.10 Tibia and fibula injuries | 199 | ||
| Anatomy | 199 | ||
| Fractures of the tibia | 199 | ||
| Fractures of the fibula | 201 | ||
| 4.11 Ankle joint injuries | 202 | ||
| Anatomy | 202 | ||
| Clinical assessment | 202 | ||
| Ankle fracture classification | 203 | ||
| Fracture management | 203 | ||
| Tibial plafond (pilon) fractures | 203 | ||
| Maisonneuve fracture | 203 | ||
| Ankle dislocations | 204 | ||
| Soft-tissue injuries | 204 | ||
| 4.12 Foot injuries | 205 | ||
| Anatomy | 205 | ||
| Clinical assessment | 205 | ||
| Hindfoot injuries | 206 | ||
| Midfoot fractures | 207 | ||
| Forefoot fractures and dislocations | 208 | ||
| 4.13 Osteomyelitis | 210 | ||
| Introduction | 210 | ||
| Aetiology, pathogenesis and pathology | 210 | ||
| Epidemiology | 210 | ||
| Clinical features | 210 | ||
| Examination | 210 | ||
| Investigations | 211 | ||
| Imaging studies | 211 | ||
| Differential diagnosis | 211 | ||
| Microbiology | 211 | ||
| Management | 211 | ||
| Prognosis | 212 | ||
| Prevention | 212 | ||
| 5 Cardiovascular Emergencies | 213 | ||
| 5.1 Chest pain | 213 | ||
| Introduction | 213 | ||
| Epidemiology | 213 | ||
| Differential diagnosis | 214 | ||
| Clinical features | 214 | ||
| Clinical investigations | 215 | ||
| Treatment | 218 | ||
| Prognosis | 218 | ||
| Likely developments over the next 5–10 years | 218 | ||
| 5.2 Acute coronary syndromes | 220 | ||
| Introduction | 220 | ||
| Aetiology, pathogenesis and pathology | 220 | ||
| Epidemiology | 220 | ||
| Prevention | 221 | ||
| Clinical features | 221 | ||
| Differential diagnosis | 221 | ||
| Clinical investigations | 221 | ||
| Criteria for diagnosis | 222 | ||
| Treatment | 223 | ||
| Disposition | 224 | ||
| Complications | 225 | ||
| Prognosis | 225 | ||
| Likely developments over the next 5–10 years | 226 | ||
| 5.3 Assessment and management of acute pulmonary oedema | 227 | ||
| Introduction | 227 | ||
| Aetiology and pathophysiology | 227 | ||
| Clinical assessment | 227 | ||
| Clinical investigations | 228 | ||
| Treatment | 229 | ||
| 5.4 Arrhythmias | 232 | ||
| Introduction | 232 | ||
| Pathophysiology and pathogenesis | 232 | ||
| Principles of assessment and management | 232 | ||
| Bradyarrhythmias | 232 | ||
| Sinus bradycardia | 233 | ||
| Sick sinus syndrome (bradycardia–tachycardia syndrome) | 233 | ||
| Heart block | 233 | ||
| Tachyarrhythmias | 235 | ||
| Broad complex tachycardias | 235 | ||
| Narrow complex tachycardias | 238 | ||
| Left anterior fascicular block | 242 | ||
| Left posterior fascicular block | 242 | ||
| Right bundle branch block | 242 | ||
| Left bundle branch block | 242 | ||
| Combination blocks | 243 | ||
| Other Disturbances of Cardiac Rhythm and Conduction | 243 | ||
| Atrial ectopics | 243 | ||
| Junctional rhythm | 243 | ||
| Brugada syndrome | 243 | ||
| 5.5 Pulmonary embolism | 244 | ||
| Introduction | 244 | ||
| Aetiology, pathogenesis and pathology | 245 | ||
| Prevention | 245 | ||
| Clinical Features | 245 | ||
| Investigations | 245 | ||
| Treatment | 249 | ||
| Prognosis | 251 | ||
| Disposition | 251 | ||
| 5.6 Pericarditis, cardiac tamponade and myocarditis | 252 | ||
| Introduction | 252 | ||
| Clinical features | 252 | ||
| Clinical investigation | 252 | ||
| Criteria for diagnosis | 253 | ||
| Treatment | 254 | ||
| Disposition | 254 | ||
| Non-Traumatic Cardiac Tamponade | 255 | ||
| Introduction | 255 | ||
| Clinical features | 255 | ||
| Differential diagnosis | 255 | ||
| Clinical investigations | 255 | ||
| Treatment | 256 | ||
| Disposition | 256 | ||
| Myocarditis | 257 | ||
| Introduction | 257 | ||
| Pathogenesis and pathophysiology | 257 | ||
| Epidemiology | 257 | ||
| Clinical features | 257 | ||
| Clinical investigations | 257 | ||
| Treatment and disposition | 258 | ||
| Prognosis | 258 | ||
| 5.7 Heart valve emergencies | 259 | ||
| Introduction | 259 | ||
| Infective endocarditis | 259 | ||
| Acute aortic incompetence | 263 | ||
| Acute deterioration in chronic aortic incompetence | 264 | ||
| Acute deterioration in critical aortic stenosis | 264 | ||
| Acute deterioration in mitral stenosis | 265 | ||
| Acute mitral incompetence | 266 | ||
| Acute deterioration in chronic mitral incompetence | 266 | ||
| Prosthetic valve complications | 267 | ||
| 5.8 Peripheral vascular disease | 268 | ||
| Arterial disease | 268 | ||
| Chronic arterial ischaemia | 268 | ||
| Acute arterial ischaemia \nof the lower limb | 269 | ||
| Acute arterial ischaemia \nof the upper limb | 270 | ||
| Venous disease: lower limb | 270 | ||
| Venous insufficiency and varicose veins | 270 | ||
| Superficial venous thrombosis | 270 | ||
| Deep venous thrombosis | 270 | ||
| Venous disease: upper limb | 272 | ||
| Likely developments over the next 5–10 years | 272 | ||
| 5.9 Hypertension | 273 | ||
| Introduction | 273 | ||
| Epidemiology | 273 | ||
| Hypertensive emergencies | 273 | ||
| Hypertensive urgency | 276 | ||
| Developments in the next 5–10 years | 276 | ||
| 5.10 Aortic dissection | 277 | ||
| Introduction | 277 | ||
| Epidemiology, pathophysiology and classification | 277 | ||
| Classification | 278 | ||
| Clinical features | 278 | ||
| Clinical investigations | 279 | ||
| Differential diagnosis | 280 | ||
| Treatment | 280 | ||
| Prognosis | 281 | ||
| Disposition | 281 | ||
| 5.11 Aneurysms | 282 | ||
| Abdominal aortic aneurysm | 282 | ||
| Thoracic aortic aneurysm | 284 | ||
| Peripheral aneurysms | 284 | ||
| Future developments | 285 | ||
| 6 Respiratory Emergencies | 286 | ||
| 6.1 Upper respiratory tract | 286 | ||
| Introduction | 286 | ||
| Triage and initial evaluation | 286 | ||
| Upper-airway obstruction | 287 | ||
| Foreign body airwayobstruction | 288 | ||
| Blunt trauma | 288 | ||
| Penetrating trauma | 289 | ||
| Thermal injury | 289 | ||
| Infections | 289 | ||
| Further reading | 291 | ||
| 6.2 Asthma | 292 | ||
| Introduction | 292 | ||
| Epidemiology | 292 | ||
| Aetiology, pathophysiologyand pathology | 292 | ||
| Clinical assessment | 293 | ||
| Clinical investigations | 293 | ||
| Treatment | 293 | ||
| Disposition | 295 | ||
| Further reading | 295 | ||
| 6.3 Community-acquired pneumonia | 296 | ||
| Introduction | 296 | ||
| Epidemiology | 296 | ||
| Clinical features | 296 | ||
| Pathogenesis and aetiology | 297 | ||
| Prevention | 299 | ||
| Differential diagnosis | 299 | ||
| Complications | 299 | ||
| Clinical investigations | 299 | ||
| Severity assessment | 301 | ||
| Treatment | 303 | ||
| Likely developments over the next 5–10 years | 305 | ||
| Acknowledgements | 306 | ||
| Further reading | 306 | ||
| 6.4 Influenza and emerging respiratory infections | 306 | ||
| Introduction | 306 | ||
| History | 307 | ||
| Epidemiology and pathology | 307 | ||
| Clinical features | 308 | ||
| Clinical investigations | 308 | ||
| Treatment | 309 | ||
| Prognosis | 309 | ||
| Prevention | 309 | ||
| Avian influenza | 309 | ||
| Organizational issues | 310 | ||
| Likely development over the next 5–10 years | 310 | ||
| Further reading | 310 | ||
| 6.5 Chronic obstructive pulmonary disease | 311 | ||
| Introduction | 311 | ||
| Aetiology, genetics, pathogenesis and pathology | 311 | ||
| Epidemiology | 311 | ||
| Clinical features | 311 | ||
| Clinical investigations | 312 | ||
| Treatment | 313 | ||
| Prognosis | 315 | ||
| Further reading | 315 | ||
| 6.6 Pneumothorax | 316 | ||
| Introduction | 316 | ||
| Aetiology, genetics, pathogenesis and pathology | 316 | ||
| Clinical features | 317 | ||
| Differential diagnosis | 317 | ||
| Clinical investigation | 317 | ||
| Treatment | 318 | ||
| Prognosis | 319 | ||
| Other issues | 319 | ||
| Further reading | 319 | ||
| 6.7 Pleural effusion | 320 | ||
| Introduction | 320 | ||
| Aetiology, pathogenesis and pathology | 320 | ||
| Clinical features | 320 | ||
| Clinical investigations | 321 | ||
| Treatment and prognosis | 323 | ||
| Complications | 323 | ||
| Disposition | 323 | ||
| Further reading | 323 | ||
| 6.8 Haemoptysis | 324 | ||
| Introduction | 324 | ||
| Aetiology | 324 | ||
| Clinical features | 324 | ||
| Differential diagnosis | 325 | ||
| Clinical investigations | 325 | ||
| Treatment | 325 | ||
| Massive haemoptysis | 325 | ||
| Further reading | 326 | ||
| 7 Digestive Emergencies | 327 | ||
| 7.1 Dysphagia | 327 | ||
| Introduction | 327 | ||
| Aetiology | 327 | ||
| Clinical features | 327 | ||
| Clinical investigations | 328 | ||
| Treatment | 328 | ||
| Disposition | 328 | ||
| 7.2 Approach to abdominal pain | 329 | ||
| Introduction | 329 | ||
| Epidemiology, pathophysiology and differential diagnosis | 329 | ||
| Clinical features | 330 | ||
| Clinical investigations | 333 | ||
| Pitfalls | 335 | ||
| Diagnosis versus disposition | 336 | ||
| Treatment | 336 | ||
| Disposition | 337 | ||
| Non-specific abdominal pain | 337 | ||
| Developments in the next 5–10 years | 337 | ||
| 7.3 Bowel obstruction | 338 | ||
| Pathology and pathophysiology | 338 | ||
| Clinical features | 338 | ||
| Clinical investigations | 339 | ||
| Treatment and prognosis | 339 | ||
| 7.4 Hernia | 340 | ||
| Introduction | 340 | ||
| Aetiology, pathology and clinical features | 340 | ||
| Complications | 341 | ||
| Treatment | 341 | ||
| 7.5 Gastroenteritis | 342 | ||
| Introduction | 342 | ||
| Pathogenesis and pathology | 342 | ||
| Epidemiology | 343 | ||
| Clinical Features | 343 | ||
| Diarrhoea in certain circumstances | 344 | ||
| Differential diagnosis | 345 | ||
| Clinical investigations | 345 | ||
| Treatment | 345 | ||
| 7.6 Haematemesis and melaena | 347 | ||
| Introduction | 347 | ||
| Definitions, epidemiology and pathogenesis | 347 | ||
| Prevention | 347 | ||
| Clinical features | 347 | ||
| Clinical investigations | 348 | ||
| Treatment | 349 | ||
| Specific therapy | 349 | ||
| Disposition | 351 | ||
| Likely developments over the next 5–10 years | 351 | ||
| 7.7 Peptic ulcer disease and gastritis | 352 | ||
| Introduction | 352 | ||
| Aetiology, genetics, pathogenesis and pathology | 352 | ||
| Epidemiology | 352 | ||
| Clinical features | 353 | ||
| Differential diagnosis | 353 | ||
| Clinical investigations | 353 | ||
| Criteria for diagnosis | 353 | ||
| Treatment | 354 | ||
| Complications | 355 | ||
| Prognosis | 355 | ||
| Disposition | 355 | ||
| Likely developments over the next 5–10 years | 356 | ||
| 7.8 Biliary tract disease | 356 | ||
| Introduction | 356 | ||
| Gallstones and acute \nbiliary pain | 356 | ||
| Acute cholecystitis | 358 | ||
| Acute acalculous cholecystitis | 359 | ||
| Choledocholithiasis | 359 | ||
| Cholangitis | 359 | ||
| 7.9 Pancreatitis | 360 | ||
| Acute pancreatitis | 360 | ||
| Chronic pancreatitis | 362 | ||
| 7.10 Acute appendicitis | 363 | ||
| Introduction | 363 | ||
| Aetiology, pathogenesis and pathology | 363 | ||
| Clinical features | 363 | ||
| Differential diagnosis | 364 | ||
| Clinical investigations | 364 | ||
| Treatment | 365 | ||
| Acute appendicitis in pregnancy | 366 | ||
| Likely developments over the next 5–10 years | 366 | ||
| 7.11 Inflammatory bowel disease | 366 | ||
| Introduction and pathology | 366 | ||
| Clinical features | 367 | ||
| Investigation | 367 | ||
| Gastrointestinal complications | 368 | ||
| Treatment | 368 | ||
| Prognosis | 369 | ||
| 7.12 Acute liver failure | 370 | ||
| Introduction | 370 | ||
| Aetiology, pathogenesis and pathology | 370 | ||
| Epidemiology | 370 | ||
| Prevention | 371 | ||
| Clinical features | 371 | ||
| Differential diagnosis | 371 | ||
| Clinical investigations | 371 | ||
| Criteria for diagnosis | 371 | ||
| Treatment | 372 | ||
| Prognosis | 374 | ||
| Likely developments over the next 5–10 years | 375 | ||
| 7.13 Rectal bleeding | 376 | ||
| Introduction | 376 | ||
| Aetiology | 376 | ||
| Clinical features | 378 | ||
| Clinical investigations | 378 | ||
| Treatment | 379 | ||
| 7.14 Perianal conditions | 382 | ||
| Anorectal abscesses and fistulae | 382 | ||
| Pilonidal disease | 383 | ||
| Haemorrhoids | 383 | ||
| Anal fissure | 384 | ||
| Pruritus ani | 384 | ||
| Proctalgia fugax | 385 | ||
| Injuries to the perianal region | 385 | ||
| Other anorectal conditions | 385 | ||
| 8 Neurology Emergencies | 386 | ||
| 8.1 Headache | 386 | ||
| Introduction | 386 | ||
| Aetiology, pathophysiology and pathology | 386 | ||
| Clinical features | 387 | ||
| Clinical investigations | 387 | ||
| Tension headache | 387 | ||
| Migraine | 388 | ||
| Trigeminal neuralgia | 389 | ||
| Temporal (giant cell) arteritis | 389 | ||
| 8.2 Stroke and transient ischaemic attacks | 390 | ||
| Introduction | 391 | ||
| Pathophysiology | 391 | ||
| Risk factors for TIA/stroke and prevention | 392 | ||
| Ischaemic stroke syndromes | 392 | ||
| Intracerebral haemorrhage | 398 | ||
| 8.3 Subarachnoid haemorrhage | 400 | ||
| Introduction | 400 | ||
| Epidemiology and pathology | 400 | ||
| Clinical features | 401 | ||
| Differential diagnosis | 401 | ||
| Clinical investigations | 401 | ||
| Complications | 403 | ||
| Treatment | 403 | ||
| Prognosis | 404 | ||
| Incidental unruptured aneurysms | 404 | ||
| Conclusion | 404 | ||
| 8.4 Altered conscious state | 405 | ||
| Introduction | 405 | ||
| Pathophysiology | 405 | ||
| Differential diagnosis | 405 | ||
| Clinical assessment | 406 | ||
| Clinical investigations | 407 | ||
| Treatment | 409 | ||
| Disposition | 410 | ||
| Prognosis | 410 | ||
| 8.5 Seizures | 411 | ||
| Introduction | 411 | ||
| First seizures | 412 | ||
| Status epilepticus | 413 | ||
| Non-convulsive seizures | 414 | ||
| Pseudoseizures | 414 | ||
| Alcohol-related seizures | 415 | ||
| Drug-related seizures | 415 | ||
| Post-traumatic seizures | 415 | ||
| Seizures and pregnancy | 415 | ||
| Future directions | 415 | ||
| 8.6 Syncope and vertigo | 416 | ||
| Introduction | 416 | ||
| Syncope | 416 | ||
| Vertigo | 418 | ||
| 8.7 Weakness | 420 | ||
| Introduction | 420 | ||
| Aetiology and pathogenesis | 420 | ||
| Pathology | 421 | ||
| Differential diagnosis | 423 | ||
| Clinical features | 423 | ||
| Clinical investigations | 423 | ||
| Treatment and prognosis | 423 | ||
| Criteria for diagnosis | 423 | ||
| Specific conditions | 424 | ||
| 9 Infectious Disease Emergencies | 428 | ||
| 9.1 Approach to undifferentiated fever in adults | 428 | ||
| Introduction | 428 | ||
| Approach | 429 | ||
| Clinical investigations | 432 | ||
| Disposition | 432 | ||
| Future research directions | 433 | ||
| 9.2 Meningitis | 434 | ||
| Introduction | 434 | ||
| Classification | 434 | ||
| Aetiology | 434 | ||
| Epidemiology | 435 | ||
| Pathogenesis | 435 | ||
| Presentation | 435 | ||
| Examination | 436 | ||
| Investigations | 436 | ||
| Differential diagnosis | 437 | ||
| Management | 437 | ||
| Disposition | 438 | ||
| Prognosis | 438 | ||
| Prevention | 438 | ||
| 9.3 Septic arthritis | 440 | ||
| Introduction | 440 | ||
| Aetiology, pathogenesis and pathology | 440 | ||
| Epidemiology | 440 | ||
| Clinical features | 440 | ||
| Differential diagnosis | 440 | ||
| Clinical investigations | 440 | ||
| Criteria for diagnosis | 441 | ||
| Management | 441 | ||
| Prognosis | 441 | ||
| Prevention | 441 | ||
| 9.4 Urinary tract infections | 442 | ||
| Introduction | 442 | ||
| Epidemiology | 442 | ||
| Aetiology | 443 | ||
| Pathogenesis | 443 | ||
| Presentation | 444 | ||
| Investigations | 444 | ||
| Imaging | 445 | ||
| Management | 445 | ||
| Disposition | 449 | ||
| Prognosis | 449 | ||
| 9.5 Skin and soft-tissue infections | 450 | ||
| Introduction | 450 | ||
| Aetiology | 450 | ||
| Examination | 451 | ||
| Investigations | 451 | ||
| Management | 451 | ||
| Disposition | 452 | ||
| Superficial skin infections | 452 | ||
| Cellulitis | 453 | ||
| Abscesses | 453 | ||
| Deep soft-tissue infections | 453 | ||
| Toxic complications of wound infections | 454 | ||
| Special infections | 455 | ||
| 9.6 Hepatitis | 458 | ||
| Introduction | 458 | ||
| Clinical presentations \nof viral hepatitis | 458 | ||
| Hepatitis A virus (HAV) | 458 | ||
| Hepatitis B virus (HBV) | 459 | ||
| Hepatitis C virus (HCV) | 460 | ||
| Hepatitis D virus (HDV) | 461 | ||
| Hepatitis E virus (HEV) | 461 | ||
| Hepatitis G virus (HGV) | 461 | ||
| Non-hepatotrophic viruses | 461 | ||
| Non-viral hepatitis | 461 | ||
| Future directions | 462 | ||
| 9.7 HIV/AIDS | 463 | ||
| Introduction | 463 | ||
| Epidemiology | 463 | ||
| Pathogenesis | 463 | ||
| Classification and natural history | 464 | ||
| Presentation | 464 | ||
| Investigations | 467 | ||
| Management | 468 | ||
| Disposition | 470 | ||
| Prognosis | 470 | ||
| Prevention | 470 | ||
| 9.8 Sexually transmitted infections | 471 | ||
| Introduction | 471 | ||
| Epidemiology | 472 | ||
| Prevention | 472 | ||
| History | 472 | ||
| General principles of examination and screening | 473 | ||
| Clinical features of specific infections | 473 | ||
| Infections presenting with discharge, urethritis and cervicitis | 473 | ||
| Infections presenting with genital ulcers | 475 | ||
| Genital warts | 476 | ||
| Principles of clinical investigations | 477 | ||
| Treatment | 477 | ||
| Follow up | 477 | ||
| 9.9 Antibiotics in the emergency department | 478 | ||
| Principles of antimicrobial therapy | 478 | ||
| Antibiotic resistance | 480 | ||
| Prophylactic use \nof antibiotics | 480 | ||
| Penicillins | 481 | ||
| Cephalosporins | 482 | ||
| Macrolides | 483 | ||
| Tetracycline | 483 | ||
| Aminoglycosides | 484 | ||
| Metronidazole | 484 | ||
| Co-trimoxazole | 484 | ||
| Quinolones | 485 | ||
| Nitrofurantoin | 485 | ||
| Colistin link parenteral | 485 | ||
| Antiviral drugs | 486 | ||
| Antiviral agents for influenza | 486 | ||
| Antiretroviral drugs | 486 | ||
| Antifungal agents | 486 | ||
| Outpatient parenteral antibiotic therapy | 487 | ||
| Other issues | 487 | ||
| Recent updates from the medical literature | 488 | ||
| Likely developments over the next 5–10 years | 488 | ||
| 9.10 Needlestick injuries and related blood and body fluid exposures | 489 | ||
| Introduction | 489 | ||
| General issues | 489 | ||
| Management | 490 | ||
| Hepatitis B | 491 | ||
| Hepatitis C | 491 | ||
| Human immunodeficiency virus | 492 | ||
| Exposures that occur \nin the community | 493 | ||
| 9.11 Tropical infectious diseases | 494 | ||
| Introduction | 494 | ||
| Parasitic tropical diseases | 494 | ||
| Viral tropical diseases | 498 | ||
| Bacterial tropical diseases | 499 | ||
| Approach to the returned traveller | 501 | ||
| 10 Genitourinary Emergencies | 503 | ||
| 10.1 Acute kidney injury | 503 | ||
| Introduction | 503 | ||
| Aetiology and pathogenesis | 504 | ||
| Epidemiology | 505 | ||
| Prevention | 505 | ||
| Clinical features | 506 | ||
| Differential diagnosis | 508 | ||
| Criteria for diagnosis | 508 | ||
| Treatment | 509 | ||
| Prognosis | 512 | ||
| 10.2 The acute scrotum | 512 | ||
| Torsion of the Spermatic Cord (Testicle) | 513 | ||
| Aetiology | 513 | ||
| Pathology | 513 | ||
| Clinical presentation | 513 | ||
| Differential diagnosis of acute testicular pain | 513 | ||
| Traps in the clinical diagnosis | 513 | ||
| Investigations | 513 | ||
| Treatment | 514 | ||
| Prognosis | 514 | ||
| Torsion of a testicular appendage | 514 | ||
| Acute epididymo-orchitis (EDO) | 514 | ||
| Aetiology | 514 | ||
| Clinical presentation | 514 | ||
| Investigations | 514 | ||
| Differential diagnosis | 514 | ||
| Treatment | 515 | ||
| Complications | 515 | ||
| Blunt traumatic injury \nto the testicle | 515 | ||
| Necrotising fasciitis of the perineum (Fournier’s gangrene) | 515 | ||
| 10.3 Renal colic | 516 | ||
| Introduction | 516 | ||
| Pathophysiology of pain | 516 | ||
| Presentation | 516 | ||
| Examination | 516 | ||
| Investigations | 517 | ||
| Radiological examination | 517 | ||
| Management | 518 | ||
| Disposition | 518 | ||
| Precautions | 519 | ||
| Conclusion | 519 | ||
| 11 Endocrine Emergencies | 520 | ||
| 11.1 Diabetes mellitus and hypoglycaemia: an overview | 520 | ||
| Diabetes mellitus | 520 | ||
| Classification system and diagnostic criteria | 520 | ||
| Aetiology | 520 | ||
| Emergency presentations of a high blood sugar | 521 | ||
| General management of diabetes mellitus | 521 | ||
| Diabetic hypoglycaemia | 521 | ||
| Clinical features | 521 | ||
| Management of hypoglycaemic coma | 521 | ||
| 11.2 Diabetic ketoacidosis and hyperosmolar, hyperglycaemic state | 522 | ||
| Introduction | 523 | ||
| Epidemiology, aetiology and pathogenesis | 523 | ||
| Clinical features | 523 | ||
| Diagnostic criteria | 523 | ||
| Typical deficits per body weight | 523 | ||
| Investigations | 523 | ||
| Differential diagnosis of DKA | 524 | ||
| Management | 524 | ||
| Hyperosmolar, hyperglycaemic state | 525 | ||
| Miscellaneous issues | 525 | ||
| 11.3 Thyroid and adrenal emergencies | 526 | ||
| Introduction | 526 | ||
| Thyrotoxicosis | 526 | ||
| Aetiology, genetics, pathogenesis and pathology | 526 | ||
| Epidemiology | 527 | ||
| Clinical features | 527 | ||
| Clinical investigations and criteria for diagnosis | 527 | ||
| Treatment | 527 | ||
| Thyroid storm | 527 | ||
| Apathetic hyperthyroidism | 528 | ||
| Hypothyroidism | 528 | ||
| Aetiology, genetics, pathogenesis and pathology | 528 | ||
| Epidemiology | 528 | ||
| Clinical features | 528 | ||
| Clinical investigations \nand criteria for diagnosis | 528 | ||
| Treatment | 529 | ||
| Myxoedema coma | 529 | ||
| Hypoadrenal states | 530 | ||
| Aetiology, genetics, pathogenesis and pathology | 530 | ||
| Primary adrenal insufficiency \n(Addison’s disease) | 530 | ||
| Secondary adrenal insufficiency | 530 | ||
| Causes of primary or secondary adrenal insufficiency | 530 | ||
| Clinical features | 530 | ||
| Differential diagnosis | 530 | ||
| Clinical investigations | 530 | ||
| Criteria for diagnosis | 530 | ||
| 12 Metabolic Emergencies | 533 | ||
| 12.1 Acid–base disorders | 533 | ||
| Introduction | 533 | ||
| Acid–base homeostasis | 533 | ||
| Acidaemia | 533 | ||
| Alkalaemia | 534 | ||
| Systematic acid–base interpretation | 535 | ||
| 12.2 Electrolyte disturbances | 537 | ||
| Hyponatraemia | 537 | ||
| Introduction | 537 | ||
| Pathophysiology | 537 | ||
| Aetiology and classification | 537 | ||
| Clinical features | 538 | ||
| Syndrome of inappropriate ADH secretion | 538 | ||
| Clinical investigations | 539 | ||
| Treatment | 539 | ||
| Hypernatraemia | 540 | ||
| Introduction | 540 | ||
| Pathophysiology | 540 | ||
| Aetiology and classification | 540 | ||
| Clinical features | 541 | ||
| 13 Haematology Emergencies | 547 | ||
| 13.1 Anaemia | 547 | ||
| Introduction | 547 | ||
| Anaemia Secondaryto Haemorrhage | 547 | ||
| Aetiology | 547 | ||
| Clinical features | 547 | ||
| Clinical investigations | 548 | ||
| Treatment | 548 | ||
| Chronic haemorrhage | 549 | ||
| Disposition | 549 | ||
| Anaemia Secondary to Decreased Redcell Production | 549 | ||
| Megaloblastic anaemia | 549 | ||
| Anaemia of chronic disorders | 549 | ||
| Other causes of decreased red cell production | 550 | ||
| Anaemia Secondary to Decreased Redcell Survival: Thehaemolytic Anaemias | 550 | ||
| Hereditary spherocytosis | 550 | ||
| Glucose-6-phosphate dehydrogenase deficiency | 551 | ||
| Sickle cell anaemia | 551 | ||
| Thalassaemias | 551 | ||
| Acquired haemolytic anaemias | 552 | ||
| Microangiopathic haemolytic anaemia | 552 | ||
| Haemolytic uraemic syndrome and thrombotic thrombocytopaenic purpura | 552 | ||
| HELLP syndrome | 552 | ||
| Disseminated intravascular coagulation | 552 | ||
| Paroxysmal noctural haemoglobinuria | 552 | ||
| Other causes of haemolysis | 553 | ||
| 13.2 Neutropaenia | 553 | ||
| Introduction | 553 | ||
| Pathophysiology \nand aetiology | 554 | ||
| Clinical features | 554 | ||
| Clinical investigations | 554 | ||
| Treatment | 555 | ||
| Disposition | 555 | ||
| Prognosis | 555 | ||
| 13.3 Thrombocytopaenia | 556 | ||
| Introduction | 556 | ||
| Aetiology | 556 | ||
| Pseudothrombocytopaenia | 556 | ||
| Thrombocytopaenia due to increased platelet destruction | 556 | ||
| Thrombocytopaenia due to impaired platelet production | 558 | ||
| Massive blood transfusion and thrombocytopenia | 558 | ||
| Hypersplenism | 558 | ||
| Clinical features | 558 | ||
| Clinical investigation | 558 | ||
| Treatment | 559 | ||
| Disposition | 559 | ||
| 13.4 Haemophilia | 560 | ||
| Introduction | 560 | ||
| Pathophysiology | 560 | ||
| Clinical features | 560 | ||
| Clinical investigations | 560 | ||
| Treatment | 561 | ||
| Disposition | 562 | ||
| von Willebrand disease | 562 | ||
| Useful contacts | 563 | ||
| 13.5 Blood and blood products | 564 | ||
| Introduction | 564 | ||
| Packed red blood cells | 564 | ||
| Precautions when cross-matching and transfusing blood | 566 | ||
| Adverse reactions to transfusion | 566 | ||
| Management of transfusion reactions | 569 | ||
| Platelets | 569 | ||
| Fresh frozen plasma | 569 | ||
| Cryoprecipitate | 569 | ||
| Refusal of blood and blood product transfusion | 570 | ||
| 14 Rheumatology and Musculoskeletal Emergencies | 571 | ||
| 14.1 Rheumatological emergencies | 571 | ||
| Introduction | 571 | ||
| Rheumatoid Arthritis | 571 | ||
| Articular manifestations of Rheumatoid arthritis | 571 | ||
| Acute monoarthritis | 571 | ||
| Cervical spine involvement | 572 | ||
| Extra-Articular Manifestations of Rheumatoid Arthritis | 572 | ||
| Rheumatoid vasculitis | 572 | ||
| Other extra-articular manifestations of RA | 572 | ||
| Ischaemic heart disease in RA and other connective tissue diseases | 573 | ||
| Systemic Lupus Erythematosus | 573 | ||
| Clinical features | 573 | ||
| Investigations | 573 | ||
| Serological abnormalities | 573 | ||
| Assessing SLE disease activity | 573 | ||
| Management | 573 | ||
| Lupus nephritis | 574 | ||
| Neuropsychiatric SLE | 574 | ||
| Temporal (giant cell) arteritis and other vasculitides | 574 | ||
| Temporal (giant cell) arteritis | 574 | ||
| Polymyalgia rheumatica | 574 | ||
| Approach to the other systemic vasculitides | 575 | ||
| Ankylosing spondylitis | 575 | ||
| Rheumatological therapy emergencies | 576 | ||
| Non-steroidal \nanti-inflammatory drugs | 576 | ||
| Corticosteroids | 576 | ||
| Immunosuppressants/disease modifying antirheumatic drugs | 576 | ||
| Biological disease modifying antirheumatic drugs | 576 | ||
| Presentations of treatment-related emergencies | 576 | ||
| 14.2 Monoarthritis | 578 | ||
| Septic arthritis | 578 | ||
| Pathogenesis \nand pathology | 578 | ||
| Epidemiology and risk factors | 578 | ||
| Clinical features | 578 | ||
| Differential diagnosis | 578 | ||
| Clinical investigations | 578 | ||
| Imaging | 578 | ||
| Criteria for diagnosis \nof septic arthritis | 579 | ||
| Treatment | 579 | ||
| Gout | 579 | ||
| Aetiology and pathogenesis | 579 | ||
| Epidemiology | 579 | ||
| Clinical features | 579 | ||
| Investigations \nand diagnosis | 579 | ||
| Management | 579 | ||
| Acute pseudogout | 580 | ||
| Aetiology and pathogenesis | 580 | ||
| 15 Dermatology Emergencies | 598 | ||
| 15.1 Emergency dermatology | 598 | ||
| Introduction | 598 | ||
| Potentially life-threatening dermatoses | 599 | ||
| Toxic epidermal necrolysis and Stevens–Johnson syndrome | 599 | ||
| Erythema multiforme | 600 | ||
| Sweet’s syndrome | 600 | ||
| Drug rash with eosinophilia (DRESS) | 600 | ||
| Erythroderma | 601 | ||
| Other bullous and vesicular conditions | 601 | ||
| Pemphigus vulgaris | 601 | ||
| Bullous pemphigoid | 601 | ||
| Petechial and purpuric rashes | 602 | ||
| Petechiae, bruising and ecchymoses | 602 | ||
| Cutaneous vasculitis | 602 | ||
| Investigations for vasculitis | 603 | ||
| Management | 603 | ||
| Pruritic (itchy) dermatoses | 603 | ||
| Urticaria | 603 | ||
| Scabies | 604 | ||
| Tinea | 604 | ||
| Investigations for pruritus | 604 | ||
| Management | 604 | ||
| Eczema and psoriasis | 604 | ||
| Eczema | 604 | ||
| Discoid eczema | 605 | ||
| Allergic contact dermatitis | 605 | ||
| Irritant contact dermatitis | 605 | ||
| Psoriasis | 605 | ||
| Other dermatoses | 606 | ||
| Skin cancer | 606 | ||
| Eczema herpeticum | 606 | ||
| Herpes zoster | 606 | ||
| 16 Ocular Emergencies | 608 | ||
| 16.1 Ocular emergencies | 608 | ||
| Introduction | 608 | ||
| Ocular trauma | 609 | ||
| History | 609 | ||
| Examination | 609 | ||
| Management of specific injuries | 609 | ||
| Acute inflammatory conditions | 611 | ||
| Acute primary angle-closure (glaucoma) | 611 | ||
| Acute iritis | 611 | ||
| Acute infectious keratitis | 612 | ||
| Adenoviral conjunctivitis | 612 | ||
| Acute visual failure | 612 | ||
| Introduction | 612 | ||
| Clinical assessment | 612 | ||
| Central retinal artery occlusion (CRAO) | 613 | ||
| Central (branch) retinal vein occlusion | 614 | ||
| Anterior ischaemic optic neuropathy | 614 | ||
| Retinal detachment | 614 | ||
| Vitreous haemorrhage | 614 | ||
| Age-related macular degeneration | 615 | ||
| Optic neuritis | 615 | ||
| 17 Dental Emergencies | 616 | ||
| 17.1 Dental emergencies | 616 | ||
| Anatomy | 616 | ||
| Dental caries | 616 | ||
| Periodontal emergencies | 616 | ||
| Alveolar osteitis (dry socket) | 616 | ||
| Postdental extraction bleeding | 616 | ||
| Traumatic dental emergencies | 617 | ||
| Dentoalveolar trauma in children | 617 | ||
| Dental fractures | 617 | ||
| Temporomandibular dislocation | 618 | ||
| Dental infection and abscess (odontogenic infection) | 618 | ||
| Dental nomenclature | 618 | ||
| 18 ENT Emergencies | 620 | ||
| 18.1 Ears, nose and throat emergencies | 620 | ||
| The ear | 620 | ||
| Introduction | 620 | ||
| Foreign body | 620 | ||
| Impacted cerumen | 621 | ||
| Trauma | 621 | ||
| Infection | 621 | ||
| The nose | 622 | ||
| Foreign body | 622 | ||
| Management | 622 | ||
| Trauma | 622 | ||
| Sinusitis | 622 | ||
| Epistaxis | 622 | ||
| The throat | 623 | ||
| Foreign body | 623 | ||
| Management | 623 | ||
| Button batteries | 624 | ||
| Inhaled foreign body | 624 | ||
| Infection | 624 | ||
| 19 Obstetrics and Gynaecology Emergencies | 626 | ||
| 19.1 Emergency delivery and complications | 626 | ||
| Introduction | 626 | ||
| Setting | 626 | ||
| History | 627 | ||
| Examination | 627 | ||
| Management | 628 | ||
| Conduct of labour | 628 | ||
| Disposition | 630 | ||
| Complications of delivery | 630 | ||
| 19.2 Ectopic pregnancy and bleeding in early pregnancy | 635 | ||
| Introduction | 635 | ||
| History | 635 | ||
| Examination | 635 | ||
| Investigations | 636 | ||
| Management | 636 | ||
| Ectopic pregnancy | 636 | ||
| Miscarriage | 636 | ||
| Prognosis | 637 | ||
| Disposition | 637 | ||
| 19.3 Bleeding after the first trimester \rof pregnancy | 638 | ||
| Introduction | 638 | ||
| Antepartum haemorrhage | 638 | ||
| Differential diagnosis | 638 | ||
| History | 638 | ||
| Examination | 639 | ||
| Investigations | 639 | ||
| Management | 639 | ||
| Prognosis | 639 | ||
| Disposition | 639 | ||
| Secondary postpartum haemorrhage | 639 | ||
| Introduction | 639 | ||
| Differential diagnosis | 640 | ||
| History | 640 | ||
| Examination | 640 | ||
| Investigations | 640 | ||
| Treatment | 640 | ||
| 19.4 Abnormal vaginal bleeding in the non-pregnant patient | 641 | ||
| Introduction | 641 | ||
| Causes of abnormal vaginal bleeding | 641 | ||
| History | 641 | ||
| Physical examination | 642 | ||
| Investigations | 642 | ||
| Management | 642 | ||
| Disposition | 643 | ||
| 19.5 Pelvic inflammatory disease | 644 | ||
| Introduction | 644 | ||
| Epidemiology | 644 | ||
| Presentation | 644 | ||
| Investigations | 645 | ||
| Differential diagnosis | 645 | ||
| Management | 645 | ||
| Disposition | 645 | ||
| Prognosis | 645 | ||
| 19.6 Pelvic pain | 646 | ||
| Introduction | 646 | ||
| Classification | 646 | ||
| Presentation | 646 | ||
| Examination | 646 | ||
| Laboratory investigations | 647 | ||
| Imaging | 647 | ||
| Differential diagnosis | 648 | ||
| Conclusion | 650 | ||
| 19.7 Pre-eclampsia and eclampsia | 651 | ||
| Introduction | 651 | ||
| Pathophysiology | 651 | ||
| Clinical features | 652 | ||
| Risk stratification of pre-eclampsia | 653 | ||
| Investigations | 653 | ||
| Management | 653 | ||
| Eclampsia | 654 | ||
| Prevention of pre-eclampsia | 654 | ||
| 20 Psychiatric Emergencies | 656 | ||
| 20.1 Mental state assessment | 656 | ||
| Epidemiology | 656 | ||
| Introduction to the mental state examination | 656 | ||
| Aims of mental health assessment | 658 | ||
| The formal psychiatric interview | 658 | ||
| Conclusion | 660 | ||
| 20.2 Distinguishing medical from psychiatric causes of mental disorder presentations | 661 | ||
| Introduction | 661 | ||
| General approach | 662 | ||
| Triage | 662 | ||
| The interview environment | 663 | ||
| History | 663 | ||
| Collateral history | 663 | ||
| Examination | 664 | ||
| Investigations | 664 | ||
| Diagnostic formulation | 664 | ||
| Conclusion | 665 | ||
| 20.3 Deliberate self-harm/suicide | 666 | ||
| Introduction | 666 | ||
| Epidemiology | 666 | ||
| Patient characteristics | 668 | ||
| Aetiology | 669 | ||
| Assessment | 670 | ||
| Definitive treatment and disposition | 671 | ||
| Prevention | 672 | ||
| Ethical considerations | 672 | ||
| Conclusion | 673 | ||
| 20.4 Depression | 674 | ||
| Introduction | 674 | ||
| Epidemiology | 675 | ||
| Aetiology | 675 | ||
| Prevention | 675 | ||
| Clinical features | 675 | ||
| Differential diagnosis | 678 | ||
| Assessment | 681 | ||
| Treatment | 681 | ||
| 20.5 Psychosis | 684 | ||
| Introduction | 684 | ||
| Classification | 684 | ||
| Epidemiology and prognosis | 684 | ||
| Aetiology and prevention | 685 | ||
| Clinical features | 685 | ||
| Assessment | 687 | ||
| Treatment | 689 | ||
| 20.6 Pharmacological management of the aroused patient | 691 | ||
| Introduction | 691 | ||
| General principles of rapid tranquillization | 691 | ||
| 21 Challenging Situations | 695 | ||
| 21.1 Death and dying | 695 | ||
| Introduction | 695 | ||
| The death process | 696 | ||
| Initiation of the grieving process | 696 | ||
| Breaking bad news | 696 | ||
| Viewing the body | 697 | ||
| Death certificates | 697 | ||
| Organ donation | 697 | ||
| Bereavement counselling | 697 | ||
| Subsequent issues | 698 | ||
| Professional issues | 698 | ||
| 21.2 Sexual assault | 698 | ||
| Introduction | 698 | ||
| Definitions | 699 | ||
| Epidemiology | 699 | ||
| Barriers to care | 699 | ||
| Consent | 699 | ||
| Chain of evidence | 699 | ||
| Medical evaluation of the victim | 699 | ||
| Forensic history, examination and evidence collection | 700 | ||
| Medical aftercare | 701 | ||
| Children | 702 | ||
| Conclusion | 702 | ||
| 21.3 Family violence | 704 | ||
| Definition | 704 | ||
| Incidence | 704 | ||
| Vulnerable groups | 704 | ||
| Risk factor identification | 705 | ||
| Outcomes | 705 | ||
| Barriers to detection and reporting of family violence | 706 | ||
| Screening | 706 | ||
| Management | 706 | ||
| Conclusion | 707 | ||
| 21.4 Alcohol-related illness | 708 | ||
| Introduction | 708 | ||
| Epidemiology | 708 | ||
| Pharmacology | 709 | ||
| Chronic alcohol-related illness | 709 | ||
| Important illnesses to be excluded that mimic alcohol intoxication | 713 | ||
| Treatment of alcohol-related illness | 714 | ||
| Assessment of alcohol misuse | 715 | ||
| Pharmacotherapy for alcohol use disorder | 716 | ||
| Likely developments over the next 5–10 years | 716 | ||
| 21.5 The challenging patient | 717 | ||
| Introduction | 717 | ||
| The homeless patient | 717 | ||
| Definition and epidemiology | 717 | ||
| Clinical features | 717 | ||
| The prisoner | 718 | ||
| Definition and epidemiology | 718 | ||
| Clinical features | 718 | ||
| Violence and security issues | 719 | ||
| Management | 719 | ||
| The behaviourally disturbed and violent patient | 719 | ||
| Aetiology and epidemiology | 719 | ||
| Prevention | 719 | ||
| Clinical features | 720 | ||
| Legal and ethical considerations | 720 | ||
| Management | 721 | ||
| Disposition | 722 | ||
| Violence | 722 | ||
| The frequent attender | 723 | ||
| Definition and epidemiology | 723 | ||
| Clinical features | 723 | ||
| Management | 723 | ||
| The patient with drug-seeking behaviour | 724 | ||
| Definition and aetiology | 724 | ||
| Clinical features | 724 | ||
| Management | 724 | ||
| The very important person (VIP) | 724 | ||
| Definition | 725 | ||
| Management | 725 | ||
| 21.6 End of life decision making \nand palliative care | 727 | ||
| Introduction | 727 | ||
| Definitions | 727 | ||
| General legal principles \nin end of life decision making | 727 | ||
| Palliative care | 729 | ||
| 21.7 Organ and tissue donation | 731 | ||
| Introduction | 731 | ||
| Donation pathways | 731 | ||
| Initiatives to improve organ donation rates | 732 | ||
| Clinical triggers for identification of potential donors | 732 | ||
| Emergency clinicians attitudes to, knowledge and perceptions of OTD | 733 | ||
| OTD discussions in the ED | 733 | ||
| Eye and tissue donation | 733 | ||
| 22 Pain Relief | 735 | ||
| 22.1 General pain management | 735 | ||
| Introduction | 735 | ||
| Physiology | 735 | ||
| Assessment of pain and pain scales | 736 | ||
| General principles | 736 | ||
| Specific agents | 736 | ||
| Pain relief in pregnancy | 739 | ||
| Non-pharmacological therapies | 739 | ||
| Special pain situations and non-analgesic agents | 739 | ||
| Acute neuropathic pain | 739 | ||
| Chronic pain | 739 | ||
| Acute abdomen | 739 | ||
| Likely developments over the next 5–10 years | 740 | ||
| 22.2 Local anaesthesia | 741 | ||
| Local anaesthesia | 741 | ||
| Topical anaesthesia | 742 | ||
| Specific nerve blocks | 742 | ||
| Nerve blocks at the wrist | 743 | ||
| Nerve blocks of the leg | 743 | ||
| Intravenous regional anaesthesia or Bier’s block | 744 | ||
| 22.3 Procedural sedation and analgesia | 747 | ||
| Introduction/rationale | 747 | ||
| Underlying principles | 747 | ||
| Pre-procedure risk assessment | 748 | ||
| Choice of agent | 749 | ||
| Preparation and monitoring | 752 | ||
| Post-procedure considerations | 753 | ||
| Developments in the next 5–10 years\r | 753 | ||
| 23 Emergency Imaging | 757 | ||
| 23.1 Emergency department ultrasound | 757 | ||
| Background | 757 | ||
| The scope of emergency department ultrasound | 759 | ||
| Abdominal aortic aneurysm | 760 | ||
| Early pregnancy | 761 | ||
| Right upper quadrant/gallbladder | 762 | ||
| Renal ultrasound | 762 | ||
| Deep vein thrombosis (DVT) | 763 | ||
| Emergency echocardiography | 764 | ||
| Lung ultrasound | 766 | ||
| Ultrasound-guided vascular access | 767 | ||
| Miscellaneous applications | 767 | ||
| Training and \rcredentialling | 768 | ||
| 23.2 CT scanning in emergency medicine | 770 | ||
| Introduction | 770 | ||
| Development science | 770 | ||
| Current uses and indications | 772 | ||
| Problems | 773 | ||
| Future directions | 775 | ||
| 23.3 Magnetic resonance imaging in emergency medicine | 776 | ||
| Introduction | 776 | ||
| Technical issues | 776 | ||
| Monitoring patients in the MRI | 778 | ||
| Indications for MRI | 779 | ||
| Contraindications, precautions and limitations | 780 | ||
| Conclusion | 780 | ||
| 24 Academic Emergency Medicine | 782 | ||
| 24.1 Research methodology | 782 | ||
| Introduction | 782 | ||
| Initiating the research project | 782 | ||
| Assembling the research team | 783 | ||
| Development of the study protocol | 783 | ||
| Study design | 784 | ||
| Concepts of methodology | 785 | ||
| Sampling study subjects | 785 | ||
| Data-collection instruments | 786 | ||
| Bias and confounding | 787 | ||
| Principles of clinical research statistics | 788 | ||
| Databases and principles of data management | 788 | ||
| Research ethics | 789 | ||
| 24.2 Writing for publication | 790 | ||
| Introduction | 790 | ||
| Important principles | 790 | ||
| Readability | 790 | ||
| Manuscript preparation | 791 | ||
| Manuscript submission | 792 | ||
| Feedback from journals | 792 | ||
| Post-acceptance issues | 792 | ||
| 24.3 Principles of medical education | 793 | ||
| Introduction | 793 | ||
| Adult learning principles | 793 | ||
| Learner-centred education | 794 | ||
| What makes a good ED teacher? | 795 | ||
| Types of teaching in the ED | 795 | ||
| Feedback to learners | 797 | ||
| Conclusion | 797 | ||
| Likely developments over the next 5–10 years | 798 | ||
| 24.4 Undergraduate teaching in emergency medicine | 799 | ||
| Introduction | 799 | ||
| Overview of undergraduate medical education in Australia | 799 | ||
| The importance of medical student teaching | 800 | ||
| Curriculum development | 800 | ||
| Methods of teaching emergency medicine | 800 | ||
| Assessment principles | 803 | ||
| Likely developments over the next 5–10 years | 803 | ||
| 24.5 Postgraduate emergency medicine teaching and simulation | 804 | ||
| Introduction | 804 | ||
| Curricular trends in emergency medicine | 805 | ||
| Teaching methods in emergency medicine | 805 | ||
| Technology for learning in emergency medicine | 805 | ||
| Simulation-based learning | 806 | ||
| Assessment and performance appraisal for emergency medicine training | 806 | ||
| Faculty development in emergency medicine | 807 | ||
| Continuing medical education (CME) | 807 | ||
| 25 Emergency Medicine and the Law | 808 | ||
| 25.1 Mental health and the law: the Australasian and UK perspectives | 808 | ||
| Introduction | 808 | ||
| Variations in practice | 809 | ||
| Mental health legislation in Australasia | 810 | ||
| 25.2 The coroner: the Australasian and UK perspectives | 817 | ||
| Australasia | 817 | ||
| Introduction | 817 | ||
| Legislation | 818 | ||
| Reportable deaths | 818 | ||
| A coronial investigation | 818 | ||
| Expert opinion | 819 | ||
| A coronial inquest | 819 | ||
| Coronial findings | 820 | ||
| The UK | 820 | ||
| Introduction | 821 | ||
| History of the coroner | 821 | ||
| Structure of the coroner system in the UK | 821 | ||
| How to report a death | 822 | ||
| Handling the body | 822 | ||
| Documentation | 823 | ||
| Information for families | 823 | ||
| Post-mortems | 823 | ||
| Preparing a statement for the coroner | 823 | ||
| Inquest | 824 | ||
| 25.3 Consent and competence – the Australasian and UK perspectives | 825 | ||
| Introduction | 825 | ||
| Consent | 825 | ||
| Competence | 827 | ||
| Patients who may be incompetent to consent | 827 | ||
| 25.4 Privacy and confidentiality | 830 | ||
| Introduction | 830 | ||
| Physical privacy | 830 | ||
| Healthcare providers | 830 | ||
| Mandatory reporting | 831 | ||
| Police | 831 | ||
| Forensic issues | 831 | ||
| Patient health information | 831 | ||
| Legislation | 831 | ||
| Australian privacy principles | 831 | ||
| New Zealand | 833 | ||
| Implementation | 833 | ||
| Communications | 833 | ||
| Medicolegal reports | 833 | ||
| Research and quality assurance | 833 | ||
| Complaints and non-compliance | 833 | ||
| 25.5 Ethics in emergency medicine | 834 | ||
| Introduction | 835 | ||
| Ethics and law | 835 | ||
| Ethical decision making – influences and processes | 835 | ||
| An ethics toolkit for the emergency department | 836 | ||
| Summary | 840 | ||
| 26 Emergency and Medical Systems | 841 | ||
| 26.1 Pre-hospital emergency medicine | 841 | ||
| Introduction | 841 | ||
| Dispatch | 841 | ||
| Clinical skills | 842 | ||
| Trauma care | 842 | ||
| Cardiac care | 843 | ||
| Other medical emergencies | 844 | ||
| 26.2 Retrieval | 846 | ||
| Retrieval systems | 846 | ||
| Retrieval processes | 847 | ||
| Clinical principles in retrieval and pre-hospital medicine | 849 | ||
| 26.3 Medical issues in disasters | 852 | ||
| Introduction | 852 | ||
| Definitions and classification | 852 | ||
| Epidemiology | 853 | ||
| Socioeconomic impact | 854 | ||
| Disaster management/emergency management | 854 | ||
| Disaster response planning | 855 | ||
| Domestic disaster response activities | 856 | ||
| Urban search and rescue | 858 | ||
| Mental health | 858 | ||
| Mass gatherings | 859 | ||
| Public health issues in disasters | 859 | ||
| Conclusion | 859 | ||
| Likely developments | 859 | ||
| 26.4 Triage | 861 | ||
| Introduction | 861 | ||
| Origins of triage | 861 | ||
| Civilian triage developments | 861 | ||
| Process of triage | 861 | ||
| Australasian triage development | 862 | ||
| The Australasian Triage Scale | 862 | ||
| Other triage scales | 862 | ||
| Use beyond waiting time | 862 | ||
| Structure and function of a triage system | 863 | ||
| Pre-hospital triage | 863 | ||
| Military and disaster triage | 863 | ||
| 26.5 Emergency care in a humanitarian crisis | 865 | ||
| Introduction | 865 | ||
| Responsibility for refugee care | 866 | ||
| Coordination in a humanitarian crisis | 866 | ||
| Before you go | 866 | ||
| Personal attributes | 867 | ||
| Camps for refugees and IDPs | 867 | ||
| Responding to a crisis | 867 | ||
| Permanent ‘durable’ solutions | 868 | ||
| Past problems | 868 | ||
| 26.6 Emergency department observation wards | 869 | ||
| Introduction | 869 | ||
| Observation ward policies and protocols | 870 | ||
| Efficiency of patient care | 871 | ||
| Staffing | 871 | ||
| Audit and feedback | 871 | ||
| Conclusions | 871 | ||
| 26.7 Overcrowding | 872 | ||
| Introduction | 872 | ||
| Theoretical basis of overcrowding | 872 | ||
| Definition of overcrowding | 872 | ||
| Causes of overcrowding | 873 | ||
| Consequences of overcrowding | 873 | ||
| Strategies to deal with overcrowding | 873 | ||
| Conclusions | 874 | ||
| Future research | 874 | ||
| 26.8 Rapid response systems and the emergency department | 875 | ||
| Introduction and definitions | 875 | ||
| Epidemiology and principles underlying \nthe MET | 876 | ||
| How MET services and RRSs work | 876 | ||
| Clinical features of MET patients | 877 | ||
| Management of MET call patients | 877 | ||
| The MET and the ED | 878 | ||
| Likely future developments | 879 | ||
| 26.9 Public health and emergency medicine | 881 | ||
| Introduction | 881 | ||
| Disease and injury surveillance | 881 | ||
| Disease prevention and control | 882 | ||
| Health of indigenous people and cultural safety | 883 | ||
| 27 Administration | 885 | ||
| 27.1 Emergency department staffing | 885 | ||
| General principles | 885 | ||
| Estimating medical workload | 885 | ||
| Structure of medical staff | 886 | ||
| Estimating nursing workload | 886 | ||
| Nurse staffing structure | 886 | ||
| Allied health, clerical and other support staff | 887 | ||
| Optimizing work practices | 887 | ||
| 27.2 Emergency department layout | 888 | ||
| Introduction | 888 | ||
| Design considerations | 888 | ||
| Size and composition of the emergency department | 888 | ||
| Clinical areas | 889 | ||
| Clinical support areas | 890 | ||
| Non-clinical areas | 891 | ||
| Likely developments over the next 5–10 years | 892 | ||
| 27.3 Quality assurance/quality improvement | 893 | ||
| Introduction | 893 | ||
| History | 893 | ||
| Definitions | 893 | ||
| Continuous quality improvement | 893 | ||
| National bodies | 894 | ||
| Quality in the ED | 894 | ||
| Common quality measures in ED | 894 | ||
| Likely developments over the next 5–10 years | 895 | ||
| 27.4 Business planning | 895 | ||
| Introduction | 895 | ||
| Types of plans | 895 | ||
| The business plan | 896 | ||
| Planning process | 896 | ||
| Private EDs | 898 | ||
| Business plan implementation and monitoring | 898 | ||
| 27.5 Accreditation, specialist training and recognition in Australasia | 898 | ||
| Specialist recognition and registration | 899 | ||
| Specialist training in emergency medicine | 899 | ||
| Accreditation | 900 | ||
| 27.6 Specialist training and recognition in emergency medicine in the United Kingdom | 904 | ||
| Introduction | 904 | ||
| Regulation of training | 904 | ||
| Training in EM in the UK | 906 | ||
| Conclusion | 907 | ||
| 27.7 Complaints | 907 | ||
| Introduction | 907 | ||
| Reasons | 908 | ||
| Responding to a complaint | 909 | ||
| Prevention | 910 | ||
| Managing specific aspects | 911 | ||
| Summary | 911 | ||
| 27.8 Patient safety | 912 | ||
| Introduction | 912 | ||
| Specific emergency department factors that may compromise patient safety | 913 | ||
| Common safety problems encountered in emergency departments | 913 | ||
| Improving safety in the emergency department | 913 | ||
| Conclusion | 914 | ||
| 28 Environmental Emergencies | 915 | ||
| 28.1 Heat-related illness | 915 | ||
| Introduction | 915 | ||
| Epidemiology and pathophysiology | 915 | ||
| Prevention | 916 | ||
| Clinical features | 916 | ||
| Clinical investigations | 917 | ||
| Treatment | 917 | ||
| Prognosis and disposition | 918 | ||
| 28.2 Hypothermia | 919 | ||
| Introduction | 919 | ||
| Epidemiology and pathophysiology | 919 | ||
| Clinical features | 919 | ||
| Clinical investigations | 920 | ||
| Treatment | 920 | ||
| Prognosis and disposition | 921 | ||
| 28.3 Dysbarism | 922 | ||
| Introduction | 922 | ||
| Diving physics and physiology | 922 | ||
| Barotrauma | 923 | ||
| Decompression illness | 925 | ||
| Other issues | 929 | ||
| Important phone \nnumbers | 929 | ||
| 28.4 Radiation incidents | 930 | ||
| Introduction | 930 | ||
| Radiation sources and incidents | 931 | ||
| Measuring radioactivity | 931 | ||
| Pathophysiology | 932 | ||
| Chronic radiation exposure | 932 | ||
| Acute radiation exposure | 932 | ||
| Occult radiation exposure | 934 | ||
| Contamination with radioactive material | 934 | ||
| Internal contamination | 936 | ||
| Likely developments over the next 5–10 years | 937 | ||
| 28.5 Drowning | 938 | ||
| Introduction | 938 | ||
| Epidemiology | 938 | ||
| Prevention | 938 | ||
| Definitions and terminology | 939 | ||
| Pathophysiology | 939 | ||
| Clinical features and \norgan-specific effects | 939 | ||
| Treatment | 940 | ||
| Clinical investigations | 942 | ||
| Prognosis | 942 | ||
| Disposition | 942 | ||
| 28.6 Electric shock and lightning injury | 943 | ||
| Electric shock | 943 | ||
| Introduction and epidemiology | 943 | ||
| Physics of electricity and pathophysiology of electrical injury | 943 | ||
| Prevention | 944 | ||
| Clinical features | 944 | ||
| Electric shock in pregnancy | 945 | ||
| Treatment | 945 | ||
| Prognosis | 945 | ||
| Disposition | 945 | ||
| The Taser | 945 | ||
| Lightning injury | 946 | ||
| Introduction and epidemiology | 946 | ||
| Physics | 946 | ||
| Clinical features | 946 | ||
| Treatment | 947 | ||
| Prognosis and disposition | 947 | ||
| 28.7 Altitude illness | 948 | ||
| Introduction | 948 | ||
| Epidemiology and pathophysiology | 948 | ||
| Prevention | 948 | ||
| Clinical features | 949 | ||
| Treatment | 949 | ||
| 29 Toxicology Emergencies | 951 | ||
| 29.1 Approach to the poisoned patient | 951 | ||
| Introduction | 951 | ||
| Pathophysiology and clinical features | 951 | ||
| Assessment | 953 | ||
| Treatment | 954 | ||
| Differential diagnosis | 956 | ||
| Clinical investigations | 956 | ||
| Disposition | 957 | ||
| 29.2 Cardiovascular drugs | 958 | ||
| Calcium channel blockers and β-blockers | 958 | ||
| Introduction | 958 | ||
| Pharmacokinetics | 958 | ||
| Pathophysiology | 958 | ||
| Clinical features | 959 | ||
| Clinical investigation | 960 | ||
| Treatment | 960 | ||
| Disposition | 961 | ||
| Digoxin | 961 | ||
| Introduction | 961 | ||
| Pharmacokinetics | 961 | ||
| Pathophysiology | 961 | ||
| Clinical features | 961 | ||
| Clinical investigations | 961 | ||
| Treatment | 962 | ||
| Disposition | 962 | ||
| Clonidine | 962 | ||
| Introduction | 962 | ||
| Pharmacokinetics | 962 | ||
| Pathophysiology | 962 | ||
| 30 Toxinology Emergencies | 1034 | ||
| 30.1 Snakebite | 1034 | ||
| Introduction | 1034 | ||
| Epidemiology | 1034 | ||
| Prevention | 1035 | ||
| Clinical features | 1035 | ||
| Clinical investigations | 1038 | ||
| Disposition | 1039 | ||
| References | 1039 | ||
| 30.2 Exotic snakebite | 1039 | ||
| Introduction | 1039 | ||
| Bites by captive non-native (exotic) venomous snakes | 1039 | ||
| Exotic venom activity | 1042 | ||
| First aid | 1042 | ||
| Venom spit ophthalmia | 1042 | ||
| Approach to hospital management | 1042 | ||
| Antivenom use | 1042 | ||
| Non-antivenom treatments | 1042 | ||
| Further Reading | 1042 | ||
| 30.3 Spider bite | 1043 | ||
| Introduction | 1043 | ||
| An approach to the patient with spider bite | 1043 | ||
| Redback spider (Latrodectus hasselti) | 1043 | ||
| Steatoda species (cupboard or button spiders) | 1045 | ||
| Funnel-web spider (Atrax and Hadronyche species) | 1045 | ||
| Mouse spiders (Missulena spp.) | 1046 | ||
| Other Australasian spiders | 1046 | ||
| Necrotic arachnidism | 1046 | ||
| References | 1046 | ||
| 30.4 Marine injury, envenomation and poisoning | 1047 | ||
| Cnidaria | 1047 | ||
| Chironex fleckeri | 1047 | ||
| Carukia barnesi | 1048 | ||
| Treatment | 1048 | ||
| Non-tropical jellyfish stings | 1048 | ||
| Fish | 1048 | ||
| Envenomations | 1048 | ||
| Poisonings | 1049 | ||
| Injuries | 1049 | ||
| Molluscs | 1050 | ||
| Blue-ringed octopus | 1050 | ||
| Index | 1051 |