BOOK
Textbook of Adult Emergency Medicine E-Book
Peter Cameron | George Jelinek | Anne-Maree Kelly | Lindsay Murray | Anthony F. T. Brown
(2011)
Additional Information
Book Details
Abstract
A major postgraduate textbook in emergency medicine, covering all the major topics that present to the trainee doctor in the emergency department.
- 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 short and concise, with key point boxes (called "Essentials") at the beginning.
- Also has boxes featuring controversial areas of treatment.
- Practical and clinically orientated.
- Major changes to resuscitation guidelines.
- Complete rewriting of ENT section.
- Significant updating of following topics - acute coronary syndrome management, trauma, sepsis management, imaging, arrhythmias.
- Expansion of administration section - especially patient safety.
- Changes to drug overdose sections in toxicology section.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Textbook of Adult Emergency Medicine | iii | ||
| Copyright | iv | ||
| Preface to the first edition | v | ||
| Preface to the third edition | vi | ||
| Contributors | vii | ||
| Contents | xiii | ||
| Section 1: Resuscitation | 1 | ||
| 1.1 Basic life support | 1 | ||
| Introduction | 1 | ||
| Development of protocols | 1 | ||
| Initial evaluation: DR ABCD approach | 2 | ||
| Management | 3 | ||
| Defibrillation | 4 | ||
| BLS summary | 4 | ||
| References | 5 | ||
| 1.2 Advanced life support | 5 | ||
| Introduction | 5 | ||
| Aetiology and incidence of cardiac arrest | 5 | ||
| Advanced life support guidelines and algorithms | 6 | ||
| Initiation of ALS | 6 | ||
| Attachment of the defibrillator/monitor and rhythm recogniton | 6 | ||
| Defibrillation | 7 | ||
| The CPR 'Code Blue' process | 9 | ||
| Other ALS interventions | 9 | ||
| Drug therapy in ALS | 10 | ||
| Haemodynamic monitoring during CPR | 12 | ||
| When to discontinue ALS | 12 | ||
| Prognosis for survival after cardiac arrest | 12 | ||
| Uniform reporting in cardiac arrest research | 13 | ||
| References | 13 | ||
| 1.3 Ethics of resuscitation | 14 | ||
| Introduction | 14 | ||
| Application of the principles of Beauchamp and Childress to resuscitation medicine | 15 | ||
| Futility | 16 | ||
| Consent, withholding and withdrawing resuscitation | 17 | ||
| 'Not For Resuscitation' (NFR) orders | 17 | ||
| Practising resuscitation procedures on the newly dead | 18 | ||
| Conclusions | 19 | ||
| References | 19 | ||
| Section 2: Critical care | 20 | ||
| 2.1 Airway and ventilation management | 20 | ||
| Introduction | 20 | ||
| Non-invasive ventilation | 20 | ||
| Endotracheal intubation | 21 | ||
| The difficult intubation | 23 | ||
| Laryngeal mask airway | 24 | ||
| Intubating laryngeal mask airway | 24 | ||
| Fibreoptic bronchoscope-assisted intubation | 24 | ||
| Retrograde intubation | 24 | ||
| Blind nasotracheal intubation | 25 | ||
| Cricothyroidotomy | 25 | ||
| Tracheostomy | 25 | ||
| Mechanical ventilation | 25 | ||
| Extubation in the emergency department | 26 | ||
| References | 26 | ||
| 2.2 Oxygen therapy | 27 | ||
| Introduction | 27 | ||
| Physiology of oxygen | 27 | ||
| Oxygen delivery systems | 29 | ||
| Variable performance systems | 29 | ||
| Fixed-performance systems | 30 | ||
| 100% oxygen delivery systems | 31 | ||
| Helium and oxygen mixtures | 33 | ||
| Measurement of oxygenation | 33 | ||
| Paediatric considerations in oxygen therapy | 33 | ||
| Transfer of patients on oxygen therapy | 34 | ||
| Oxygen therapy in specific circumstances | 34 | ||
| Complications of oxygen therapy | 36 | ||
| Special delivery systems | 36 | ||
| References | 37 | ||
| 2.3 Haemodynamic monitoring | 38 | ||
| Introduction | 38 | ||
| Historical background | 38 | ||
| Overview of cardiovascular physiology | 39 | ||
| Role of haemodynamic monitoring in the emergency department | 39 | ||
| Clinical assessment | 39 | ||
| Blood pressure monitoring | 40 | ||
| Other non-invasive monitoring methods for cardiac output | 40 | ||
| Invasive devices | 41 | ||
| Conclusion | 43 | ||
| Future developments | 43 | ||
| References | 43 | ||
| 2.4 Shock overview | 45 | ||
| Introduction | 45 | ||
| Aetiology and epidemiology | 45 | ||
| Pathophysiology | 46 | ||
| Clinical features in the initial diagnosis of shock | 46 | ||
| Initial emergency management of the shocked patient | 47 | ||
| Guidance for interventions and treatments | 48 | ||
| Interventions in shock | 49 | ||
| The effects of shock on other interventions | 52 | ||
| The management of specific shock syndromes | 52 | ||
| Conclusion | 55 | ||
| References | 56 | ||
| 2.5 Sepsis and septic shock | 57 | ||
| Introduction | 57 | ||
| Aetiology and pathophysiology | 57 | ||
| Clinical features | 57 | ||
| Clinical investigations | 58 | ||
| Treatment | 58 | ||
| References | 60 | ||
| 2.6 Arterial blood gases | 61 | ||
| Introduction | 61 | ||
| Normal values | 61 | ||
| Definitions and conventions | 61 | ||
| Venous gas correlation | 61 | ||
| Arterial blood gas specimen collection | 61 | ||
| Arterial blood gas interpretation | 62 | ||
| Rules for complex acid-base disorders | 63 | ||
| Clinical use of blood gases in the seriously ill patient | 63 | ||
| Detection of non-clinically suspected serious disease | 64 | ||
| References | 64 | ||
| 2.7 Cerebral resuscitation after cardiac arrest | 65 | ||
| Introduction | 65 | ||
| Definition | 65 | ||
| Pathophysiology of cerebral ischaemia | 65 | ||
| Reperfusion injury | 65 | ||
| Cerebral haemodynamics after reperfusion | 66 | ||
| Pharmacological interventions | 66 | ||
| Therapeutic hypothermia | 66 | ||
| Other interventions | 67 | ||
| Outcome prediction | 67 | ||
| Summary | 67 | ||
| References | 67 | ||
| Section 3: Trauma | 68 | ||
| 3.1 Trauma overview | 68 | ||
| Introduction | 68 | ||
| Initial management | 69 | ||
| Clinical presentation | 71 | ||
| Monitoring | 72 | ||
| Management | 72 | ||
| Hypotensive resuscitation | 72 | ||
| Next steps | 73 | ||
| Trauma audit | 73 | ||
| Trauma in developing countries | 74 | ||
| References | 74 | ||
| Further reading | 74 | ||
| 3.2 Neurotrauma | 75 | ||
| Introduction | 75 | ||
| Pathogenesis | 75 | ||
| Epidemiology | 76 | ||
| Prevention | 76 | ||
| Clinical features | 76 | ||
| Clinical investigation | 77 | ||
| Treatment | 77 | ||
| Disposition | 79 | ||
| Prognosis | 79 | ||
| References | 79 | ||
| 3.3 Spinal trauma | 80 | ||
| Introduction | 80 | ||
| Pathophysiology | 80 | ||
| Neurological injuries | 81 | ||
| Autonomic nervous system effects of spinal cord damage | 82 | ||
| Spinal shock10,15-17 | 83 | ||
| Vertebral injury2,10,13-20 | 83 | ||
| Spinal cord injury management | 85 | ||
| Documentation conventions | 87 | ||
| Unconscious patients | 89 | ||
| Referral-disposition | 91 | ||
| Other treatments | 91 | ||
| Clearing the spine | 91 | ||
| Immobilization | 92 | ||
| References | 92 | ||
| Further reading | 93 | ||
| 3.4 Facial trauma | 94 | ||
| Introduction | 94 | ||
| History | 94 | ||
| Examination | 94 | ||
| Radiographic examination | 95 | ||
| Immediate management in the emergency department | 95 | ||
| Specific injuries | 96 | ||
| Penetrating injuries to the face | 97 | ||
| Conclusion | 98 | ||
| References | 98 | ||
| 3.5 Abdominal trauma | 99 | ||
| Introduction | 99 | ||
| Primary and secondary surveys | 99 | ||
| Penetrating injuries | 101 | ||
| Disposition | 102 | ||
| Future directions | 102 | ||
| References | 103 | ||
| 3.6 Chest trauma | 104 | ||
| Introduction | 104 | ||
| Chest wall injury | 104 | ||
| Pleural injury | 105 | ||
| Lung injury | 106 | ||
| Tracheobronchial injury | 106 | ||
| Mediastinal injury | 106 | ||
| Vertebral column and spinal cord injury | 107 | ||
| Indications for emergency thoracotomy33 | 107 | ||
| Conclusion | 108 | ||
| References | 109 | ||
| 3.7 Limb trauma | 109 | ||
| Introduction | 109 | ||
| Presentation | 110 | ||
| Investigations | 110 | ||
| Management | 111 | ||
| Disposition | 112 | ||
| Hyperbaric oxygen therapy | 113 | ||
| Complications | 113 | ||
| Acute limb compartment syndrome | 114 | ||
| Fat embolism syndrome | 114 | ||
| Crush syndrome | 114 | ||
| Immobilization | 115 | ||
| References | 115 | ||
| 3.8 Radiology in major trauma | 116 | ||
| Emergency department reception | 116 | ||
| Hazards of radiation | 116 | ||
| The trauma series | 117 | ||
| Specific regional radiology | 117 | ||
| Chest trauma | 124 | ||
| Abdomen/pelvis | 127 | ||
| Extremities | 129 | ||
| Conclusion | 129 | ||
| References | 130 | ||
| 3.9 Trauma in pregnancy | 131 | ||
| Introduction | 131 | ||
| Anatomical and physiological changes in pregnancy | 131 | ||
| Epidemiology | 131 | ||
| Specific injuries | 132 | ||
| Presentation | 132 | ||
| Investigations | 132 | ||
| Management | 133 | ||
| Disposition | 133 | ||
| Prognosis | 133 | ||
| Prevention | 133 | ||
| References | 134 | ||
| 3.10 Wound care and repair | 134 | ||
| Introduction | 135 | ||
| Clinical presentation | 135 | ||
| Wound cleansing | 135 | ||
| Tetanus prophylaxis | 137 | ||
| Wound-healing mechanisms | 137 | ||
| Suture types | 137 | ||
| Needles | 138 | ||
| Basic suture technique | 139 | ||
| Special sites and situations | 142 | ||
| Special suture techniques | 142 | ||
| The 'dog-ea' | 143 | ||
| Wound drainage | 144 | ||
| Dressings | 144 | ||
| Immobilization | 145 | ||
| Disposal/removal | 145 | ||
| References | 148 | ||
| 3.11 Burns | 149 | ||
| Introduction | 149 | ||
| Pathophysiology | 149 | ||
| Classification | 149 | ||
| Thermal Burns | 149 | ||
| Presentation | 149 | ||
| Investigations | 151 | ||
| Management | 151 | ||
| Burn shock | 152 | ||
| Inhalation injury | 152 | ||
| Disposition | 152 | ||
| Chemical Burns | 153 | ||
| General principles | 153 | ||
| Disposition | 153 | ||
| References | 153 | ||
| Section 4: Orthopaedic emergencies | 154 | ||
| 4.1 Injuries of the shoulder | 154 | ||
| Fractures of the clavicle | 154 | ||
| Acromioclavicular joint injuries | 155 | ||
| Sternoclavicular subluxation and dislocation | 155 | ||
| Fractures of the scapula | 155 | ||
| Rotator cuff injuries | 155 | ||
| Dislocation of the shoulder | 156 | ||
| Further reading | 157 | ||
| 4.2 Fractures of the humerus | 157 | ||
| Introduction | 157 | ||
| Fractures of the proximal humerus | 157 | ||
| Fractures of the shaft of humerus | 159 | ||
| Fractures of the distal humerus | 160 | ||
| References | 161 | ||
| Further reading | 161 | ||
| 4.3 Dislocations of the elbow | 161 | ||
| Introduction | 161 | ||
| Clinical assessment | 161 | ||
| Investigations | 162 | ||
| Management | 162 | ||
| Disposition | 162 | ||
| References | 163 | ||
| Further reading | 163 | ||
| 4.4 Fractures of the forearm and carpal bones | 163 | ||
| Radial head fractures | 163 | ||
| Shaft fractures | 164 | ||
| Fractures of the distal radius and ulna | 165 | ||
| Carpal fractures and dislocations | 167 | ||
| Further reading | 168 | ||
| 4.5 Hand injuries | 168 | ||
| Introduction | 168 | ||
| Clinical features | 168 | ||
| Investigations | 169 | ||
| Treatment | 170 | ||
| Fingertip injuries | 170 | ||
| Digital nerve injuries | 171 | ||
| Nailbed injuries | 171 | ||
| Terminalization | 171 | ||
| Distal interphalangeal joint injuries | 171 | ||
| Middle phalangeal injuries | 171 | ||
| Proximal interphalangeal joint injuries | 171 | ||
| Proximal phalangeal injuries | 172 | ||
| Metacarpophalangeal joint injuries | 172 | ||
| Metacarpal injuries | 172 | ||
| Dorsal hand injuries | 172 | ||
| Palmar hand injuries | 172 | ||
| Disposition | 172 | ||
| Prognosis | 173 | ||
| Prevention | 173 | ||
| References | 173 | ||
| Further reading | 173 | ||
| 4.6 Pelvic injuries | 174 | ||
| Anatomy | 174 | ||
| Classification of pelvic fractures | 174 | ||
| Clinical assessment | 175 | ||
| Injuries associated with pelvic fractures | 175 | ||
| Management of unstable pelvic fracture | 176 | ||
| Open pelvic fractures | 176 | ||
| Stable fractures of the pelvis | 176 | ||
| Acetabular fractures | 177 | ||
| Further reading | 177 | ||
| 4.7 Hip injuries | 178 | ||
| Anatomy | 178 | ||
| Classification of hip fractures | 178 | ||
| Hip dislocation | 181 | ||
| Further reading | 182 | ||
| 4.8 Femur injuries | 182 | ||
| Femoral shaft fracture | 182 | ||
| Further reading | 183 | ||
| 4.9 Knee injuries | 184 | ||
| Anatomy | 184 | ||
| Clinical assessment | 184 | ||
| Fractures around the knee joint | 185 | ||
| Dislocations around the knee joint | 187 | ||
| Soft tissue injuries | 188 | ||
| Further reading | 190 | ||
| 4.10 Tibia and fibula injuries | 190 | ||
| Anatomy | 190 | ||
| Fractures of the tibia | 190 | ||
| Fractures of the fibula | 192 | ||
| References | 193 | ||
| Further reading | 193 | ||
| 4.11 Ankle joint injuries | 193 | ||
| Anatomy | 193 | ||
| Clinical assessment | 193 | ||
| Ankle fracture classification | 194 | ||
| Fracture management | 194 | ||
| Pilon fractures | 195 | ||
| Maisonneuve fracture | 195 | ||
| Ankle dislocations | 195 | ||
| Soft tissue injuries | 195 | ||
| References | 196 | ||
| Further reading | 196 | ||
| 4.12 Foot injuries | 197 | ||
| Anatomy | 197 | ||
| Clinical assessment | 197 | ||
| Hindfoot injuries | 198 | ||
| Midfoot fractures | 199 | ||
| Forefoot fractures | 200 | ||
| References | 201 | ||
| Further reading | 201 | ||
| Section 5: Cardiovascular | 202 | ||
| 5.1 Chest pain | 202 | ||
| Introduction | 202 | ||
| Epidemiology | 202 | ||
| Differential diagnosis | 203 | ||
| Clinical features | 203 | ||
| Clinical investigation | 204 | ||
| Treatment | 206 | ||
| Prognosis | 207 | ||
| Likely developments over the next 5-10 years | 207 | ||
| Further reading | 207 | ||
| 5.2 Acute coronary syndromes | 208 | ||
| Introduction | 208 | ||
| Aetiology, pathogenesis and pathology | 208 | ||
| Epidemiology | 209 | ||
| Prevention | 209 | ||
| Clinical features | 209 | ||
| Differential diagnosis | 210 | ||
| Clinical investigation | 210 | ||
| Criteria for diagnosis | 211 | ||
| Treatment | 211 | ||
| Disposition | 213 | ||
| Complications | 213 | ||
| Prognosis | 213 | ||
| Likely developments over the next 5-10 years | 214 | ||
| Further reading | 214 | ||
| 5.3 Assessment and management of acute pulmonary oedema | 215 | ||
| Introduction | 215 | ||
| Pathophysiology | 215 | ||
| Clinical assessment | 215 | ||
| Investigation | 216 | ||
| Management | 216 | ||
| References | 218 | ||
| 5.4 Arrhythmias | 219 | ||
| Introduction | 219 | ||
| Pathophysiology and pathogenesis | 219 | ||
| Principles of assessment and management | 220 | ||
| Further reading | 231 | ||
| 5.5 Pulmonary embolism | 232 | ||
| Introduction | 232 | ||
| History | 232 | ||
| Examination | 233 | ||
| Investigations | 233 | ||
| Management | 236 | ||
| Specific treatments in unstable patients | 237 | ||
| Prognosis | 237 | ||
| Disposition | 237 | ||
| Conclusion | 237 | ||
| References | 238 | ||
| 5.6 Pericarditis, cardiac tamponade and myocarditis | 239 | ||
| Pericarditis | 239 | ||
| Introduction | 239 | ||
| Clinical features | 239 | ||
| Investigations | 239 | ||
| Making the diagnosis | 240 | ||
| Management | 241 | ||
| Disposition | 241 | ||
| Non-Traumatic Cardiac Tamponade | 241 | ||
| Introduction | 241 | ||
| Clinical features | 241 | ||
| Differential diagnosis | 242 | ||
| Investigations | 242 | ||
| Treatment | 242 | ||
| Disposition | 243 | ||
| Myocarditis | 243 | ||
| Introduction | 243 | ||
| Clinical features | 243 | ||
| Investigations | 244 | ||
| Treatment and disposition | 244 | ||
| Prognosis | 245 | ||
| Further reading | 245 | ||
| 5.7 Heart valve emergencies | 246 | ||
| Introduction | 246 | ||
| Infective endocarditis | 246 | ||
| Acute aortic incompetence | 250 | ||
| Acute deterioration in chronic aortic incompetence | 250 | ||
| Acute deterioration in critical aortic stenosis | 251 | ||
| Acute deterioration in mitral stenosis | 251 | ||
| Acute mitral incompetence | 252 | ||
| Acute deterioration in chronic mitral incompetence | 252 | ||
| Prosthetic valve complications | 253 | ||
| Further reading | 253 | ||
| 5.8 Peripheral vascular disease | 254 | ||
| Arterial Disease | 254 | ||
| Introduction | 254 | ||
| Chronic arterial ischaemia | 254 | ||
| Acute arterial ischaemia of the lower limb | 255 | ||
| Acute arterial ischaemia of the upper limb | 256 | ||
| Venous Disease: Lower Limb | 256 | ||
| Introduction | 256 | ||
| Venous insufficiency and varicose veins | 256 | ||
| Superficial venous thrombosis | 256 | ||
| Deep venous thrombosis | 257 | ||
| Venous Disease: Upper Limb | 258 | ||
| Introduction | 258 | ||
| Likely developments over the next 5-10 years | 258 | ||
| Further reading | 258 | ||
| 5.9 Hypertension | 259 | ||
| Introduction | 259 | ||
| Hypertensive emergencies | 259 | ||
| Hypertensive urgency | 262 | ||
| Developments in the next 5-10 years | 262 | ||
| Further reading | 262 | ||
| 5.10 Aortic dissection | 263 | ||
| Introduction | 263 | ||
| Epidemiology | 263 | ||
| Pathophysiology | 263 | ||
| Classification | 264 | ||
| Clinical features | 264 | ||
| Investigation | 265 | ||
| Differential diagnosis | 266 | ||
| Treatment | 266 | ||
| Prognosis | 267 | ||
| Disposition | 268 | ||
| References | 268 | ||
| 5.11 Aneurysms | 269 | ||
| Introduction | 269 | ||
| Aetiology, genetics, pathogenesis and pathology | 269 | ||
| Central aneurysms | 269 | ||
| Cerebral aneurysms | 271 | ||
| Peripheral aneurysms | 271 | ||
| Likely developments over the next 5-10 years | 272 | ||
| References | 272 | ||
| Section 6: Respiratory | 314 | ||
| 6.1 Upper respiratory tract | 273 | ||
| Introduction | 273 | ||
| Triage and initial evaluation | 273 | ||
| Upper airway obstruction | 274 | ||
| Investigation | 274 | ||
| Management | 275 | ||
| Trauma | 275 | ||
| Thermal injury | 276 | ||
| Investigations | 276 | ||
| Infections | 276 | ||
| Further reading | 278 | ||
| 6.2 Asthma | 279 | ||
| Introduction | 279 | ||
| Epidemiology | 279 | ||
| Pathophysiology | 279 | ||
| Clinical assessment | 280 | ||
| Investigation | 280 | ||
| Management | 280 | ||
| Disposition | 282 | ||
| Further reading | 282 | ||
| 6.3 Community-acquired pneumonia | 283 | ||
| Introduction | 283 | ||
| Pathogenesis and aetiology | 283 | ||
| Epidemiology | 285 | ||
| Prevention | 285 | ||
| Clinical features | 285 | ||
| Differential diagnosis | 286 | ||
| Complications | 286 | ||
| Investigation | 286 | ||
| Treatment | 290 | ||
| Likely developments over the next 5-10 years | 292 | ||
| Acknowledgements | 293 | ||
| Further reading | 293 | ||
| 6.4 Influenza and emerging respiratory infections | 293 | ||
| Introduction | 293 | ||
| Influenza | 294 | ||
| History | 294 | ||
| Clinical features | 295 | ||
| Assessment | 296 | ||
| Treatment | 296 | ||
| Prevention | 296 | ||
| Avian influenza | 297 | ||
| Organizational issues | 297 | ||
| Further reading | 297 | ||
| 6.5 Chronic obstructive pulmonary disease | 298 | ||
| Introduction | 298 | ||
| Aetiology, genetics, pathogenesis and pathology | 298 | ||
| Epidemiology | 298 | ||
| Clinical features | 298 | ||
| Clinical investigations | 299 | ||
| Treatment | 300 | ||
| Prognosis | 302 | ||
| Further reading | 303 | ||
| 6.6 Pneumothorax | 303 | ||
| Introduction | 303 | ||
| Clinical features | 304 | ||
| Differential diagnosis | 304 | ||
| Investigations | 304 | ||
| Management | 304 | ||
| Prognosis | 306 | ||
| Disposition | 306 | ||
| Further reading | 306 | ||
| 6.7 Pleural effusion | 307 | ||
| Introduction | 307 | ||
| Pathophysiology | 307 | ||
| Aetiology | 307 | ||
| Classification | 307 | ||
| Clinical features | 307 | ||
| Investigations | 308 | ||
| Management | 309 | ||
| Complications | 310 | ||
| Disposition | 310 | ||
| Summary | 310 | ||
| References | 310 | ||
| Further reading | 310 | ||
| 6.8 Haemoptysis | 311 | ||
| Introduction | 311 | ||
| Aetiology | 311 | ||
| Clinical features | 311 | ||
| Clinical investigations | 311 | ||
| Treatment | 312 | ||
| Massive haemoptysis | 312 | ||
| References | 313 | ||
| Section 7: Digestive | 314 | ||
| 7.1 Dysphagia | 314 | ||
| Introduction | 314 | ||
| Aetiology | 314 | ||
| Clinical features | 314 | ||
| Clinical investigation | 315 | ||
| Treatment | 315 | ||
| Other issues | 315 | ||
| References | 315 | ||
| 7.2 Approach to abdominal pain | 316 | ||
| Introduction | 316 | ||
| Epidemiology | 316 | ||
| Pathophysiology and differential diagnosis | 316 | ||
| Causes of diffuse abdominal pain | 317 | ||
| Clinical features | 318 | ||
| Investigations | 320 | ||
| Pitfalls | 322 | ||
| Diagnosis versus disposition | 323 | ||
| General management | 323 | ||
| Disposition | 323 | ||
| Non-specific abdominal pain (NSAP) | 324 | ||
| Discharge advice | 324 | ||
| Developments in the next 5-10 years | 324 | ||
| References | 324 | ||
| 7.3 Bowel obstruction | 325 | ||
| Introduction | 325 | ||
| Aetiology and pathophysiology | 325 | ||
| Clinical features | 325 | ||
| Investigations | 326 | ||
| Management | 326 | ||
| Disposition | 327 | ||
| Further reading | 327 | ||
| 7.4 Hernia | 327 | ||
| Introduction | 327 | ||
| Inguinal hernia | 328 | ||
| Femoral hernia | 328 | ||
| Umbilical hernia | 328 | ||
| Epigastric hernia | 328 | ||
| Other herniae | 328 | ||
| Complications | 328 | ||
| Treatment | 328 | ||
| References | 329 | ||
| 7.5 Gastroenteritis | 329 | ||
| Introduction | 329 | ||
| Pathophysiology and microbiology | 330 | ||
| Clinical presentation | 330 | ||
| Clinical examination | 330 | ||
| Diarrhoea in certain circumstances | 331 | ||
| Differential diagnosis | 331 | ||
| Investigations | 331 | ||
| Treatment | 332 | ||
| References | 333 | ||
| 7.6 Haematemesis and melaena | 334 | ||
| Introduction | 334 | ||
| Epidemiology, aetiology and differential dignosis | 334 | ||
| Prevention | 334 | ||
| Definitions | 334 | ||
| Clinical features | 334 | ||
| Clinical investigation | 335 | ||
| Treatment | 335 | ||
| Specific therapy | 336 | ||
| Other issues | 338 | ||
| Likely developments over the next 5-10 years | 338 | ||
| References | 339 | ||
| 7.7 Peptic ulcer disease and gastritis | 339 | ||
| Introduction | 339 | ||
| Pathophysiology | 339 | ||
| Clinical features | 340 | ||
| Investigations | 340 | ||
| Management | 341 | ||
| Complications | 342 | ||
| Disposition | 343 | ||
| Further reading | 343 | ||
| 7.8 Biliary tract disease | 344 | ||
| Introduction | 344 | ||
| Gallstones | 344 | ||
| Cholelithiasis | 345 | ||
| Acute cholecystitis | 345 | ||
| Acalculous cholecystitis | 346 | ||
| Choledocholithiasis | 346 | ||
| Cholangitis | 346 | ||
| Further reading | 347 | ||
| 7.9 Pancreatitis | 347 | ||
| Acute pancreatitis | 347 | ||
| Likely developments over the next 5-10 years | 348 | ||
| Chronic pancreatitis | 349 | ||
| References | 350 | ||
| 7.10 Acute appendicitis | 350 | ||
| Introduction | 350 | ||
| Presentation | 350 | ||
| Differential diagnosis | 351 | ||
| Investigation | 351 | ||
| Treatment | 352 | ||
| Acute appendicitis in Pregnancy | 353 | ||
| Likely developments over the next 5-10 years | 353 | ||
| Further reading | 353 | ||
| 7.11 Inflammatory bowel disease | 353 | ||
| Introduction | 353 | ||
| Aetiology, genetics, pathogenesis and pathology | 353 | ||
| Epidemiology | 354 | ||
| Clinical Features | 354 | ||
| Clinical investigation | 354 | ||
| Management | 354 | ||
| Disposition | 355 | ||
| References | 356 | ||
| 7.12 Acute liver failure | 356 | ||
| Introduction | 356 | ||
| Aetiology, pathogenesis and pathology | 356 | ||
| Epidemiology | 356 | ||
| Prevention | 357 | ||
| Clinical features | 357 | ||
| Differential diagnosis | 357 | ||
| Clinical investigations | 357 | ||
| Criteria for diagnosis | 358 | ||
| Treatment | 358 | ||
| Prognosis | 360 | ||
| Likely developments over the next 5-10 years | 361 | ||
| Further reading | 361 | ||
| 7.13 Rectal bleeding | 361 | ||
| Introduction | 361 | ||
| Aetiology | 362 | ||
| History | 362 | ||
| Examination | 362 | ||
| Investigations | 362 | ||
| Treatment | 363 | ||
| Conclusion | 363 | ||
| Further reading | 364 | ||
| 7.14 Perianal conditions | 364 | ||
| Pilonidal disease | 364 | ||
| Anorectal abscesses | 364 | ||
| Anal fistula | 365 | ||
| Haemorrhoids | 365 | ||
| Anal fissure | 366 | ||
| Pruritus ani | 367 | ||
| Proctalgia fugax | 367 | ||
| Injuries to the perianal region | 367 | ||
| Other anorectal conditions | 367 | ||
| References | 367 | ||
| Section 8: Neurology | 368 | ||
| 8.1 Headache | 368 | ||
| Introduction | 368 | ||
| Pathophysiology | 368 | ||
| Assessment | 369 | ||
| Investigation | 369 | ||
| Tension headache | 370 | ||
| Migraine | 370 | ||
| Trigeminal neuralgia | 371 | ||
| Further reading | 372 | ||
| 8.2 Stroke and transient ischaemic attacks | 372 | ||
| Introduction | 372 | ||
| Pathophysiology | 372 | ||
| Prevention | 373 | ||
| Ischaemic stroke syndromes | 374 | ||
| Pre-hospital care | 375 | ||
| Clinical evaluation in the ED | 375 | ||
| Differential diagnosis | 376 | ||
| Complications of stroke | 376 | ||
| Investigations | 376 | ||
| Treatment | 378 | ||
| Intracerebral haemorrhage (ICH) | 379 | ||
| References | 380 | ||
| Further reading | 381 | ||
| 8.3 Subarachnoid haemorrhage | 381 | ||
| Introduction | 381 | ||
| Pathology and epidemiology | 381 | ||
| Clinical features | 382 | ||
| Investigations | 382 | ||
| Complications | 384 | ||
| Management | 384 | ||
| Prognosis | 385 | ||
| Incidental unruptured aneurysms | 385 | ||
| Conclusion | 385 | ||
| Further reading | 386 | ||
| 8.4 Altered conscious state | 386 | ||
| Introduction | 386 | ||
| Pathophysiology | 386 | ||
| Differential diagnoses | 387 | ||
| Clinical assessment | 387 | ||
| Investigations | 389 | ||
| Management | 390 | ||
| Disposition | 391 | ||
| Prognosis | 391 | ||
| Further reading | 391 | ||
| 8.5 Seizures | 392 | ||
| Introduction | 392 | ||
| First seizures | 393 | ||
| Status epilepticus | 394 | ||
| Non-convulsive seizures | 395 | ||
| Pseudoseizures | 395 | ||
| Alcohol-related seizures | 396 | ||
| Drug-related seizures | 396 | ||
| Post-traumatic seizures | 396 | ||
| Seizures and pregnancy | 396 | ||
| Future directions | 397 | ||
| References | 397 | ||
| 8.6 Syncope and vertigo | 398 | ||
| Introduction | 398 | ||
| Syncope | 398 | ||
| Vertigo | 400 | ||
| References | 401 | ||
| Section 9: Infectious diseases | 402 | ||
| 9.1 Approach to undifferentiated fever in adults | 402 | ||
| Introduction | 402 | ||
| Approach | 403 | ||
| Clinical investigation | 406 | ||
| Disposition | 406 | ||
| Future research directions | 407 | ||
| References | 407 | ||
| Further reading | 407 | ||
| 9.2 Meningitis | 408 | ||
| Introduction | 408 | ||
| Classification | 408 | ||
| Aetiology | 408 | ||
| Epidemiology | 408 | ||
| Pathogenesis | 409 | ||
| Presentation | 409 | ||
| Examination | 410 | ||
| Investigations | 410 | ||
| Differential diagnosis | 411 | ||
| Management | 411 | ||
| Disposition | 412 | ||
| Prognosis | 412 | ||
| Prevention | 412 | ||
| References | 413 | ||
| 9.3 Septic arthritis | 414 | ||
| Introduction | 414 | ||
| Presentation | 414 | ||
| Investigation | 414 | ||
| Differential diagnosis | 415 | ||
| Management | 415 | ||
| Disposition | 415 | ||
| Prognosis | 415 | ||
| Prevention | 415 | ||
| References | 415 | ||
| 9.4 Osteomyelitis | 416 | ||
| Introduction | 416 | ||
| Presentation | 416 | ||
| Investigations | 416 | ||
| Differential diagnosis | 416 | ||
| Management | 417 | ||
| Disposition | 417 | ||
| Prognosis | 417 | ||
| Prevention | 417 | ||
| References | 417 | ||
| 9.5 Urinary tract infection | 418 | ||
| Introduction | 418 | ||
| Epidemiology | 418 | ||
| Aetiology | 418 | ||
| Pathogenesis | 419 | ||
| Presentation | 420 | ||
| Investigations | 420 | ||
| Imaging | 421 | ||
| Management | 422 | ||
| Disposition | 424 | ||
| Prognosis | 424 | ||
| References | 424 | ||
| Further reading | 425 | ||
| 9.6 Skin and soft-tissue infections | 426 | ||
| Introduction | 426 | ||
| Aetiology | 426 | ||
| Examination | 426 | ||
| Investigations | 427 | ||
| Management | 427 | ||
| Disposition | 428 | ||
| Superficial skin infections | 428 | ||
| Cellulitis | 429 | ||
| Abscesses | 429 | ||
| Deep soft-tissue infections | 429 | ||
| Toxic complications of wound infections | 430 | ||
| Special infections | 431 | ||
| References | 433 | ||
| 9.7 Hepatitis | 434 | ||
| Introduction | 434 | ||
| Clinical presentations of viral hepatitis | 434 | ||
| Hepatitis A virus | 434 | ||
| Hepatitis B virus | 435 | ||
| Hepatitis C virus | 436 | ||
| Hepatitis D virus | 436 | ||
| Hepatitis E virus | 437 | ||
| Hepatitis G virus | 437 | ||
| Non-hepatotrophic viruses | 437 | ||
| Non-viral hepatitis | 437 | ||
| Future directions | 438 | ||
| References | 438 | ||
| 9.8 HIV/AIDS | 438 | ||
| Introduction | 438 | ||
| Epidemiology | 439 | ||
| Pathogenesis | 439 | ||
| Classification and natural history | 439 | ||
| Presentation | 439 | ||
| Investigation | 442 | ||
| Management | 443 | ||
| Disposition | 445 | ||
| Prognosis | 445 | ||
| Prevention | 445 | ||
| References | 446 | ||
| 9.9 Antibiotics in the emergency department | 446 | ||
| Principles of antimicrobial therapy | 446 | ||
| Antibiotic resistance | 447 | ||
| Prophylactic use of antibiotics | 447 | ||
| Penicillins | 449 | ||
| Cephalosporins | 450 | ||
| Macrolides | 451 | ||
| Tetracycline | 452 | ||
| Aminoglycosides | 452 | ||
| Metronidazole | 452 | ||
| Co-trimoxazole | 453 | ||
| Quinolones | 453 | ||
| Nitrofurantoin | 454 | ||
| Antiviral drugs | 454 | ||
| Antiretroviral drugs | 454 | ||
| Outpatient parenteral antibiotic therapy | 454 | ||
| Other issues | 455 | ||
| Likely developments over the next 5-10 years | 455 | ||
| References | 456 | ||
| 9.10 Needlestick injuries and related blood and body fluid exposures | 456 | ||
| Introduction | 456 | ||
| General issues | 457 | ||
| Hepatitis B | 457 | ||
| Hepatitis C | 457 | ||
| Human immunodeficiency virus | 458 | ||
| Exposures that occur in the community | 459 | ||
| Illustrative cases | 459 | ||
| References | 460 | ||
| Further reading | 460 | ||
| Section 10: Genitourinary | 461 | ||
| 10.1 Acute kidney injury | 461 | ||
| Introduction | 462 | ||
| Aetiology and pathogenesis | 462 | ||
| Epidemiology | 464 | ||
| Prevention | 464 | ||
| Clinical features | 465 | ||
| Differential diagnosis | 467 | ||
| Criteria for diagnosis | 468 | ||
| Treatment | 469 | ||
| Prognosis | 472 | ||
| References | 472 | ||
| 10.2 The acute scrotum | 473 | ||
| Torsion of the Spermatic Cord (Testicle) | 473 | ||
| Aetiology | 473 | ||
| Pathology | 473 | ||
| Clinical presentation | 473 | ||
| Differential diagnosis of acute testicular pain | 473 | ||
| Traps in the clinical diagnosis | 474 | ||
| Investigations | 474 | ||
| Treatment | 474 | ||
| Prognosis | 474 | ||
| Torsion of a testicular appendage | 475 | ||
| Acute Epididymo-Orchitis | 475 | ||
| Introduction | 475 | ||
| Aetiology | 475 | ||
| Clinical presentation | 475 | ||
| Investigations | 475 | ||
| Differential diagnosis | 475 | ||
| Treatment | 475 | ||
| Complications | 475 | ||
| Blunt traumatic injury to the testicle | 475 | ||
| References | 476 | ||
| 10.3 Renal colic | 477 | ||
| Introduction | 477 | ||
| Pathophysiology of pain | 477 | ||
| Presentation | 477 | ||
| Radiological examination | 478 | ||
| Management | 479 | ||
| Precautions | 479 | ||
| Conclusion | 480 | ||
| References | 480 | ||
| Section 11: Endocrine | 481 | ||
| 11.1 Diabetes mellitus and hypoglycaemia: an overview | 481 | ||
| Diabetes Mellitus | 481 | ||
| Classification system and diagnostic criteria | 481 | ||
| Aetiology | 481 | ||
| Emergency presentations of a high blood sugar | 481 | ||
| General management of diabetes mellitus | 482 | ||
| Diabetic Hypoglycaemia | 482 | ||
| Clinical features | 482 | ||
| Management of hypoglycaemic coma | 482 | ||
| References | 483 | ||
| 11.2 Diabetic ketoacidosis and hyperosmolar, hyperglycaemic non-ketotic state | 483 | ||
| Introduction | 484 | ||
| Aetiology, genetics, pathogenesis and pathology | 484 | ||
| Epidemiology | 484 | ||
| Clinical features | 484 | ||
| DKA differential diagnosis | 484 | ||
| Clinical investigations in DKA | 484 | ||
| Criteria for diagnosis | 484 | ||
| Treatment of DKA | 484 | ||
| Treatment of HHNS | 486 | ||
| Prognosis | 486 | ||
| Miscellaneous issues | 486 | ||
| References | 486 | ||
| 11.3 Thyroid and adrenal emergencies | 487 | ||
| Introduction | 487 | ||
| Thyrotoxicosis | 487 | ||
| Aetiology, genetics, pathogenesis and pathology | 487 | ||
| Epidemiology | 487 | ||
| Clinical features | 487 | ||
| Clinical investigation and criteria for diagnosis1-3 | 488 | ||
| Treatment | 488 | ||
| Thyroid storm | 488 | ||
| Apathetic hyperthyroidism | 489 | ||
| Hypothyroidism | 489 | ||
| Aetiology, genetics, pathogenesis and pathology | 489 | ||
| Epidemiology | 489 | ||
| Clinical features | 489 | ||
| Clinical investigation and criteria for diagnosis | 490 | ||
| Treatment | 490 | ||
| Myxoedema coma | 490 | ||
| Hypoadrenal States | 490 | ||
| Aetiology, genetics, pathogenesis and pathology | 490 | ||
| Clinical features | 491 | ||
| Differential diagnosis | 491 | ||
| Clinical investigation | 491 | ||
| Criteria for diagnosis 3 | 491 | ||
| Treatment | 491 | ||
| Prognosis | 492 | ||
| Response to severe illness | 492 | ||
| Hyperadrenal States | 492 | ||
| Aetiology, pathogenesis and epidemiology | 492 | ||
| Clinical features | 492 | ||
| Clinical investigation and criteria for diagnosis | 492 | ||
| Treatment | 492 | ||
| References | 493 | ||
| Further reading | 493 | ||
| Section 12: Metabolic | 494 | ||
| 12.1 Acid-base disorders | 494 | ||
| Introduction | 494 | ||
| Acid-base homeostasis | 494 | ||
| Acidosis | 494 | ||
| Alkalosis | 496 | ||
| References | 497 | ||
| 12.2 Electrolyte disturbances | 497 | ||
| Hyponatraemia | 497 | ||
| Introduction | 497 | ||
| Pathophysiology | 497 | ||
| Aetiology and classification | 498 | ||
| Clinical features | 498 | ||
| Syndrome of inappropriate ADH secretion | 499 | ||
| Clinical investigation | 499 | ||
| Treatment | 499 | ||
| Hypernatraemia | 500 | ||
| Introduction | 500 | ||
| Aetiology and classification | 501 | ||
| Clinical features | 501 | ||
| Treatment | 501 | ||
| Hypokalaemia | 501 | ||
| Introduction | 501 | ||
| Pathophysiology | 501 | ||
| Section 13: Haematology | 508 | ||
| 13.1 Anaemia | 508 | ||
| Introduction | 508 | ||
| Anaemia Secondary to Haemorrhage | 508 | ||
| Aetiology | 508 | ||
| Clinical features | 508 | ||
| Clinical investigations | 509 | ||
| Treatment | 510 | ||
| Chronic haemorrhage | 510 | ||
| Disposition | 510 | ||
| Anaemia Secondary to Decreased Red Cell Production | 510 | ||
| Megaloblastic anaemia | 510 | ||
| Anaemia of chronic disorders | 511 | ||
| Other causes of decreased red cell production | 511 | ||
| Anaemia Secondary to Decreased Red Cell Survival: The Haemolytic Anaemias | 511 | ||
| Hereditary spherocytosis | 512 | ||
| Glucose-6-phosphate dehydrogenase deficiency | 512 | ||
| Sickle cell anaemia | 512 | ||
| Thalassaemias | 513 | ||
| Acquired haemolytic anaemias | 513 | ||
| Microangiopathic haemolytic anaemia | 513 | ||
| Haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura | 513 | ||
| HELLP syndrome | 514 | ||
| Disseminated intravascular coagulation | 514 | ||
| Paroxysmal noctural haemoglobinuria | 514 | ||
| Other causes of haemolysis | 514 | ||
| Further reading | 514 | ||
| 13.2 Neutropenia | 515 | ||
| Introduction | 515 | ||
| Pathophysiology and aetiology | 515 | ||
| Clinical features | 516 | ||
| Clinical investigation | 516 | ||
| Treatment | 516 | ||
| Disposition | 516 | ||
| Prognosis | 517 | ||
| References | 517 | ||
| 13.3 Thrombocytopenia | 517 | ||
| Introduction | 517 | ||
| Aetiology | 517 | ||
| Artifactual thrombocytopenia | 517 | ||
| Immune-related thrombocytopenia | 518 | ||
| Non-immune platelet destruction | 518 | ||
| Massive blood transfusion and thrombocytopenia | 519 | ||
| Hypersplenism | 519 | ||
| Clinical features | 519 | ||
| Clinical investigation | 520 | ||
| Treatment | 520 | ||
| Disposition | 520 | ||
| References | 520 | ||
| 13.4 Haemophilia | 521 | ||
| Introduction | 521 | ||
| Pathophysiology | 521 | ||
| Clinical features | 521 | ||
| Clinical investigation | 522 | ||
| Treatment | 522 | ||
| Disposition | 523 | ||
| von Willebrand disease | 523 | ||
| Useful contacts | 524 | ||
| Further reading | 525 | ||
| 13.5 Blood and blood products | 525 | ||
| Introduction | 525 | ||
| Packed red blood cells | 526 | ||
| Precautions when cross-matching and transfusing blood | 528 | ||
| Adverse reactions to transfusion | 528 | ||
| Management of transfusion reactions | 530 | ||
| Platelets | 530 | ||
| Fresh frozen plasma | 530 | ||
| Cryoprecipitate | 530 | ||
| Massive transfusion | 531 | ||
| References | 531 | ||
| Section 14: Rheumatology and Musculoskeletal | 532 | ||
| 14.1 Rheumatological emergencies | 532 | ||
| Introduction | 532 | ||
| Rheumatoid Arthritis | 532 | ||
| Emergencies in RA - Articular Manifestations | 532 | ||
| Acute monoarthritis | 532 | ||
| Cervical spine involvement | 533 | ||
| Section 15: Dermatology | 559 | ||
| 15.1 Emergency dermatology | 559 | ||
| Introduction | 559 | ||
| Potentially Life-Threatening Dermatoses | 559 | ||
| Toxic epidermal necrolysis and Stevens-Johnson syndrome | 559 | ||
| Investigations | 560 | ||
| Management | 560 | ||
| Erythroderma | 561 | ||
| Complications of erythroderma | 561 | ||
| Investigations | 561 | ||
| Management | 561 | ||
| Other bullous and vesicular conditions | 561 | ||
| Pemphigus vulgaris | 562 | ||
| Bullous pemphigoid | 562 | ||
| Petechial and Purpuric Rashes | 562 | ||
| Petechiae, bruising and ecchymoses | 562 | ||
| Cutaneous vasculitis | 562 | ||
| Pruritic (Itchy) Dermatoses | 563 | ||
| Scabies | 564 | ||
| Eczema and Psoriasis | 565 | ||
| Eczema | 565 | ||
| Psoriasis | 566 | ||
| Other Dermatoses | 566 | ||
| Skin cancer | 566 | ||
| Herpes zoster | 566 | ||
| Non-accidental injury and neglect | 566 | ||
| Further reading | 567 | ||
| Section 16: Eyes | 568 | ||
| 16.1 Ocular emergencies | 568 | ||
| Introduction | 568 | ||
| Ocular Trauma | 569 | ||
| History | 569 | ||
| Examination | 569 | ||
| Investigation | 569 | ||
| Management of specific injuries | 569 | ||
| Prevention | 570 | ||
| Acute Inflammatory Conditions | 570 | ||
| Acute primary angle-closure (glaucoma) | 570 | ||
| Acute iritis | 571 | ||
| Acute infectious keratitis | 571 | ||
| Acute Visual Failure | 572 | ||
| Introduction | 572 | ||
| Clinical assessment | 572 | ||
| Central retinal artery occlusion | 572 | ||
| Central (branch) retinal vein occlusion | 573 | ||
| Anterior ischaemic optic neuropathy | 574 | ||
| Retinal detachment | 574 | ||
| Vitreous haemorrhage | 574 | ||
| Age-related macular degeneration | 574 | ||
| Optic neuritis | 575 | ||
| References | 575 | ||
| Further reading | 575 | ||
| Section 17: Dental | 576 | ||
| 17.1 Dental emergencies | 576 | ||
| Anatomy | 576 | ||
| Dental caries | 576 | ||
| Periodontal emergencies | 576 | ||
| Alveolar osteitis (dry socket) | 577 | ||
| Postdental extraction bleeding | 577 | ||
| Traumatic dental emergencies | 577 | ||
| Dentoalveolar trauma in children | 577 | ||
| Dental fractures | 577 | ||
| Temporomandibular dislocation | 578 | ||
| Dental infection and abscess (odontogenic infection) | 578 | ||
| References | 578 | ||
| Section 18: Ent | 579 | ||
| 18.1 Ears, nose and throat | 579 | ||
| The Ear | 579 | ||
| Introduction | 579 | ||
| Foreign body | 579 | ||
| Trauma | 580 | ||
| Infection | 580 | ||
| The Nose | 581 | ||
| Foreign body | 581 | ||
| Trauma | 581 | ||
| Sinusitis | 581 | ||
| Epistaxis | 582 | ||
| Summary | 582 | ||
| The Throat | 582 | ||
| Foreign body | 582 | ||
| Infection | 583 | ||
| References | 584 | ||
| Section 19: Obstetrics and Gynaecology | 585 | ||
| 19.1 Emergency delivery | 585 | ||
| Introduction | 585 | ||
| The setting | 585 | ||
| History | 586 | ||
| Examination | 586 | ||
| Management | 587 | ||
| Procedure post delivery | 589 | ||
| Disposition | 589 | ||
| Complications of delivery | 589 | ||
| Resuscitation of the neonate | 590 | ||
| Acknowledgements | 592 | ||
| References | 592 | ||
| Further reading | 592 | ||
| 19.2 Ectopic pregnancy and bleeding in early pregnancy | 592 | ||
| Introduction | 592 | ||
| History | 593 | ||
| Examination | 593 | ||
| Investigations | 593 | ||
| Management | 594 | ||
| Ectopic pregnancy | 594 | ||
| Failed pregnancy (miscarriage) | 594 | ||
| Prognosis | 594 | ||
| Disposition | 594 | ||
| References | 595 | ||
| 19.3 Bleeding after the first trimester of pregnancy | 595 | ||
| Introduction | 595 | ||
| Antepartum Haemorrhage | 595 | ||
| Differential diagnosis | 595 | ||
| History | 596 | ||
| Examination | 596 | ||
| Investigations | 596 | ||
| Management | 596 | ||
| Prognosis | 597 | ||
| Disposition | 597 | ||
| Secondary Post-Partum Haemorrhage | 597 | ||
| Introduction | 597 | ||
| Differential diagnosis | 597 | ||
| History | 597 | ||
| Examination | 597 | ||
| Investigations | 597 | ||
| Treatment | 597 | ||
| References | 597 | ||
| 19.4 Abnormal vaginal bleeding in the non-pregnant patient | 598 | ||
| Introduction | 598 | ||
| Causes of abnormal vaginal bleeding | 598 | ||
| History | 598 | ||
| Physical examination | 599 | ||
| Investigations | 599 | ||
| Management | 599 | ||
| Disposition | 600 | ||
| Conclusions | 600 | ||
| References | 600 | ||
| 19.5 Pelvic inflammatory disease | 601 | ||
| Introduction | 601 | ||
| Epidemiology | 601 | ||
| Presentation | 601 | ||
| Investigations | 602 | ||
| Differential diagnosis | 602 | ||
| Management | 602 | ||
| Disposition | 602 | ||
| Prognosis | 602 | ||
| References | 602 | ||
| 19.6 Pelvic pain | 603 | ||
| Introduction | 603 | ||
| Classification | 603 | ||
| History | 603 | ||
| Examination | 604 | ||
| Laboratory investigations | 604 | ||
| Imaging | 605 | ||
| Differential diagnosis | 605 | ||
| Conclusion | 607 | ||
| Further Reading | 608 | ||
| 19.7 Pre-eclampsia and eclampsia | 608 | ||
| Introduction | 608 | ||
| Aetiology, genetics and pathogenesis of pre-eclampsia | 608 | ||
| Epidemiology | 609 | ||
| Clinical features of pre-eclampsia and eclampsia | 609 | ||
| Differential diagnosis | 610 | ||
| Clinical investigation | 610 | ||
| Treatment | 611 | ||
| Prognosis of pre-eclampsia and eclampsia | 612 | ||
| Likely developments in the next 5-10 years | 612 | ||
| References | 612 | ||
| Section 20: Psychiatric Emergencies | 613 | ||
| 20.1 Mental state assessment | 613 | ||
| Epidemiology | 613 | ||
| Introduction to the mental state examination | 614 | ||
| Aims of mental health assessment | 615 | ||
| The formal psychiatric interview | 615 | ||
| Conclusion | 618 | ||
| References | 618 | ||
| 20.2 Distinguishing medical from psychiatric causes of mental disorder presentations | 619 | ||
| Introduction | 619 | ||
| General approach | 619 | ||
| Triage | 620 | ||
| The interview environment | 621 | ||
| History | 621 | ||
| Collateral history | 621 | ||
| Examination | 621 | ||
| Investigations | 623 | ||
| Diagnostic formulation | 623 | ||
| Conclusion | 624 | ||
| References | 624 | ||
| 20.3 Deliberate self-harm/suicide | 625 | ||
| Introduction | 625 | ||
| Incidence | 625 | ||
| Aetiology | 625 | ||
| Patient characteristics | 626 | ||
| Assessment | 627 | ||
| Definitive treatment and disposition | 628 | ||
| Consequences | 629 | ||
| Prevention | 630 | ||
| Conclusion | 630 | ||
| References | 630 | ||
| 20.4 Depression | 631 | ||
| Introduction | 631 | ||
| Epidemiology | 632 | ||
| Aetiology | 632 | ||
| Prevention | 633 | ||
| Clinical features | 633 | ||
| Differential diagnosis | 636 | ||
| Assessment | 638 | ||
| Treatment | 639 | ||
| References | 641 | ||
| 20.5 Psychosis | 641 | ||
| Introduction | 641 | ||
| Classification | 642 | ||
| Epidemiology and prognosis | 642 | ||
| Aetiology and prevention | 642 | ||
| Clinical features | 642 | ||
| Assessment | 645 | ||
| Treatment | 647 | ||
| References | 648 | ||
| 20.6 Pharmacological management of the aroused patient | 649 | ||
| Introduction | 649 | ||
| General principles of rapid tranquillization | 650 | ||
| References | 652 | ||
| Section 21: Challenging Situations | 653 | ||
| 21.1 Death and dying | 653 | ||
| Introduction | 653 | ||
| The death process | 654 | ||
| Dying persons | 654 | ||
| Breaking bad news | 654 | ||
| Viewing the body | 655 | ||
| Legal issues | 656 | ||
| Euthanasia | 656 | ||
| Death certificates | 656 | ||
| Organ donation | 656 | ||
| Bereavement counselling | 656 | ||
| Subsequent issues | 656 | ||
| An ED protocol | 657 | ||
| Professional issues | 657 | ||
| References | 658 | ||
| Further reading | 658 | ||
| 21.2 Sexual assault | 658 | ||
| Introduction | 658 | ||
| Definitions | 658 | ||
| Epidemiology | 659 | ||
| Rape myths and barriers to care | 659 | ||
| Medical care for the victim | 659 | ||
| The forensic examination | 661 | ||
| Psychological impact of a sexual assault | 662 | ||
| Sexual assault in special circumstances | 662 | ||
| Conclusion | 663 | ||
| References | 663 | ||
| 21.3 Domestic violence | 664 | ||
| Definition | 664 | ||
| Incidence | 664 | ||
| Predictors of domestic violence | 665 | ||
| Outcomes | 665 | ||
| Social | 666 | ||
| Barriers to detection and reporting of domestic violence | 667 | ||
| Screening | 667 | ||
| Management | 667 | ||
| Conclusion | 668 | ||
| References | 669 | ||
| 21.4 Alcohol-related illness | 670 | ||
| Introduction | 670 | ||
| Epidemiology | 670 | ||
| Pharmacology | 670 | ||
| Chronic alcohol-related illness | 671 | ||
| Important illnesses to be excluded that mimic alcohol intoxication | 675 | ||
| Treatment of alcohol-related illness | 676 | ||
| Assessment of alcohol misuse | 677 | ||
| Pharmacotherapy for alcohol use disorder | 678 | ||
| Likely developments over the next 5-10 years | 678 | ||
| References | 678 | ||
| 21.5 The challenging patient | 680 | ||
| The Homeless Patient | 680 | ||
| Definition and epidemiology | 680 | ||
| Clinical features | 681 | ||
| Management | 681 | ||
| The Prisoner | 681 | ||
| Definition and epidemiology | 681 | ||
| Clinical features | 682 | ||
| Management | 682 | ||
| The Behaviourally Disturbed and Violent Patient | 683 | ||
| Aetiology and epidemiology | 683 | ||
| Prevention | 683 | ||
| Clinical features | 683 | ||
| Legal and ethical considerations | 684 | ||
| Management | 684 | ||
| Violence | 686 | ||
| The Frequent Attender | 687 | ||
| Definition and epidiemiology | 687 | ||
| Clinical features | 687 | ||
| Management | 687 | ||
| The Patient With Drug-Seeking Behaviour | 688 | ||
| Definition and aetiology | 688 | ||
| Clinical features | 688 | ||
| Management | 688 | ||
| The Very Important Person | 689 | ||
| Definition | 689 | ||
| Management | 689 | ||
| References | 690 | ||
| Section 22: Pain relief | 692 | ||
| 22.1 General pain management | 692 | ||
| Introduction | 692 | ||
| Physiology | 692 | ||
| Assessment of pain and pain scales | 693 | ||
| General principles | 693 | ||
| Specific agents | 693 | ||
| Other analgesic agents | 696 | ||
| Pain relief in pregnancy | 696 | ||
| Non-pharmacological therapies | 696 | ||
| Special pain situations and non-analgesic agents | 696 | ||
| Chronic pain | 696 | ||
| The acute abdomen | 697 | ||
| Likely developments over the next 5-10 years | 697 | ||
| References | 697 | ||
| 22.2 Local anaesthesia | 698 | ||
| Local anaesthesia | 698 | ||
| Topical agents | 699 | ||
| Specific nerve blocks | 699 | ||
| Intravenous regional anaesthesia or Bier's block | 701 | ||
| References | 703 | ||
| 22.3 Procedural sedation and analgesia | 704 | ||
| Introduction and rationale | 704 | ||
| Underlying principles | 704 | ||
| Pre-procedure risk assessment | 705 | ||
| Choice of agent | 706 | ||
| Preparation and monitoring | 708 | ||
| Post-procedure considerations | 709 | ||
| Likely developments in the next 5-10 years106 | 709 | ||
| References | 710 | ||
| Section 23: Ultrasound | 712 | ||
| 23.1 Emergency department ultrasound | 712 | ||
| Background | 712 | ||
| Basic physics of ultrasound | 712 | ||
| Transducers | 713 | ||
| The scope of emergency department ultrasound | 713 | ||
| Abdominal aortic aneurysm | 715 | ||
| Early pregnancy | 716 | ||
| RUQ/Gallbladder | 717 | ||
| Renal ultrasound | 717 | ||
| Deep vein thrombosis | 718 | ||
| Emergency echocardiography | 719 | ||
| Ultrasound guided vascular access | 720 | ||
| Miscellaneous applications | 720 | ||
| Training and credentialing | 721 | ||
| References | 722 | ||
| Section 24: Academic Emergency Medicine | 724 | ||
| 24.1 Research methodology | 724 | ||
| Introduction | 724 | ||
| Initiating the research project | 724 | ||
| Assembling the research team | 725 | ||
| Development of the study protocol | 725 | ||
| Study design | 726 | ||
| Concepts of methodology | 727 | ||
| Sampling study subjects | 728 | ||
| Data-collection instruments | 728 | ||
| Bias and confounding | 729 | ||
| Principles of clinical research statistics | 730 | ||
| Databases and principles of data management | 731 | ||
| Research ethics | 731 | ||
| References | 732 | ||
| 24.2 Writing for publication | 733 | ||
| Introduction | 733 | ||
| Manuscript preparation | 733 | ||
| Manuscript submission | 734 | ||
| Feedback from journals | 735 | ||
| Post acceptance issues | 735 | ||
| Scientific misconduct | 735 | ||
| Further reading | 735 | ||
| 24.3 Principles of medical education | 735 | ||
| Introduction | 735 | ||
| Adult learning principles | 736 | ||
| Learner-centred education | 736 | ||
| What makes a good ED teacher? | 737 | ||
| Types of teaching in the ED | 738 | ||
| Feedback to learners | 740 | ||
| Conclusion | 740 | ||
| Likely developments over the next 5-10 years | 740 | ||
| References | 741 | ||
| 24.4 Undergraduate teaching in emergency medicine | 741 | ||
| Introduction | 741 | ||
| Overview of undergraduate medical education in Australia | 742 | ||
| The importance of medical student teaching | 742 | ||
| Curriculum development | 742 | ||
| Different ways to teach emergency medicine | 743 | ||
| Assessment principles | 745 | ||
| Likely developments over the next 5-10 years | 745 | ||
| References | 746 | ||
| 24.5 Postgraduate emergency medicine teaching and simulation | 746 | ||
| Introduction | 746 | ||
| Current training pathways in postgraduate emergency medicine | 747 | ||
| Challenges for contemporary emergency medicine education | 747 | ||
| Curricular trends | 747 | ||
| Innovation in teaching and learning | 747 | ||
| Learning technology | 748 | ||
| Simulation-based learning for emergency medicine | 748 | ||
| Assessment and performance appraisal | 749 | ||
| Faculty development in emergency medicine | 749 | ||
| Non-vocational teaching in emergency medicine | 750 | ||
| References | 750 | ||
| Section 25: Emergency medicine and the law | 751 | ||
| 25.1 Mental health and the law: the Australasian and UK perspectives | 751 | ||
| Introduction | 751 | ||
| Variations in practice | 752 | ||
| Mental health legislation in Australasia | 753 | ||
| References | 760 | ||
| Further reading | 760 | ||
| 25.2 The coroner: the Australasian and UK perspectives | 760 | ||
| Australasia | 761 | ||
| Introduction | 761 | ||
| Legislation | 761 | ||
| Reportable deaths | 762 | ||
| A coronial investigation | 762 | ||
| Expert opinion | 763 | ||
| A coronial inquest | 763 | ||
| Coronial findings | 764 | ||
| UK | 764 | ||
| Introduction | 765 | ||
| History of the coroner | 765 | ||
| Structure of the coroner system in the UK | 765 | ||
| How to report a death | 766 | ||
| Handling the body | 766 | ||
| Documentation | 766 | ||
| Information for families | 766 | ||
| Postmortems | 766 | ||
| Preparing a statement for the coroner | 767 | ||
| Inquest | 767 | ||
| References | 767 | ||
| 25.3 Consent and competence - the Australasian and UK perspectives | 768 | ||
| Consent | 768 | ||
| Competence | 769 | ||
| Patients who might not be able to consent | 769 | ||
| References | 771 | ||
| Further reading | 771 | ||
| 25.4 Privacy and confidentiality | 771 | ||
| Introduction | 772 | ||
| Physical privacy | 772 | ||
| Healthcare providers | 772 | ||
| Mandatory reporting | 772 | ||
| Police | 772 | ||
| Forensic issues | 773 | ||
| Patient health information | 773 | ||
| Legislation | 773 | ||
| National privacy principles | 773 | ||
| NPP10 | 774 | ||
| New Zealand | 774 | ||
| Implementation | 774 | ||
| Communications | 774 | ||
| Medicolegal reports | 775 | ||
| Research and quality assurance | 775 | ||
| Complaints and non-compliance | 775 | ||
| Retrospectivity | 775 | ||
| State, territory and New Zealand privacy laws | 775 | ||
| Section 26: Emergency Medical Systems | 776 | ||
| 26.1 Pre-hospital emergency medicine | 776 | ||
| Introduction | 776 | ||
| Dispatch | 776 | ||
| Clinical skills | 777 | ||
| Trauma care | 777 | ||
| Cardiac care | 778 | ||
| Other medical emergencies | 779 | ||
| References | 779 | ||
| 26.2 Retrieval | 780 | ||
| Introduction | 781 | ||
| Principles of transport | 781 | ||
| Organization structure and staffing | 781 | ||
| Modes of transport | 781 | ||
| Preparation for transport | 782 | ||
| Common problems in transit | 782 | ||
| Special problems associated with travelling at altitude | 783 | ||
| Decisions on flight safety | 784 | ||
| Future directions | 784 | ||
| References | 784 | ||
| 26.3 Medical issues in disasters | 785 | ||
| Introduction | 785 | ||
| Definitions and classification | 785 | ||
| Epidemiology | 786 | ||
| Socioeconomic impact | 787 | ||
| Disaster management/emergency management | 787 | ||
| Disaster planning | 788 | ||
| Disaster response activities | 788 | ||
| Urban search and rescue | 791 | ||
| Mental health | 791 | ||
| Mass gatherings | 791 | ||
| Public health issues in disasters | 791 | ||
| Conclusion | 792 | ||
| References | 792 | ||
| 26.4 Triage | 793 | ||
| Introduction | 793 | ||
| Civilian triage developments | 793 | ||
| Process of triage | 793 | ||
| Australasian triage development | 794 | ||
| The Australasian triage scale | 794 | ||
| Other triage scales | 794 | ||
| Use beyond waiting time | 794 | ||
| Structure and function of a triage system | 795 | ||
| Pre-hospital triage | 795 | ||
| References | 796 | ||
| 26.5 Refugee health | 796 | ||
| Introduction | 796 | ||
| Responsibility for refugee care | 797 | ||
| Refugee camps | 797 | ||
| Emergency phase | 797 | ||
| Post-emergency phase | 798 | ||
| Permanent solutions | 798 | ||
| Past problems | 798 | ||
| Innovations in refugee care | 799 | ||
| Attributes of a refugee doctor | 799 | ||
| Further reading | 799 | ||
| 26.6 Emergency department observation wards | 800 | ||
| Introduction | 800 | ||
| OW policies and protocols | 800 | ||
| Efficiency of patient care | 801 | ||
| Staffing | 801 | ||
| Audit and feedback | 802 | ||
| Overall impact of observation wards | 802 | ||
| Short-stay medicine | 802 | ||
| References | 802 | ||
| 26.7 Emergency department overcrowding and access block | 803 | ||
| Introduction | 803 | ||
| Theoretical basis of overcrowding | 803 | ||
| Definition of overcrowding | 803 | ||
| Causes of overcrowding | 804 | ||
| Results of overcrowding | 804 | ||
| Strategies to deal with overcrowding | 804 | ||
| Conclusions | 804 | ||
| References | 805 | ||
| 26.8 Patient safety | 806 | ||
| Introduction | 807 | ||
| Specific emergency department factors that may compromise patient safety | 807 | ||
| Common safety problems encountered in emergency departments | 807 | ||
| Improving safety in the emergency department | 808 | ||
| Conclusion | 808 | ||
| References | 809 | ||
| 26.9 The medical emergency team | 809 | ||
| Introduction and definitions | 809 | ||
| Epidemiology and principles underlying the MET | 809 | ||
| How MET services and RRS work | 810 | ||
| Clinical features of MET patients | 810 | ||
| Management of MET call patients | 811 | ||
| Other issues - the MET and the ED | 811 | ||
| Controversies | 812 | ||
| Likely future developments | 812 | ||
| References | 812 | ||
| Section 27: Administration | 814 | ||
| 27.1 Emergency department staffing | 814 | ||
| General principles | 814 | ||
| Calculating clinical workload | 815 | ||
| Medical staff | 815 | ||
| Ancillary staff | 815 | ||
| Optimizing work practices | 815 | ||
| References | 816 | ||
| 27.2 Emergency department layout | 816 | ||
| Introduction | 816 | ||
| Design considerations | 816 | ||
| Size and composition of the emergency department | 817 | ||
| Clinical areas | 817 | ||
| Clinical support areas | 819 | ||
| Non-clinical areas | 819 | ||
| Likely developments over the next 5-10 years | 820 | ||
| Further reading | 820 | ||
| 27.3 Quality assurance/quality improvement | 821 | ||
| Introduction | 821 | ||
| History | 821 | ||
| Definitions | 821 | ||
| Continuous quality improvement | 821 | ||
| National bodies | 822 | ||
| Quality in the ED | 822 | ||
| Common measures of clinical performance or outcome | 822 | ||
| Likely developments over the next 5-10 years | 823 | ||
| References | 823 | ||
| 27.4 Business planning | 823 | ||
| Introduction | 823 | ||
| Types of plans | 824 | ||
| The business plan | 824 | ||
| Planning process | 824 | ||
| Private EDS | 826 | ||
| Business plan implementation and monitoring | 826 | ||
| 27.5 Accreditation, specialist training and recognition in Austral | 826 | ||
| Specialist recognition and registration | 827 | ||
| Specialist training in emergency medicine | 827 | ||
| Accreditation | 828 | ||
| References | 832 | ||
| 27.6 Specialist training and recognition in emergency medicine in | 833 | ||
| Introduction | 833 | ||
| Regulation of training | 833 | ||
| Modernizing medical careers | 834 | ||
| Training in EM in the UK | 834 | ||
| Conclusion | 835 | ||
| 27.7 Complaints | 835 | ||
| Introduction | 835 | ||
| Reasons | 836 | ||
| Pressure for litigation and compensation | 837 | ||
| Responding to complaints | 838 | ||
| Resolution | 839 | ||
| Prevention | 839 | ||
| References | 840 | ||
| 27.8 Clinical risk management in the emergency department | 840 | ||
| Introduction | 840 | ||
| The extent of the problem | 841 | ||
| Incidents, errors, adverse events and adverse outcomes | 843 | ||
| Cause and effect | 843 | ||
| Practical application of CRM strategies | 843 | ||
| Indicators/benchmarks | 845 | ||
| Indicators and audit | 845 | ||
| Future directions | 847 | ||
| References | 847 | ||
| Section 28: Environmental | 848 | ||
| 28.1 Heat-related illness | 848 | ||
| Introduction | 848 | ||
| Epidemiology and pathophysiology | 848 | ||
| Prevention | 849 | ||
| Clinical features | 849 | ||
| Clinical investigation | 850 | ||
| Treatment | 850 | ||
| Prognosis and disposition | 851 | ||
| References | 851 | ||
| 28.2 Hypothermia | 852 | ||
| Introduction | 852 | ||
| Epidemiology and pathophysiology | 852 | ||
| Clinical features | 852 | ||
| Clinical investigation | 853 | ||
| Treatment | 853 | ||
| Prognosis and disposition | 854 | ||
| References | 855 | ||
| 28.3 Dysbarism | 856 | ||
| Introduction | 856 | ||
| Diving physics and physiology | 856 | ||
| Barotrauma | 857 | ||
| Decompression illness | 859 | ||
| Other issues | 863 | ||
| Important phone numbers | 863 | ||
| References | 864 | ||
| 28.4 Radiation incidents | 865 | ||
| Introduction | 865 | ||
| Radiation sources and incidents | 865 | ||
| Measuring radioactivity | 866 | ||
| Pathophysiology | 866 | ||
| Chronic radiation exposure | 867 | ||
| Acute radiation exposure | 867 | ||
| Occult radiation exposure | 869 | ||
| Contamination with radioactive material | 869 | ||
| Internal contamination | 871 | ||
| References | 872 | ||
| Further reading | 872 | ||
| 28.5 Drowning | 872 | ||
| Introduction | 873 | ||
| Epidemiology | 873 | ||
| Prevention | 873 | ||
| Definitions and terminology | 873 | ||
| Pathophysiology | 873 | ||
| Clinical features and organ-specific effects | 874 | ||
| Treatment | 874 | ||
| Clinical investigation | 875 | ||
| Prognosis | 876 | ||
| Disposition | 876 | ||
| References | 876 | ||
| 28.6 Electric shock and lightning injury | 877 | ||
| Electric Shock | 877 | ||
| Introduction and epidemiology | 877 | ||
| Physics of electricity and pathophysiology of electrical Injury | 877 | ||
| Prevention | 878 | ||
| Clinical features | 878 | ||
| Electric shock in pregnancy | 879 | ||
| Treatment | 879 | ||
| Prognosis | 879 | ||
| Disposition | 879 | ||
| The Taser | 879 | ||
| Lightning Injury | 880 | ||
| Introduction and epidemiology | 880 | ||
| Physics | 880 | ||
| Clinical features | 880 | ||
| Treatment | 881 | ||
| Prognosis and disposition | 881 | ||
| References | 881 | ||
| 28.7 Anaphylaxis | 882 | ||
| Introduction | 882 | ||
| Definition | 882 | ||
| Aetiology | 883 | ||
| Epidemiology | 884 | ||
| Pathophysiology | 884 | ||
| Clinical features | 885 | ||
| Differential diagnosis | 886 | ||
| Clinical investigation | 886 | ||
| Treatment | 886 | ||
| Disposition | 888 | ||
| Discharge policy | 888 | ||
| References | 889 | ||
| 28.8 Altitude illness | 889 | ||
| Introduction | 890 | ||
| Epidemiology and pathophysiology | 890 | ||
| Prevention | 890 | ||
| Clinical features | 890 | ||
| Treatment | 891 | ||
| References | 892 | ||
| Section 29: Toxicology | 893 | ||
| 29.1 Approach to the poisoned patient | 893 | ||
| Introduction | 893 | ||
| Pathophysiology and clinical features | 894 | ||
| Assessment | 895 | ||
| Treatment | 896 | ||
| Differential diagnosis | 898 | ||
| Clinical investigation | 898 | ||
| Disposition | 899 | ||
| References | 899 | ||
| 29.2 Cardiovascular drugs | 900 | ||
| Calcium Channel Blockers and beta-Blockers | 900 | ||
| Introduction | 900 | ||
| Pharmacokinetics | 900 | ||
| Pathophysiology | 900 | ||
| Clinical features | 901 | ||
| Clinical investigation | 902 | ||
| Treatment | 902 | ||
| Disposition | 903 | ||
| Digoxin | 903 | ||
| Introduction | 903 | ||
| Pharmacokinetics | 903 | ||
| Pathophysiology | 903 | ||
| Clinical features | 903 | ||
| Clinical investigation | 903 | ||
| Treatment | 903 | ||
| Disposition | 904 | ||
| Clonidine | 904 | ||
| Introduction | 904 | ||
| Pharmacokinetics | 904 | ||
| Pathophysiology | 904 | ||
| Clinical features | 905 | ||
| Investigations | 905 | ||
| Treatment | 905 | ||
| Disposition | 905 | ||
| References | 905 | ||
| 29.3 Central nervous system drugs | 906 | ||
| Introduction | 906 | ||
| Benzodiazepines | 906 | ||
| Pharmacology | 906 | ||
| Clinical features | 907 | ||
| Treatment | 907 | ||
| Clinical investigation | 907 | ||
| Non-Benzodiazepine Sedative-Hypnotics | 907 | ||
| Pharmacology | 907 | ||
| Clinical features | 908 | ||
| Treatment | 908 | ||
| Antipsychotic Drugs | 908 | ||
| Pharmacology | 908 | ||
| Clinical features | 909 | ||
| Section 30: Toxinology | 984 | ||
| 30.1 Snakebite | 984 | ||
| Introduction | 984 | ||
| Epidemiology | 984 | ||
| Prevention | 985 | ||
| Clinical features and toxinology | 985 | ||
| Treatment | 986 | ||
| Clinical investigation | 988 | ||
| Disposition | 989 | ||
| References | 989 | ||
| 30.2 Spider bite | 989 | ||
| Introduction | 989 | ||
| Redback spider (Latrodectus hasselti) | 990 | ||
| Steatoda species (Cupboard or button spiders) | 991 | ||
| Funnel web spider (Atrax and Hadronyche Species) | 991 | ||
| Mouse spiders (Missulena spp.) | 992 | ||
| Other Australasian spiders | 992 | ||
| Necrotic arachnidism | 992 | ||
| An approach to the patient with spider bite | 992 | ||
| References | 993 | ||
| 30.3 Marine envenoming and poisoning | 993 | ||
| Introduction | 993 | ||
| Jellyfish envenoming | 993 | ||
| Sea snake envenoming | 994 | ||
| Blue-ringed octopus envenoming | 995 | ||
| Cone-shell envenoming | 995 | ||
| Stonefish envenoming | 995 | ||
| Management of other venomous fish stings | 995 | ||
| Stingray injury | 996 | ||
| Ciguatera poisoning | 996 | ||
| Scombroid poisoning | 996 | ||
| Paralytic shellfish poisoning | 996 | ||
| Tetrodotoxin poisoning | 996 | ||
| References | 996 |