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 |