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Acute Medicine: A Practical Guide to the Management of Medical Emergencies
Management of the Patient with Acute Vomiting
Table of Contents
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Acute Coronary Syndromes (1): ST-Segment Elevation
Calculator - Anion Gap
Calculator - Ascites Albumin Gradient
Dedication
Delirium
Flowchart - Algorithm for Adult Advanced Life Support
Flowchart - Algorithm for Initial Management of In-Hospital Cardiac Arrest or Peri-Arrest
Hospital-Acquired Pneumonia
Insertion of an Intercostal Chest Drain
Management of Anticoagulation
Myxoedema Coma
Palliative and End-of-Life Care
Preface
Subarachnoid Haemorrhage
The Critically Ill Patient
Ultrasonography in Acute Medicine
I. Presentations in Acute Medicine
Abdominal
20. Acute Vomiting
21. Acute Abdominal Pain
22. Acute Diarrhoea
23. Acute Jaundice
24. Ascites
25. Acute Kidney Injury
B - 21.1. Acute Abdominal Pain - Alerts
B - 22.1. Acute Diarrhoea - Definitions
B - 24.1. Diagnostic Aspiration of Ascites
B - 25.1. Acute Kidney Injury (AKI)
B - 25.2. Acute Kidney Injury - Alerts
F - 20.1. Management of the Patient with Acute Vomiting
F - 21.1. Management of Acute Abdominal Pain
F - 22.1. Management of Acute Diarrhoea
F - 23.1. Assessment of the Patient with Acute Jaundice
F - 24.1. Assessment and Management of the Patient with Ascites
F - 25.1. Stage-Based Management of Acute Kidney Injury
T - 20.1. Causes of Acute Vomiting
T - 20.2. Clinical Assessment of the Patient with Vomiting
T - 20.3. Investigation of the Patient with Acute Severe Vomiting
T - 20.4. Anti-Emetic Therapy
T - 21.1. Causes of Acute Severe Abdominal Pain with Shock
T - 21.2. Focused Assessment in Acute Abdominal Pain
T - 21.3. Urgent Investigation in Acute Abdominal Pain
T - 21.4. 'Medical' Causes of Acute Abdominal Pain
T - 22.1. Focused Assessment of the Patient with Acute Diarrhoea
T - 22.2. Urgent Investigation in Acute Severe Diarrhoea
T - 22.3. Causes of Community-Acquired Diarrhoea
T - 22.4. Causes of Hospital-Acquired Diarrhoea
T - 22.5. Causes of Acute Diarrhoea Following Recent Travel Abroad
T - 22.6. Acute Diarrhoea in the Immunosuppressed/HIV-Positive Patient: Specific Pathogens to Consider
T - 23.1. Focused Assessment of the Jaundiced Patient
T - 23.2. Urgent Investigation in Acute Jaundice
T - 23.3. Jaundice with Abnormal Conscious Level/Mental State
T - 23.4. Jaundice with Abdominal Pain, Distension or Tenderness
T - 23.5. Causes of Intrahepatic Cholestasis
T - 23.6. Causes of Plasma Aspartate and Alanine Transaminase Levels of More Than 1000 Units/L
T - 24.1. Ascites: Diagnostic Tests
T - 24.2. Causes of Ascites According to the Serum-to-Ascites Albumin Gradient (SAAG)
T - 25.1. Causes of Acute Kidney Injury: Clinical Features, Typical Findings on Examination of the Urine and Confirmatory Tests
T - 25.2. Potentially Correctable Factors Which May Cause or Contribute to Acute Kidney Injury
T - 25.3. Focused Assessment in Acute Kidney Injury
T - 25.4. Investigation in Acute Kidney Injury
T - 25.5. Criteria for Initiation of Renal Replacement Therapy in Acute Kidney Injury
T - 25.6. Monitoring and Supportive Care in Acute Kidney Injury
Cardiorespiratory
10. Acute Breathlessness
11. Acute Respiratory Failure
12. Pleural Effusion
13. Cough and Haemoptysis
6. Cardiac Arrest in Hospital
7. Acute Chest Pain
8. Palpitations
9. Transient Loss of Consciousness
B - 10.1. Acute Breathlessness
B - 10.2. Stridor and Pulsus Paradoxus
B - 13.1. Definitions
B - 6.1. In-Hospital Cardiac Arrest
B - 7.1. Causes of Acute Chest Pain
B - 9.1. Causes of Transient Loss of Consciousness
B - 9.2. Causes of Syncope
F - 10.1. Assessment and Initial Management of the Patient with Acute Breathlessness
F - 11.1. Management of the Patient with Suspected Acute Respiratory Failure: Priorities
F - 11.2. Management of the Patient with Suspected Acute Respiratory Failure: Assessment and Action
F - 12.1. Investigation of Pleural Effusion
F - 13.1. Management of Cough
F - 13.2. Management of Haemoptysis
F - 6.1. Algorithm for Initial Management of In-Hospital Cardiac Arrest or Peri-Arrest
F - 6.2. Algorithm for Adult Advanced Life Support
F - 6.3. Tachycardia with Pulse
F - 6.4. Bradycardia with Pulse
F - 6.5. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) Form
F - 7.1. Assessment of the Patient with Acute Chest Pain
F - 9.1. Assessment after Transient Loss of Consciousness
T - 10.1. Focused Assessment of the Patient with Acute Breathlessness
T - 10.2. Urgent Investigation in Acute Breathlessness
T - 10.3. Breathlessness with Clear Lungs on Chest X-Ray
T - 11.1. Causes of Acute Respiratory Failure
T - 11.2. Clinical Assessment in Acute Respiratory Failure
T - 11.3. Investigation in Acute Respiratory Failure
T - 11.4. Non-Invasive Ventilation in Acute Respiratory Failure
T - 11.5. Invasive Ventilation in Acute Respiratory Failure
T - 12.1. Causes of Transudative Pleural Effusion
T - 12.2. Causes of Exudative Pleural Effusion
T - 12.3. Focused Assessment of the Patient with Pleural Effusion
T - 12.4. Pleural Fluid Analysis: (1) In All Patients; (2) Additional Tests for Exudative Effusions
T - 12.5. Indications for Chest Tube Insertion for Parapneumonic Effusions/Empyema
T - 13.1. Causes of Cough
T - 13.2. Cough History
T - 13.3. Clinical Signs Warranting Inpatient Admission of the Patient with Cough
T - 13.4. Investigations
T - 13.5. Causes of Haemoptysis
T - 13.6. Management of Massive Haemoptysis
T - 13.7. Investigation of Haemoptysis
T - 6.1. Causes of Cardiac Arrest
T - 6.2. Urgent Investigation after Successful Resuscitation
T - 7.1. Focused Assessment in Acute Chest Pain
T - 7.2. Urgent Investigation in Acute Chest Pain
T - 7.3. Causes of ST-Segment Elevation Other Than Acute Coronary Syndrome
T - 7.4. Comparison of ECG Features of ST Segment Elevation Acute Myocardial Infarction, Early Repolarization and Acute Pericarditis
T - 7.5. Chest X-Ray Abnormalities Possible in Pulmonary Embolism, Aortic Dissection and Oesophageal Rupture
T - 7.6. Plasma Markers of Myocardial Necrosis
T - 7.7. Point-of-Care Echocardiography in Acute Chest Pain
T - 8.1. Assessment of the Patient with Palpitation
T - 8.2. Pointers in the Description of Palpitation
T - 8.3. Urgent Investigation of the Patient with Palpitation
T - 8.4. ECG in the Patient with Suspected Paroxysmal Arrhythmia (I.e. Recorded after Palpitation Has Resolved)
T - 8.5. Systemic Factors Which May Trigger or Exacerbate Palpitation
T - 8.6. When to Admit the Patient with Palpitation
T - 9.1. Focused Assessment after Transient Loss of Consciousness
T - 9.2. Features Differentiating a Generalized Seizure from Vasovagal Syncope and Cardiac Syncope Due to Arrhythmia (Stokes-Adams Attack)
T - 9.3. The ECG after Transient Loss of Consciousness
T - 9.4. Testing for Carotid Sinus Hypersensitivity
General
1. The Critically Ill Patient
2. Hypotension and Shock
3. Reduced Conscious Level
4. Delirium
5. Falls in Older People
B - 1.1. The Critically Ill Patient: Principles of Management (Resuscitation Council (UK))
B - 4.1. Delirium
B - 5.1. Falls
F - 1.1. Approach to the Patient with Suspected Critical Illness
F - 2.1. Management of Hypotension and Shock
F - 3.1. Assessment and Management of the Patient with a Reduced Conscious Level
F - 3.2. Glasgow Coma Scale
F - 3.3. Eye Signs in the Comatose Patient
F - 4.1. Assessment of the Patient with Delirium
F - 5.1. Initial Assessment after a Fall
T - 1.1. Nine Key Observations in Suspected Critical Illness
T - 1.2. National Early Warning Score (NEWS)
T - 1.3. Assessment and Stabilization of the Airway
T - 1.4. Investigation of the Critically Ill Patient
T - 2.1. Differential Diagnosis of Hypotension and Shock
T - 2.2. Clinical Signs Pointing to the Cause of Hypotension
T - 2.3. Urgent Investigation in Hypotension
T - 2.4. Indications for Urgent Echocardiography in the Hypotensive Patient
T - 2.5. Echocardiographic Findings in Hypotension
T - 2.6. Choice of Inotropic/Vasopressor Therapy
T - 2.7. Inotropic/Vasopressor Therapy: Dosages
T - 3.1. Causes of a Reduced Conscious Level
T - 3.2. Focused Assessment of the Patient with Reduced Conscious Level
T - 3.3. Investigation of the Patient with Reduced Conscious Level
T - 4.1. Differential Diagnosis of Acutely Disturbed Behaviour or Language
T - 4.2. Causes of Delirium to Consider in Specific Patient Groups
T - 4.3. Abbreviated Mental Test Score
T - 4.4. Urgent Investigation in Delirium
T - 4.5. Supportive Care of the Patient with Delirium
T - 5.1. Focused Assessment after a Fall
T - 5.2. Investigation after a Fall
Miscellaneous
31. Comprehensive Geriatric Assessment
32. Acute Medical Problems in Pregnancy
33. Fever on Return from Abroad
34. Acute Medical Problems in the HIV-Positive Patient
B - 31.1. Comprehensive Geriatric Assessment
B - 33.1. Advice on Management of Infectious Diseases Acquired Abroad
B - 34.1. Spectrum of HIV Infection
F - 31.1. Comprehensive Geriatic Assessment (CGA)
F - 33.1. Management of the Patient with a Febrile Illness Within Two Months of Travel Abroad
F - 34.1. Assessment and Management of the HIV-Positive Patient with Respiratory Symptoms
T - 32.1. Differential Diagnosis of Breathlessness in Pregnancy
T - 32.2. Interpreting Investigations in Pregnancy
T - 32.3. Differential Diagnosis of Chest Pain/Shock in Pregnancy
T - 32.4. Differential Diagnosis of Headache in Pregnancy
T - 32.5. Differential Diagnosis of Seizures in Pregnancy
T - 32.6. Pre-Eclampsia and HELLP Syndrome (Haemolysis, Elevated Liver Enzymes, Low Platelets)
T - 32.7. Acute Fatty Liver of Pregnancy
T - 32.8. Use of Intravenous Magnesium Sulphate
T - 33.1. Focused Assessment of the Patient with a Febrile Illness after Travel Abroad
T - 33.2. Indicative Incubation Periods for Selected Tropical Infections
T - 33.3. Urgent Investigation of the Patient with a Febrile Illness after Travel Abroad
T - 33.4. Chemotherapy of Falciparum Malaria (See Guidelines and British National Formulary)
T - 33.5. Management of Complications of Falciparum Malaria
T - 34.1. Respiratory Symptoms in the HIV-Positive Patient
T - 34.2. Urgent Investigation of the HIV-Positive Patient with Respiratory Symptoms
T - 34.3. Diagnostic Clues in the HIV-Positive Patient with Respiratory Symptoms
T - 34.4. Pneumocystis Jirovecii Pneumonia (PCP): Diagnosis and Management
T - 34.5. Headache/Delirium/Focal Neurological Signs in the HIV-Positive Patient
T - 34.6. Chronic Diarrhoea in the HIV-Positive Patient: Specific Pathogens to Consider (in Addition to Other Causes)
Neurological
14. Neurological Diagnosis in Acute Medicine
15. Acute Headache
16. Seizures and Epilepsy
17. Weakness and Paralysis
18. Acute Sensory Symptoms
19. Loss of Vision
B - 14.1. Neurological Diagnosis in Acute Medicine
B - 14.2. Neurological Diagnosis - Alerts
B - 17.1. Medical Research Council (MRC) Scale for Assessment of Muscle Power
B - 17.2. Weakness and Paralysis - Alerts
B - 18.1. Acute Sensory Symptoms - Alerts
F - 14.1. Approach to the Patient with Potential Acute Neurological Disease
F - 17.1. Assessment of the Patient with Weakness or Paralysis
F - 18.1. Assessment of the Patient with Acute Sensory Symptoms
F - 18.2. Sensory Innervation of the Skin
F - 19.1. Visual Pathway
F - 19.2. Analysis of Sudden Visual Loss
T - 14.1. Priority Differential Diagnoses to Consider Based on Presentation
T - 14.2. Focused History-Taking in Acute Neurological Disease
T - 14.3. Anatomical Localization in Neurological Diagnosis
T - 14.4. Temporal Evolution: What is the Lesion?
T - 14.5. Focused Examination in Acute Neurological Disease
T - 14.6. Diagnostic Testing in Acute Neurological Disease
T - 15.1. Focused Assessment of the Patient with Acute Headache
T - 15.2. Urgent Investigation in Acute Headache
T - 15.3. Causes of Acute Headache with 'Red-Flag' Features: Fever, Reduced Conscious Level, Papilloedema, Neck Stiffness or Focal Neurological Signs
T - 15.4. Acute Headache with Local Signs
T - 15.5. Acute Headache with No Abnormal Signs
T - 15.6. Diagnostic Criteria for Migraine
T - 16.1. Investigation in Status Epilepticus or after a First Seizure
T - 16.2. Drug Therapy for Generalized Convulsive Status Epilepticus
T - 16.3. Causes of Tonic-Clonic Status Epilepticus
T - 16.4. Characteristics of Dissociative Seizures (Non-Epileptic Attack Disorder)
T - 16.5. Features Differentiating a Generalized Seizure from Vasovagal and Cardiac Syncope (Stokes-Adams Attack)
T - 17.1. Localization of the Cause of Weakness by Clinical Syndrome
T - 17.2. Features of Lower Motor Neuron (LMN) and Upper Motor Neuron (UMN) Weakness
T - 17.3. Focused Assessment of the Patient with Weakness
T - 17.4. Urgent Investigation of the Patient with Weakness
T - 18.1. Focused Assessment of the Patient with Acute Sensory Symptoms
T - 18.2. Clues to the Pathology from the Tempo of Sensory Symptoms
T - 18.3. Localization: Clues from the History
T - 18.4. Localization: Clues from the Examination
T - 18.5. Urgent Investigation of the Patient with Acute Sensory Symptoms
T - 19.1. Focused Assessment of the Patient with Visual Loss
T - 19.2. Differential Diagnosis of Gradual Visual Loss
T - 19.3. Differential Diagnosis of Sudden Persistent Visual Loss
T - 19.4. Differential Diagnosis of Transient Visual Loss
T - 19.5. Drugs Causing Visual Symptoms
Skin and Musculoskeletal
26. Acute Rash
27. Urticaria and Angioedema
28. Acute Arthritis
29. Acute Spinal Pain
30. Acute Limb Pain
B - 26.1. Definition of Skin Abnormalities
B - 27.1. Clinical Features of Urticaria, Angioedema and Urticarial Vasculitis
B - 27.2. Alert
B - 29.1. Acute Spinal Pain - Alerts
B - 30.1. Differential Diagnosis of Acute Limb Pain
F - 26.1. Assessment of an Acute Rash by Morphology and Distribution
F - 26.2. Approach to Diagnosis and Initial Management of the Patient with Acute Rash
F - 27.1. Assessment of Urticaria
F - 28.1. Assessment of the Patient with Acute Arthritis
T - 26.1. Common Eruptions Seen Acutely in the Emergency Department and in Inpatients
T - 26.2. Focused Assessment of the Patient with Acute Rash
T - 26.3. Urgent Investigation in Acute Rash
T - 27.1. Causes of Urticaria
T - 27.2. Focused Assessment in Urticaria
T - 27.3. Causes of Isolated Angioedema
T - 27.4. Focused Assessment in Angioedema
T - 28.1. Causes of Acute Arthritis
T - 28.2. Focused Assessment of Acute Arthritis
T - 28.3. Urgent Investigation in Acute Arthritis
T - 28.4. Initial Antibiotic Therapy for Suspected Septic Arthritis
T - 28.5. Management of Acute Arthritis
T - 29.1. Focused Assessment in Acute Spinal Pain
T - 30.1. Focused Assessment in Acute Limb Pain
T - 30.2. Urgent Investigation in Acute Limb Pain
II. Syndromes and Disorders
Abdominal
73. Acute Upper Gastrointestinal Bleeding
74. Acute Lower Gastrointestinal Bleeding
75. Acute Oesophageal Disorders
76. Inflammatory Bowel Disease Flare
77. Acute Liver Failure and Decompensated Chronic Liver Disease
78. Alcoholic Hepatitis
79. Biliary Tract Disorders and Acute Pancreatitis
80. Urinary Tract Infection
B - 73.1. Manifestations of Acute Upper GI Bleeding
B - 77.1. Liver Failure
B - 80.1. Definitions
F - 73.1. Management of Acute Upper Gastrointestinal Bleeding
F - 76.1. Management of Severe Ulcerative Colitis
F - 77.1. Management of Suspected Acute Liver Failure
T - 73.1. Causes of Upper Gastrointestinal Haemorrhage
T - 73.2. Focused Assessment in Acute Upper GI Bleeding
T - 73.3. Urgent Investigation in Acute Upper GI Bleeding
T - 73.4. Blatchford Score
T - 73.5. Rockall Score Post-Endoscopy
T - 74.1. Small Bowel and Proximal Colonic Sources of Melaena
T - 74.2. Causes of Haematochezia
T - 74.3. Focused Assessment in Acute Lower GI Bleeding
T - 74.4. Urgent Investigation in Acute Lower GI Bleeding
T - 75.1. Causes of Oesophageal Perforation and Rupture
T - 75.2. Urgent Investigation in Suspected Boerhaave Syndrome
T - 76.1. Focused Assessment in Suspected Inflammatory Bowel Disease Flare
T - 76.2. Investigations in a Flare of Inflammatory Bowel Disease
T - 77.1. Causes of Acute Liver Failure (Fulminant Hepatic Failure)
T - 77.2. Focused Assessment of the Patient with Possible Acute Liver Failure
T - 77.3. Urgent Investigation in Suspected Acute Liver Failure
T - 77.4. Major Complications of Acute Liver Failure and Their Management
T - 77.5. Criteria for Transplantation in Acute Liver Failure(ALF) (King's College Hospital)
T - 77.6. Precipitants of Decompensated Chronic Liver Disease
T - 78.1. Alcoholic Hepatitis: Diagnosis
T - 78.2. Alcoholic Hepatitis: Management
T - 79.1. Biliary Tract Disorders: Clinical Features and Management
T - 79.2. Acute Pancreatitis (AP): Clinical Features and Management
T - 80.1. Factors Suggestive of Complicated Urinary Tract Infection
T - 80.2. Focused Assessment of the Patient with Suspected Urinary Tract Infection
T - 80.3. Urgent Investigations in Suspected Urinary Tract Infection
T - 80.4. Indications for Renal/Urinary Tract Imaging
T - 80.5. Empirical Antibiotic Therapy in Suspected Urinary Tract Infection
T - 80.6. Common Antimicrobials in the Treatment of Urinary Tract Infection
T - 80.7. Indications for Referral to Urology
Cardiovascular
39. Acute Arrhythmias: General Principles of Management
40. Regular Broad Complex Tachycardia
41. Irregular Broad Complex Tachycardia
42. Narrow Complex Tachycardia
43. Atrial Fibrillation and Flutter
44. Bradycardia and Atrioventricular Block
45. Acute Coronary Syndromes (1): ST-Segment Elevation
46. Acute Coronary Syndromes (2): Non-ST-Segment Elevation
47. Acute Pulmonary Oedema
48. Acute Heart Failure and Decompensated Chronic Heart Failure
49. Cardiogenic Shock
50. Aortic Dissection and Other Acute Aortic Syndromes
51. Heart Valve Disease and Prosthetic Heart Valves
52. Infective Endocarditis
53. Acute Pericarditis
54. Cardiac Tamponade
55. Severe Hypertension
56. Deep Vein Thrombosis
57. Pulmonary Embolism
58. Problems with Pacemakers and Other Cardiac Devices
B - 50.1. Aortic Dissection - Alerts
B - 51.1. Heart Valve Disease - Alerts
B - 52.1. Infective Endocarditis - Alerts
F - 40.1. Approach to the Patient with Regular Broad Complex Tachycardia
F - 40.2. Monomorphic Ventricular Tachycardia (VT)
F - 40.3. Pseudoventricular Tachycardia
F - 41.1. Approach to the Patient with Irregular Broad Complex Tachycardia
F - 41.2. Pre-Excited Atrial Fibrillation in Wolff-Parkinson-White Syndrome
F - 42.1. Paroxysmal Supraventricular Tachycardia, Due to AV Re-Entrant Tachycardia with Retrograde P Wave Inscribed on ST Segment
F - 42.2. Atrial Flutter with 2:1 Conduction
F - 43.1. Approach to the Patient with Atrial Fibrillation or Flutter
F - 43.2. Management of the Stable Patient with Atrial Fibrillation or Flutter
F - 44.1. Approach to the Patient with Bradycardia and/or Atrioventricular Block
F - 44.2. Junctional Bradycardia Secondary to Sinus Node Disease
F - 44.3. Second-Degree Atrioventricular Block, Mobitz Type 1 (Wenckebach)
F - 44.4. 2:1 Second-Degree Atrioventricular (AV) Block: Alternate P Waves Non-Conducted
F - 44.5. Second-Degree Atrioventricular (AV) Block, Mobitz Type 2
F - 44.6. Complete Atrioventricular Block
F - 45.1. Management of Acute ST-Segment Elevation Myocardial Infarction (STE-ACS)
F - 46.1. Management of Suspected Non-ST-Segment Elevation Acute Coronary Syndrome (NSTE-ACS)
F - 47.1. Approach to the Patient with Suspected Pulmonary Oedema
F - 50.1. Classification of Aortic Dissection
F - 50.2. Management of Suspected Acute Aortic Dissection
F - 53.1. Assessment of Suspected Acute Pericarditis
F - 55.1. Management of the Patient with Severe Hypertension
F - 56.1. Assessment and Management of Suspected Deep Vein Thrombosis
F - 57.1. Suspected Pulmonary Embolism with Shock or Hypotension
F - 57.2. Suspected Pulmonary Embolism Without Shock or Hypotension
F - 58.1. Management of Acute Arrhythmia and/or Shocks in the Patient with an ICD or CRT-D
F - 58.2. ECG Showing Dual Chamber Pacing
T - 39.1. Focused Assessment of the Patient with an Acute Arrhythmia
T - 39.2. Urgent Investigation of the Patient with an Acute Arrhythmia
T - 39.3. Differential Diagnosis of Bradycardia and AV Block
T - 39.4. Differential Diagnosis of Narrow Complex Tachycardia
T - 40.1. Regular Broad Complex Tachycardia: Differential Diagnosis and Management
T - 40.2. Drug Therapy of Haemodynamically Stable Monomorphic Ventricular Tachycardia
T - 41.1. Irregular Broad Complex Tachycardia: Differential Diagnosis and Management
T - 41.2. Drug Therapy of Haemodynamically Stable Polymorphic Ventricular Tachycardia (VT) Without Preceding QT Prolongation
T - 41.3. Drug Therapy of Haemodynamically Stable Pre-Excited Atrial Fibrillation
T - 42.1. Differential Diagnosis and Management of Narrow Complex Regular Tachycardia
T - 42.2. Differential Diagnosis and Management of Narrow Complex Irregular Tachycardia
T - 42.3. Intravenous Therapy to Terminate Supraventricular Tachycardia (AV Nodal Re-Entrant Tachycardia and AV Re-Entrant Tachycardia)
T - 42.4. Intravenous Therapy for Rate Control in Atrial Fibrillation, Atrial Flutter and Atrial Tachycardia
T - 43.1. Disorders Associated with Atrial Fibrillation
T - 43.2. Rate Control in Atrial Fibrillation and Flutter
T - 43.3. Drug Therapy of Atrial Fibrillation or Flutter: Medication to Restore Sinus Rhythm (Chemical Cardioversion)
T - 44.1. Classification of Bradycardia and Atrioventricular (AV) Block
T - 44.2. Drug Therapy of Bradycardia
T - 44.3. Causes of Sinus Bradycardia
T - 44.4. Causes of Atrioventricular (AV) Block
T - 44.5. Temporary Cardiac Pacing: Indications, Contraindications and Potential Complications (for Technique)
T - 45.1. Investigation in Suspected ST-Segment Elevation ACS
T - 45.10. Discharge Checklist after Myocardial Infarction
T - 45.2. Thrombolytic Therapy: Contraindications
T - 45.3. Thrombolytic Therapy
T - 45.4. Thrombolytic Therapy: Problems
T - 45.5. Features of Stress (Takotsubo) Cardiomyopathy
T - 45.6. Choice of Inotropic/Vasopressor Therapy in Cardiogenic Shock Due to Myocardial Infarction
T - 45.7. Indications for Temporary Pacing in Acute Myocardial Infarction
T - 45.8. Fever after Myocardial Infarction
T - 45.9. Complications of Myocardial Infarction and Their Management
T - 46.1. Investigation in Suspected Non-ST-Segment-Elevation ACS
T - 46.2. Universal Classification of Myocardial Infarction and Injury
T - 46.3. Causes of Raised Troponin Concentration Not Due to Acute Coronary Syndrome
T - 46.4. Risk Criteria Mandating an Invasive Strategy in Non-ST-Elevation Acute Coronary Syndrome
T - 47.1. Causes of Acute Pulmonary Oedema
T - 47.2. Focused Assessment in Acute Pulmonary Oedema
T - 47.3. Initial Drug Therapy in Acute Pulmonary Oedema
T - 47.4. Urgent Investigation in Acute Pulmonary Oedema
T - 47.5. Further Drug Therapy of Acute Cardiogenic Pulmonary Oedema
T - 47.6. Ventilatory Support for Respiratory Failure Due to Cardiogenic Pulmonary Oedema
T - 47.7. Management of Acute Respiratory Distress Syndrome (ARDS)
T - 47.8. Negative-Pressure Pulmonary Oedema
T - 48.1. Focused Assessment of the Patient with Acute Heart Failure or Decompensated Chronic Heart Failure
T - 48.2. Urgent Investigation of the Patient with Acute Heart Failure or Decompensated Chronic Heart Failure
T - 48.3. Causes of Acute Heart Failure
T - 48.4. Management of Oral Therapy for Acute Heart Failure in the First 48h
T - 49.1. Causes of Cardiogenic Shock and Their Management
T - 49.2. Focused Assessment in Suspected Cardiogenic Shock
T - 49.3. Urgent Investigation in Suspected Cardiogenic Shock
T - 49.4. Echocardiographic Findings in Cardiogenic Shock
T - 50.1. Clinical Assessment in Suspected Dissection
T - 50.2. Urgent Investigation in Suspected Aortic Dissection
T - 50.3. Chest X-Ray and Echocardiographic Findings in Aortic Dissection
T - 50.4. Clinical Scoring in Suspected Acute Aortic Syndrome
T - 50.5. Hypotensive Therapy for Acute Aortic Dissection
T - 50.6. Monitoring in Distal (Type B) Dissection
T - 51.1. Echocardiography in Valve Disease: Key Information
T - 51.2. Causes of Acute Presentation in Valve Disease
T - 51.3. Target (and Range) International Normalized Ratio (INR) for Mechanical Prostheses
T - 52.1. Conditions Predisposing to Infective Endocarditis
T - 52.10. Causes of Blood Culture-Negative Endocarditis
T - 52.2. Organisms and Infective Endocarditis
T - 52.3. Focused Assessment in Suspected Infective Endocarditis
T - 52.4. Urgent Investigation in Suspected Infective Endocarditis
T - 52.5. Indications for Transthoracic Echocardiography in Suspected Infective Endocarditis
T - 52.6. Modified Duke Criteria for the Diagnosis of Infective Endocarditis
T - 52.7. Empirical Antibiotic Therapy in Suspected Infective Endocarditis
T - 52.8. Indications for Transfer to a Surgical Centre
T - 52.9. Monitoring in Infective Endocarditis
T - 53.1. Causes of Acute Pericarditis
T - 53.2. Focused Clinical Assessment in Suspected Acute Pericarditis
T - 53.3. Investigation in Suspected Acute Pericarditis
T - 53.4. Drug Therapy in Acute Pericarditis
T - 54.1. Causes of Cardiac Tamponade
T - 54.2. Echocardiography in Suspected Cardiac Tamponade
T - 55.1. Focused Assessment in Severe Hypertension
T - 55.2. Urgent Investigation in Severe Hypertension
T - 55.3. Hypertensive Encephalopathy
T - 55.4. Intravenous Therapy for Severe Hypertension with Organ Damage
T - 55.5. Initial Oral Therapy for Severe Hypertension in a Patient Not Already Receiving Anti-Hypertensive Therapy
T - 55.6. Causes of Secondary Hypertension
T - 56.1. Risk Factors for Venous Thromboembolism
T - 56.2. Estimating the Clinical Probability of DVT with Three-Level Wells Score
T - 56.3. Causes of Leg Swelling
T - 56.4. Investigation after Unprovoked Venous Thromboembolism
T - 57.1. Clinical Prediction Rules for Pulmonary Embolism (PE) Probability
T - 57.2. Chest X-Ray Findings in Pulmonary Embolism
T - 57.3. Echocardiographic Findings in Pulmonary Embolism with Haemodynamic Instability
T - 57.4. Thrombolytic Therapy for Acute Pulmonary Embolism with Shock or Persistent Hypotension
T - 57.5. Pulmonary Embolism Severity Index (PESI) Score
T - 58.1. Cardiac Device Functions
T - 58.2. Complications of Cardiac Devices
T - 58.3. Assessment of Suspected Pacemaker Malfunction
T - 58.4. Findings and Management on Interrogation of an Implantable Cardioverter-Defibrillator (ICD) or CRT-D Device after the Patient Reports a Shock
General
35. Sepsis
36. Poisoning
37. Acid-Base Disorders
38. Anaphylaxis
B - 35.1. Definitions and Criteria
B - 35.2. Sepsis Care Bundle: Quality Standards
B - 37.1. Compensation for Acid-Base Disturbances
F - 36.1. Management of the Patient with Suspected Poisoning
F - 36.2. Management of Paracetamol Poisoning
F - 36.3. Treatment Threshold after Paracetamol Poisoning
F - 36.4. Management of Carbon Monoxide Poisoning
F - 37.1. Acid-Base Diagram Relating Arterial pH or Hydrogen Ion Concentration to PaCO2
F - 38.1. Management of Anaphylaxis
T - 35.1. Clinical Assessment of the Patient with Suspected Sepsis
T - 35.2. Urgent Investigation of the Patient with Sepsis
T - 35.3. Microbiological Tests in Suspected Sepsis
T - 35.4. Good Practice in Antimicrobial Prescribing for Sepsis
T - 35.5. An Example of Initial Antibiotic Therapy Regime for Adult Sepsis (Excludes Penicillin Allergic Patients)
T - 35.6. Sequential (Sepsis-Related) Organ Failure Assessment Score
T - 35.7. Possible Causes of Fever Associated with IV Drug Use
T - 36.1. Clues to the Poison (1): Clinical and Biochemical Features
T - 36.10. Paracetamol Poisoning: Indications of Severe Hepatotoxicity
T - 36.11. Acute Carbon Monoxide Poisoning: Clinical Features
T - 36.2. Clues to the Poison (2): Toxidromes
T - 36.3. Urgent Investigation of the Patient with Poisoning
T - 36.4. Poisoning in Which Plasma Levels Should Be Measured
T - 36.5. Specific Antidotes
T - 36.6. Charcoal Administration after Poisoning
T - 36.7. Problems Encountered in the Patient with Poisoning
T - 36.8. Patients with Self-Poisoning at High Risk of Suicide
T - 36.9. Acetylcysteine (AC) Regimen in Paracetamol Poisoning
T - 37.1. Acidity of Arterial Blood: Conversion of pH Units to Hydrogen Ion Concentration (nmol/L)
T - 37.2. Classification of Acid-Base Disorders According to Arterial Hydrogen Ion Concentration/pH and PCO(2)
T - 37.3. Grading of Severity of Acid-Base Disorders
T - 37.4. Consequences of Acid-Base Disorders
T - 37.5. Causes of Metabolic Acidosis
T - 37.6. Causes of Respiratory Acidosis(Inadequate Alveolar Ventilation Resulting in a Raised Arterial PCO(2))
T - 37.7. Causes of Metabolic Alkalosis
T - 37.8. Causes of Respiratory Alkalosis
T - 38.1. Manifestations of Anaphylaxis and Anaphylactoid Reactions
T - 38.2. Causes of Anaphylactic and Anaphylactoid Reactions
T - 38.3. Differential Diagnosis of Anaphylaxis
T - 38.4. Serum Mast Cell Tryptase
Haematology and Miscellaneous
100. Interpretation of Full Blood Count and Film
101. Pancytopenia and Febrile Neutropenia
102. Bleeding Disorders
103. Management of Anticoagulation
104. Acute Painful Sickle Cell Crisis
105. Complications of Cancer
106. Alcohol-Related Problems in Acute Medicine
107. Hypothermia
108. Drowning
109. Electrical Injury
110. Palliative and End-of-Life Care
111. Medicolegal Issues in Acute Medicine
B - 100.1. Findings on the Full Blood Count
B - 103.1. Box 103-1
B - 108.1. Drowning - Alerts
B - 110.1. Palliative Care
B - 111.1. Valid Consent
F - 101.1. Assessment and Management of Pancytopenia
F - 104.1. Assessment and Management of Acute Painful Sickle Cell Crisis
F - 107.1. Management of Hypothermia
F - 107.2. ECG in Hypothermia (Core Temperature 30c) Showing Bradycardia, Prolongation of ECG Intervals, and Elevation of the J Point in the Chest Leads Giving a J or Osborne Wave
F - 108.1. Pathophysiology of Drowning
F - 110.1. Who Analgesic Ladder
F - 111.1. Flow Chart for Decision-Making When Patients May Lack Capacity, in Relation to Treatment and Care Towards the End of Life
T - 100.1. Normal Values for Full Blood Count
T - 100.10. Causes of Pancytopenia
T - 100.2. Clues from the Blood Film
T - 100.3. Microcytic Anaemia (MCV 80fl)
T - 100.4. Macrocytosis (MCV >100fl)
T - 100.5. Normocytic Anaemia (MCV 80 - 100fl)
T - 100.6. Polycythaemia (Erythrocytosis)
T - 100.7. White Blood Cell Abnormalities
T - 100.8. Causes of Thrombocytopenia
T - 100.9. Causes of Thrombocytopenia in Pregnancy and Post-Partum
T - 101.1. Drugs Associated with Cytopenias
T - 101.2. Urgent Investigation in Patients with Pancytopenia of Unknown Aetiology
T - 101.3. Further Investigation in Febrile Neutropenia
T - 101.4. Transfusion for Patients with Bone Marrow Failure: When to Use Irradiated Blood Products
T - 101.5. Pancytopenia: Clues from the Peripheral Blood Film
T - 102.1. Causes of Abnormal Bleeding
T - 102.2. Acquired Causes of Prolonged Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT)
T - 102.3. Diagnosis of Heparin-Induced Thrombocytopenia (HIT): the 4t Score
T - 103.1. Indications for Anticoagulation and Recommended Anticoagulant
T - 103.10. Clinical Conditions Affecting the Response to Warfarin
T - 103.11. Starting Warfarin
T - 103.12. Comparison of Direct-Acting Oral Anticoagulants
T - 103.13. Circumstances When Measurements of DOACs May Be Necessary (BSH)
T - 103.14. Dosing of Direct Oral Anticoagulants by Indication
T - 103.15. Management of Bleeding in a Patient Taking an Anticoagulant or Antiplatelet Drug
T - 103.16. Specific Measures According to the Anticoagulant/Antiplatelet Agent
T - 103.17. Management of over-Anticoagulation in a Patient Taking Warfarin or Another Vitamin K Antagonist Who is Not Bleeding
T - 103.18. Safe Timing of Invasive Procedures in Patients on Anticoagulation
T - 103.2. Comparison of Unfractionated Heparin and Low-Molecular-Weight Heparin (LMWH)
T - 103.3. Commonly Used LMWH Products and Their Anti-Xa Activity Per mg
T - 103.4. Unfractionated Heparin by Infusion
T - 103.5. Example of Lwmh Dosing: Enoxaparin for the Treatment of Deep Vein Thrombosis/Pulmonary Embolism (DVT/PE) and Acute Coronary Syndrome (ACS)
T - 103.6. CHA(2)DS(2)Vascscore(Estimates the Annual Risk of Stroke or Systemic Thromboembolism in Non-Valvular AF)
T - 103.7. Cumulative CHA(2)DS(2)Vasc Score and Risk of Stroke or Systemic Thromboembolism
T - 103.8. Thehas-Bledscore (Estimates the Annual Risk of Major Bleeding for Patients on Warfarin for Atrial Fibrillation)
T - 103.9. Cumulative HAS-BLED Score and Risk of Major Bleeding
T - 104.1. Urgent Investigation of Suspected Painful Sickle Cell Crisis
T - 104.2. Other Acute Complications of Sickle Cell Disease
T - 105.1. Complications or Progression of Cancer
T - 105.10. Causes of Pain in the Patient with Cancer: Other Causes
T - 105.2. Complications of Chemotherapy
T - 105.3. Complications of Radiotherapy
T - 105.4. Causes of Breathlessness in the Patient with Cancer
T - 105.5. Acute Superior Vena Caval (SVC) Obstruction
T - 105.6. Causes of Vomiting in the Patient with Cancer
T - 105.7. Causes of Diarrhoea in the Patient with Cancer
T - 105.8. Causes of Delirium in the Patient with Cancer
T - 105.9. Causes of Pain in the Patient with Cancer: Due to the Cancer
T - 106.1. Taking an Alcohol History
T - 106.2. Common Acute Medical Problems in the Patient Who Drinks Heavily
T - 106.3. Management of Alcohol Withdrawal Syndrome and Wernicke Encephalopathy
T - 107.1. Rewarming Methods
T - 107.2. Urgent Investigation in Hypothermia
T - 107.3. Management of Hypothermia
T - 107.4. Monitoring in Hypothermia
T - 108.1. Clinical Assessment of the Patient after Drowning
T - 108.2. Urgent Investigation after Drowning
T - 108.3. Monitoring after Drowning with Moderate or Severe Immersion Injury
T - 108.4. Clinical Features at Presentation after Drowning Indicating a Poor Prognosis
T - 109.1. Effects of Electrical Injury
T - 109.2. Investigation after Electrical Injury
T - 109.3. Management after Electrical Injury
T - 110.1. Adjuvant Analgesics
T - 110.2. Specific Causes of Breathlessness and Their Management
T - 110.3. Management of Breathlessness
T - 110.4. Antiemetic Therapy
T - 110.5. Common Causes of Agitation in Palliative Care and Their Management
T - 110.6. Elements that Should Be Included in an Individualised Plan of Care for a Patient Nearing the End of Life
T - 110.7. Common Symptoms in Dying Patients for Which Anticipatory As-Required Prescribing is Appropriate
T - 110.8. Opioid Drug Conversions
T - 111.1. The Legal Framework in Which Patients are Treated
Metabolic
81. Hypoglycaemia
82. Hyperglycaemic States
83. Diabetic Ketoacidosis
84. Hyperosmolar Hyperglycaemic State
85. Disorders of Plasma Sodium Concentration
86. Disorders of Plasma Potassium Concentration
87. Disorders of Plasma Calcium Concentration
88. Disorders of Plasma Magnesium Concentration
89. Disorders of Plasma Phosphate Concentration
90. Acute Adrenal Insufficiency
91. Thyrotoxic Storm
92. Myxoedema Coma
93. Pituitary Apoplexy
94. Paraganglioma (Phaeochromocytoma) Crisis
B - 85.1. Disorders of Plasma Sodium Concentration
B - 85.2. Assessment of Volume Status
B - 86.1. Disorders of Plasma Potassium Concentration
B - 87.1. Disorders of Plasma Calcium Concentration
B - 88.1. Classification of Plasma Magnesium Concentration
B - 89.1. Classification of Plasma Phosphate Concentration
B - 90.1. Acute Adrenal Insufficiency - Alerts
B - 93.1. Pituitary Apoplexy - Alerts
B - 94.1. Paragangliomas (Phaeochromocytomas)
F - 85.1. Management of Hypernatraemia
F - 85.2. Management of Hyponatraemia
F - 86.1. Management of Hyperkalaemia
F - 86.2. Management of Hypokalaemia
T - 81.1. Manifestations of Hypoglycaemia
T - 81.2. Causes of Hypoglycaemia
T - 82.1. Clinical States in Which Derangements of Blood Glucose Must Be Excluded
T - 82.2. Categorization of the Patient with Blood Glucose >11 mmol/L
T - 82.3. Variable-Rate Insulin Infusion ('Sliding Scale')
T - 82.4. Management of Hyperglycemia after Acute Coronary Syndrome (DIGAMI Regimen)
T - 83.1. Focused Assessment in Suspected Diabetic Ketoacidosis
T - 83.2. Urgent Investigation in Suspected Diabetic Ketoacidosis
T - 83.3. Fluid Replacement in Diabetic Ketoacidosis
T - 83.4. Potassium Replacement in Diabetic Ketoacidosis
T - 83.5. Fixed Rate Insulin Infusion in Diabetic Ketoacidosis
T - 83.6. Switching from IV to SC Insulin after Resolution of Diabetic Ketoacidosis
T - 85.1. Causes of Hypernatraemia
T - 85.2. Causes of Hypo-Osmolar Hyponatraemia
T - 85.3. Syndrome of Inappropriate ADH Secretion (SIADH)
T - 86.1. Causes of Hyperkalaemia
T - 86.2. Causes of Hypokalaemia
T - 87.1. Causes of Hypercalcaemia
T - 87.2. Investigation in Hypercalcaemia
T - 87.3. Drug Therapy in Moderate or Severe Hypercalcaemia
T - 87.4. Causes of Hypocalcaemia
T - 88.1. Causes of Hypermagnesaemia
T - 88.2. Causes of Hypomagnesaemia
T - 89.1. Causes of Hyperphosphataemia
T - 89.2. Causes of Hypophosphataemia
T - 90.1. Clinical Features of Adrenal Insufficiency
T - 90.2. Causes of Adrenal Insufficiency
T - 90.3. Urgent Investigation in Suspected Acute Adrenal Insufficiency
T - 90.4. Short Tetracosactrin (Synacthen) Test
T - 91.1. Causes of Hyperthyroidism
T - 91.2. Diagnosis of Thyrotoxic Storm
T - 92.1. Features Suggesting Myxoedema Coma in the Patient with Hypothermia
T - 92.2. Urgent Investigation in Suspected Myxoedema Coma
T - 93.1. Urgent Investigation in Suspected Pituitary Apoplexy
T - 94.1. When to Consider a Catecholamine-Induced Crisis
T - 94.2. Investigation of Suspected Catecholamine-Induced Crisis
Neurological
65. Stroke
66. Transient Ischaemic Attack
67. Subarachnoid Haemorrhage
68. Bacterial Meningitis
69. Encephalitis
70. Spinal Cord Compression
71. Guillain-Barre Syndrome
72. Raised Intracranial Pressure
B - 66.1. Causes of Transient Ischaemic Attack
B - 67.1. Subarachnoid Haemorrhage (SAH)
B - 67.2. Pitfalls in the Diagnosis of Subarachnoid Haemorrhage
B - 70.1. Clinical Features of Spinal Cord Compression and Cauda Equina Syndrome
B - 70.2. Spinal Cord Compression - Alert
B - 71.1. Pitfalls in the Diagnosis of Guillain-Barre Syndrome
B - 72.1. Intracranial Pressure-Volume Relationship
B - 72.2. Cautions Before Lumbar Puncture
F - 65.1. Management of Suspected Stroke
F - 68.1. Management of Suspected Bacterial Meningitis
F - 70.1. Management of Suspected Spinal Cord Compression or Cauda Equina Syndrome
F - 71.1. Management of Suspected Guillain-Barre Syndrome
T - 65.1. Focused Assessment of the Patient with Suspected Stroke
T - 65.2. National Institute of Health Stroke Score (NIHSS)
T - 65.3. Urgent Investigation in Suspected Stroke
T - 65.4. Diseases Which May Mimic Stroke
T - 65.5. Some Atypical Presentations of Stroke
T - 65.6. Contraindications to Thrombolysis for Cerebral Infarction
T - 65.7. Thrombolysis with Alteplase for Ischaemic Stroke
T - 65.8. Further Investigation to Determine the Cause of Stroke
T - 66.1. Focal Neurological Symptoms: Attributable to a Focal Area of the Brain and Therefore More Likely to Represent TIA
T - 66.2. Non-Focal (Global) Neurological Symptoms: Not Attributable to a Focal Area of the Brain and Therefore Very Unlikely to Represent TIA
T - 66.3. Causes of Transient Neurological or Monocular Visual Symptoms
T - 66.4. TIA: Which Vascular Territory Was Involved?
T - 66.5. Investigation after TIA
T - 68.1. Clinical Findings in Bacterial Meningitis
T - 68.2. Urgent Investigation in Suspected Meningitis
T - 68.3. Initial Antibiotic Therapy for Suspected Bacterial Meningitis in Adults
T - 68.4. Adjunctive Dexamethasone in Suspected Bacterial Meningitis
T - 68.5. CSF Formulae in Meningitis and Encephalitis
T - 68.6. Causes of Meningitis with a High CSF Lymphocyte Count
T - 69.1. Causes of Fever with Headache, Abnormal Behaviour or Reduced Conscious Level
T - 69.2. Focused Assessment in Suspected Encephalitis
T - 69.3. Urgent Investigation in Suspected Encephalitis
T - 71.1. Clinical Assessment
T - 71.2. Investigation in Suspected Guillain-Barre Syndrome
T - 71.3. Causes of Acute Weakness
T - 72.1. Causes of Raised Intracranial Pressure
T - 72.2. Clinical Features of Raised Intracranial Pressure
Respiratory
59. Upper Airway Obstruction
60. Acute Asthma
61. Exacerbation of Chronic Obstructive Pulmonary Disease (COPD)
62. Community-Acquired Pneumonia
63. Hospital-Acquired Pneumonia
64. Pneumothorax
B - 60.1. Asthma
B - 60.2. Pitfalls in the Management of Acute Asthma
B - 62.1. Definitions
B - 63.1. Hospital-Acquired Pneumonia
B - 64.1. The Chest X-Ray in Suspected Pneumothorax
F - 60.1. Management of Acute Asthma
F - 60.2. Discharge Planning of the Patient with Acute Asthma
F - 61.1. Algorithm for the Use of NIV in Acute Exacerbations of COPD
F - 62.1. Management of Suspected Community-Acquired Pneumonia
F - 64.1. Management of Suspected Pneumothorax
T - 59.1. Mechanical Causes of Upper Airway Obstruction
T - 59.2. Clinical Features of Upper Airway Obstruction
T - 59.3. Medical Treatments in Upper Airway Obstruction
T - 60.1. Differential Diagnosis of Acute Asthma
T - 60.2. Assessment of Severity of Acute Asthma
T - 60.3. Monitoring of the Patient with Acute Asthma
T - 61.1. Focused Clinical Assessment in Suspected Acute Exacerbation of COPD
T - 61.2. Investigation in Suspected Acute Exacerbation of COPD
T - 62.1. Differential Diagnosis of Suspected Pneumonia
T - 62.2. Chest X-Ray Findings in Pneumonia
T - 62.3. Urgent Investigations in Suspected Community Acquired Pneumonia
T - 62.4. CURB-65 Score
T - 62.5. Initial Empirical Treatment Regimens for Community-Acquired Pneumonia in Adults (Source: Adapted from British Thoracic Society Guidelines)
T - 63.1. Initial Antibiotic Therapy of Hospital-Acquired Pneumonia (HAP)
T - 63.2. Aspiration Pneumonia Syndromes
T - 64.1. Classification and Causes of Pneumothorax
T - 64.2. Signs of Tension Pneumothorax
T - 64.3. Needle Aspiration of Pneumothorax
Skin and Musculoskeletal
95. Cellulitis and Necrotizing Fasciitis
96. Erythroderma and Toxic Epidermal Necrolysis
97. Acute Gout and Pseudogout
98. Septic Arthritis
99. Acute Vasculitis
F - 95.1. Assessment of Suspected Cellulitis
F - 96.1. Management of Erythroderma
F - 97.1. Treatment Algorithm for Acute Gout and Pseudogout
F - 99.1. Management of Suspected Giant Cell Arteritis (GCA)
F - 99.2. Initial Management of Suspected Systemic Vasculitis
T - 95.1. Disorders Which May Be Mistaken for Cellulitis
T - 95.2. Urgent Investigation in Suspected Cellulitis or Necrotizing Fasciitis
T - 95.3. Cellulitis: Assessment of Severity of Illness and Management
T - 95.4. Initial Antibiotic Therapy in Cellulitis and Necrotizing Fasciitis
T - 96.1. Common Causes of Erythroderma
T - 96.2. Focused Assessment of the Patient with Erythroderma
T - 96.3. Urgent Investigation in Erythroderma
T - 96.4. Features of Toxic Epidermal Necrolysis (TEN), Stevens-Johnson Syndrome (SJS) and Erythema Multiforme Major
T - 96.5. Medications Which are Likely Causative Agents in Toxic Epidermal Necrolysis/Stevens-Johnson Syndrome
T - 96.6. Focused Assessment in Toxic-Epidermal Necrolysis
T - 96.7. Urgent Investigation in Toxic Epidermal Necrolysis
T - 96.8. SCORTEN Scoring System for Toxic Epidermal Necrolysis
T - 97.1. Epidemiology of Gout and Pseudogout
T - 97.2. Focused Assessment in Suspected Acute Gout or Pseudogout
T - 97.3. Urgent Investigation for Suspected Acute Gout or Pseudogout
T - 98.1. Comparison of Gonococcal and Non-Gonococcal Septic Arthritis
T - 98.2. Investigation in Suspected Septic Arthritis
T - 98.3. Initial Antibiotic Therapy for Suspected Native Joint Septic Arthritis
T - 99.1. Typical Presentations of Acute Vasculitis
T - 99.2. Pulmonary-Renal Syndromes
T - 99.3. Differential Diagnosis of Systemic Vasculitis
T - 99.4. Focused Assessment of the Patient with Possible Systemic Vasculitis
T - 99.5. Investigation of the Patient with Suspected Systemic Vasculitis
III. Techniques and Procedures in Acute Medicine
112. Airway Management
112. Airway Management
F - 112.1. Head Tilt and Chin Lift
F - 112.2. Jaw Thrust
F - 112.3. Insertion of an Oropharyngeal (Guedel) Airway
F - 112.4. Two-Person Bag-Mask Ventilation with a Two-Handed Mask Technique to Achieve a Good Seal
113. Non-Invasive Ventilation
113. Non-Invasive Ventilation
T - 113.1. Contraindications to NIV
T - 113.2. Checklist for Set-Up of NIV (Bi-Level NIV)
T - 113.3. Problem-Solving in NIV
114. Ultrasonography in Acute Medicine
114. Ultrasonography in Acute Medicine
B - 114.1. Ultrasonography in Acute Medicine
F - 114.1. Appearances of A-Lines (Left) and B-Lines (Right) on Thoracic Scan
T - 114.1. Indications for Emergency Ultrasonography
T - 114.2. Practical Guide to Emergency Ultrasonography
T - 114.3. Reversible Causes of Hypotension/Shock/Cardiac Arrest
T - 114.4. The Cardiac Scan in Cardiac Arrest/Shock: Appearances in the 2Ts and 2Hs Pathologies
T - 114.5. Appearances of A- and B-Lines on Thoracic Scan
T - 114.6. The Abdominal Scan in Suspected Ascites
115. Reading a Chest X-Ray
115. Reading a Chest X-Ray
F - 115.1. Patterns of Lobar Collapse
T - 115.1. Systematic Approach to the Chest X-Ray
T - 115.10. Pleural Diseases
T - 115.11. Chest Wall and Abdomen
T - 115.12. Diffuse Lung Shadowing
T - 115.2. Common Normal Variants
T - 115.3. Hilar Enlargement
T - 115.4. Mediastinal Mass
T - 115.5. Pneumomediastinum
T - 115.6. Cardiac Silhouette
T - 115.7. Alveolar and Interstitial Lung Disease
T - 115.8. Lobar Collapse
T - 115.9. Lung Nodules and Masses
116. Central Vein Cannulation
116. Central Vein Cannulation
F - 116.1. Relations of the Right Internal Jugular Vein
F - 116.2. Ultrasonography of the Right Internal Jugular Vein
F - 116.3. Method of Measuring Central Venous Pressure (CVP)
F - 116.4. Right Femoral Vein Puncture
T - 116.1. Central Vein Cannulation: Indications, Contraindications and Potential Complications
T - 116.2. Central Vein Cannulation: Equipment
117. Arterial Blood Sampling and Cannulation
117. Arterial Blood Sampling and Cannulation
T - 117.1. Arterial Cannulation: Indications, Contraindications and Potential Complications
T - 117.2. Selection of Artery for Cannulation
118. Arterial Blood Gases, Oxygen Saturation and Oxygen Therapy
118. Arterial Blood Gases, Oxygen Saturation and Oxygen Therapy
F - 118.1. Oxygen Prescription for Acutely Hypoxaemic Patients in Hospital
T - 118.1. Overview
T - 118.2. Estimation of the Alveolar-Arterial Oxygen Difference
T - 118.3. Pulse Oximetry: Causes of Inaccurate Reading
T - 118.4. Oxygen Delivery Devices
119. Temporary Cardiac Pacing
119. Temporary Cardiac Pacing
F - 119.1. (a) Placement of a Ventricular Pacing Lead from the Superior Vena Cava (Via the Internal Jugular or Subclavian Veins)
F - 119.2. Lead Position for Temporary Pacing: (a) Anatomy; and (B) Screening
T - 119.1. Temporary Cardiac Pacing: Indications, Contraindications and Potential Complications
T - 119.2. Temporary Transvenous Pacing: Equipment
120. Pericardial Aspiration (Pericardiocentesis)
120. Pericardial Aspiration (Pericardiocentesis)
F - 120.1. Anatomy of the Pericardial Space and Pericardiocentesis
T - 120.1. Pericardial Aspiration: Indications, Contraindications and Potential Complications
T - 120.2. Equipment Needed for Pericardiocentesis
121. DC Cardioversion
121. DC Cardioversion
T - 121.1. DC Cardioversion: Indications, Contraindications and Potential Complications
T - 121.2. Assistance/Equipment
T - 121.3. Checklist Before DC Cardioversion of Haemodynamically Stable Atrial Fibrillation or Flutter
T - 121.4. Cardioversion of Arrhythmias: Charges
122. Insertion of an Intercostal Chest Drain
122. Insertion of an Intercostal Chest Drain
F - 122.1. The 'triangle of Safety'
F - 122.2. Intercostal Chest Drain Attached to Underwater Seal
F - 122.3. Common Patient Positions for Chest Drain Insertion
F - 122.4. Stay and Closing Sutures for a Chest Drain
T - 122.1. Insertion of a Chest Drain: Indications, Contraindications and Potential Complications
T - 122.2. Insertion of a Chest Drain: Equipment Needed
123. Lumbar Puncture
123. Lumbar Puncture
F - 123.1. Positioning the Patient for Lumbar Puncture
F - 123.2. Anatomy of Lumbar Puncture
T - 123.1. Lumbar Puncture: Indications, Contraindications and Potential Complications
T - 123.2. Lumbar Puncture: Equipment Needed
T - 123.3. Cerebrospinal Fluid (CSF): Normal Values and Correction for Traumatic Tap
T - 123.4. Cerebrospinal Fluid (CSF) Formulae in Meningitis and Encephalitis
124. Aspiration of the Knee Joint
124. Aspiration of the Knee Joint
F - 124.1. Points of Needle Entry (Marked X) for Aspiration of the Knee Joint
T - 124.1. Aspiration of a Knee Joint: Indications, Contraindications and Potential Complications
T - 124.2. Findings on Analysis of Synovial Fluid
125. Insertion of a Sengstaken-Blakemore Tube
125. Insertion of a Sengstaken-Blakemore Tube
F - 125.1. Four-Lumen Sengstaken-Blakemore Tube in Place to Compress Bleeding Varices
T - 125.1. Insertion of a Sengstaken-Blakemore Tube: Indications, Contraindications and Potential Complications
T - 125.2. Insertion of a Sengstaken-Blakemore Tube: Equipment Needed
Appendice(s)
102.1. Disseminated Intravascular Coagulation (DIC)
102.2. Thrombotic Thrombocytopenic Purpura
102.3. Heparin-Induced Thrombocytopenia
24.1. Spontaneous Bacterial Peritonitis (SBP)
25.1. Rhabdomyolysis
31.1. Formulation of a Comprehensive Problem List
33.1. Falciparum Malaria
33.2. Enteric Fever (Typhoid and Paratyphoid)
36.1. Paracetamol Poisoning
36.2. Carbon Monoxide Poisoning
4.1. Causes of Delirium
59.1. Upper Airway Obstruction
6.1. Decisions About Cardiopulmonary Resuscitation
63.1. Aspiration Pneumonia Syndromes
65.1. Classification of Stroke
68.1. Tuberculous Meningitis
68.2. Cryptococcal Meningitis
69.1. Herpes Simplex Encephalitis
69.2. Neuroleptic Malignant Syndrome
71.1. Guillain-Barre Syndrome
76.1. Inflammatory Bowel Disease
77.1. Hepatorenal Syndrome
80.1. Causative Agents of Urinary Tract Infection (UTI) and Urethritis
99.1. The Spectrum of Systemic Vasculitides
Front Matter
Dedication
Evolution of Acute Medicine: the Development of Ambulatory Emergency Care
Box(s) - 1. Ambulatory Emergency Care (AEC)
Evolution of Acute Medicine: the Development of Ambulatory Emergency Care
F - 1. Ambulatory Emergency Care (AEC) in Acute Medicine
T - 1. The Amb Score
T - 2. Clinical Teams in the Ambulatory Emergency Care Network
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