Acute Medicine

The frail older person in the emergency department - Acute care and frail older people ...

This chapter provides concise details of the clinical features, immediate management, key investigations and further management of all of the common acute medical presentations. Other scales, charts and reference tables are also provided where relevant. These emergency presentations are clearly organized in the following sections: cardiac, respiratory, gastrointestinal, renal, metabolic and endocrine, neurological, infectious diseases, psychiatric, and ‘other’ (Disseminated intravascular coagulation [DIC], extremes of temperature and sickle-cell crises).Links throughout the chapter also point back into the detailed discussion of each relevant presentation that the Oxford Textbook of Medicine provides. ...Less

Adult basic life support - Adult advanced life support - Universal treatment algorithm - Acute coronary syndrome (ACS) - ST elevation myocardial infarction (STEMI) - STEMI: diagnosis 1 - STEMI: diagnosis 2 - STEMI: general measures - STEMI: reperfusion therapy (thrombolysis) 1 - STEMI: thrombolysis 2 - STEMI: reperfusion by primary percutaneous coronary intervention (PCI) - Surgery for acute STEMI - STEMI: additional measures - Right ventricular (RV) infarction - STEMI: predischarge risk stratification - STEMI: complications - Ventricular septal defect post myocardial infarction (MI) - Acute mitral regurgitation post MI - Pseudoaneurysm and free wall rupture - Cocaine-induced MI - Ventricular tachyarrhythmia post MI - Atrial tachyarrhythmia post MI - Bradyarrhythmias and indications for pacing - Bradyarrhythmias post MI - Hypotension and shock post MI - Cardiogenic shock - Non-ST elevation myocardial infarction (NSTEMI)/unstable angina (UA) - NSTEMI/UA: diagnosis - NSTEMI/UA: risk stratification - NSTEMI/UA: late risk stratification - NSTEMI/UA: medical management 1 - NSTEMI/UA: medical management 2 - NSTEMI/UA: invasive versus non-invasive strategies - NSTEMI/UA: discharge and secondary prevention - Arrhythmias: general approach - Tachyarrhythmias heart rate (HR) >120bpm - Treatment options in tachyarrhythmias - Broad complex tachycardia: diagnosis - Monomorphic ventricular tachycardia (MVT) - Polymorphic ventricular tachycardia (PVT) - Ventricular tachycardia: drugs - Narrow complex tachyarrhythmias (SVT) - Dosages of selected antiarrhythmics for SVT - Atrial fibrillation (AF): assessment - AF: management - AF: rate control - Atrial flutter - Multifocal atrial tachycardia (MAT) - Accessory pathway tachycardia (AV re-entrant tachycardia, AVRT) - Atrioventricular-nodal re-entry tachycardia (AVNRT) - Bradyarrhythmias: general approach - Sinus bradycardia or junctional rhythm - Intraventricular conduction disturbances - Types of atrioventricular (AV) conduction block - Pulmonary oedema: assessment - Pulmonary oedema: causes - Pulmonary oedema: management 1 - Pulmonary oedema: management 2 - Pulmonary oedema: management 3 - Pulmonary oedema: specific conditions - Infective endocarditis (IE) - IE: diagnosis - IE: investigations - IE: antibiotics - IE: monitoring treatment - Culture-negative endocarditis - Right-sided endocarditis - Prosthetic valve endocarditis (PVE) - Surgery for IE - Endocarditis prophylaxis - Acute aortic regurgitation (AR) - Acute mitral regurgitation (MR) - Deep vein thrombosis (DVT): assessment - DVT: management - Pulmonary embolism (PE): assessment - PE: investigations 1 - PE: investigations 2 - Pulmonary embolism: management 1 - Pulmonary embolism: management 2 - Fat embolism - Hypertensive emergencies - Hypertensive emergencies: management - Hypertensive emergencies: drug treatment - Hypertensive emergency with retinopathy (accelerated and malignant hypertension) - Hypertensive encephalopathy - Aortic dissection: assessment - Aortic dissection: investigations - Aortic dissection: management 1 - Aortic dissection: management 2 - Acute pericarditis: assessment - Acute pericarditis: management - Bacterial pericarditis - Cardiac tamponade: presentation - Cardiac tamponade: management - Congenital heart disease in adults 1 - Congenital heart disease in adults 2 ...Less

Cutaneous drug reactions - Erythroderma - Urticaria - Autoimmune bullous disease - Eczema herpeticum - Herpes zoster - Generalized pustular psoriasis - Toxic epidermal necrolysis (TEN) 1 - TEN 2 ...Less

Introduction - Systemic enquiry - Abdominal pain 1 - Abdominal pain 2 - Abdominal pain (referred) - Abdominal distension - Back pain - Blackouts - Breathlessness/dyspnoea - Chest pain - Chest pain (pleuritic) - Collapse - Confusion - Constipation - Cough - Cutaneous manifestations of internal malignancy - Diarrhoea - Diarrhoea (bloody) - Dysphagia - Falls - Fever - Fever in a traveller - Fits - Haematemesis and melaena - Haematuria - Haemoptysis - Headache - Hemiparesis - Hoarseness - Itching/pruritus - Joint pain/swelling - Leg swelling - Melaena - Muscle weakness - Nausea - Palpitations - Seizures - Tremor - Unconsciousness/reduced consciousness - Vomiting - Weak legs - Wheeze ...Less

Overdoses: general approach - Drug overdoses and antidotes - Amphetamines - Antipsychotic drugs - Benzodiazepines - β-blockers - Calcium channel blockers - Carbon monoxide - Cocaine - Cyanide - Digoxin - Ecstasy - Ethanol: acute intoxication - Ethylene glycol - Flunitrazepam - Gamma hydroxybutyric acid (GHB) or liquid ecstasy - Iron - Lithium - Lysergic acid diethylamide (LSD) - Methanol - Isopropanol - Olanzapine - Opiates - Paracetamol: assessment - Paracetamol: management - Paraquat - Risperidone - Salicylates - Selective serotonin reuptake inhibitors (SSRIs) - Theophylline - Tricyclic antidepressants - Valproate ...Less

Emergency presentations of HIV infection - Factors influencing presentation in HIV disease - HIV testing - Clinical indicator diseases for adult HIV infection - Primary HIV infection (PHI) - Acute neurological conditions in HIV-positive patients: assessment - Acute neurological conditions in HIV-positive patients: investigations - Acute neurological conditions in HIV-infected patients: treatment - Respiratory emergencies in HIV-positive patients: assessment - Respiratory emergencies in HIV-positive patients: investigations - Respiratory emergencies in HIV-positive patients: management - Gastrointestinal (GI) presentations in HIV-positive patients: assessment - GI presentations in HIV-positive patients: investigations - GI presentations in HIV-positive patients: management - Pyrexia of unknown origin - Immune reconstitution inflammatory syndrome (IRIS) - Dermatological presentations - Haematological presentations - Antiretroviral toxicity - Drug interactions with antiretroviral therapy - Post-exposure prophylaxis (PEP) ...Less

Diabetic ketoacidosis (DKA): assessment - DKA: management 1 - DKA: management 2 - DKA: complications - Hyperosmolar non-ketotic coma (HONK) 1 - HONK 2 - Hypoglycaemic coma: assessment - Hypoglycaemic coma: management - Urgent surgery in patients with diabetes - Hyponatraemia: assessment - Hyponatraemia: causes - Hyponatraemia: management - Hypernatraemia - Acute hypocalcaemia - Hypercalcaemia - Hypophosphataemia - Addisonian crisis: assessment - Addisonian crisis: management - Myxoedema coma - Thyrotoxic crisis: assessment - Thyrotoxic crisis: management - Pituitary apoplexy - Hypopituitary coma - Phaeochromocytomas: assessment - Phaeochromocytomas: management - Polyuria - Malignant hyperthermia - Neurolepetic malignant syndrome ...Less

Acute upper gastrointestinal (GI) bleeding 1 - Acute upper GI bleeding 2 - Acute upper GI bleeding 3 - Peptic ulcer disease - Erosive gastritis/oesophagitis - Variceal haemorrhage: medical management - Variceal haemorrhage: further management - Mallory–Weiss tear - Acute gastroenteritis: assessment - Bacterial gastroenteritis - Viral gastroenteritis - Clostridum difficile - Giardiasis - Travellers’ diarrhoea - Bloody diarrhoea - Bacterial dysentery - Amoebic dysentery - Inflammatory bowel disease (IBD) 1 - Inflammatory bowel disease 2 - Inflammatory bowel disease 3 - Jaundice: assessment - Viral hepatitis - Alcoholic hepatitis - Drug-induced hepatitis - Autoimmune hepatitis - Acholuric jaundice - Sepsis - Ischaemic hepatitis - Obstructive jaundice - Gallstone disease - Acute cholecystitis - Biliary obstruction - Ascites - Acute liver failure: assessment and investigations - Acute liver failure: management - ‘Acute-on-chronic’ liver failure - Hepatic encephalopathy - Liver abscesses - Acute pancreatitis: assessment - Acute pancreatitis: management ...Less

Blood transfusion reactions - Sickle cell crisis: presentation - Sickle cell crisis: management - Bleeding disorders: general approach - Abnormal coagulation 1 - Abnormal coagulation 2 - Circulating inhibitors of coagulation - Abnormal platelets - Anticoagulant therapy - Bleeding with fibrinolytic therapy - Bleeding in liver disease - Bleeding in uraemia - Massive transfusion/cardiopulmonary bypass - Haemophilia and related disorders 1 - Haemophilia and related disorders 2 - Combined thrombotic and haemorrhagic disorders - Disseminated intravascular coagulation (DIC) - Thrombotic thrombocytopenic purpura (TTP) and haemolytic-uraemic syndrome (HUS) - Microangiopathic haemolytic anaemia - Heparin-associated thrombocytopenia - Acute leukaemias: presentation - Acute leukaemias: management - Acute leukaemias: treatment - Early complications of bone marrow transplantation (BMT) - Complications of BMT - The febrile neutropenic patient 1 - The febrile neutropenic patient 2 - Infections in the transplant patient - Cytomegalovirus (CMV) infections in transplant patients - Hyperviscosity syndrome - Tumour lysis syndrome - Hypercalcaemia of malignancy - Superior vena cava obstruction - Massive mediastinal mass ...Less