Oxford Handbook of Acute Medicine Book

Symbols and abbreviations

1 Cardiac emergencies 1

Adult basic life support 4

Adult advanced life support 6

Universal treatment algorithm 8

Acute coronary syndrome (ACS) 10

ST elevation myocardial infarction (STEMI) 12

STEMI: diagnosis 1 14

STEMI: diagnosis 2 16

STEMI: general measures 18

STEMI: reperfusion therapy (thrombolysis) 1 20

STEMI: thrombolysis 2 21

STEMI: reperfusion by primary percutaneous coronary intervention (PCI) 24

Surgery for acute STEMI 26

STEMI: additional measures 27

Right ventricular (RV) infarction 28

STEMI: predischarge risk stratification 30

STEMI: complications 32

Ventricular septal defect post myocardial infarction (MI) 34

Acute mitral regurgitation post MI 35

Pseudoaneurysm and free wall rupture 35

Cocaine-induced MI 36

Ventricular tachyarrhythmia post MI 38

Atrial tachyarrhythmia post MI 38

Bradyarrhythmias and indications for pacing 39

Bradyarrhythmiaspost MI 39

Hypotension and shock post MI 40

Cardiogenic shock 42

Non-ST elevation myocardial infarction (NSTEMI)/unstable angina (UA) 44

NSTEMI/UA: diagnosis 46

NSTEMI/UA: risk stratification 48

NSTEMI/UA: late risk stratification 50

NSTEMI/UA: medical management 1 51

NSTEMI/UA: medical management 2 52

NSTEMI/UA: invasive versus non-invasive strategies 54

NSTEMI/UA: discharge and secondary prevention 54

Arrhythmias: general approach 55

Tachyarrhythmias heart rate (HR) >120bpm 56

Treatment options in tachyarrhythmias 58

Broad compiex tachycardia: diagnosis 60

Monomorphic ventricular tachycardia (MVT) 62

Polymorphic ventricular tachycardia (PVT) 64

Ventricular tachycardia: drugs 66

Narrow complex tachyarrhythmias (SVT) 68

Dosages of selected antiarrhythmics for SVT 71

Atrial fibrillation (AF): assessment 72

AF: management 74

AF: rate control 77

Atrial flutter 78

Multifocal atrial tachycardia (MAT) 79

Accessory pathway tachycardia (AV re-entrant tachycardia, AVRT) 80

Atrioventricular-nodal re-entry tachycardia (AVNRT) 81

Bradyarrhythmias: general approach 82

Sinus bradycardia or junctional rhythm 84

Intraventricular conduction disturbances 85

Types of atrioventricular (AV) conduction block 86

Pulmonary oedema: assessment 87

Pulmonary oedema: causes 89

Pulmonary oedema: management 1 90

Pulmonary oedema: management 2 91

Pulmonary oedema: management 3 93

Pulmonary oedema: specific conditions 95

Infective endocarditis (IE) 96

IE: diagnosis 98

IE: investigations 99

IE: antibiotics 100

IE: monitoring treatment 102

Culture-negative endocarditis 104

Right-sided endocarditis 106

Prosthetic valve endocarditis (PVE) 106

Surgery for IE 108

Endocarditis prophylaxis 110

Acute aortic regurgitation (AR) 112

Acute mitral regurgitation (MR) 114

Deep vein thrombosis (DVT): assessment 116

DVT: management 118

Pulmonary embolism (PE): assessment 120

PE: investigations 1 122

PE: investigations 2 124

Pulmonary embolism: management 1 126

Pulmonary embolism: management 2 128

Fat embolism 130

Hypertensive emergencies 132

Hypertensive emergencies: management 134

Hypertensive emergencies: drug treatment 136

Hypertensive emergency with retinopathy (accelerated and malignant hypertension) 138

Hypertensive encephalopathy 140

Aortic dissection: assessment 142

Aortic dissection: investigations 144

Aortic dissection: management 1 146

Aortic dissection: management 2 148

Acute pericarditis: assessment 150

Acute pericarditis: management 152

Bacterial pericarditis 154

Cardiac tamponade: presentation 156

Cardiac tamponade: management 158

Congenital heart disease in adults 1 160

Congenital heart disease in adults 2 162

2 Respiratory emergencies 165

Acute pneumonia: assessment 166

Acute pneumonia: investigations 168

Acute pneumonia: management 170

Acute pneumonia: specific situations 172

Acute pneumonia: complications 173

Mycoplasma pneumonia 174

Legionella pneumonia 174

Viral pneumonia 175

Chlamydia pneumonia 175

Psittacosis 175

Miscellaneous conditions 176

Acute asthma: assessment 178

Acute severe asthma: immediate therapy 180

Acute severe asthma: further management 182

Mild-moderate asthmatic attacks 184

Acute exacerbation of chronic obstructive pulmonary disease (COPD): assessment 186

Acute exacerbation of COPD: management 188

Acute exacerbation of COPD 190

Respiratory failure: assessment 192

Respiratory failure: investigations 194

Respiratory failure: management 196

Adult respiratory distress syndrome 1 198

Adult respiratory distress syndrome 2 200

Adult respiratory distress syndrome 3 202

Pneumothorax: assessment 204

Pneumothorax: management 206

Acute pneumothorax: management 208

Tension pneumothorax 210

Haemoptysis: assessment 212

Haemoptysis: management 214

Pleural effusions 216

Chronic massive effusion 218

Empyema 219

Acute upper airway obstruction 220

3 Gastroenterological emergencies 223

Acute upper gastrointestinal (GI) bleeding 1 224

Acute upper GI bleeding 2 226

Acute upper GI bleeding 3 228

Peptic ulcer disease 230

Erosive gastritis/oesophagitis 230

Variceal haemorrhage: medical management 232

Variceal haemorrhage: further management 234

Mallory-Weiss tear 234

Acute gastroenteritis: assessment 236

Bacterial gastroenteritis 238

Viral gastroenteritis 239

Clostridum difficile 240

Giardiasis 240

Travellers' diarrhoea 242

Bloody diarrhoea 244

Bacterial dysentery 246

Amoebic dysentery 247

Inflammatory bowel disease (IBD) 1 248

Inflammatory bowel disease 2 250

Inflammatory bowel disease 3 252

Jaundice: assessment 254

Viral hepatitis 256

Alcoholic hepatitis 258

Drug-induced hepatitis 260

Autoimmune hepatitis 260

Acholuric jaundice 260

Sepsis 261

Ischaemic hepatitis 261

Obstructive jaundice 261

Gallstone disease 262

Acute cholecystitis 263

Biliary obstruction 264

Ascites 266

Acute liver failure: assessment and investigations 268

Acute liver failure: management 270

áAcute-on-chronic' liver failure 272

Hepatic encephalopathy 273

Liver abscesses 274

Acute pancreatitis: assessment 276

Acute pancreatitis: management 278

4 Renal emergencies 281

Acute kidney injury (AKI) 1 282

AKI 2 284

AKI: investigations 286

AKI: management 288

AKI: further management 290

Anuria 292

Interstitial nephritis 293

Rhabdomyolysis 294

Hepatorenal syndrome 296

Acute upper urinary tract infections 298

Renal colic and renal stones 300

Haematuria 302

Renovascular disease 304

Cholesterol embolism 306

Contrast nephropathy 306

5 Shock 309

Shock 310

Shock assessment 312

Shock management 314

Sepsis syndrome and septic shock 316

Septic shock management 318

Sepsis syndrome/septic shock antibiotics 320

Toxic shock syndrome 321

Anaphylaxis 322

Lactic acidosis 324

Appendix 1 Haemodynamic calculations 326

Appendix 2 Understanding circulatory failure 327

Appendix 3 Inotrope support 328

Appendix 4 Sodium bicarbonate 330

6 Neurological emergencies 331

Coma: assessment 332

Coma: immediate management 334

Coma: clues from examination 336

Coma: management 338

Limb weakness: assessment 340

Limb weakness: localizing the lesion 342

Acute dizziness: assessment 344

Acute dizziness: management 346

Acute loss of vision 348

Approach to acute/sub-acute visual loss 350

Painful red eye: assessment 352

Painful red eye: management 354

Acute bacterial meningitis: assessment 355

Acute bacteria! meningitis: immediate management 356

Acute bacterial meningitis: continuing therapy 358

Acute bacterial meningitis: complications and their treatment 359

Meningitis with lymphocytic CSF 360

Acute viral encephalitis 362

Head injury: presentation 364

Head injury: assessment 366

Head injury: immediate management 368

Head injury: further management 370

Raised intracranial pressure (ICP) 372

Raised ICP: further management 374

Intracranial space-occupying lesion 376

Extradural haemorrhage 378

Intracerebral haemorrhage 380

Subdural haematoma 382

Subarachnoid haemorrhage: assessment 384

Subarachnoid haemorrhage: immediate management 386

Subarachnoid haemorrhage: further management 388

Status epilepticus (tonic-clonic) 390

Status epilepticus (tonic-clonic) 2 392

Stroke: overview 394

Stroke: haemorrhage or infarct? 396

Stroke: thrombolysis 396

Stroke: other investigations 398

Stroke: management 399

Stroke: complications 400

Stroke: acute blood pressure control 401

Stroke: secondary prevention 402

Cerebral infarction syndromes 403

Brainstem stroke 404

Cerebellar stroke 406

Transient ischaemic attacks (TIAs) 408

Confusional states and delirium: assessment 410

Confusional states and delirium: management 412

Acute alcohol withdrawal 414

Neuromuscular respiratory failure: assessment 416

Neuromuscular respiratory failure: investigations and management 418

Myasthenic crises 420

Spinal cord compression: assessment 422

Spinal cord compression: management 424

Guillain-Barre Syndrome (GBS) 426

Botulism 428

Tetanus 430

Glasgow Coma Scale (GCS) 432

Examination of brainstem function 1 434

Examination of brainstem function 2 436

Examination of brainstem function 3 438

Oculocephalic and oculovestibular responses 440

Brain death 442

7 Infectious diseases 445

Fever in a traveller 1 446

Fever in a traveller 2 448

Malaria: assessment 450

Malaria: investigations 452

Malaria: management 453

Malaria: anti-malarial therapy 454

Infections presenting with fever and rash 456

Primary varicella infection (chickenpox) 458

Herpes zoster (shingles) 460

Varicella infection control 461

Meningococcal infection: assessment 462

Meningococcal infection: management 464

Enteric fever (typhoid) 466

Viral haemorrhagic fevers 468

Rickettsial infections 470

Q fever 471

Human bites 471

Non-human mammalian bites 472

Infections in intravenous drug users 472

Necrotizing fasciitis 473

Severe acute respiratory syndrome (SAKS) 473

Bioterrorism 474

8 Emergencies in HIV-positive patients 479

Emergency presentations of HIV infection 480

Factors influencing presentation in HIV disease 482

HIV testing 484

Clinical indicator diseases for adult HIV infection 486

Primary HIV infection (PHI) 487

Acute neurological conditions in HIV-positive patients: assessment 488

Acute neurological conditions in HIV-positive patients: investigations 490

Acute neurological conditions in HIV-infected patients: treatment 492

Respiratory emergencies in HIV-positive patients: assessment 494

Respiratory emergencies in HIV-positive patients: investigations 496

Respiratory emergencies in HIV-positive patients: management 498

Gastrointestinal (GI) presentations in HIV-positive patients: assessment 500

GI presentations in HIV-positive patients: investigations 502

GI presentations in HIV-positive patients: management 503

Pyrexia of unknown origin 506

Immune reconstitution inflammatory syndrome (IRIS) 507

Dermatologtcal presentations 508

Haematological presentations 509

Antiretroviral toxicity 510

Drug interactions with antiretroviral therapy 512

Post-exposure prophylaxis (PEP) 513

9 Endocrine emergencies 515

Diabetic ketoacidosis (DKA): assessment 516

DKA: management 1 518

DKA: management 2 520

DKA: complications 522

Hyperosmolar non-ketotic coma (HONK) 1 524

HONK 2 526

Hypoglycaernic coma: assessment 528

Hypoglycaernic coma: management 530

Urgent surgery in patients with diabetes 532

Hyponatraemia: assessment 534

Hyponatremia: causes 536

Hyponatraemia: management 538

Hypernatraemia 540

Acute hypocalcaemia 542

Hypercalcaemia 544

Hypophosphataemia 546

Addisonian crisis: assessment 548

Addisonian crisis: management 550

Myxoedema coma 552

Thyrotoxic crisis: assessment 554

Thyrotoxic crisis: management 556

Pituitary apoplexy 558

Hypopituitary coma 560

Phaeochromocytomas: assessment 562