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Preface v
Contributors vi
Section 1 Basic principles of patient care
1 Initial assessment and emergency management 1
General history and examination 1
Assessment of the acutely ill patient 8
Cardiac arrest management 11
2 Use of equipment and procedures 18
Procedural competence 18
The sterile field 19
Local anaesthetics 22
Venepuncture and cannulation 25
Blood cultures 27
Injections and infusions 29
Arterial blood gas sampling 31
Arterial line insertion 32
Urinary catheterization 34
Lumbar puncture 37
Pleural aspiration 38
Chest drain insertion and management 40
Nasogastric tube insertion 44
PEG tube and drain insertion 45
Ascitic tap and drain insertion 46
Joint aspiration and injection 48
Central line insertion 50
Temporary cardiac pacing 54
Defibrillation and electrical cardioversion 58
Wound closure and dressings 61
Suturing 63
ECG recording 65
Oxygen delivery 66
Nebulizers 67
Peak flow and spirometry 68
3 Interpreting tests 70
Laboratory tests 70
ECG interpretation 78
Peak flow and spirometry 89
Radiological tests 90
Chest X-rays 94
Abdominal X-rays 101
4 Drugs and prescribing 106
General prescribing 106
Common prescribing 107
Common interactions 111
Prescribing errors 113
Drug reactions 114
Dose calculation 115
Drug monitoring 118
Drug use in special circumstances 119
Prescribing fluid and blood 122
Section 2 Symptoms and related acute presentations
5 Cardiac and chest 125
Chest pain 125
Arrhythmias 132
Breathlessness 139
6 Abdominal 159
Acute abdominal pain 159
Diarrhoea, vomiting and constipation 169
Gastrointestinal bleeding 174
Abnormal liver function178
Nutrition 183
Haematuria and urinary retention 185
7 Endocrine, electrolyte and renal 187
Diabetes mellitus 187
Thyroid and adrenal problems 197
Electrolyte imbalance 202
Renal dysfunction 209
8 Neurological and psychiatric 216
The unconscious patient 216
Headache 218
Fits and faints 220
Stroke 223
Focal neurology 226
Falls and immobility 231
Delirium and alcohol withdrawal 233
Acute psychosis 235
Self-injury and self-poisoning 237
9 Sepsis, shock and trauma 242
Sepsis and infection 242
Fluid balance, shock and anaphylaxis 249
Major trauma 254
Fractures and minor trauma 259
Acute leg pain 270
Wounds and burns 272
Section 3 Specialties and cancers
10 Specialty acute presentations 276
Haematological 276
Rheumatological 283
Dermatological 292
Ear, nose and throat 308
Ophthalmic 313
Obstetric 318
Gynaecological 331
Paediatric 335
Surgical lumps 343
11 Cancers and palliative care 349
Performance status and quality of life 349
Lung cancer 350
Breast cancer 353
Colorectal cancer 355
Oesophageal cancer 357
Stomach cancer 359
Pancreatic cancer 360
Ovarian cancer 361
Cervical cancer 363
Endometrial cancer 364
Prostate cancer 365
Bladder cancer 367
Renal cancer 368
Testicular cancer 369
Leukaemia 370
Lymphoma 373
Myeloma 375
Palliative care 376
Section 4 Everyday life as a junior doctor
12 On the ward 383
Time and 'take' management 383
Verbal communication 385
Written communication 389
Before, during and after theatre 392
13 Legal and ethical practice 397
The doctor-patient relationship 397
Appropriate resuscitation and DNAR 399
Death certification 400
Capacity, consent and competence 404
Child protection 407
Mental health act 409
Driving 411
Notifiable diseases 414
HIV testing 414
Computers and data protection 416
14 Looking after yourself 418
Occupational health department and personal health 418
Aggression and violence 420
Difficult colleagues and colleagues in difficulty 422
Complaints handling 424
15 Developing a career 426
Choosing a career 426
Applications, CV and interviews 428
Appraisal and assessment 430
Research 432
Teaching and life-long learning 433
Making and giving presentations 435
16 Working as part of the system of care 439
The good doctor 439
Clinical governance 440
Patient safety and risk management 440
Healthcare-associated infection 441
Audit 443
Evidence-based medicine, statistics and guidelines 445
Diversity, religion, culture and disability 448
Primary and secondary care interface 451
Epidemiology, screening and health promotion 452
Rehabilitation 455
Complementary and alternative therapy 456
17 Working in the UK 458
The new post 458
Finance 460
Leave 461
Important professional bodies 463
Index 466
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