acute medicine

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Contents
Preface
Abbreviations
01 - Resuscitation
	1.1 - Introduction
	1.2 - Initiating resuscitation
	1.3 - Basic Iife support: UK Guidelines 2015
	1.4 - Advanced life support: UK Guidelines 2015
	1.5 - Treatment of shockable rhythms (VF/pulseless VT)
	1.6 - Treatment of non-shockable rhythms (asystole/PEA)
	1.7 - Reversible causes of cardiac arrest
	1.8 - Resuscitation issues
	1.9 - Drugs for cardiac arrest
	1.10 - Special cases in resuscitation
	1.11 - Return of spontaneous circulation (ROSC)
	1.12 - Bradycardia management: be prepared to pace
	1.13 - Tachycardia management: be prepared to DC shock
	1.14 - Emergency DC cardioversion
	1.15 - Emergency pericardiocentesis
	1.16 - Automated implantable cardioverter defibrillator (AICD)
	1.17 - Adult choking algorithm
02 - The acutely ill patient
	2.1 - Levels of care
	2.2 - National early warning scores
	2.3 - Clinical risk and response
	2.4 - ABCDE assessment
	2.5 - Getting senior help: advice before you call for advice
	2.6 - Phone protocols
	2.7 - Advanced airways management
	2.8 - Tracheostomy/laryngectomy emergencies
	2.9 - Assessing and managing fluid balance
	2.10 - Fluid replacement regimens
	2.11 - Venous access: choosing a venous cannula
	2.12 - Acid–base balance and blood gas interpretation
	2.13 - Assessment of shocked patient
	2.14 - Immediate actions in a shocked patient
	2.15 - Quick review of different forms of shock
	2.16 - Acute heart failure/cardiogenic shock
	2.17 - Vasopressors and inotropes
	2.18 - Anaphylactic/anaphylactoid shock
	2.19 - Toxic shock syndrome
	2.20 - Hypovolaemic shock
	2.21 - Systemic inflammatory response syndrome/sepsis/severe sepsis
	2.22 - Haemorrhagic shock
	2.23 - Massive transfusion protocol
03 - Cardiology emergencies
	3.1 - Anatomy and physiology
	3.2 - Chest pain assessment
	3.3 - Chest pain differentials
	3.4 - Palpitations
	3.5 - Syncope and transient loss of consciousness (TLOC)
	3.6 - Differentials of syncope/transient loss of consciousness (TLOC)
	3.7 - Sudden cardiac death
	3.8 - Acute coronary syndrome
	3.9 - Stable angina
	3.10 - Arrhythmias
	3.11 - Tachyarrhythmias
	3.12 - Monomorphic ventricular tachycardia
	3.13 - Polymorphic ventricular tachycardia (torsades de pointes)
	3.14 - Supraventricular tachycardia
	3.15 - Symptomatic bradycardia
	3.16 - Atrial fibrillation
	3.17 - Aortic dissection
	3.18 - Acute myocarditis
	3.19 - Acute pericarditis
	3.20 - Pericardial effusion/tamponade
	3.21 - Severe (malignant) hypertension
	3.22 - Infective endocarditis
	3.23 - Cardiomyopathy
04 - Respiratory emergencies
	4.1 - Pathophysiology
	4.2 - Oxygen therapy
	4.3 - Acute breathlessness
	4.4 - Acute stridor
	4.5 - Acute respiratory failure
	4.6 - NIV protocol and settings
	4.7 - Invasive ventilation
	4.8 - Massive haemoptysis
	4.9 - Acute respiratory distress syndrome (ARDS)
	4.10 - Acute exacerbation of COPD
	4.11 - Acute severe asthma
	4.12 - Pneumothorax
	4.13 - Pleural effusion
	4.14 - Pneumonia
	4.15 - Pneumocystis pneumonia
	4.16 - Empyema
	4.17 - Pulmonary embolism and deep vein thrombosis
	4.18 - Lung ‘white out’
	4.19 - Lung abscess
05 - Endocrine and diabetic emergencies
	5.1 - Primary hypoadrenalism (Addisonian crisis)
	5.2 - Hypoglycaemia
	5.3 - Hyperkalaemia
	5.4 - Hypokalaemia
	5.5 - Hypercalcaemia
	5.6 - Hypocalcaemia
	5.7 - Myxoedema coma
	5.8 - Thyroid storm/thyrotoxic crisis
	5.9 - Pituitary apoplexy
	5.10 - Hyponatraemia
	5.11 - Hypernatraemia
	5.12 - Hypophosphataemia
	5.13 - Hyperphosphataemia
	5.14 - Hypomagnesaemia
	5.15 - Hypermagnesaemia
	5.16 - Lactic acidosis
	5.17 - Acute porphyria
	5.18 - Diabetic ketoacidosis
	5.19 - Hyperosmolar hyperglycaemic state (HHS)
	5.20 - Diabetic foot infections
	5.21 - Diabetes and surgery
	5.22 - Variable rate intravenous insulin infusion
	5.23 - Diabetes care in emergencies
06 - Gastroenterology emergencies
	6.1 - Acute diarrhoea
	6.2 - Constipation
	6.3 - Dyspepsia
	6.4 - Upper gastrointestinal bleeding
	6.5 - Lower gastrointestinal bleeding
	6.6 - Acute abdomen
	6.7 - Acute abdomen – surgical causes
	6.8 - Acute abdomen – medical causes
	6.9 - Gastric outlet obstruction/pyloric stenosis
	6.10 - Acute severe colitis
	6.11 - Clostridium difficile colitis
	6.12 - Intestinal obstruction
	6.13 - Acute colonic pseudo-obstruction
	6.14 - Acute bowel ischaemia
	6.15 - Acute diverticulitis
	6.16 - Re-feeding syndrome
	6.17 - Ingested foreign bodies and food impactions
07 - Hepatobiliary emergencies
	7.1 - Jaundice
	7.2 - Acute liver failure
	7.3 - Viral hepatitis
	7.4 - Alcoholic hepatitis
	7.5 - Alcoholic ketoacidosis
	7.6 - Alcohol abuse
	7.7 - Zieve’s syndrome
	7.8 - Delirium tremens/alcohol withdrawal
	7.9 - Decompensated cirrhosis, ascites and spontaneous bacterial peritonitis
	7.10 - Hepatorenal syndrome
	7.11 - Hepatic encephalopathy
	7.12 - Chronic liver disease
	7.13 - Liver abscess
	7.14 - Gallstone disease and local complications
	7.15 - Acute cholangitis
	7.16 - Acute pancreatitis
08 - Haematological emergencies
	8.1 - Anaemia
	8.2 - Severe thrombocytopenia
	8.3 - Heparin-induced thrombocytopenia
	8.4 - Disseminated intravascular coagulation
	8.5 - Sickle cell crisis
	8.6 - Haemolytic uraemic syndrome
	8.7 - Thrombotic thrombocytopenic purpura
	8.8 - Bleeding disorders and reversal of anticoagulation
	8.9 - Bleeding on warfarin
	8.10 - Bleeding on heparin
	8.11 - Bleeding on direct oral anticoagulants
	8.12 - Bleeding on/after thrombolysis
	8.13 - Blood transfusion and blood products
	8.14 - Which blood/plasma product?
	8.15 - Cross-matching
	8.16 - Acute transfusion reactions
	8.17 - Indications for irradiated blood
	8.18 - Immunocompromised patients
	8.19 - Plasmapheresis/plasma exchange (PLEX)
09 - Infectious disease emergencies
	9.1 - Pyrexia of unknown origin
	9.2 - Assessment of the febrile traveller
	9.3 - Falciparum malaria
	9.4 - Traveller’s diarrhoea
	9.5 - Tick typhus
	9.6 - Rocky Mountain Spotted fever
	9.7 - Schistosomiasis (Katayama fever)
	9.8 - Dengue
	9.9 - Viral haemorrhagic fever
	9.10 - Chikungunya
	9.11 - Plague/tularaemia
	9.12 - Brucellosis
	9.13 - Pseudomonas infection
	9.14 - Q fever
	9.15 - Anthrax
	9.16 - Leptospirosis
	9.17 - Listeriosis
	9.18 - Botulism
	9.19 - Clostridial infection
	9.20 - Acute bacterial sepsis
	9.21 - Measles
	9.22 - Chickenpox/varicella zoster virus (Shingles)
	9.23 - Mumps infection
	9.24 - Herpes simplex 1 and 2
	9.25 - Infectious mononucleosis
	9.26 - Cytomegalovirus
	9.27 - Influenza
	9.28 - Severe acute respiratory syndrome
	9.29 - Middle Eastern respiratory syndrome
	9.30 - Zika virus infection
	9.31 - Needlestick injury
	9.32 - Tuberculosis (Mycobacterium tuberculosis)
	9.33 - HIV/acquired immunodeficiency syndrome
	9.34 - Syphilis
	9.35 - Oropharyngeal bacterial infections
	9.36 - Diphtheria
	9.37 - Lemierre’s syndrome (Fusobacterium necrophorum)
	9.38 - Meticillin sensitive/resistant Staph. aureus
	9.39 - Bacterial resistance: VRE, ESBL, CRE/CRO
	9.40 - Gastroenteritis and similar infections
	9.41 - E. coli infections
	9.42 - Staphylococcal food poisoning
	9.43 - Shigella dysenteriae
	9.44 - Enteric fever (typhoid/paratyphoid)
	9.45 - Bacillus cereus
	9.46 - Cholera
	9.47 - Giardiasis
	9.48 - Amoebiasis
	9.49 - Neurocysticercosis
	9.50 - Tetanus
	9.51 - Lyme disease
10 - Renal and urological emergencies
	10.1 - Pathophysiology
	10.2 - Haematuria
	10.3 - Reduced urinary output (anuria/oliguria)
	10.4 - Acute kidney injury
	10.5 - Chronic kidney disease
	10.6 - Urinary tract infection
	10.7 - Renal obstruction (obstructive uropathy)
	10.8 - Nephrolithiasis
	10.9 - Ischaemic priapism
11 - Neurological emergencies
	11.1 - Neuroscience and neuroanatomy
	11.2 - Clinical assessment
	11.3 - Patterns of weakness
	11.4 - Coma
	11.5 - Acute headache
	11.6 - Primary headaches
	11.7 - Secondary headaches
	11.8 - Acute delirium/confusion
	11.9 - Viral encephalitis
	11.10 - Rabies
	11.11 - Acute bacterial meningitis
	11.12 - Acute viral (aseptic) meningitis
	11.13 - Cerebral abscess
	11.14 - Septic cavernous sinus thrombosis
	11.15 - Idiopathic intracranial hypertension
	11.16 - Seizures: status epilepticus
	11.17 - Non-convulsive status epilepticus
	11.18 - Neuroleptic malignant syndrome
	11.19 - Cerebrovascular disease
	11.20 - Transient ischaemic attacks
	11.21 - Ischaemic stroke
	11.22 - Haemorrhagic stroke
	11.23 - Subarachnoid haemorrhage
	11.24 - Cerebral hyperperfusion syndrome
	11.25 - Subdural haematoma
	11.26 - Epidural haematoma/head trauma
	11.27 - Guillain–Barré syndrome
	11.28 - Myasthenia gravis
	11.29 - Acute cord injury
	11.30 - Acute transverse myelitis
	11.31 - Acute dystonic reactions
	11.32 - Acute vertigo
	11.33 - Bell’s palsy/Ramsay Hunt syndrome
	11.34 - Acute demyelination
	11.35 - Acute peripheral mononeuropathy
	11.36 - Motor neurone disease (amyotrophic lateral sclerosis)
	11.37 - Dementias
	11.38 - Acute hydrocephalus and shunts
	11.39 - Managing raised intracranial pressure
	11.40 - Cerebral oedema
	11.41 - Neurosurgical options
12 - Rheumatological emergencies
	12.1 - Septic arthritis
	12.2 - Osteomyelitis
	12.3 - Reactive arthritis
	12.4 - Acute gout and pseudogout
	12.5 - Rheumatoid arthritis
	12.6 - Trauma and fractures in elderly
	12.7 - Proximal femoral fracture
	12.8 - Fractured pubic ramus
13 - Ophthalmological emergencies
	13.1 - Acute visual loss
	13.2 - Red eye
	13.3 - Neuro-ophthalmology
	13.4 - Giant cell (temporal) arteritis
14 - Toxicology emergencies
	14.1 - Reduce absorption or increase excretion/elimination of toxins
	14.2 - Supportive management of specific issues
	14.3 - Intralipid therapy
	14.4 - (High dose) Insulin–glucose euglycaemic therapy
	14.5 - Amphetamine (‘speed’) and 3,4 MDMA (‘ecstasy’) toxicity
	14.6 - Beta-blocker toxicity
	14.7 - Benzodiazepine toxicity
	14.8 - Calcium channel blocker toxicity
	14.9 - Sodium valproate toxicity
	14.10 - Carbon monoxide toxicity
	14.11 - Cocaine toxicity
	14.12 - Local anaesthetic toxicity
	14.13 - Cyanide toxicity
	14.14 - Digoxin toxicity
	14.15 - Ethanol (C2H5OH) toxicity
	14.16 - Ethylene glycol toxicity
	14.17 - Methanol toxicity
	14.18 - Gamma hydroxybutyrate (GHB) toxicity
	14.19 - Insulin toxicity
	14.20 - Iron (ferrous sulphate) toxicity
	14.21 - Lithium toxicity
	14.22 - Monoamine oxidase inhibitors toxicity
	14.23 - Neuroleptics toxicity
	14.24 - Direct (novel) oral anticoagulants toxicity
	14.25 - Non-steroidal anti-inflammatory drugs (NSAIDs) toxicity
	14.26 - Opioid/opiate toxicity
	14.27 - Organophosphate/carbamates toxicity
	14.28 - Paracetamol (acetaminophen) toxicity
	14.29 - Paraquat toxicity
	14.30 - Chloroquine/quinine toxicity
	14.31 - Salicylate toxicity
	14.32 - SSRI/SNRI toxicity
	14.33 - Tricyclic antidepressant toxicity
	14.34 - Theophylline toxicity
	14.35 - Body packers (‘mules’)
	14.36 - Cannabis toxicity
	14.37 - Sulphonylurea toxicity
	14.38 - Methaemoglobinaemia
	14.39 - Phenobarbital toxicity
	14.40 - Carbamazepine toxicity
	14.41 - Lead, arsenic, mercury, thallium (heavy metal) toxicity
15 - Medical emergencies in pregnancy
	15.1 - Medical problems in pregnancy
	15.2 - Pharmacology in pregnancy
	15.3 - Amniotic fluid embolism
	15.4 - Hypertension in pregnancy
	15.5 - Eclampsia and pre-eclampsia
	15.6 - Diabetes in pregnancy
	15.7 - Acute hepatobiliary disease in pregnancy
	15.8 - Diagnoses and management of liver disease in pregnancy
	15.9 - Pulmonary embolism and pregnancy
	15.10 - Acute severe asthma in pregnancy
	15.11 - Status epilepticus in pregnancy
	15.12 - Cardiac disease in pregnancy
	15.13 - Inflammatory bowel disease and pregnancy
16 - Oncological emergencies
	16.1 - Malignancy-related hypercalcaemia
	16.2 - Tumour lysis syndrome
	16.3 - Hyperviscosity syndrome
	16.4 - Brain tumour
	16.5 - Neutropenic sepsis
	16.6 - Malignant superior vena caval obstruction
	16.7 - Severe nausea and vomiting
	16.8 - Malignant spinal cord compression
17 - Miscellaneous emergencies
	17.1 - Abnormal gaits
	17.2 - Falls with no altered consciousness
	17.3 - Fat embolism
	17.4 - Air embolism
	17.5 - Refeeding syndrome
	17.6 - Accidental hypothermia
	17.7 - Malignant hyperpyrexia
	17.8 - Acute rhabdomyolysis
	17.9 - Painful leg
	17.10 - Acute limb ischaemia
	17.11 - Abdominal aortic aneurysm
18 - Dermatological emergencies
	18.1 - Introduction
	18.2 - Toxic epidermal necrolysis/Stevens–Johnson syndrome
	18.3 - Cellulitis/erysipelas, bites, surgery
	18.4 - Erythroderma (exfoliative dermatitis)
	18.5 - Severe (erythrodermic/pustular) psoriasis
	18.6 - Necrotising fasciitis
	18.7 - Other important rashes for acute physicians
19 - General management
	19.1 - Enteral feeding
	19.2 - Parenteral feeding
	19.3 - Pain management
	19.4 - WHO pain ladder
	19.5 - Using opiates and other analgesics
	19.6 - Venous thromboembolism prevention
	19.7 - Duties of a doctor
	19.8 - Medical errors, harm and duty of candour
	19.9 - Never events – events that should ‘never’ occur
	19.10 - Risk management and risk register
	19.11 - Duty of candour
	19.12 - Discharging patients safely
	19.13 - Self-discharge
	19.14 - Suicidal patients
	19.15 - Common law and Mental Health Act
	19.16 - Mental capacity
	19.17 - Managing opiate addicts
	19.18 - Driving and disease
	19.19 - Do not attempt cardiopulmonary resuscitation (DNACPR)
	19.20 - End of life care
	19.21 - Palliative care drugs
	19.22 - Roles and responsibilities after death
	19.23 - Death certification
	19.24 - Managing inpatients with pressure sores and ulcers
	19.25 - Rehabilitation, function and discharge
	19.26 - Drains and tubes
	19.27 - Surgical problems and referrals
20 - Procedures
	20.1 - Checks before any procedure
	20.2 - Venepuncture
	20.3 - Chest drain insertion
	20.4 - Central venous line insertion
	20.5 - Lumbar puncture
	20.6 - Abdominal paracentesis
	20.7 - Arterial blood gas
	20.8 - Nasogastric tube insertion
21 - Normal laboratory values
	21.1 - Clinical chemistry values
	21.2 - Haematology values
	21.3 - CSF values
22 - Emergency drugs (use with BNF)
	22.1 - Prescribing and side effects abbreviations
	22.2 - Antibiotic prescribing advice
	22.3 - Commonly used and emergency drugs
	22.4 - Important drug interactions and metabolism
	22.5 - Potentially fatal drug errors
	22.6 - Prescribing warfarin
	22.7 - Steroids
Index