Acute Medicine: A Practical Guide to the Management of Medical Emergencies

List of Contributors x

Introduction xx

Section 1: Emergency Presentations 1

1 Cardiorespiratory arrest in hospital 3

2 The critically ill patient 9

3 The unconscious patient 21

4 Anaphylaxis 27

5 Sepsis 33

6 Cardiac tamponade 43

7 Acid– base disorders 46

8 Poisoning 52

9 Hypothermia 62

10 Drowning 66

Section 2: Cardiology 69

11 Syncope and presyncope 71

12 Acute coronary syndromes (ACS) 78

13 Cardiac arrhythmia 89

14 Heart failure 107

15 Infective endocarditis 118

16 Acute pericarditis 125

17 Cardiomyopathies and congenital heart disease in adults 129

18 Aortic dissection and other acute aortic syndromes 140

19 Pulmonary hypertension 147

20 Heart valve disease: native prosthetic and repaired valves 155

21 Hypertensive emergencies 160

Section 3: Respiratory Medicine 167

22 Acute asthma 169

23 Exacerbation of chronic obstructive pulmonary disease (COPD) 174

24 Haemoptysis 181

25 Respiratory infection: CAP HAP and TB 185

26 Bronchiectasis 197

27 Interstitial lung disease 204

28 Pleural disease 214

29 Sleep- disordered breathing 223

30 Respiratory failure: oxygenation and ventilatory support 229

31 Venous thromboembolism 236

Section 4: Gastroenterology and Hepatology 247

32 Abdominal pain 249

33 Nausea and vomiting 255

34 Diarrhoea 259

35 Jaundice 265

36 Abdominal swelling, mass and hepato- splenomegaly 268

37 Acute oesophageal disorders 274

38 Haematemesis and melaena 279

39 Lower gastrointestinal bleeding 287

40 Inflammatory bowel disease 292

41 Alcohol- related liver disease and acute medical complications 300

42 Acute liver failure and decompensated chronic liver disease 304

43 Biliary tract disorders and acute pancreatitis 313

Section 5: Endocrinology and Metabolic Disorders 317

44 Diabetic emergencies: DKA and HHS 319

45 Hyperglycaemic states 325

46 Hypoglycaemia 328

47 Adrenal disorders 331

48 Disorders of anterior and posterior pituitary 338

49 Thyroid emergencies 343

50 Parathyroid disorders 351

51 Pancreatic endocrine disorders (non- diabetic) 358

52 Electrolyte disorders 368

Section 6: Neurology 383

53 Headache syndromes: including subarachnoid haemorrhage and cerebral venous sinus thrombosis 385

54 Weakness and paralysis 391

55 Visual disturbance 396

56 Transient ischaemic attack and stroke 405

57 Seizures and epilepsy 419

58 Peripheral neuropathy (acute and chronic) 426

59 Guillain– Barré syndrome 429

60 Multiple sclerosis 434

61 Myasthenia gravis 442

62 Parkinson’s disease and other movement disorders 446

63 Motor neurone disease 452

64 Raised intracranial pressure 456

65 Acute spinal pain 460

66 Spinal cord compression 463

67 Functional neurological disorder in the acute setting 467

Section 7: Geriatric Medicine 479

68 Comprehensive geriatric assessment 481

69 Delirium, dementia and cognitive disorders 488

70 Perioperative medicine 494

Section 8: Infectious Diseases 501

71 Cellulitis and necrotising fasciitis 503

72 Urinary tract infection 507

73 Central nervous system infection 514

74 Pancytopenia and febrile neutropenia 524

75 Fever on return from abroad 530

76 Pyrexia of unknown origin 538

77 HIV infection 542

78 COVID- 19 and future pandemics 549

79 Septic arthritis 556

Section 9: Haematology 559

80 Anaemia: blood transfusion and alternatives 561

81 Bleeding disorders 568

82 Thrombocytopenia and thrombosis 571

83 Acute painful sickle cell crisis 574

84 Common haematological malignancies 577

85 Management of anticoagulation 590

Section 10: Renal Medicine 601

86 Acute kidney injury 603

87 Chronic kidney disease, including end- stage kidney disease 610

88 Renal tubular disorders 618

89 Nephrotic syndrome 625

90 Glomerular diseases 634

Section 11: Rheumatology 641

91 Acute arthritis 643

92 Crystal arthropathies 646

93 Rheumatoid arthritis 650

94 Acute vasculitis 656

95 Multisystem rheumatic disorders 663

Section 12: Oncology and Palliative Care 669

96 Complications of cancer 671

97 Palliative and end- of- life care 687

Section 13: Dermatology 695

98 Acute rash 697

99 Erythroderma and toxic epidermal necrolysis 703

100 Urticaria and angioedema 710

Section 14: Same Day Emergency Care 717

101 Same- day emergency care 719

102 Hospital at home 725

Section 15: Miscellaneous 731

103 Pregnancy- related medical conditions 733

104 Capacity and consent 742

Section 16: Practical Procedures 747

105 Airway management and upper airway obstruction 749

106 DC cardioversion 759

107 Temporary cardiac pacing 763

108 Central vein cannulation 769

109 Intraosseous access 775

110 Insertion of an intercostal chest drain 778

111 Aspiration of the knee joint 786

112 Abdominal paracentesis 789

113 Non- invasive ventilation 793

114 Arterial line insertion 798

115 Point- of- care ultrasound 802

Index 809