Emergency Medicine

557 Pages · 2011 · 2.58 MB · English

  • Emergency Medicine

    EMERGENCY MEDICINE This page intentionally left blank EMERGENCY MEDICINE


    Sixth edition

    Anthony F. T. Brown



    Discipline of Anaesthesiology and Critical Care

    School of Medicine

    University of Queensland, Brisbane

    Senior Staff Specialist

    Department of Emergency Medicine

    Royal Brisbane and Women’s Hospital



    Emergency Medicine Australasia

    Senior Court of Examiners

    Australasian College for Emergency Medicine (ACEM)

    Inaugural ACEM Teaching Excellence Award 2001

    Mike D. Cadogan

    MA(Oxon), MB ChB (Ed), FACEM

    Staff Specialist in Emergency Medicine

    Department of Emergency Medicine

    Sir Charles Gairdner Hospital


    Medical Editor and Founder


    Winner, Gold Medal/Buchanan Prize

    ACEM Fellowship Exam 2003 First published in Great Britain by Hodder Arnold

    Fifth edition 2006

    This sixth edition published in 2011 by

    Hodder Arnold, an imprint of Hodder Education, a division of Hachette UK

    338 Euston Road, London NW1 3BH


    © 2011 Anthony Brown and Michael Cadogan

    All rights reserved. Apart from any use permitted under UK copyright law, this publication

    may only be reproduced, stored or transmitted, in any form, or by any means with prior

    permission in writing of the publishers or in the case of reprographic production in

    accordance with the terms of licences issued by the Copyright Licensing Agency. In the

    United Kingdom such licences are issued by the Copyright licensing Agency: Saffron House,

    6-10 Kirby Street, London EC1N 8TS

    Whilst the advice and information in this book are believed to be true and accurate at the

    date of going to press, neither the author[s] nor the publisher can accept any legal

    responsibility or liability for any errors or omissions that may be made. In particular (but

    without limiting the generality of the preceding disclaimer) every effort has been made to

    check drug dosages; however it is still possible that errors have been missed. Furthermore,

    dosage schedules are constantly being revised and new side-effects recognized. For these

    reasons the reader is strongly urged to consult the drug companies’ printed instructions

    before administering any of the drugs recommended in this book.

    British Library Cataloguing in Publication Data

    A catalogue record for this book is available from the British Library

    Library of Congress Cataloging-in-Publication Data

    A catalog record for this book is available from the Library of Congress

    ISBN-13 978 1 444 120 134

    1 2 3 4 5 6 7 8 9 10

    Commissioning Editor: Caroline Makepeace

    Project Editor: Sarah Penny

    Production Controller: Kate Harris

    Cover Design: Helen Townson

    Cover image © beerkoff-Fotolia

    Typeset in Minion Pro 9pt by Dorchester Typesetting, Dorchester, Dorset

    Printed and bound in India by Replika Press Ltd

    What do you think about this book? Or any other Hodder Arnold title?

    Please visit our website: www.hodderarnold.com DEDICATION

    To Regina, my beautiful and understanding wife, for her encouragement and

    patience. And to Edward and Lucy, who continue to impress and amaze, and

    bring such joy and happiness whilst reminding me what really matters.


    To my wonderful wife Fiona for her tolerance and support. To my enigmatic

    children William, Hamish and Olivia for their enduring patience and i nspiration.

    M.D.C. This page intentionally left blank CONTENTS

    Dedication v

    Preface xxi

    Acknowledgements xxiii


    Cardiopulmonary Resuscitation 2

    Initial approach 2

    Definitive care 6

    Acute Upper Airway Obstruction 13

    Shocked Patient 15

    General approach 15

    Hypovolaemic shock 19

    Septic shock 21

    Unconscious Patient 24

    Anaphylaxis 27

    Severe Head Injury 29

    Critical-Care Areas Drug Infusion Guideline 34

    Further Reading 41


    Chest Pain 44

    Acute coronary syndrome 44

    ST elevation myocardial infarction 44

    Non-ST elevation myocardial infarction and unstable angina 48

    Non-cardiac chest pain 51

    Pulmonary embolus 51

    Venous thromboembolism with deep vein thrombosis 55

    Aortic dissection 57

    Pericarditis 58

    Pleurisy 59

    Abdominal causes of chest pain 59

    Musculoskeletal and chest wall pain 60

    Contents vii Cardiac Arrhythmias 60

    Breathless Patient 64

    Acute asthma 65

    Community-acquired pneumonia 67

    Chronic obstructive pulmonary disease 71

    Pneumothorax 72

    Pulmonary embolus 75

    Pulmonary oedema 75

    Acute upper airway obstruction 76

    Upper Gastrointestinal Haemorrhage 76

    Diabetic Coma and Pre-coma 78

    Diabetic ketoacidosis 78

    Hyperglycaemic, hyperosmolar non-ketotic syndrome 80

    Altered Conscious Level 80

    Confused patient 81

    Alcohol-related medical problems 85

    Patient with an altered conscious level and smelling of alcohol 85

    Alcohol withdrawal 86

    Acute Neurological Conditions 87

    Syncope 87

    Seizure (Fit) 89

    Generalized convulsive status epilepticus 91

    Transient ischaemic attack 93

    Stroke 95

    Headache 97

    Meningitis 97

    Subarachnoid haemorrhage 99

    Space-occupying lesion 100

    Temporal arteritis 101

    Hypertensive encephalopathy 101

    Migraine 102

    Tension (muscle contraction) headache 104

    Post-traumatic headache 104

    Disease in other cranial structures 105

    Acute Arthropathy 105

    Acute monoarthropathy 105

    Septic arthritis 105

    Gouty arthritis 106

    Pseudogout 107

    Traumatic arthritis 107

    Acute polyarthropathy 108

    Rheumatoid arthritis 109

    viii Contents Osteoarthritis 109

    Allergic or Immunological Conditions 110

    Urticaria (hives) 110

    Angioedema 111

    Skin Disorders 112

    Blistering (vesicobullous) conditions 112

    Pruritus (itching conditions) 113

    Purpuric conditions 114

    Exanthematous diseases 116

    Malignant melanoma 117

    Elderly Patient 118

    Disordered behaviour in the elderly 119

    Falls in the elderly 120

    Further Reading 121



    Acid–Base Disturbances 124

    Arterial blood gas interpretation 124

    Metabolic acidosis 126

    Metabolic alkalosis 128

    Respiratory acidosis 129

    Respiratory alkalosis 130

    Electrolyte Disorders 131

    Potassium disorders 132

    Hyperkalaemia 132

    Hypokalaemia 134

    Sodium disorders 135

    Hypernatraemia 135

    Hyponatraemia 136

    Calcium disorders 138

    Hypercalcaemia 138

    Hypocalcaemia 139

    Magnesium disorders 139

    Hypermagnesaemia 139

    Hypomagnesaemia 140

    Acute Renal Failure 141

    Acute kidney injury 141

    Further Reading 144

    Contents ix

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