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Emergency Medicine

557 Pages · 2011 · 2.58 MB · English

  • Emergency Medicine

    EMERGENCY MEDICINE This page intentionally left blank EMERGENCY MEDICINE


    DIAGNOSIS AND MANAGEMENT


    Sixth edition


    Anthony F. T. Brown


    MB ChB, FRCP, FRCS(Ed), FACEM, FCEM


    Professor


    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


    Brisbane


    Editor-in-Chief


    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


    Perth


    Medical Editor and Founder


    Lifeinthefastlane.com


    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


    http://www.hodderarnold.com


    © 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.


    A.F.T.B.


    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


    Section I CRITICAL CARE EMERGENCIES


    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


    Section II GENERAL MEDICAL EMERGENCIES


    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


    Section III ACID–BASE, ELECTROLYTE AND RENAL


    EMERGENCIES


    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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