Since the first edition of Textbook of Adult Emergency Medicine was published twenty years ago, there has been enormous change in the way emergency care is delivered. This has occurred both in countries where emergency medicine was originally developed and in those where its application was limited because of cost. Emergency medicine is now perceived as the cornerstone of response to acute illness regardless of resources.
This fully revised Fifth Edition provides clear and consistent coverage of this constantly evolving specialty. Building on the success of previous editions it covers all the major topics relevant to the practice of emergency medicine. The book will prove invaluable to professionals working in this setting – including nurse specialists and paramedics – who require concise, highly practical guidance, incorporating the latest best practice and evidence-based guidelines.
This edition comes with an enhanced electronic version with video and self-assessment content, providing a richer learning experience and making rapid reference easier than ever before, anytime, anywhere.
A comprehensive textbook of adult emergency medicine for trainee doctors - covers all the problems likely to present to a trainee in the emergency department.
Chapters are highly readable and concise – boxes summarise chapter key points and highlight controversial areas of treatment.
The content is highly practical, clinically orientated and thoroughly updated in all the core subjects
There have been major updates in topics such as airway, shock and sepsis where guidelines have changed rapidly.
The imaging chapters have also evolved with changing practice and improved technology, to be concordant with evidence on the importance of image interpretation by emergency clinicians.
There are major sections on other skills and issues of key importance to today’s advanced emergency medicine practitioner, such as staffing, overcrowding, triage, patient safety and quality measures.
In addition, difficult topics such as death and dying, the challenging patient, ethics, giving evidence and domestic violence are covered. Governance, training, research and organisational subjects such as disaster planning and response, humanitarian emergencies and refugee medicine are included to give the reader a framework to understand the complexity of managing major emergency systems of care.
Author(s): Peter Cameron, Mark Little, Biswadev Mitra, Conor Deasy
Edition: 5th
Publisher: Elsevier
Year: 2019
Language: English
Commentary: TRUE PDF
Pages: 1068
Tags: Emergency Medicine
Front Cover......Page 1
IFC......Page 2
Textbook of ADULT EMERGENCY MEDICINE......Page 3
Textbook of ADULT EMERGENCY MEDICINE......Page 5
Copyright......Page 6
Contents......Page 7
Preface......Page 13
Contributors......Page 14
Acknowledgements......Page 22
Introduction......Page 23
Development of protocols......Page 25
Check for response and send for help......Page 26
Airway obstruction manoeuvres A number of manoeuvres have been proposed to clear the airway if it is completely obstructed by a .........Page 27
Basic life support summary......Page 28
International Liaison Committee on Resuscitation......Page 29
Manual external defibrillator......Page 30
Automated external defibrillators......Page 31
The 4Ts......Page 32
Amiodarone......Page 33
Arterial blood gases......Page 34
Prognosis for survival after cardiac arrest......Page 35
Non-invasive ventilation......Page 36
Apnoeic oxygenationThe continuous provision of oxygen through a patent airway in the form of high flow nasal oxygen is called ‘a.........Page 37
Ketamine......Page 38
Airway plan......Page 40
Front of neck access......Page 41
Airway trauma......Page 42
Audit and education......Page 43
Credentialing......Page 44
Pulmonary gas exchange......Page 46
Variable-performance oxygen delivery systems......Page 47
Face-masks (e.g. Hudson, Edinburgh, Medishield)......Page 48
Advantages......Page 49
Advantages......Page 50
Transfer of patients on oxygen therapy......Page 51
Controlled titration of oxygen dose in chronic obstructive pulmonary disease......Page 52
Hyperbaric oxygen treatment......Page 53
Oxygen toxicity......Page 54
Practical use of monitoring......Page 55
Blood pressure monitoring......Page 56
Invasive blood pressure measurement......Page 57
The pulse-induced contour cardiac output system of arterial waveform monitoring......Page 58
Future developments......Page 59
Pump dysfunction—cardiogenic (see Box 2.4.4)......Page 60
Clinical features......Page 61
Emergency department investigations......Page 62
Complications of fluid therapy......Page 63
Titration targets......Page 64
Management of specific shock syndromes......Page 65
Aetiology......Page 66
Emergency department therapy......Page 67
Definitions......Page 68
Apply vasopressors if patient is hypotensive during or after fluid resuscitation to maintain mean arterial pressure at or above .........Page 70
Corticosteroids......Page 71
Post-sepsis syndrome......Page 73
Collection and handling......Page 75
Pathophysiology of hypoxaemic respiratory failure......Page 76
Hypoventilation......Page 77
Acid–base disorders......Page 78
Venous blood gases......Page 81
Oxygenation after resuscitation......Page 82
Targeted temperature management......Page 84
Summary......Page 85
Aetiology......Page 86
Latex-induced anaphylaxis......Page 87
Fatal anaphylaxis......Page 88
Cutaneous and generalized allergic reactions......Page 89
Histamine......Page 90
H1 and H2 antihistamines......Page 91
Allergist/immunologist referral......Page 92
IgE skin testing, in vitro testing and challenge testing......Page 93
The trauma system—background......Page 95
Preparation......Page 96
Airway......Page 97
Exposure......Page 98
Trauma in developing countries......Page 99
Intracranial haematoma......Page 101
Primary survey......Page 102
Moderate/severe traumatic brain injury......Page 103
Disposition......Page 104
Associated injuries......Page 105
In-line protection of the spine......Page 106
Circulation......Page 107
Head and neck......Page 108
Sensory function......Page 109
HyperextensionAnterior widening of disc spaces, prevertebral swelling, avulsion of a vertebral body by the anterior longitudinal.........Page 110
Spinal shock......Page 111
Acute central cervical cord syndrome......Page 112
Documentation conventions......Page 113
Airway......Page 117
Imaging......Page 118
Orbital fractures......Page 119
Conclusion......Page 120
Abdominal examination......Page 122
Abdominal computed tomography......Page 123
Future directions......Page 124
Support of pulmonary function......Page 126
Fractured sternum......Page 127
Pneumothorax......Page 128
Thoracic aortic transection......Page 129
Conclusion......Page 130
Fractures......Page 131
History and examination......Page 133
Management......Page 134
Disposition......Page 135
Crush syndrome......Page 136
Immobilization......Page 137
The trauma series......Page 139
Head......Page 141
Classification of intracranial haemorrhage......Page 142
Cervical spine......Page 143
Thoraco-lumbar spine......Page 144
Chest trauma......Page 145
Thoracic computed tomography scan......Page 147
Visceral angiography and embolization......Page 148
Computed tomography scan of the pelvis......Page 149
Extremity injury......Page 151
Conclusion......Page 153
Respiratory......Page 154
X-rays......Page 159
Prevention......Page 160
Wound cleansing......Page 161
Wound-healing mechanisms......Page 163
Needles......Page 164
Basic suture technique......Page 165
Special sites and situations......Page 166
The ‘dog-ear’......Page 167
Dressings......Page 168
Disposal/removal......Page 170
Likely developments over the next 5 to 10 years......Page 172
Examination......Page 174
Pre-hospital......Page 175
Fluid Resuscitation7......Page 176
Disposition......Page 177
What is a massive transfusion......Page 178
Predicting massive transfusion......Page 180
Circulatory management......Page 181
Calcium......Page 182
Acute traumatic coagulopathy......Page 183
Future directions......Page 184
Fractures of the clavicle......Page 185
Fractures of the scapula......Page 186
Anterior dislocation......Page 187
Inferior dislocation (luxatio erecta)......Page 188
Treatment......Page 189
Disposition......Page 190
Treatment......Page 191
Clinical assessment......Page 192
Treatment and disposition......Page 193
Complications......Page 194
Monteggia fracture dislocation......Page 195
Colles fracture......Page 196
Scaphoid fracture......Page 197
TreatmentAll wrist dislocations require orthopaedic consultation and prompt reduction......Page 198
Examination......Page 199
Fingertip injuries......Page 200
Middle phalangeal injuries......Page 201
Prognosis......Page 202
Young and Resnik classification......Page 203
Haemorrhage......Page 204
Laparotomy with pelvic packing......Page 205
Management of isolated stable fractures......Page 206
Garden I:Incomplete, impacted or stress fractures that are stable. Trabeculae of the inferior neck are still intact and, althoug.........Page 207
ComplicationsSurvival is directly related to the patient’s age and pre-existing medical conditions......Page 208
Closed reduction......Page 209
Complications......Page 210
Reduction and splinting......Page 211
Complications......Page 212
Tibial plateau fracture......Page 213
Mechanism......Page 214
Management......Page 215
RadiologyX-rays may reveal avulsion of the posterior tibial spine but, as with ACL injuries, MRI demonstrates over 90% sensitivi.........Page 216
Management......Page 217
Clinical assessment......Page 218
Osgood-Schlatter disease (traction apophysitis of the tibial tubercle)......Page 219
Maisonneuve fracture......Page 220
Ottawa ankle rules......Page 221
Open dislocations......Page 222
Management......Page 223
Mechanism and classification......Page 224
Management......Page 225
Radiology......Page 226
Management......Page 227
Laboratory tests......Page 228
Prognosis......Page 229
Prevention......Page 230
Differential diagnosis and approach......Page 231
Clinical features......Page 232
Clinical investigations......Page 234
Prognosis......Page 236
Introduction......Page 237
Clinical features......Page 239
Clinical investigations......Page 240
Reperfusion therapy......Page 241
Complications of therapy......Page 242
Primary and secondary prevention......Page 243
History......Page 245
Treatment......Page 246
Furosemide......Page 247
Hypotensive patients......Page 248
Triggered activity......Page 249
Sick sinus syndrome (bradycardia-tachycardia syndrome)......Page 251
Second-degree Mobitz type ll atrioventricular block......Page 252
Ventricular tachycardias 10......Page 253
Treatment 1......Page 254
Right ventricular outflow tract ventricular tachycardia Right ventricular outflow tract VT has a typical LBBB inferior axis morp.........Page 255
Sinus tachycardia......Page 256
Paroxysmal supraventricular tachycardia......Page 257
Treatment3 Emergency management depends on the chronicity of the condition, haemodynamic stability, the ventricular response rat.........Page 258
Right bundle branch block......Page 259
Atrial ectopics......Page 260
Brugada syndrome9......Page 261
Aetiology, pathogenesis and pathology......Page 264
Electrocardiography......Page 266
Computed tomographic pulmonary angiography and venography......Page 267
Risk stratification......Page 268
Thrombolysis......Page 269
Disposition......Page 270
Blood tests......Page 271
Criteria for diagnosis......Page 272
Clinical management and treatment......Page 273
History......Page 274
Drainage procedures......Page 275
First-line clinical Investigations......Page 276
Prognosis......Page 277
Pathology and pathogenesis......Page 278
Clinical features......Page 279
Diagnosis......Page 280
Echocardiography......Page 281
Treatment......Page 282
Practice points......Page 283
Clinical features......Page 284
Mechanical valves......Page 285
5.8 Peripheral vascular disease......Page 286
Clinical features......Page 288
Venous disease: lower limb......Page 289
Treatment......Page 290
Likely developments over the next 5 to 10 years......Page 291
Epidemiology......Page 292
Bedside tests......Page 293
Renal emergencies......Page 294
Developments in the next 5 to 10 years......Page 295
Epidemiology, pathophysiology and classification......Page 296
Electrocardiography......Page 297
Magnetic resonance imaging......Page 298
Treatment of type B aortic dissection......Page 299
Disposition......Page 300
History......Page 301
Introduction......Page 302
Future developments......Page 303
Upper airway obstruction......Page 304
Treatment......Page 305
Imaging......Page 306
Epidemiology and pathology......Page 307
Treatment......Page 308
6.2 Asthma......Page 309
Severe or life-threatening asthma......Page 310
Oxygen......Page 311
Disposition......Page 313
Epidemiology......Page 314
Streptococcus pneumoniae......Page 315
Other important organisms......Page 316
Full blood count......Page 317
Urinary antigen testing......Page 318
CORB......Page 319
General supportive care......Page 320
Antibiotic treatment......Page 321
Pneumonia in tropical areas......Page 322
Likely developments over the next 5 to 10 years......Page 323
Avian and other zoonotic influenzas......Page 324
Microbiology......Page 325
Influenza preparedness......Page 326
6.5 Chronic obstructive pulmonary disease......Page 327
Examination......Page 328
Other tests......Page 329
Invasive ventilation......Page 330
Prognosis......Page 331
Aetiology, genetics, pathogenesis and pathology......Page 332
Size estimation......Page 333
Catheter drainage......Page 334
Other issues......Page 335
Physical examination......Page 336
Thoracocentesis......Page 337
Treatment and prognosis......Page 339
Clinical features......Page 340
Other......Page 341
Other approaches......Page 342
Clinical features......Page 343
Disposition......Page 344
Patient history......Page 345
Associated symptoms......Page 346
Limitations of the abdominal examination......Page 347
Laboratory tests......Page 348
The elderly......Page 349
Antibiotics......Page 350
Introduction and pathophysiology......Page 351
General measures......Page 353
Surgical therapy......Page 354
Complications......Page 355
Surgical repair......Page 356
Epidemiology......Page 358
Differential diagnosis......Page 359
Clinical investigations......Page 360
Treatment......Page 361
Prevention......Page 362
Endoscopy......Page 363
Proton pump inhibitors The PPIs are the most common class of drugs used for peptic ulcer disease based on their profound and per.........Page 364
Transjugular intrahepatic portosystemic stent-shunt......Page 365
Likely developments over the next 5 to 10 years......Page 366
Epidemiology......Page 367
Treatment......Page 368
Haemorrhage......Page 369
Likely developments over the next 5 to 10 years......Page 370
History......Page 371
Disposition......Page 372
Pathology......Page 373
Treatment......Page 374
Severe pancreatitis scoring systems......Page 375
Chronic pancreatitis......Page 376
Aetiology, pathogenesis and pathology......Page 377
Imaging......Page 378
Likely developments over the next 5 to 10 years......Page 379
Examination......Page 380
Medical therapy......Page 381
Prognosis......Page 382
Clinical features......Page 383
Criteria for diagnosis......Page 384
Lamivudine and nucleoside analogues......Page 385
Prognosis......Page 386
Introduction......Page 387
Aortoenteric fistula......Page 388
Risk Assessment......Page 389
Colonoscopy......Page 390
Surgery......Page 391
Treatment......Page 392
Prolapsed irreducible haemorrhoids......Page 393
Injuries and foreign bodies in the perianal region......Page 394
Other anorectal conditions......Page 395
Aetiology, pathophysiology and pathology......Page 397
Classification and clinical features......Page 398
Treatment......Page 399
Temporal (giant cell) arteritis......Page 400
Ischaemic strokes......Page 401
Risk factors for transient ischaemic attack/stroke and prevention......Page 402
Posterior circulation ischaemia......Page 403
General investigations......Page 404
Imaging in stroke......Page 405
Transient ischaemic attacks......Page 406
Clot retrievalA number of similar studies (MR Clean, ESCAPE, SWIFT PRIME, EXTEND 1A and REVASCAT) have shown that in patients wi.........Page 407
Medical Treatment......Page 408
Epidemiology and pathology......Page 409
Differential diagnosis......Page 411
Lumbar puncture......Page 412
Prevention of delayed cerebral ischaemia......Page 413
Introduction......Page 414
Clinical assessment......Page 416
Examination......Page 417
Microbiology......Page 418
Prognosis......Page 419
Management principles......Page 421
Electroencephalography......Page 422
Non-convulsive seizures......Page 423
Drug-related seizures......Page 424
Future directions......Page 425
Differential diagnosis......Page 426
Clinical features......Page 427
Treatment......Page 428
Differential diagnosis......Page 430
Treatment and prognosis......Page 431
Multiple sclerosis......Page 433
Amyotrophic lateral sclerosis (motor neuron disease)......Page 434
Tetanus......Page 435
Envenomations......Page 436
Introduction......Page 437
Step 3: look for the ‘at-risk’ patient......Page 438
Clinical pointers: exposure history......Page 439
Step 4: a final caveat......Page 440
Future research directions......Page 441
Epidemiology......Page 442
History......Page 443
Computed tomography scan......Page 444
Prognosis......Page 445
Prevention......Page 446
Epidemiology......Page 447
Suggested initial empiric regimen12......Page 448
Epidemiology......Page 449
Ageing......Page 451
Nitrites......Page 452
Frequency dysuria syndrome: presumed simple cystitis......Page 453
Pregnancy......Page 454
Complicated urinary tract infection......Page 455
Prognosis......Page 456
Epidemiology and aetiology......Page 457
Antibiotic therapy......Page 458
Cellulitis......Page 459
Necrotizing fasciitis......Page 460
Animal bites......Page 461
Diabetic foot infections......Page 462
Introduction......Page 463
Prevention and immunization......Page 465
Management......Page 466
Natural history......Page 467
Future directions......Page 468
Pathogenesis......Page 469
Previously undiagnosed HIV infection......Page 470
Previously diagnosed HIV infection7......Page 471
Difficult or painful swallowing......Page 472
Other presentations......Page 473
Antiretrovirals in the management ofHIV infection......Page 474
References......Page 475
Introduction......Page 476
Practices......Page 477
Chlamydia......Page 478
Gonorrhoea......Page 479
Lymphogranuloma venereum......Page 480
Follow-up......Page 481
Microorganism susceptibility......Page 482
Host factors......Page 485
Route of administration......Page 486
Bacterial resistance to penicillins......Page 487
Classification and uses......Page 488
Bacterial resistance......Page 489
Co-trimoxazole......Page 490
Colistin Link Parenteral......Page 491
Treatment......Page 492
Recent updates from the medical literature......Page 493
Prevention of needlestick injuries......Page 494
Counselling of exposed worker......Page 496
Hepatitis C......Page 497
Human immunodeficiency virus......Page 498
Pre-exposure prophylaxis......Page 499
References......Page 495
References......Page 500
Clinical features......Page 501
Schistosomiasis (bilharzia)......Page 502
African trypanosomiasis (sleeping sickness)......Page 503
Helminths (worms)......Page 504
Viral haemorrhagic fevers......Page 505
Introduction......Page 506
Cholera......Page 507
Investigations......Page 508
Management......Page 509
Pre-renal acute kidney injury......Page 510
Renal acute kidney injury......Page 511
Clinical features......Page 512
Evaluation of prerenal (intravascular volume) status......Page 513
Serum biochemistry......Page 514
Full blood examination......Page 515
Potassium......Page 516
Fluid overload......Page 517
Prognosis......Page 518
Traps in the clinical diagnosis......Page 519
Urine testing......Page 520
Penetrating......Page 521
Investigations......Page 523
Management......Page 524
Conclusion......Page 525
Diabetes secondary to other conditions......Page 526
Management of hypoglycaemic coma......Page 527
Epidemiology and aetiology......Page 528
Diabetic ketoacidosis......Page 529
Potassium replacement......Page 530
Miscellaneous issues......Page 531
Clinical features......Page 532
General supportive measures......Page 533
Administration of thyroid hormones......Page 534
Laboratory findings......Page 535
Treatment......Page 536
Metabolic acidosis......Page 538
Alkalaemia......Page 539
Respiratory alkalosis (Box 12.1.6)......Page 540
Lactate gap......Page 541
Euvolaemic hyponatraemia......Page 542
Treatment......Page 543
Pathophysiology......Page 544
Pathophysiology......Page 545
Treatment......Page 546
Chronic asymptomatic hypocalcaemia......Page 547
Inhibition of bone resorption......Page 548
Treatment......Page 549
Aetiology......Page 551
Treatment......Page 552
Other causes of decreased red cell production......Page 553
Sickle cell anaemia......Page 554
Haemolytic uraemic syndrome and thrombotic thrombocytopaenic purpura......Page 555
Other causes of haemolysis......Page 556
Pathophysiology and aetiology......Page 557
Prognosis......Page 558
Drug-related thrombocytopaenia......Page 559
Massive blood transfusion and thrombocytopenia......Page 560
Disposition......Page 561
Treatment......Page 562
Treatment of bleeding......Page 563
Contacts......Page 564
WA......Page 565
Packed red blood cells......Page 566
Effect of storage on red blood cells......Page 567
Immediate......Page 568
Red-cell alloimmunization When antibodies are formed against foreign antigens from an individual’s own species, the process is t.........Page 569
Platelets......Page 570
Refusal of blood and blood product transfusion......Page 571
Cervical spine involvement......Page 572
Renal disease......Page 573
Giant cell (temporal) arteritis......Page 574
Investigations and diagnosis......Page 575
Biological disease-modifying antirheumatic drugs......Page 576
Allopurinol hypersensitivity syndrome......Page 577
Blood tests......Page 578
Colchicine......Page 579
Investigations......Page 580
Haemophilia or other bleeding diathesis......Page 581
Diagnosis......Page 582
Prognosis......Page 583
Investigations......Page 584
Prognosis......Page 585
Hepatitis A, B and C viruses......Page 586
Diagnosis and clinical features......Page 587
History......Page 588
Management......Page 590
General management of non-arthritic joint and soft-tissue disorders......Page 591
Diagnosis and management......Page 592
Management......Page 593
Investigations......Page 594
Management......Page 595
Painful arc of the shoulder......Page 596
Clinical features......Page 598
Erythema multiforme......Page 599
Complications of erythroderma......Page 600
Bullous pemphigoid......Page 601
Investigations for vasculitis......Page 602
Investigations for pruritus......Page 603
Eczema herpeticum......Page 604
Skin cancer......Page 605
Management......Page 606
Visual acuity testing......Page 607
Penetrating injury......Page 608
Acute infectious keratitis......Page 609
Acute iritis......Page 610
Clinical assessment......Page 611
Central retinal artery occlusion......Page 612
Giant cell arteritis......Page 613
Optic neuritis......Page 614
Periodontal emergencies......Page 615
Management......Page 616
Dental nomenclature......Page 617
Perichondritis......Page 619
Acute facial (seventh) nerve palsy......Page 620
Epistaxis......Page 621
Fractured nose......Page 622
Oesophageal foreign body......Page 623
History......Page 625
Laboratory investigations......Page 626
Intra-ovarian haemorrhage......Page 627
Primary dysmenorrhoea......Page 628
Risk factors......Page 629
Sexually acquired pelvic inflammatory disease......Page 630
Physiological uterine bleeding......Page 631
Laboratory investigations......Page 632
Other drug treatments......Page 633
Disposition......Page 634
Haemodynamically unstable patient......Page 635
Disposition......Page 636
Examination......Page 637
Investigations......Page 638
Clinical features......Page 639
Prevent further seizure......Page 640
Summary......Page 641
History......Page 642
Transferring the patient......Page 643
Second stage......Page 644
Apgar score......Page 645
Management of breech delivery......Page 646
Treatment of shoulder dystocia......Page 647
Management of postpartum haemorrhage......Page 648
Other surgical causes......Page 649
Positive-pressure ventilation......Page 650
Meconium-stained liquor......Page 651
Neonatal transfer......Page 652
Epidemiology......Page 653
Aims of the mental health assessment......Page 654
Presenting complaint......Page 655
Appearance, attitude and behaviour......Page 656
Conclusion......Page 657
General approach......Page 659
History......Page 660
Diagnostic formulation......Page 661
Conclusion......Page 662
Repeated episodes of deliberate self-harm......Page 663
Social and cultural factors......Page 664
Assessment......Page 665
Use of scales......Page 666
Definitive treatment and disposition......Page 667
Conclusion......Page 668
Introduction......Page 669
Symptoms......Page 671
Signs......Page 672
Differential diagnosis......Page 673
Mood disorder due to psychoactive substance use......Page 674
Assessment......Page 675
Medications......Page 676
Severe depressive episodes......Page 677
Epidemiology and prognosis......Page 679
Acute and chronic schizophrenia......Page 680
Substance-induced psychosis......Page 681
Risk assessment......Page 682
Management in the emergency department......Page 683
Acknowledgements......Page 684
Risks of rapid tranquillization......Page 686
Dexmedetomidine and clonidine......Page 687
Maintenance therapy......Page 688
Acknowledgements......Page 689
Introduction......Page 691
Breaking bad news......Page 692
Professional issues......Page 693
Barriers to care......Page 694
Forensic history, examination and evidence collection (MCQ 3)......Page 695
The risk of genital infection after sexual assault (MCQ 4)......Page 696
Conclusion......Page 697
Elderly......Page 699
Economic cost......Page 700
Documentation......Page 701
Conclusion......Page 702
Coagulopathy and encephalopathy Coagulopathy results from the failure of hepatic synthesis of coagulation factors, thus parenter.........Page 703
Alcohol withdrawal seizures Around 3% to 5% of those with severe alcohol use disorder experience withdrawal seizures within 48 h.........Page 704
Diabetic ketoacidosis......Page 705
Important illnesses to be excluded that mimic alcohol intoxication......Page 706
‘Hangover’......Page 707
Pharmacotherapy for alcohol use disorder......Page 708
Definition and epidemiology......Page 709
Clinical features......Page 711
Prevention......Page 712
Management......Page 713
Violence......Page 714
Definition and epidemiology......Page 715
Management......Page 716
Administrative issues......Page 717
Expected legal knowledge of medical practitioners......Page 719
Resuscitation and not-for-resuscitation orders......Page 720
Anticipating the end of life and diagnosing the dying......Page 721
The dying......Page 722
Identification of potential organ donors......Page 724
Best practice in raising organ donation......Page 725
Eye and tissue donation......Page 726
Nociceptor function......Page 728
Use of intravenous opioids......Page 729
Tapentadol Tapentadol is a centrally acting opioid analgesic with a dual mode of action as an agonist of the μ-opioid receptor a.........Page 730
Pain relief in pregnancy......Page 731
Likely developments over the next 5 to 10 years......Page 732
Management of systemic toxicity......Page 734
Ulnar nerve wrist block (lateral approach)......Page 735
Saphenous nerve The saphenous nerve is blocked by injecting 3 to 5 mL of 1% lignocaine subcutaneously above the medial malleolus.........Page 736
Technique......Page 737
Guidelines......Page 740
Past medical history......Page 741
Sedative hypnotics......Page 742
Ketamine......Page 743
Sedation scoring......Page 744
Postprocedure considerations......Page 745
Basic physics of ultrasound2......Page 749
Extended focused assessment with sonography for trauma3–6......Page 750
Clinical implications and utility......Page 751
Technique......Page 752
Right upper quadrant/gallbladder14......Page 753
Technique......Page 754
Emergency echocardiography......Page 755
Clinical indications and utility......Page 756
Technique......Page 757
Scrotal ultrasound......Page 758
Training and credentialling1......Page 759
Development science......Page 760
Artefacts......Page 762
Unstable patients......Page 763
Overuse......Page 764
Advances in CT scanning......Page 765
Components......Page 766
Angiography and gadolinium......Page 767
Monitoring patients in the magnetic resonance imaging......Page 768
Soft tissue musculoskeletal injury......Page 769
Noise......Page 770
Conclusion......Page 771
Epidemiology and pathophysiology......Page 772
Prognosis and disposition......Page 773
Epidemiology and pathophysiology......Page 774
Rewarming therapies......Page 775
Prognosis and disposition......Page 777
Diving physics and physiology......Page 778
Clinical features......Page 779
Pathophysiology3......Page 780
Clinical features......Page 781
Recompression......Page 782
Prognosis after treatment......Page 783
UK......Page 784
Terrorism......Page 785
Clinical features......Page 786
Treatment......Page 787
Scene management......Page 788
Decontamination process......Page 789
Likely developments over the next 10 years......Page 790
Definitions and terminology......Page 791
Airways/lungs......Page 792
History......Page 793
Prognosis......Page 794
Disposition......Page 795
Resistance......Page 796
Pre-hospital......Page 797
Introduction and epidemiology......Page 798
Prognosis and disposition......Page 799
Prevention......Page 800
High-altitude pulmonary oedema......Page 801
25.1 Approach to the poisoned patient......Page 803
Pathophysiology and clinical features......Page 804
Resuscitation, supportive care and monitoring......Page 805
Enhanced elimination......Page 807
Disposition......Page 808
Pathophysiology......Page 809
Treatment......Page 811
Clinical investigations......Page 812
Clinical features......Page 813
Disposition......Page 814
Pharmacology......Page 816
Chlorpromazine......Page 817
Neuroleptic malignant syndrome......Page 818
Treatment......Page 819
Clinical investigations......Page 820
Treatment......Page 821
Clinical features......Page 822
Treatment......Page 823
Disposition......Page 824
Chronic lithium toxicity......Page 825
Chronic lithium toxicity......Page 826
Disposition and prognosis......Page 827
Pharmacokinetics and pathophysiology......Page 828
Assessment of risk of hepatotoxicity......Page 829
The staggered acute overdose......Page 830
Massive ingestions of paracetamol......Page 831
Pharmacology and pathophysiology......Page 832
Treatment......Page 833
Disposition......Page 834
Treatment......Page 835
Pharmacology and pathophysiology......Page 836
Disposition......Page 837
Clinical features......Page 838
Prognosis......Page 839
Clinical features......Page 840
Caffeine......Page 841
Systemic effects......Page 842
Differential diagnosis......Page 844
Prognosis......Page 845
Introduction......Page 846
Pharmacology and pathophysiology......Page 847
Clinical features......Page 848
Clinical investigations......Page 849
Treatment......Page 850
Clinical investigations......Page 851
Antidote treatment principles......Page 852
Dicobalt edetate (Kelocyanor)......Page 853
Pathophysiology......Page 854
Treatment......Page 855
Disposition......Page 856
Primary exposures......Page 857
Criteria for diagnosis......Page 858
Mild poisoning and dermal exposures......Page 860
Oximes......Page 861
Immunosuppression......Page 862
How to perform the urinary diothonite test......Page 863
Prognosis......Page 864
Treatment......Page 865
Ethanol withdrawal syndrome......Page 866
Ethanol withdrawal......Page 867
Wernicke encephalopathy......Page 868
Disposition......Page 869
Toxicology......Page 870
Haemodialysis......Page 871
Aetiology, pathophysiology and pathology......Page 872
Electrocardiogram......Page 874
Other treatments......Page 875
Treatment......Page 876
Clinical features......Page 878
Clinical features......Page 879
Treatment......Page 880
Venom immunotherapy......Page 881
Compounds......Page 882
Monitoring......Page 883
Monitoring......Page 884
Tachycardia/hypertension......Page 885
General notes......Page 886
Muscarinic toxicity......Page 887
Generic management......Page 888
Other therapies......Page 890
Management......Page 891
Fentanyl......Page 892
Introduction......Page 893
Warfarin......Page 894
Disposition......Page 895
Epidemiology......Page 897
Neurotoxicity......Page 898
Further management......Page 899
Administration of antivenom......Page 900
Disposition......Page 901
Antivenom use......Page 903
Non-antivenom treatments......Page 905
An approach to the patient with spider bite......Page 906
Clinical features......Page 907
Supportive treatment......Page 908
Necrotic arachnidism......Page 909
First aid......Page 910
Scorpaenidae: stonefish, bullrout, lionfish, scorpionfish......Page 911
Ciguatera poisoning......Page 912
Tetrodotoxin poisoning......Page 913
Assembling the research team......Page 914
Case-control studies......Page 915
Validity and repeatability of the study methods......Page 916
Designing a survey......Page 917
Confounding......Page 918
Database design......Page 919
Informed consent......Page 920
Readability......Page 921
Discussion......Page 922
Social media......Page 923
Adult learning principles......Page 924
Learner-centred education......Page 925
‘Trolley-side’ teaching......Page 926
Simulation......Page 927
Likely developments over the next 5 to 10 years......Page 928
Curriculum and discipline development......Page 930
Methods of teaching emergency medicine......Page 931
Tutorials and small-group learning......Page 932
Future directions......Page 933
Learning and teaching methods in emergency medicine......Page 934
Training for providers of simulation-based learning......Page 935
Continuing professional development......Page 936
Introduction......Page 938
Advance directives The Act makes provision for advance directives to be made at a time when the patient has capacity. These dire.........Page 939
New Zealand......Page 940
Involuntary admission......Page 941
Tasmania......Page 942
Emergency treatment and surgery......Page 943
Deaths......Page 944
Reportable deaths......Page 946
A coronial inquest......Page 947
Coronial findings......Page 948
Reportable deaths......Page 949
Post-mortems......Page 950
Inquest......Page 951
Consent......Page 952
Competence......Page 954
Mentally ill......Page 955
The emergency patient......Page 956
Physical privacy......Page 958
Australian Privacy Principle 3......Page 959
New Zealand......Page 960
28.5 Ethics in emergency medicine......Page 961
An ethics tool kit for the emergency department......Page 962
Tool 1: The four principles (Box 28.5.2)......Page 963
Tool 4: reassurance about competence (Box 28.5.5)......Page 964
Tool 6: Stopping resuscitation (see Box 28.5.8)......Page 965
Summary......Page 966
Dispatch......Page 968
Intravenous fluid......Page 969
Acute coronary syndromes......Page 970
Acute agitation......Page 971
Retrieval systems......Page 973
Crew......Page 974
Equipment......Page 975
Environmental impacts......Page 976
Highly specialized retrieval......Page 977
Introduction......Page 978
Definitions and classification......Page 979
Epidemiology......Page 980
Comprehensive approach......Page 981
Domestic emergency response activities......Page 982
Prehospital mass casualty management......Page 983
Health facility management......Page 984
Likely developments......Page 985
Origins of triage......Page 986
Other triage scales......Page 988
Military and disaster triage......Page 989
29.5 Emergency care in a humanitarian crisis......Page 990
Emergency Medical Teams......Page 991
Shelter and site planning......Page 992
Past problems......Page 993
Introduction......Page 994
Other uses of an observation ward......Page 995
Conclusions......Page 996
Causes of overcrowding......Page 997
Future research......Page 998
Introduction and definitions......Page 999
Hospital admission......Page 1000
Emergency-department-based rapid response systems......Page 1001
Future developments......Page 1002
Disease and injury surveillance......Page 1004
Health of Indigenous people and cultural safety......Page 1005
Cultural safety and competency......Page 1006
Estimating medical workload......Page 1007
Allied health, clerical and other support staff......Page 1008
Optimizing work practices......Page 1009
Size and composition of the emergency department......Page 1010
Acute mental health area......Page 1011
Reception/triage area......Page 1012
Likely developments over the next 5 to 10 years......Page 1013
Definitions......Page 1014
Quality standards......Page 1015
Introduction......Page 1016
Budget......Page 1017
Business plan implementation and monitoring......Page 1018
Provisional training......Page 1019
Accreditation......Page 1020
Accreditation outcomes......Page 1021
Future directions......Page 1022
Medical training initiative......Page 1023
Training in emergency medicine in the United Kingdom......Page 1024
Incidence......Page 1025
Administration......Page 1026
Determining the issues......Page 1027
Catastrophic adverse events......Page 1028
Summary......Page 1029
Common safety problems encountered in emergency departments......Page 1030
Conclusion......Page 1031
Compassion fatigue and compassion satisfaction......Page 1032
Mentorship and peer support......Page 1033
A......Page 1035
B......Page 1038
C......Page 1039
D......Page 1042
E......Page 1044
F......Page 1045
G......Page 1046
H......Page 1047
I......Page 1049
L......Page 1050
M......Page 1051
N......Page 1052
O......Page 1053
P......Page 1054
R......Page 1057
S......Page 1058
T......Page 1061
U......Page 1062
W......Page 1063
Z......Page 1064
