Emergency Medicine

Contents xix

• Cardiopulmonary Resuscitation Section I CRITICAL CARE EMERGENCIES


• Initial approach


• Definitive care


• Acute Upper Airway Obstruction


• Shocked Patient


• General approach


• Hypovolaemic shock


• Septic shock


• Unconscious Patient


• Anaphylaxis


• Severe Head Injury


• Critical-Care Areas Drug Infusion Guideline


• Further Reading


• Chest Pain Section II GENERAL MEDICAL EMERGENCIES


• Acute coronary syndrome


• ST elevation myocardial infarction


• Non-ST elevation myocardial infarction and unstable angina


• Non-cardiac chest pain


• Pulmonary embolus


• Venous thromboembolism with deep vein thrombosis


• Aortic dissection


• Pericarditis


• Pleurisy


• Abdominal causes of chest pain


• Musculoskeletal and chest wall pain


• Cardiac Arrhythmias viii Contents


• Breathless Patient


• Acute asthma


• Community-acquired pneumonia


• Chronic obstructive pulmonary disease


• Pneumothorax


• Pulmonary embolus


• Pulmonary oedema


• Acute upper airway obstruction


• Upper Gastrointestinal Haemorrhage


• Diabetic Coma and Pre-coma


• Diabetic ketoacidosis


• Hyperglycaemic, hyperosmolar non-ketotic syndrome


• Altered Conscious Level


• Confused patient


• Alcohol-related medical problems


• Patient with an altered conscious level and smelling of alcohol


• Alcohol withdrawal


• Acute Neurological Conditions


• Syncope


• Seizure (Fit)


• Generalized convulsive status epilepticus


• Transient ischaemic attack


• Stroke


• Headache


• Meningitis


• Subarachnoid haemorrhage


• Space-occupying lesion


• Temporal arteritis


• Hypertensive encephalopathy


• Migraine


• Tension (muscle contraction) headache


• Post-traumatic headache


• Disease in other cranial structures


• Acute Arthropathy


• Acute monoarthropathy


• Septic arthritis


• Gouty arthritis


• Pseudogout


• Traumatic arthritis


• Acute polyarthropathy


• Rheumatoid arthritis


• Osteoarthritis Contents ix


• Allergic or Immunological Conditions


• Urticaria (hives)


• Angioedema


• Skin Disorders


• Blistering (vesicobullous) conditions


• Pruritus (itching conditions)


• Purpuric conditions


• Exanthematous diseases


• Malignant melanoma


• Elderly Patient


• Disordered behaviour in the elderly


• Falls in the elderly


• Further Reading


• Acid–Base Disturbances EMERGENCIES


• Arterial blood gas interpretation


• Metabolic acidosis


• Metabolic alkalosis


• Respiratory acidosis


• Respiratory alkalosis


• Electrolyte Disorders


• Potassium disorders


• Hyperkalaemia


• Hypokalaemia


• Sodium disorders


• Hypernatraemia


• Hyponatraemia


• Calcium disorders


• Hypercalcaemia


• Hypocalcaemia


• Magnesium disorders


• Hypermagnesaemia


• Hypomagnesaemia


• Acute Renal Failure


• Acute kidney injury


• Further Reading


• Febrile Neutropenic Patient EMERGENCIES


• Hepatitis


• Gastrointestinal Tract Infection


• Sexually Transmitted Diseases


• Needlestick and Sharps Incidents


• Inoculation Incident with HIV Risk


• Inoculation Incident with Hepatitis Risk


• Human Immunodeficiency Virus Infection


• Tuberculosis


• Bites with Rabies or other Lyssavirus Risk


• Rabies and Lyssavirus risk


• Common Imported Diseases of Travellers


• Malaria


• Typhoid


• Dengue


• Typhus and spotted fevers


• Helminth infections


• Pandemic Influenza


• Further Reading


• Acute Poisoning: General Principles Section V TOXICOLOGY


• Specific Poisons


• Paracetamol


• Salicylates


• Tricyclic antidepressants


• Benzodiazepines


• Opioids


• Iron


• Digoxin


• Lithium


• Theophylline


• Beta-blockers


• Calcium-channel blocking drugs


• Carbon monoxide


• Cyanide


• Chloroquine


• Cocaine


• Organophosphates Contents xi


• Paraquat


• Chemical Burns


• Further Reading


• Snake Bites Section VI TOXINOLOGY EMERGENCIES


• Elapid snake bites


• Viper (adder) snake bites


• Spider Bites


• Marine Envenomation


• Bee and Wasp Stings


• Further Reading


• Heat, Cold and Drowning Section VII ENVIRONMENTAL EMERGENCIES


• Heat illness


• Other hyperthermia-related illness


• Hypothermia


• Drowning


• Sports-Diving Accidents


• Decompression illness


• Decompression illness with barotrauma


• Electrical Burns, Electrocution and Lightning Strike


• Electrical flash burns


• Low-voltage electrocution


• High-voltage electrocution


• Lightning strike


• Further Reading


• Multiple Injuries Section VIII SURGICAL EMERGENCIES


• Definitive Care Further Diagnosis and Management of Multiple Injuries:


• Head and Facial Injuries


• Neck Injuries


• Cervical spine injury


• Airway injury


• Vascular injury in the neck


• Nerve injury in the neck


• Oesophageal injury xii Contents


• Neck sprain


• Chest Injuries


• Pneumothorax


• Haemothorax


• Rib and sternum fractures


• Myocardial contusion


• Aortic rupture


• Diaphragm rupture


• Oesophageal rupture


• Penetrating chest injury


• Abdominal and Pelvic Trauma


• Blunt abdominal trauma


• Penetrating abdominal trauma


• Pelvic injury


• Blunt renal injury


• Penetrating renal injury


• Bladder and urethral injuries


• Additional Orthopaedic Injuries in Multiple Trauma


• Thoracic and lumbosacral spine injury


• Limb injury


• Head Injury


• Conscious head injury


• Burns


• Major burns


• Minor burns and scalds


• Minor burns of the hand


• Minor burns of the face


• Bitumen burns


• Acute Abdomen


• Seriously ill patient


• Stable patient with an acute abdomen


• Causes of acute abdominal pain


• Acute appendicitis


• Intestinal obstruction


• Intussusception


• Perforation of a viscus


• Diverticulitis


• Inflammatory bowel disease


• Biliary colic


• Acute cholecystitis


• Ruptured abdominal aortic aneurysm


• Ischaemic colitis


• Mesenteric infarction Contents xiii


• Ruptured spleen


• Acute pancreatitis


• Renal and ureteric colic


• Pyelonephritis


• Acute urinary retention


• Acute epididymo-orchitis


• Acute testicular torsion


• Primary peritonitis


• Retroperitoneal haemorrhage


• Gynaecological causes


• Medical disorders presenting with acute abdominal pain


• Further Reading


• Injuries to the Shoulder and Upper Arm Section IX ORTHOPAEDIC EMERGENCIES


• Fractures of the clavicle


• Acromioclavicular dislocation


• Sternoclavicular dislocation


• Fractures of the scapula


• Anterior dislocation of the shoulder


• Posterior dislocation of the shoulder


• Fractures of the upper humerus


• Fractures of the shaft of the humerus


• Injuries to the Elbow and Forearm


• Supracondylar fracture of the humerus


• Condylar and epicondylar fractures of the humerus


• Dislocation of the elbow


• Pulled elbow


• Fractures of the olecranon


• Fractures of the radial head


• Fractures of the radial and ulnar shafts


• Injuries to the Wrist and Hand


• Colles’ fracture


• Smith’s fracture


• Barton’s fracture-dislocation


• Radial styloid fracture


• Distal radial fractures in children


• Fractures of the scaphoid


• Dislocations of the carpus


• Fractures of the other carpal bones


• Fractures of the thumb metacarpal


• Dislocation of the thumb metacarpal


• Rupture of the ulnar collateral ligament xiv Contents


• Fractures of the other metacarpals


• Fractures of the proximal and middle phalanges


• Fractures of the distal phalanges


• Dislocation of the phalanges


• Flexor tendon injuries in the hand


• Extensor tendon injuries in the hand


• Digital nerve injuries


• Fingertip injuries


• Cervical Spine Injuries


• Thoracic and Lumbar Spine Injuries


• Pelvic Injuries


• Injuries to the Hip and Upper Femur


• Dislocation of the hip


• Fractures of the neck of the femur


• Fractures of the shaft of the femur


• Injuries to the Lower Femur, Knee and Upper Tibia


• Supracondylar and condylar fractures of the femur


• Fractures of the patella and injury to the quadriceps apparatus


• Dislocation of the patella


• Soft-tissue injuries of the knee


• Dislocation of the knee


• Fractures of the tibial condyles


• Injuries to the Lower Tibia, Ankle and Foot


• Fractures of the shaft of the tibia


• Isolated fracture of the fibula


• Inversion ankle injuries


• Other ankle injuries


• Dislocation of the ankle


• Fractures and dislocation of the talus


• Fractures of the calcaneus


• Rupture of the tendo Achilles


• Mid-tarsal dislocations


• Metatarsal injuries and tarsometatarsal dislocations


• Fractures of the phalanges of the foot


• Dislocations of the phalanges of the foot


• Further Reading


• Soft-Tissue Injuries EMERGENCIES


• Tetanus prophylaxis


• Crush injury and compartment syndrome


• Puncture injuries


• Hand infections


• Pre-tibial laceration


• Non-articular Rheumatism


• Torticollis (wry neck)


• Frozen shoulder


• Rotator cuff tear: supraspinatus rupture


• Supraspinatus tendinitis


• Subacromial bursitis


• Tennis and golfer’s elbow


• Olecranon bursitis


• De Quervain’s stenosing tenosynovitis


• Carpal tunnel syndrome


• Housemaid’s knee


• Back Pain


• Direct back trauma


• Indirect mechanical back trauma


• Severe or atypical, non-traumatic back pain


• Mild to moderate, non-traumatic back pain


• Further Reading


• General Assessment Section XI PAEDIATRIC EMERGENCIES


• Cardiopulmonary Resuscitation


• Breathless Child


• Asthma


• Bronchiolitis


• Pneumonia


• Anaphylaxis


• Stridor


• Croup (acute laryngotracheobronchitis)


• Epiglottitis (supraglottitis)


• Inhaled foreign body


• Abdominal Pain, Diarrhoea and Vomiting


• Acute abdominal pain


• Diarrhoea, vomiting and dehydration


• Febrile Child xvi Contents


• Seizures and Febrile Convulsions


• Seizures


• Febrile convulsions


• Acute Poisoning


• Limping Child


• Sudden Unexpected Death in Infancy


• Child Abuse (Non-accidental Injury)


• Further Reading


• Gynaecological Assessment and Management EMERGENCIES


• General principles


• Prescribing in pregnancy


• Gynaecological Causes of Acute Abdominal Pain


• Ruptured ectopic pregnancy


• Pelvic inflammatory disease (acute salpingitis)


• Ruptured ovarian cyst


• Torsion of an ovarian tumour


• Endometriosis


• Bleeding in Early Pregnancy


• Spontaneous miscarriage


• Induced septic abortion


• Conditions in Late Pregnancy


• Terminology


• Antepartum haemorrhage


• Pre-eclampsia and eclampsia


• Emergency delivery


• Trauma in late pregnancy


• Cardiopulmonary resuscitation in late pregnancy


• Women’s Medicine Crises


• Post-coital contraception


• Missed oral contraceptive pill


• Domestic violence to females


• Female rape


• Further Reading


• Traumatic Conditions of the Ear Section XIII ENT EMERGENCIES


• Subperichondrial haematoma


• Wounds of the auricle


• Foreign body in the external ear


• Perforated eardrum


• Basal skull fracture


• Non-traumatic Conditions of the Ear


• Otitis externa


• Furunculosis of the external ear


• Acute otitis media


• Mastoiditis


• Vertigo


• Facial nerve palsy


• Traumatic Conditions of the Nose


• Fractured nose


• Foreign body in the nose


• Non-traumatic Conditions of the Nose


• Epistaxis


• Traumatic Conditions of the Throat


• Non-traumatic Conditions of the Throat


• Tonsillitis


• Quinsy (peritonsillar abscess)


• Foreign body in the pharynx


• Swallowed foreign body


• Stridor


• Further Reading


• Visual Acuity Section XIV OPHTHALMIC EMERGENCIES


• Topical Ophthalmic Preparations


• Traumatic Conditions of the Eye


• Periorbital haematoma (‘black eye’)


• Subconjunctival haematoma


• Eyelid laceration


• Eyelid burn


• Chemical burns to the eye


• Conjunctival foreign body


• Corneal foreign body


• Corneal abrasion


• Flash burn (arc eye)


• Blunt trauma to the eye xviii Contents


• Penetrating trauma to the eye


• Conditions Affecting the Eyelids


• Blepharitis


• Stye (external hordeolum)


• Meibomian abscess (internal hordeolum)


• Meibomian cyst (chalazion)


• Dacryocystitis


• Orbital and periorbital cellulitis


• Basal cell carcinoma (rodent ulcer)


• Ophthalmic shingles (herpes zoster ophthalmicus)


• Painful, Red Eye


• Acute conjunctivitis


• Acute keratitis


• Acute iritis


• Acute episcleritis and scleritis


• Acute glaucoma


• Sudden Loss of Vision in the Uninflamed Eye


• Central retinal artery occlusion


• Central retinal vein occlusion


• Vitreous haemorrhage


• Retinal detachment


• Optic neuritis


• Further Reading


• Traumatic Conditions of the Face and Mouth EMERGENCIES


• Lacerations


• Tooth injuries


• Fractured mandible


• Dislocated mandible


• Fracture of the zygoma or zygomaticomaxillary (malar) complex


• ‘Blow-out’ fracture of the orbital floor


• Le Fort middle-third of face fractures


• Non-traumatic Conditions of the Mouth


• Toothache


• Dental abscess


• Ludwig’s angina


• Submandibular swellings


• Further Reading


• Deliberate Self-harm Section XVI PSYCHIATRIC EMERGENCIES


• Violent Patient


• Alcohol and Drug Dependency and Abuse


• Alcohol and drug withdrawal


• Problem drinking


• Opiate and intravenous drug addiction


• Benzodiazepine and solvent addiction


• Involuntary Detention


• Further Reading


• Desirable Habits of the Good Emergency Department Doctor Section XVII ADMINISTRATIVE AND LEGAL ISSUES


• Excellence in emergency department care


• Emergency department medical records


• Communicating with the general practitioner


• Breaking bad news


• Risk management and incident reporting


• Triage


• Consent, Competence and Refusal of Treatment


• Consent and competence


• Refusal of treatment and discharge against medical advice


• Police, Coroner and Attending Court


• Police request for patient information


• Police request to interview a patient


• Police request for an alcohol breath test or blood sample


• Request for a police medical statement


• Coroner


• Attending an inquest or court


• Retrieval and Inter-hospital Transfer


• Major Incident


• External disaster


• Specialized responses


• Chemical incident


• Biological incident


• Radiological incident


• Further Reading