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Acute Medicine
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Table of Contents

Preface xi Introduction xiii 1 Patient Assessment 1 Communication 1 History taking 3 The functional enquiry 6 The physical assessment 8 General inspection 11 Respiratory examination 12 Cardiovascular examination 14 Gastrointestinal examination 17 Neurological examination 18 Musculoskeletal examination 24 Post examination 25 Conclusion 25 2 Emergencies 27 Anaphylaxis 27 Cardio-respiratory arrest 29 Ethical Issues 36 3 Acute Poisoning and Drug Overdose 41 Deliberate self-harm 41 Paracetamol overdose 45 Aspirin overdose 48 Tricyclic antidepressant overdose 51 Heroin overdose 53 Alcohol overdose 54 The National Institute for Clinical Excellence (NICE) self-harm guideline 56 Alcohol withdrawal 58 Drug withdrawal 60 4 Infection 65 Sepsis and septic shock 65 Meningitis 67 Infective endocarditis 71 Gastroenteritis 75 Urinary tract infection (UTI) 77 Fever in the returning traveller 79 Hot swollen joints 83 Antimicrobial resistance 86 5 Respiratory Conditions 89 Asthma 89 Chronic obstructive pulmonary disease (COPD) 93 Pulmonary embolism 96 Community and hospital acquired pneumonia 100 Pneumothorax 104 Type I respiratory failure 106 Type II respiratory failure 108 6 Cardiovascular Conditions 113 Acute coronary syndromes (ACS) 113 Stable angina 113 Unstable angina 114 Non-ST elevation myocardial infarction 116 ST elevation myocardial infarction 117 DIGAMI 121 Arrhythmias 121 Bradycardia 123 Tachycardia 126 Atrial fibrillation (AF) 129 Cardiac failure 132 Deep vein thrombosis (DVT) 134 Aortic dissection 136 Cardiac tamponade 138 7 Gatrointestinal Conditions 143 Upper gastrointestinal bleeding (GI bleed) 143 Variceal bleeding 145 Acute liver failure with encephalopathy 147 Acute ulcerative colitis and crohn s disease 149 8 Metabolic Conditions 153 Diabetic ketoacidosis (DKA) 153 Hyperosmolar non-ketotic state (HONK) 155 Hypoglycaemia 157 Hyperglycaemia in the critically ill patient 159 Hypercalcaemia 162 Hyponatraemia 164 Hypernatraemia 166 Hypokalaemia 168 Hyperkalaemia 170 Addisonian crisis 172 Thyroid crisis (thyroid storm) 174 Myxedema crisis 177 9 Neurological Conditions 181 Status epilepticus 181 Stroke 184 Transient ischaemic attacks (TIA) 186 Isolated seizure and unexplained loss of consciousness 188 Headache 190 Subarachnoid haemorrhage (SAH) 192 Spinal cord compression 195 10 Renovascular Conditions 197 Acute renal failure (ARF) 197 Accelerated (malignant) hypertension 199 11 Elderly Care 203 Hypothermia 203 Confusion 205 12 Haematological Conditions 209 Severe anaemia 209 Sickle cell crisis 212 Neutropenic sepsis 215 Blood transfusion guidance 217 13 Advanced Practice 223 An overview of advanced practice 223 The challenges of advanced practice 225 Legal perspective 225 Ethical principles 226 Informed consent 228 Assessment of capacity 229 Prescribing 231 Patient group directions 233 Conclusion 234 Appendices Appendix I Examples of Clinical Management Plans 237 Appendix II Examples of Patient Group Directions 245 Glossary 255 Index 259

About the Author

Lisa Carroll RGN, MSc, Consultant Nurse Acute Medicine. University Hospital of North Staffordshire, UK.

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