Oxford Desk Reference

855 Pages·2016·32.85 MB·English

by  Bell

OXFORD MEDICAL PUBLICATION
Oxford Desk Reference
Acute Medicine
Oxford Desk Reference: Acute Medicine Oxford Desk Reference: Obstetrics and
Edited by Richard Leach, Derek Bell, and Kevin Moore Gynaecology
Edited by Sabaratnam Arulkumaran, Lesley Regan,
Oxford Desk Reference: Cardiology Aris Papageorghiou, Ash Monga, and David
Edited by Hung-Fat Tse, Gregory Y. Lip, and Farquharson
Andrew J. Stewart Coats
Oxford Desk Reference: Oncology
Oxford Desk Reference: Clinical Genetics Edited by Thankamma V. Ajithkumar, Ann Barrett,
Helen V. Firth and Jane A. Hurst Helen Hatcher, and Natalie Cook
Oxford Desk Reference: Critical Care Oxford Desk Reference: Respiratory Medicine
Carl Waldmann, Neil Soni, and Andrew Rhodes Edited by Nick Maskell and Ann Millar
Oxford Desk Reference: Geriatric Medicine Oxford Desk Reference: Rheumatology
Edited by Margot Gosney, Adam Harper, and Edited by Richard Watts, Gavin Clunie, Frances Hall, and
Simon Conroy Tarnya Marshall
Oxford Desk Reference: Major Trauma Oxford Desk Reference: Toxicology
Edited by Jason Smith, Ian Greaves, and Keith Porter Edited by D. Nicholas Bateman, Robert D. Jefferson,
Simon H. L. Thomas, John P. Thompson, and
Oxford Desk Reference: Nephrology J. Allister Vale
Jonathan Barratt, Kevin Harris, and Peter Topham
Oxford Desk Reference
Acute Medicine
Edited by
Dr Richard Leach
Consultant Physician and Honorary Reader in
Medicine, Departments of Respiratory and
Critical Care Medicine, Guy’s and St Thomas’
Hospital Trust and Kings College,
London, UK
Professor Derek Bell
Professor of Acute Medicine, Faculty of
Medicine, Imperial College London and Chelsea
and Westminster Hospital, London
Professor Kevin Moore
Professor of Hepatology, University College
London Medical School, UCL,
London, UK 
1
1
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Foreword
Acute and general (internal) medicine is a broad specialty covering a wide spectrum of
emergency medical presentations and illnesses, and it is at the forefront of the delivery
of acute medical care. Few medical specialties have had to adapt as rapidly to the dra-
matic improvements in medical care that have become available over the last decade.
For many conditions, the improved outcomes are critically dependent on the early phase
of management. Consequently, acute physicians, clinical trainees and associated health
care workers have had to develop early clinical recognition skills, acquire new theoretical
knowledge and implement an increasing number of guidelines and practical require-
ments.
Acute medical services are under increasing pressure as emergency admissions have
increased by 37% over the last decade, whilst acute medical beds have decreased by
about a third over the preceding 25 years. Over two thirds of emergency hospital admis-
sions are over 65 years old, and many are frail or suffer with dementia. Recent evidence
suggests that for many medical registrars the current emergency, out-of-hours admission
work load is unmanageable and will put the delivery of optimal acute medical manage-
ment at risk. There are no signs that this will fall any time soon.
All acute medical admissions deserve to receive safe, high quality care appropriate to
their needs, delivered by caring, compassionate, health professionals. In an era of
increasing evidence based medicine, national guidelines, rising workloads and increasing
knowledge, the need for text books that provide simple, guideline-based assistance to
the busy clinician are ever more important. The Oxford Desk Reference: Acute Medicine
brings together the key recommendations found in recent evidence based guidelines and
presents them in an easily accessible form so that locating and assimilating the required
information is quick and simple. Many of the chapters and specialty sections have been
written by recognized national or international leaders in their fields, who have provided
the best available advice where guidelines or evidence do not exist.
This eminently practical textbook should be a useful daily resource to all those busy
caring for acute medical admissions.
Sir Richard Thompson
President of the Royal College of Physicians (2010–14)

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Preface
All of us working as acute and general physicians wish to provide the best care for
our acutely unwell patients. The early medical management of such patients is critical
and has profound effects on survival and long-term outcomes. One of the major
challenges facing the busy general clinician is how to keep abreast of the rapidly changing
clinical practice guidelines produced by specialist societies and national organizations.
Accessing this information, when it is most needed, is not always easy; and yet, it is in the
emergency department or on the post-take ward round where this vital information
could make a significant difference to outcome.
Given that most general physicians will be dealing with problems outside their special-
ist field, it is apparent that we need practice-based textbooks aimed at providing easy
access to accredited guidelines, web-based information and details of specialist patient
support groups. In the Oxford Desk Reference of Acute Medicine we have attempted to
produce a practical, comprehensive but brief guide to the management of acute medical
emergencies which will enable the acute physician to deliver the best possible early care
for their patients, irrespective of the cause or base specialty.
To some extent we have apportioned space according to the frequency with which a
clinical problem is likely to be encountered in developed countries, whilst identifying and
addressing those emergency presentations, which although rare, require immediate and
often life-saving interventions. Key recommendations and evidence-based guidelines
have been combined in a uniform and practical format, to enable the reader to quickly
locate and rapidly assimilate the key information about a specific topic. Inevitably, in
order to produce a succinct, practical and appropriately sized book, some detail is omit-
ted, but much of this can be obtained from the companion specialist Oxford Desk
Reference series.
This book is aimed at acute, general and trainee physicians participating in ‘unselected’
general medical admissions rotas or working in acute medical units. It should also be of
interest to acute nurse practitioners, pharmacists participating in ‘post-take’ ward rounds
and to the many specialists and junior clinicians, who at times, may have to deal with
acute medical problems. We hope that you will find it a useful, time-saving and reassuring
resource in your routine working day.
Dr Richard Leach
Professor Derek Bell
Professor Kevin Moore

ix
Acknowledgements
Development of a new textbook inevitably involves the help and advice of a wide range
of people and it is not always possible to acknowledge every contribution. Nevertheless
we would like to thank all the chapter authors, from the United Kingdom, United States
of America and Europe who, without exception have contributed work of the highest
quality. Our thanks are also due to Fiona Goodgame, Katy Loftus, Christopher Reid, and
especially Fiona Richardson and Angela Butterworth from Oxford University Press who
have guided and supported us throughout, and been instrumental in the production of
this book.
Finally, as editors and authors, we owe particular thanks to our partners or wives who
between them have provided the essential support, encouragement and patience neces-
sary for the writing and editing process. In particular, RL would like to thank Clare (for
her many hours of proofreading and support), Helen, Marc, and Niall.