Acute Medical Emergencies, Second Edition, Second Edition

508 Pages·2010·12.306 MB·English

by  Advanced Life Support Group(auth.)

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Acute Medical
Emergencies
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Useful website addresses
AdvancedLifeSupportGroup http://www.alsg.org
BestEvidenceinEmergencyMedicine http://www.bestbets.org
Evidencebasedon-call http://cebm.jr2.ox.ac.uk/eboc/eboc.html
RoyalCollegeofPhysicians http://www.rcplondon.ac.uk/
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Acute Medical
Emergencies
The Practical Approach
SECOND EDITION
Advanced Life Support Group
A John Wiley & Sons, Ltd., Publication
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Thiseditionfirstpublished2010,(cid:1)c 2010byBlackwellPublishingLtd
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LibraryofCongressCataloging-in-PublicationData
Acutemedicalemergencies:thepracticalapproach/AdvancedLifeSupportGroup.–2nded.
p.;cm.
Includesindex.
ISBN978-0-7279-1854-3
1.Medicalemergencies–Handbooks,manuals,etc. 2.Emergencymedicine–Handbooks,manuals,
etc. I.AdvancedLifeSupportGroup(Manchester,England)
[DNLM:1.EmergencyTreatment–methods.2.Emergencies.WB105A18952010]
RC86.7.A2822010
616.02’5–dc22 2009046382
ISBN:9780727918543
AcataloguerecordforthisbookisavailablefromtheBritishLibrary.
Setin10/13ptMeridienbyAptara(cid:1)R Inc.,NewDelhi,India
PrintedandboundinSingapore
1 2010
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Contents
WorkingGroup,vii
Contributorstofirstedition,viii
Contributorstosecondedition,ix
Prefacetosecondedition,x
Prefacetofirstedition,xi
Acknowledgments,xii
Part I: Introduction
Chapter1 Introduction,3
Chapter2 Recognitionofthemedicalemergency,7
Part II: Structured Approach
Chapter3 Astructuredapproachtomedicalemergencies,15
Chapter4 Airwayassessment,33
Chapter5 Breathingassessment,43
Chapter6 Circulationassessment,55
Chapter7 Disabilityassessment,67
Part III: Presenting Complaints
Chapter8 Thepatientwithbreathingdifficulties,87
Chapter9 Thepatientwithshock,121
Chapter10 Thepatientwithchestpain,147
Chapter11 Thepatientwithalteredconsciouslevel,159
Chapter12 The‘collapsed’patient,187
Chapter13 Theoverdosepatient,203
Chapter14 Thepatientwithaheadache,215
Chapter15 Thepatientwithabdominalpain,233
Chapter16 Thepatientwithhotredlegsorcoldwhitelegs,261
Chapter17 Thepatientwithhotand/orswollenjoints,269
Chapter18 Thepatientwitharash,281
Chapter19 Thepatientwithacuteconfusion,293
Part IV: Organ Failure
Chapter20 Organfailure,309
v
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vi CONTENTS
Part V: Special Circumstances
Chapter21 Theelderlypatient,345
Chapter22 Transportationoftheseriouslyillpatient,355
Chapter23 Thepregnantpatient,369
Chapter24 Theimmunocompromisedpatient,377
Chapter25 Thepatientwithacutespinalcordcompression,381
Part VI: Interpretation of Emergency Investigations
Chapter26 Acid–basebalanceandbloodgasanalysis,387
Chapter27 Dysrhythmiarecognition,409
Chapter28 ChestX-rayinterpretation,431
Chapter29 Haematologicalinvestigations,437
Chapter30 Biochemicalinvestigations,449
Part VII: Practical Procedures
Chapter31 Practicalprocedures:airwayandbreathing,457
Chapter32 Practicalprocedures:circulation,469
Chapter33 Practicalprocedures:medical,477
Part VIII: Appendix
Appendix:Drugscommonlyusedinthemanagementofmedicalemergencies,487
Answerstotimeoutquestions,493
Index,505
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Working group
PDriscoll EmergencyMedicine,Manchester
PDyer GeneralMedicine,Birmingham
CDuffy ALSG,Manchester
RKishen Anaesthesia/ICU,Manchester
KMackway-Jones EmergencyMedicine,Manchester
GMcCarthy EmergencyMedicine,Cork
TDWardle GeneralMedicine,Chester
JWhitaker CareoftheElderly,Harrogate
SWieteska ALSG,Manchester
REVIEWERS
PDriscoll EmergencyMedicine,Manchester
MEmons EmergencyMedicine,Rijen,Netherlands
AEriksson Medicine,Stockholm,Sweden
RKishen Anaesthesia/ICU,Manchester
DMacKechnie EmergencyMedicine,Rochdale
GMcCarthy EmergencyMedicine,Cork
TDWardle GeneralMedicine,Chester
EDITORIAL GROUP
PDriscoll EmergencyMedicine,Manchester
TDWardle GeneralMedicine,Chester
SWieteska CEO,ALSG,Manchester
vii
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Contributors to first edition
MBhushan Dermatology,Manchester
PDavies EmergencyMedicine,Bristol
PDriscoll EmergencyMedicine,Manchester
CEMGriffiths Dermatology,Manchester
CGwinnutt Anaesthesia,Manchester
JHanson EmergencyMedicine,Preston
RKishen Anaesthesia/ICU,Manchester
KMackway-Jones EmergencyMedicine,Manchester
AMcGowan EmergencyMedicine,Leeds
GMcMahon EmergencyMedicine,Manchester
FMorris EmergencyMedicine,Sheffield
CMoulton EmergencyMedicine,Bolton
KReynard EmergencyMedicine,Manchester
PSammy GeneralPractice,Manchester
PTerry EmergencyMedicine,Manchester
DWallis EmergencyMedicine,London
TDWardle GeneralMedicine,Chester
BWaters Anaesthesia/ICU,NorthWales
JWhitaker CareoftheElderly,Harrogate
viii
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Contributors to second edition
ZLBorrill GeneralMedicine,Manchester
PDavies EmergencyMedicine,Bristol
PDriscoll EmergencyMedicine,Manchester
PDyer GeneralMedicine,Birmingham
RDowdle GeneralMedicine,Glamorgan
JHanson EmergencyMedicine,Preston
RHardern EmergencyMedicine,Durham
PHormbrey EmergencyMedicine,Oxford
SJHutchison Cardiology,Abergavenny
KJones RespiratoryMedicine,Bolton
TJordan RespiratoryMedicine,Liverpool
RKishen IntensiveCare,Manchester
GLloyd EmergencyMedicine,Exeter
AMacNab EmergencyMedicine,Swansea
GMcCarthy EmergencyMedicine,Cork
DWallis EmergencyMedicine,London
TDWardle GeneralMedicine,Chester
JWhitaker CareoftheElderly,Harrogate
DWWrathall IntensiveCare,Dumfries
ix
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Preface to second edition
Sinceitsfirstpublicationin2001,thistexthasbeenakeycomponentofanedu-
cational package that has trained in excess of 600 providers in the management
of acute medical emergencies. The course is now running in the UK, Eire, the
NetherlandsandSweden.
Over this time,new guidelines and changes in practice have provided impetus
toproducethesecondedition.Thechallengeofupdatingthiswitheverevolving
guidelines has now been met. However, despite evidence-based developments
and improvement in medical practice, the foundation of MedicALS – the struc-
turedapproach–remainsunchanged,reassuringly.
The second edition will continue to promote the essence of MedicALS, which
is to ensure that the candidate leaves the course equipped with a ‘Practical Ap-
proach’thatissafetopatientswithanykindofacutemedicalemergency.
As new or updated guidelines become available, we will provide those on the
ALSGwebsitewww.alsg.orgtoensurethatyourAcuteMedicalEmergenciestext
remainscurrent.
Overtheyears,anincreasingnumber ofexpertshavecontributedtothework
andweextendourthanksbothtothemandtoourinstructors,whounceasingly
providehelpfulfeedback.Consultationwithinstructorshasgreatlycontributedto
thisneweditionandtotherevisedcourse.
x