Acute Medicine: Clinical Cases Uncovered PDF
Preview Acute Medicine: Clinical Cases Uncovered
For Tom and Matthew 2 3 This edition first published 2009, © 2009 by Chris Roseveare Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell’s publishing programme has been merged with Wiley’s global Scientific, Technical and Medical business to form Wiley-Blackwell. Registered office: John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 9600 Garsington Road, Oxford, OX4 2DQ, Editorial offices: UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 111 River Street, Hoboken, NJ 07030-5774, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell The right of the author to be identified as the author of this work has been asserted in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. 4 Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought. Library of Congress Cataloging-in-Publication Data Roseveare, Chris. Acute medicine / Chris Roseveare. p. ; cm. – (Clinical cases uncovered) Includes index. ISBN 978-1-4051-6883-0 1. Critical care medicine.2. Internal medicine.I. Title.II. Series. [DNLM:1. Acute Disease–therapy–Case Reports.2. Diagnosis, Differential–Case Reports.3. Emergency Medicine–methods–Case Reports.4. Emergency Treatment–Case Reports.WB 105 R817a 2009] RC86.7.R683 2009 616.02’8–dc22 5 2008039514 ISBN: 978-1-4051-6883-0 A catalogue record for this book is available from the British Library. Set in 9/12 pt Minion by SNP Best-set Typesetter Ltd., Hong Kong Printed & bound in Singapore by Fabulous Printers Pte Ltd 1 2009 6 Acknowledgements Many people have assisted in the preparation of this manuscript and I will attempt to aknowledge all of these. Dr Ben Chadwick and Dr Stuart Henderson helped significantly in the writing of the chapters on the shocked and comatose patients; Dr Rebecca Strivens, Dr Nik Wennike, Dr Matt Todd, Dr Steven Hill and Dr Felicity Chastney also made very helpful contributions to the cases of chronic obstructive pulmonary disease, pyrexia, renal failure, seizure and the breathless elderly patient. I am also grateful to my colleagues, Dr Beata Brown, Dr Janet Butler, Dr Arthur Yue, Dr John Paisey, Professor Derek Bell and Dr Anindo Banerjee for reviewing some of the cases and for their helpful comments. I would also like to thank Dr Ivan Brown, Dr Harriet Joy and Dr Lynne Burgess in the radiology department at Southampton, for kindly providing radiographs for use in many of the cases. Finally, I would like to thank my wife, Nicola, without whose patience and understanding I would not have been able to devote the necessary time to the production of this text. 7 How to use this book Clinical Cases Uncovered (CCU) books are carefully designed to help supplement your clinical experience and assist with refreshing your memory when revising. Each book is divided into three sections: Part 1 Basics; Part 2 Cases; and Part 3 Self-assessment. Part 1 gives you a quick reminder of the basic science, history and examination, and key diagnoses in the area. Part 2 contains many of the clinical presentations you would expect to see on the wards or in exams, with questions and answers leading you through each case. New information, such as test results, is revealed as events unfold and each case concludes with a handy case summary explaining the key points. Part 3 allows you to test your learning with several question styles (MCQs, EMQs and SAQs), each with a strong clinical focus. Whether reading individually or working as part of a group, we hope you will enjoy using your CCU book. If you have any recommendations on how we could improve the series, please do let us know by contacting us at: [email protected]. Disclaimer CCU patients are designed to reflect real life, with their own reports of symptoms and concerns. Please note that all names used are entirely fictitious and any similarity to patients, alive or dead, is coincidental. 8 List of abbreviations ABG arterial blood gas ACE angiotensin-converting enzyme ACS acute coronary syndrome AF atrial fibrillation ALP alkaline phosphatase ALT alanine transaminase ANA anti-nuclear antibody ANCA anti-neutrophil cytoplasmic antibody APTR activated partial thromboplastin ratio AST aspartate transaminase BBB bundle branch block BCT broad complex tachycardia BiPAP biphasic positive airway pressure CDU clinical decision unit COPD chronic obstructive pulmonary disease CPR cardiopulmonary resucitation CRP C-reactive protein CSF cerebrospinal fluid CT computed tomography CTPA computed tomography pulmonary angiogram CVP central venous pressure DIC disseminated intravascular coagulation DKA diabetic ketoacidosis DVT deep vein thrombosis EM emergency medicine 9 ESR erythrocyte sedimentation rate EWS early warning score FBC full blood count FEV1 forced expiratory volume in 1 second FVC forced vital capacity GCS Glasgow Coma Score GI gastrointestinal GTN glyceryl trinitrate Hb haemoglobin HDU high-dependency unit HPC history of presenting complaint IBD inflammatory bowel disease INR international normalized ratio JVP jugular venous pressure LFT liver function tests LMN lower motor neurone LMWH low molecular weight heparin LP lumbar puncture MI myocardial infarction NSAIDs non-steroidal anti-inflammatory drugs NSTEMI non-ST elevation myocardial infarction OGD oesophagogastroduodenoscopy OSCE objective structured clinical examination PA posteroanterior PCI percutaneous coronary intervention PE pulmonary embolism PEA pulseless electrical activity PEFR peak expiratory flow rate PND paroxysmal nocturnal dyspnoea 10
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