Emergency Medicine (A Hodder Arnold Publication) - 5th edition

532 Pages·2006·7.92 MB·English

by  Anthony F. T. Brown

EMERGENCY MEDICINE
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EMERGENCY MEDICINE
Emergency and Acute Medicine:
Diagnosis and Management
Fifth edition
ANTHONY F.T. BROWN
MB ChB (Bristol), FRCP, FRCS(Edin), FACEM, FCEM
Associate Professor, Discipline of Anaesthesiology and Critical Care,
School of Medicine, University of Queensland, Brisbane
Senior Staff Specialist, Department of Emergency Medicine, Royal
Brisbane and Women’s Hospital, Brisbane
Trained in the UK and currently working in Australia. Editor-in-Chief of
Emergency Medicine Australasia. Senior Court of Examiners, Australasian
College for Emergency Medicine (ACEM). Inaugural ACEM Teaching
Excellence Award 2001.
MICHAEL D. CADOGAN
MA(Oxon), MB ChB (Edin), FACEM
Clinical Senior Lecturer, Faculty of Medicine, Dentistry and Health
Sciences, University of Western Australia, Perth
Staff Specialist in Emergency Medicine, Department of Emergency
Medicine, Sir Charles Gairdner Hospital, Perth
Trained in the UK and currently working in Australia. Expert in Medical
Informatics. Winner, Gold Medal/Buchanan Prize, Australasian College
for Emergency Medicine Fellowship Exam 2003
Hodder Arnold
AMEMBER OF THE HODDER HEADLINE GROUP
First published in Great Britain by Hodder Arnold
Fourth edition 2002
This fifth edition published in 2006 by
Hodder Arnold, an imprint of Hodder Education and a member of the Hodder Headline Group,
338 Euston Road, London NW1 3BH
http://www.hoddereducation.com
Distributed in the United States of America by
Oxford University Press Inc.,
198 Madison Avenue, New York, NY10016
Oxford is a registered trademark of Oxford University Press
© 2006 Anthony FT Brown & Michael D Cadogan
All rights reserved. Apart from any use permitted under UK copyright law, this publication may only
be reproduced, stored or transmitted, in any form, or by any means with prior permission in writing of
the publishers or in the case of reprographic production in accordance with the terms of licences issued
by the Copyright Licensing Agency. In the United Kingdom such licences are issued by the Copyright
Licensing Agency: Saffron House, 6–10 Kirby Street, London EC1N 8TS.
Hodder Headline’s policy is to use papers that are natural, renewable and recyclable products and made
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conform to the environmental regulations of the country of origin.
Whilst the advice and information in this book are believed to be true and accurate at the date of
going to press, neither the author[s] nor the publisher can accept any legal responsibility or liability for
any errors or omissions that may be made. In particular (but without limiting the generality of the
preceding disclaimer) every effort has been made to check drug dosages; however it is still possible that
errors have been missed. Furthermore, dosage schedules are constantly being revised and new side-
effects recognized. For these reasons the reader is strongly urged to consult the drug companies'
printed instructions before administering any of the drugs recommended in this book.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
A catalog record for this book is available from the Library of Congress
ISBN-10: 0 340 92770 4
ISBN-13: 978 0 340 92770 0
1 2 3 4 5 6 7 8 9 10
Commissioning Editor: Philip Shaw
Project Editor: Heather Fyfe
Production Controller: Karen Tate
Cover Designer: Laura de Grasse
Typeset in 10/12pt Adobe Garamond by Dorchester Typesetting Group Ltd, Dorchester, Dorset
Printed and bound in Spain
What do you think about this book? Or any other Hodder Arnold title? Please send
your comments to www.hoddereducation.com
Dedication
To Regina, my beautiful and patient wife, for her encouragement and
understanding. And to our wonderful children Edward and Lucy, who
never cease to amaze and bring such joy and happiness, plus constantly
reminding me what really matters.
A.F.T.B.
To my beautiful wife, Fiona, for her enduring patience, love and support;
to William, Hamish and Olivia, for helping me to appreciate the impor-
tance of family and the necessity of life outside medicine.
M.D.C.
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Contents
Dedication
Preface
Acknowledgements
Section I GENERAL MEDICAL EMERGENCIES
Cardiopulmonary Resuscitation 2
Chest Pain 13
Acute coronary syndrome 14
ST elevation myocardial infarction 14
Non-ST elevation myocardial infarction, unstable angina and
non-cardiac chest pain 18
Venous thromboembolism with pulmonary embolus 22
Venous thromboembolism with deep vein thrombosis 26
Aortic dissection 28
Pericarditis 29
Pleurisy 30
Abdominal causes of chest pain 30
Musculoskeletal and chest wall pain 31
Cardiac Arrhythmias 31
The Breathless Patient 36
Acute asthma 36
Community-acquired pneumonia 39
Chronic obstructive pulmonary disease 41
Pneumothorax 42
Pulmonary embolus 45
Pulmonary oedema 45
Acute upper airway obstruction 47
Upper Gastrointestinal Haemorrhage 50
Diabetic Coma and Pre-coma 51
Diabetic ketoacidosis 52
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Contents
Hyperglycaemic, hyperosmolar non-ketotic syndrome 53
The Patient with an Altered Conscious Level 54
The collapsed or unconscious patient 54
The confused patient 58
Alcohol-related medical problems 62
The patient with an altered conscious level and smelling of
alcohol 63
Alcohol withdrawal 64
Acute Neurological Conditions 65
Syncope 65
Seizure 67
Generalized convulsive status epilepticus 69
Transient ischaemic attack 71
Stroke 73
Headache 75
Meningitis 75
Subarachnoid haemorrhage 77
Space-occupying lesion 78
Temporal arteritis 78
Acute narrow-angle glaucoma 79
Hypertensive encephalopathy 79
Migraine 80
Tension (muscle contraction) headache 81
Post-traumatic headache 82
Disease in other cranial structures 82
Acute Arthropathy 82
Acute monoarthropathy 83
Septic arthritis 83
Traumatic arthritis 84
Gouty arthritis 84
Pseudogout 85
Acute polyarthropathy 85
Rheumatoid arthritis 86
Osteoarthritis 87
Periarticular swellings 87
Allergic or Immunological Conditions 87
Urticaria (hives) 87
Angioedema 88
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Contents
Anaphylaxis 89
Skin Disorders 91
Blistering (vesicobullous) conditions 91
Pruritus (itching conditions) 93
Purpuric conditions 94
Exanthematous diseases 97
Malignant melanoma 97
The Elderly Patient 98
Disordered behaviour in the elderly 99
Falls in the elderly 100
Further Reading 102
Section II ACID–BASE, ELECTROLYTE AND RENAL
EMERGENCIES
Acid–Base Disturbances 106
Arterial blood gas interpretation 106
Metabolic acidosis 108
Metabolic alkalosis 110
Respiratory acidosis 112
Respiratory alkalosis 113
Electrolyte Disorders 114
Potassium disorders
Hyperkalaemia 115
Hypokalaemia 117
Sodium disorders
Hypernatraemia 118
Hyponatraemia 119
Calcium disorders
Hypercalcaemia 121
Hypocalcaemia 122
Magnesium disorders
Hypermagnesaemia 123
Hypomagnesaemia 124
Acute Renal Failure 125
Further Reading 127
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