Table Of Content

BASIC LIFE SUPPORT UNRESPONSIVE ? SHOUT FOR HELP OPEN AIRWAY NOT BREATHING NORMALLY ? CALL EMERGENCY SERVICES 30 CHEST COMPRESSIONS 2 RESCUE BREATHS 30 COMPRESSIONS Send or go for help as soon as possible according to guidelines Basic life support. (out of hospital). With permission from Resuscitation Council UK http://www.resus.org.uk * Studies have shown that compression alone is as good as compression with rescue breaths. Compression should be at least 5 cm and performed at 100 compressions/min. The heel of one hand is placed over the centre of the chest, and the heel of the second hand is placed over the first, with the fingers interlocked. Unresponsive? Not breathing or only occasional gasps Call resuscitation team CPR 30:2 Attach defibrillator/monitor Minimise interruptions Assess rhythm Shockable Non-shockable (VF/pulseless VT) (PEA/asystole) Return of spontaneous 1 Shock circulation Immediate post cardiac Immediately Immediately arrest treatment resume resume CPR for 2 min • Use ABCDE approach CPR for 2 min Minimise • Controlled oxygenation Minimise interruptions and ventilation interruptions • 12-lead ECG • Treat precipitating cause • Temperature control/ therapeutic hypothermia During CPR Reversible causes • Ensure high quality CPR: rate, depth, recoil • Hypoxia • Plan actions before interrupting CPR • Hypovolaemia • Give oxygen • Hypo/hyperkalaemia/ • Consider advanced airway and metabolic capnography • Hypothermia • Continuous chest compressions when • Thrombosis - coronary or advanced airway in place pulmonary • Vascular access (intravenous, intraosseous) • Tamponade - cardiac • Give adrenaline every 3-5 min • Toxins • Correct reversible causes • Tension pneumothorax Adult advanced life support. CPR = cardiopulmonary resuscitation; PEA = pulseless electrical activity; VF = ventricular fibrillation. (Reproduced with permission from the Resuscitation Council, http://www.resus.org.uk/siteindex.htm) Medical Management and Therapeutics Commissioning Editor: Pauline Graham Senior Development Editor: Ailsa Laing Project Manager: Kerrie-Anne McKinlay Designer: Kirsteen Wright Illustrations Manager: Merlyn Harvey Illustrator: Ethan Danielson Medical Management and Therapeutics Edited by PROFESSOR PARVEEN KUMAR CBE BSc MD DM(hc) FRCP(l&e) FRCPath Professor of Medicine and Education, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, and Honorary Consultant Physician and Gastroenterologist, Barts and The London NHS Trust and Homerton University Hospital NHS Foundation Trust, London, UK DR MICHAEL CLARK MD FRCP Honorary Senior Lecturer, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2011 © 2011 Elsevier Ltd. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). ISBN 9780702027659 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 Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. The Working together to grow publisher’s libraries in developing countries policy is to use paper manufactured www.elsevier.com | www.bookaid.org | www.sabre.org from sustainable forests Printed in China Contents List of Contributors vii Preface ix List of abbreviations xi Acknowledgements xiii 1 Inpatient medical care 1 Vimal Gokani, Parveen Kumar 2 Infectious disease 29 Timothy Planche, Peter A Riley 3 Human immune deficiency virus and AIDS 95 James E Thaventhiran 4 Nutrition 119 Michael Clark 5 Gastrointestinal disease 133 Joel Mawdsley 6 Liver disease 175 Michael Clark 7 Haematological disease 199 Jason Coppell 8 Malignant disease 253 Sarah Ngan, Mohini Varughese 9 Rheumatological disease 297 Dev Pyne 10 Kidney and urinary tract disease 327 Alistair Chesser 11 Water, electrolyte and acid-base balance 367 Neil Ashman 12 Cardiovascular disease 385 Mehul B Dhinoja, James Wilkinson, Chris Skene, Mike Ward 13 Respiratory disease 473 Susannah Leaver 14 Critical care 533 Tony M Rahman, Jonathan Ball v Contents 15 Endocrine disease 565 Philippa Hanson 16 Diabetes mellitus and hyperlipidaemia 593 Philippa Hanson 17 Neurological disease 623 Paul Jarman, Arjune Sen 18 Poisoning 661 Allister Vale, Sally Bradberry 19 Environmental medicine 697 Michael Clark 20 Emergencies in medicine 703 Michael Clark Appendix A Useful websites for drugs and their use in disease states and pregnancy, and for toxicology 723 Appendix B Normal values 725 Index 729 vi Contributors Neil Ashman FRCP PhD Mehul Dhinoja MBBS Consultant Nephrologist, Renal MRCP(UK) Unit, Royal London Hospital, Consultant Cardiologist & London, UK Electrophysiologist, Arrhythmia Service, St Bartholomew’s Jonathan Ball MRCP MSc Hospital, London, UK EDIC MD FCCP Consultant & Honorary Senior Vimal J Gokani BMedSci Lecturer in General & Neuro MB BS MSc MRCS Intensive Care, St George’s NIHR Academic Clinical Fellow, Hospital & Medical School, Department of Cardiovascular London, UK Sciences, University of Leicester, Leicester, UK Sally Bradberry BSc MD MRCP FAACT Philippa Hanson MBBS Consultant Clinical Toxicologist, MRCP BMedSci MD National Poisons Information Consultant Physician, Diabetes Service, City Hospital, Endocrinology and General Birmingham, UK Medicine, Newham University Hospitals Trust, London, UK Alistair Chesser MB BChir FRCP PhD Paul Jarman MA Consultant Nephrologist, Renal MBBS(Hons) PhD Unit, Royal London Hospital, Consultant Neurologist, The London, UK National Hospital for Neurology and Neurosurgery, London, UK Michael Clark MD FRCP Honorary Senior Lecturer, Barts Parveen Kumar CBE BSc and The London School of MD DM(HC) FRCP Medicine and Dentistry, Queen FRCP(Edin) Mary University of London, Professor of Medicine and London, UK Education, Barts and the London School of Medicine and Dentistry, Jason Coppell MA MBBS Queen Mary University of MRCP FRCPath London, UK; Honorary Consultant Haematologist, Royal Consultant Physician and Devon & Exeter Hospital, Exeter, Gastroenterologist, Barts and The UK London NHS Trust and Homerton University Hospital NHS Foundation Trust, London, UK vii

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Readers of Kumar & Clark's Clinical Medicine have consistently requested a handbook with the essentials for medical management and therapeutics, and this new handbook concentrates on the therapeutic side of what procedures to perform, how and - critically - why. Written by young doctors at the foref