Table Of Content

OXFORD MEDICAL PUBLICATIONS Oxford Handbook of Acute Medicine ii Published and forthcoming Oxford Handbooks Oxford Handbook for the Foundation Oxford Handbook of Infectious Programme 5e Diseases and Microbiology 2e Oxford Handbook of Acute Oxford Handbook of Integrated Dental Medicine 4e Biosciences 2e Oxford Handbook of Anaesthesia 4e Oxford Handbook of Humanitarian Oxford Handbook of Cardiology 2e Medicine Oxford Handbook of Clinical and Oxford Handbook of Key Clinical Healthcare Research Evidence 2e Oxford Handbook of Clinical and Oxford Handbook of Medical Laboratory Investigation 4e Dermatology 2e Oxford Handbook of Clinical Oxford Handbook of Medical Imaging Dentistry 6e Oxford Handbook of Medical Oxford Handbook of Clinical Sciences 2e Diagnosis 3e Oxford Handbook for Medical School Oxford Handbook of Clinical Oxford Handbook of Medical Statistics Examination and Practical Skills 2e Oxford Handbook of Neonatology 2e Oxford Handbook of Clinical Oxford Handbook of Nephrology and Haematology 4e Hypertension 2e Oxford Handbook of Clinical Oxford Handbook of Neurology 2e Immunology and Allergy 3e Oxford Handbook of Nutrition and Oxford Handbook of Clinical Dietetics 2e Medicine – Mini Edition 10e Oxford Handbook of Obstetrics and Oxford Handbook of Clinical Gynaecology 3e Medicine 10e Oxford Handbook of Occupational Oxford Handbook of Clinical Pathology Health 2e Oxford Handbook of Clinical Oxford Handbook of Oncology 3e Pharmacy 3e Oxford Handbook of Operative Oxford Handbook of Clinical Surgery 3e Specialties 10e Oxford Handbook of Oxford Handbook of Clinical Surgery 4e Ophthalmology 4e Oxford Handbook of Complementary Oxford Handbook of Oral and Medicine Maxillofacial Surgery 2e Oxford Handbook of Critical Care 3e Oxford Handbook of Orthopaedics Oxford Handbook of Dental and Trauma Patient Care Oxford Handbook of Paediatrics 2e Oxford Handbook of Dialysis 4e Oxford Handbook of Pain Management Oxford Handbook of Emergency Oxford Handbook of Palliative Care 3e Medicine 4e Oxford Handbook of Practical Drug Oxford Handbook of Endocrinology Therapy 2e and Diabetes 3e Oxford Handbook of Pre- Hospital Care Oxford Handbook of ENT and Head Oxford Handbook of Psychiatry 3e and Neck Surgery 2e Oxford Handbook of Public Health Oxford Handbook of Epidemiology for Practice 3e Clinicians Oxford Handbook of Rehabilitation Oxford Handbook of Expedition and Medicine 3e Wilderness Medicine 2e Oxford Handbook of Reproductive Oxford Handbook of Forensic Medicine Medicine & Family Planning 2e Oxford Handbook of Gastroenterology Oxford Handbook of Respiratory & Hepatology 2e Medicine 3e Oxford Handbook of General Oxford Handbook of Rheumatology 4e Practice 4e Oxford Handbook of Sport and Exercise Oxford Handbook of Genetics Medicine 2e Oxford Handbook of Genitourinary Handbook of Surgical Consent Medicine, HIV, and Sexual Health 2e Oxford Handbook of Tropical Oxford Handbook of Geriatric Medicine 4e Medicine 3e Oxford Handbook of Urology 4e Oxford Handbook of Acute Medicine FOURTH EDITION Punit S. Ramrakha Consultant Cardiologist Buckinghamshire Hospitals NHS Trust and Hammersmith Hospital London, UK Kevin P. Moore Professor of Hepatology Royal Free and University College London Medical School University College London, UK Amir H. Sam Consultant Physician and Endocrinologist Hammersmith Hospital, and Reader in Endocrinology Imperial College London, UK 1 iv 1 Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Punit S. Ramrakha and Kevin P. Moore 1997, 2004, 2010, 2019 The moral rights of the authors have been asserted First edition published 1997 Second edition published 2004 Third edition published 2010 Fourth edition published 2019 Impression: 1 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, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America British Library Cataloguing in Publication Data Data available Library of Congress Control Number: 2018941855 ISBN 978– 0– 19– 879742– 5 Printed and bound in China by C&C Offset Printing Co., Ltd. Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-t o- date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-p regnant adult who is not breast- feeding Links to third party websites are provided by Oxford in good faith and for information only. Oxford disclaims any responsibility for the materials contained in any third party website referenced in this work. v Foreword to fourth edition The first edition of the Oxford Handbook of Acute Medicine was published in 1997. Since then, acute medicine has evolved as a fully established spe- cialty within the UK, and over 95% of hospitals now have an acute medical unit. Importantly, acute medicine is developing in Europe and Australia as part of providing high-q uality care for patients presenting as a medical emergency to hospital. Such patients now constitute the largest group of patients occupying inpatient hospital beds. It is imperative therefore that all staff are trained in the management of acute medical emergencies and, importantly, have easy access to information to support the management of this acutely unwell subgroup of patients. This textbook is clearly structured and is supported by useful diagrams and algorithms, and hence the information is readily accessible. The practical procedure section is comprehensive. While many practising clinicians will not be required to undertake all these procedures, they will be involved in discussion on these issues with patients and relatives, and this text will be an invaluable guide. The handbook series from Oxford University Press already provides useful information to many clinicians working in clinical practice. Irrespective of age or seniority, for clinicians directly involved in the early diagnosis and management of patients who present acutely, this book will provide a concise aid. The clear and up- to- date content of this text reflects the experi- ence of the authors, and I am personally delighted to provide a foreword to a book which will undoubtedly help support the growing number of trainees working in the field of acute medicine. Derek Bell Professor of Acute Medicine Imperial College London vi vi Preface The management of acute medical emergencies is the most demanding and rewarding aspect of medical training. The aim of this handbook is to give confidence to junior doctors to manage acute medical problems effectively and safely. This edition has been updated to ensure that every aspect of the care recommended is in line with current clinical guidelines. The fourth edition of the Oxford Handbook of Acute Medicine includes summary boxes for the key points in the management of common medical emergencies. These concise and practical ‘management key points’ can be a useful guide to junior doctors in the emergency department. The layout of the book reflects clinical practice: assessment, differential diagnosis, immediate management, and some aspects of long- term therapy. Throughout the book, the text commonly exceeds that required for the management of specialist problems by the generalist. This is deliberate, but intended, to provide the doctor with an understanding of specialist interventions, so that they are more conversant with what is possible and what is happening to their patient. We have included a new section on acute medicine and the older patient. A word of advice—p atients who present acutely ill are frequently scared and need to be kept informed and to feel safe, however busy you are. Being admitted to hospital means you lose control of your life. Thus, it is our duty as their doctor to make all of our patients feel safe and cared for, and to keep them informed of plans and what is happening to them. vii Acknowledgements We would like to thank all of the contributors who provided initial drafts of chapters which have evolved over time, as well as friends and col- leagues who gave up their time to read a chapter and verify its accuracy. We would also like to thank OUP for their encouragement during the re- writing of this book. PSR is indebted to Sanjana, Aarav, and Dhruv for their support and motivation. KPM is indebted to Janet, Alice, and Thomas for their continued patience when the portable computer accompanied family holidays. Finally, we would like to acknowledge the environment at the Hammersmith Hospital where we trained and learned that acute medicine is both interesting and fun. viii ix Contents Specialist reviewers x Symbols and abbreviations xii 1 Cardiac emergencies 1 2 Respiratory emergencies 171 3 Gastroenterological emergencies 227 4 Renal emergencies 289 5 Shock 327 6 Neurological emergencies 347 7 Infectious diseases 469 8 Emergencies in HIV- positive patients 505 9 Diabetes and endocrine emergencies 545 10 Haematological emergencies 607 11 Rheumatological emergencies 659 12 Dermatological emergencies 691 13 Psychiatric emergencies 711 14 Drug overdoses 739 15 Practical procedures 783 16 Differential diagnoses of common presentations 863 17 Acute medicine and the older patient 891 Appendix 907 Index 915