465. Emergency Medicine

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465. Emergency Medicine

 

 

CATEGORY: Medical & Medicine – 500 Courses

COURSE NUMBER: 465

FEES: 555/- INR only

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BOOKS/ MANUALS: Pages

Syllabus

Dedication v
Preface xxi
Acknowledgements xxiii
Section I CRITICAL CARE EMERGENCIES
Cardiopulmonary Resuscitation 2
Initial approach 2
Definitive care 6
Acute Upper Airway Obstruction 13
Shocked Patient 15
General approach 15
Hypovolaemic shock 19
Septic shock 21
Unconscious Patient 24
Anaphylaxis 27
Severe Head Injury 29
Critical-Care Areas Drug Infusion Guideline 34
Further Reading 41
Section II GENERAL MEDICAL EMERGENCIES
Chest Pain 44
Acute coronary syndrome 44
ST elevation myocardial infarction 44
Non-ST elevation myocardial infarction and unstable angina 48
Non-cardiac chest pain 51
Pulmonary embolus 51
Venous thromboembolism with deep vein thrombosis 55
Aortic dissection 57
Pericarditis 58
Pleurisy 59
Abdominal causes of chest pain 59
Musculoskeletal and chest wall pain 60

Cardiac Arrhythmias 60
Breathless Patient 64
Acute asthma 65
Community-acquired pneumonia 67
Chronic obstructive pulmonary disease 71
Pneumothorax 72
Pulmonary embolus 75
Pulmonary oedema 75
Acute upper airway obstruction 76
Upper Gastrointestinal Haemorrhage 76
Diabetic Coma and Pre-coma 78
Diabetic ketoacidosis 78
Hyperglycaemic, hyperosmolar non-ketotic syndrome 80
Altered Conscious Level 80
Confused patient 81
Alcohol-related medical problems 85
Patient with an altered conscious level and smelling of alcohol 85
Alcohol withdrawal 86
Acute Neurological Conditions 87
Syncope 87
Seizure (Fit) 89
Generalized convulsive status epilepticus 91
Transient ischaemic attack 93
Stroke 95
Headache 97
Meningitis 97
Subarachnoid haemorrhage 99
Space-occupying lesion 100
Temporal arteritis 101
Hypertensive encephalopathy 101
Migraine 102
Tension (muscle contraction) headache 104
Post-traumatic headache 104
Disease in other cranial structures 105
Acute Arthropathy 105
Acute monoarthropathy 105
Septic arthritis 105
Gouty arthritis 106
Pseudogout 107
Traumatic arthritis 107
Acute polyarthropathy 108
Rheumatoid arthritis 109

Osteoarthritis 109
Allergic or Immunological Conditions 110
Urticaria (hives) 110
Angioedema 111
Skin Disorders 112
Blistering (vesicobullous) conditions 112
Pruritus (itching conditions) 113
Purpuric conditions 114
Exanthematous diseases 116
Malignant melanoma 117
Elderly Patient 118
Disordered behaviour in the elderly 119
Falls in the elderly 120
Further Reading 121
Section III ACID–BASE, ELECTROLYTE AND RENAL

Acid–Base Disturbances 124
Arterial blood gas interpretation 124
Metabolic acidosis 126
Metabolic alkalosis 128
Respiratory acidosis 129
Respiratory alkalosis 130
Electrolyte Disorders 131
Potassium disorders 132
Hyperkalaemia 132
Hypokalaemia 134
Sodium disorders 135
Hypernatraemia 135
Hyponatraemia 136
Calcium disorders 138
Hypercalcaemia 138
Hypocalcaemia 139
Magnesium disorders 139
Hypermagnesaemia 139
Hypomagnesaemia 140
Acute Renal Failure 141
Acute kidney injury 141
Further Reading 144

Section IV INFECTIOUS DISEASE AND FOREIGN TRAVEL

EMERGENCIES

Febrile Neutropenic Patient 146
Hepatitis 147
Gastrointestinal Tract Infection 148
Sexually Transmitted Diseases 150
Needlestick and Sharps Incidents 151
Inoculation Incident with HIV Risk 151
Inoculation Incident with Hepatitis Risk 151
Human Immunodeficiency Virus Infection 153
Tuberculosis 155
Bites with Rabies or other Lyssavirus Risk 157
Rabies and Lyssavirus risk 157
Common Imported Diseases of Travellers 158
Malaria 159
Typhoid 160
Dengue 161
Typhus and spotted fevers 161
Helminth infections 162
Pandemic Influenza 163
Further Reading 164
Section V TOXICOLOGY
Acute Poisoning: General Principles 166
Specific Poisons 169
Paracetamol 170
Salicylates 172
Tricyclic antidepressants 174
Benzodiazepines 175
Opioids 176
Iron 177
Digoxin 178
Lithium 179
Theophylline 181
Beta-blockers 182
Calcium-channel blocking drugs 183
Carbon monoxide 184
Cyanide 185
Chloroquine 185
Cocaine 186

Organophosphates 187
Paraquat 188
Chemical Burns 189
Further Reading 190
Section VI TOXINOLOGY EMERGENCIES
Snake Bites 192
Elapid snake bites 192
Viper (adder) snake bites 195
Spider Bites 196
Marine Envenomation 197
Bee and Wasp Stings 199
Further Reading 200
Section VII ENVIRONMENTAL EMERGENCIES
Heat, Cold and Drowning 202
Heat illness 202
Other hyperthermia-related illness 204
Hypothermia 205
Drowning 207
Sports-Diving Accidents 208
Decompression illness 209
Decompression illness with barotrauma 210
Electrical Burns, Electrocution and Lightning Strike 212
Electrical flash burns 212
Low-voltage electrocution 212
High-voltage electrocution 213
Lightning strike 215
Further Reading 216
Section VIII SURGICAL EMERGENCIES
Multiple Injuries 218
Further Diagnosis and Management of Multiple Injuries:
Definitive Care 223
Head and Facial Injuries 223
Neck Injuries 224
Cervical spine injury 224
Airway injury 229
Vascular injury in the neck 229
Nerve injury in the neck 229

Oesophageal injury 230
Neck sprain 230
Chest Injuries 231
Pneumothorax 231
Haemothorax 231
Rib and sternum fractures 232
Myocardial contusion 233
Aortic rupture 234
Diaphragm rupture 235
Oesophageal rupture 236
Penetrating chest injury 237
Abdominal and Pelvic Trauma 238
Blunt abdominal trauma 238
Penetrating abdominal trauma 240
Pelvic injury 241
Blunt renal injury 242
Penetrating renal injury 243
Bladder and urethral injuries 244
Additional Orthopaedic Injuries in Multiple Trauma 244
Thoracic and lumbosacral spine injury 245
Limb injury 246
Head Injury 247
Conscious head injury 247
Burns 250
Major burns 250
Minor burns and scalds 252
Minor burns of the hand 253
Minor burns of the face 254
Bitumen burns 254
Acute Abdomen 254
Seriously ill patient 254
Stable patient with an acute abdomen 255
Causes of acute abdominal pain 259
Acute appendicitis 260
Intestinal obstruction 260
Intussusception 261
Perforation of a viscus 262
Diverticulitis 262
Inflammatory bowel disease 263
Biliary colic 264
Acute cholecystitis 264
Ruptured abdominal aortic aneurysm 265
Ischaemic colitis 266

Mesenteric infarction 266
Ruptured spleen 267
Acute pancreatitis 267
Renal and ureteric colic 268
Pyelonephritis 269
Acute urinary retention 270
Acute epididymo-orchitis 271
Acute testicular torsion 271
Primary peritonitis 272
Retroperitoneal haemorrhage 272
Gynaecological causes 273
Medical disorders presenting with acute abdominal pain 273
Further Reading 274
Section IX ORTHOPAEDIC EMERGENCIES
Injuries to the Shoulder and Upper Arm 276
Fractures of the clavicle 276
Acromioclavicular dislocation 276
Sternoclavicular dislocation 277
Fractures of the scapula 278
Anterior dislocation of the shoulder 278
Posterior dislocation of the shoulder 280
Fractures of the upper humerus 281
Fractures of the shaft of the humerus 282
Injuries to the Elbow and Forearm 283
Supracondylar fracture of the humerus 283
Condylar and epicondylar fractures of the humerus 284
Dislocation of the elbow 285
Pulled elbow 286
Fractures of the olecranon 286
Fractures of the radial head 287
Fractures of the radial and ulnar shafts 287
Injuries to the Wrist and Hand 288
Colles’ fracture 288
Smith’s fracture 290
Barton’s fracture-dislocation 291
Radial styloid fracture 291
Distal radial fractures in children 292
Fractures of the scaphoid 292
Dislocations of the carpus 294
Fractures of the other carpal bones 294
Fractures of the thumb metacarpal 295
Dislocation of the thumb metacarpal 296

Rupture of the ulnar collateral ligament 296
Fractures of the other metacarpals 297
Fractures of the proximal and middle phalanges 298
Fractures of the distal phalanges 298
Dislocation of the phalanges 299
Flexor tendon injuries in the hand 300
Extensor tendon injuries in the hand 300
Digital nerve injuries 301
Fingertip injuries 301
Cervical Spine Injuries 301
Thoracic and Lumbar Spine Injuries 302
Pelvic Injuries 302
Injuries to the Hip and Upper Femur 302
Dislocation of the hip 302
Fractures of the neck of the femur 303
Fractures of the shaft of the femur 304
Injuries to the Lower Femur, Knee and Upper Tibia 305
Supracondylar and condylar fractures of the femur 305
Fractures of the patella and injury to the quadriceps apparatus 305
Dislocation of the patella 306
Soft-tissue injuries of the knee 306
Dislocation of the knee 308
Fractures of the tibial condyles 308
Injuries to the Lower Tibia, Ankle and Foot 309
Fractures of the shaft of the tibia 309
Isolated fracture of the fibula 310
Inversion ankle injuries 310
Other ankle injuries 312
Dislocation of the ankle 312
Fractures and dislocation of the talus 312
Fractures of the calcaneus 313
Rupture of the tendo Achilles 314
Mid-tarsal dislocations 314
Metatarsal injuries and tarsometatarsal dislocations 314
Fractures of the phalanges of the foot 315
Dislocations of the phalanges of the foot 315
Further Reading 316

Section X MUSCULOSKELETAL AND SOFT-TISSUE

EMERGENCIES

Soft-Tissue Injuries 318
Tetanus prophylaxis 321
Crush injury and compartment syndrome 323
Puncture injuries 324
Hand infections 325
Pre-tibial laceration 326
Non-articular Rheumatism 326
Torticollis (wry neck) 327
Frozen shoulder 327
Rotator cuff tear: supraspinatus rupture 328
Supraspinatus tendinitis 328
Subacromial bursitis 329
Tennis and golfer’s elbow 329
Olecranon bursitis 329
De Quervain’s stenosing tenosynovitis 329
Carpal tunnel syndrome 330
Housemaid’s knee 330
Back Pain 330
Direct back trauma 331
Indirect mechanical back trauma 331
Severe or atypical, non-traumatic back pain 332
Mild to moderate, non-traumatic back pain 333
Further Reading 333
Section XI PAEDIATRIC EMERGENCIES
General Assessment 336
Cardiopulmonary Resuscitation 339
Breathless Child 347
Asthma 347
Bronchiolitis 349
Pneumonia 350
Anaphylaxis 351
Stridor 352
Croup (acute laryngotracheobronchitis) 352
Epiglottitis (supraglottitis) 352
Inhaled foreign body 354
Abdominal Pain, Diarrhoea and Vomiting 355
Acute abdominal pain 355
Diarrhoea, vomiting and dehydration 357

Febrile Child 361
Seizures and Febrile Convulsions 364
Seizures 364
Febrile convulsions 365
Acute Poisoning 367
Limping Child 369
Sudden Unexpected Death in Infancy 370
Child Abuse (Non-accidental Injury) 372
Further Reading 374
Section XII OBSTETRIC AND GYNAECOLOGICAL

EMERGENCIES

Gynaecological Assessment and Management 376
General principles 376
Prescribing in pregnancy 376
Gynaecological Causes of Acute Abdominal Pain 376
Ruptured ectopic pregnancy 377
Pelvic inflammatory disease (acute salpingitis) 379
Ruptured ovarian cyst 380
Torsion of an ovarian tumour 380
Endometriosis 381
Bleeding in Early Pregnancy 381
Spontaneous miscarriage 381
Induced septic abortion 383
Conditions in Late Pregnancy 383
Terminology 384
Antepartum haemorrhage 384
Pre-eclampsia and eclampsia 385
Emergency delivery 386
Trauma in late pregnancy 387
Cardiopulmonary resuscitation in late pregnancy 388
Women’s Medicine Crises 389
Post-coital contraception 389
Missed oral contraceptive pill 390
Domestic violence to females 391
Female rape 391
Further Reading 393

Section XIII ENT EMERGENCIES
Traumatic Conditions of the Ear 396
Subperichondrial haematoma 396
Wounds of the auricle 396
Foreign body in the external ear 396
Perforated eardrum 397
Basal skull fracture 397
Non-traumatic Conditions of the Ear 398
Otitis externa 398
Furunculosis of the external ear 398
Acute otitis media 399
Mastoiditis 399
Vertigo 400
Facial nerve palsy 400
Traumatic Conditions of the Nose 401
Fractured nose 401
Foreign body in the nose 402
Non-traumatic Conditions of the Nose 402
Epistaxis 402
Traumatic Conditions of the Throat 404
Non-traumatic Conditions of the Throat 404
Tonsillitis 404
Quinsy (peritonsillar abscess) 405
Foreign body in the pharynx 405
Swallowed foreign body 406
Stridor 407
Further Reading 407
Section XIV OPHTHALMIC EMERGENCIES
Visual Acuity 410
Topical Ophthalmic Preparations 410
Traumatic Conditions of the Eye 411
Periorbital haematoma (‘black eye’) 411
Subconjunctival haematoma 411
Eyelid laceration 412
Eyelid burn 412
Chemical burns to the eye 412
Conjunctival foreign body 413
Corneal foreign body 414
Corneal abrasion 414
Flash burn (arc eye) 414

Blunt trauma to the eye 415
Penetrating trauma to the eye 416
Conditions Affecting the Eyelids 417
Blepharitis 417
Stye (external hordeolum) 417
Meibomian abscess (internal hordeolum) 417
Meibomian cyst (chalazion) 417
Dacryocystitis 417
Orbital and periorbital cellulitis 418
Basal cell carcinoma (rodent ulcer) 418
Ophthalmic shingles (herpes zoster ophthalmicus) 418
Painful, Red Eye 419
Acute conjunctivitis 419
Acute keratitis 420
Acute iritis 421
Acute episcleritis and scleritis 421
Acute glaucoma 422
Sudden Loss of Vision in the Uninflamed Eye 422
Central retinal artery occlusion 422
Central retinal vein occlusion 423
Vitreous haemorrhage 424
Retinal detachment 424
Optic neuritis 425
Further Reading 425
Section XV MAXILLOFACIAL AND DENTAL

EMERGENCIES

Traumatic Conditions of the Face and Mouth 428
Lacerations 428
Tooth injuries 428
Fractured mandible 430
Dislocated mandible 430
Fracture of the zygoma or zygomaticomaxillary (malar) complex 431
‘Blow-out’ fracture of the orbital floor 432
Le Fort middle-third of face fractures 433
Non-traumatic Conditions of the Mouth 434
Toothache 434
Dental abscess 434
Ludwig’s angina 434
Submandibular swellings 435
Further Reading 435

Section XVI PSYCHIATRIC EMERGENCIES
Deliberate Self-harm 438
Violent Patient 439
Alcohol and Drug Dependency and Abuse 441
Alcohol and drug withdrawal 441
Problem drinking 441
Opiate and intravenous drug addiction 442
Benzodiazepine and solvent addiction 443
Involuntary Detention 443
Further Reading 444
Section XVII ADMINISTRATIVE AND LEGAL ISSUES
Desirable Habits of the Good Emergency Department Doctor 446
Excellence in emergency department care 446
Emergency department medical records 446
Communicating with the general practitioner 447
Breaking bad news 448
Risk management and incident reporting 449
Triage 450
Consent, Competence and Refusal of Treatment 451
Consent and competence 451
Refusal of treatment and discharge against medical advice 452
Police, Coroner and Attending Court 453
Police request for patient information 453
Police request to interview a patient 453
Police request for an alcohol breath test or blood sample 453
Request for a police medical statement 454
Coroner 454
Attending an inquest or court 455
Retrieval and Inter-hospital Transfer 456
Major Incident 456
External disaster 456
Specialized responses 459
Chemical incident 460
Biological incident 462
Radiological incident 463
Further Reading 464

Section XVIII PRACTICAL PROCEDURES
Endotracheal Intubation 466
Rapid Sequence Induction (RSI) Intubation 466
Cricothyrotomy 469
Needle Thoracentesis 471
Intercostal Catheter Insertion 473
DC Cardioversion 474
Pericardial Aspiration 475
Central Line Insertion 476
Intraosseous Line Insertion 480
Lumbar Puncture 482
Indwelling Urethral Catheter Insertion 484
Nasogastric Tube Insertion 486
Bier’s Intravenous Regional Block 488
Femoral Nerve Block 489
Digital Nerve Ring Block 491
Knee Aspiration 492
Further Reading 492
Glossary 495
Appendix: Normal Laboratory Values 503
Index 507

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