Table of Contents

Preface 6 Acknowledgements 7 Units, symbols and abbreviations 8 Part 1 General. 1 Recognizing the unwell patient 12 2 Admission and ongoing management of the acutely unwell patient 14 3 Monitoring in acute and critical care medicine 16 4 Oxygen transport 18 5 Cardiopulmonary resuscitation 20 6 Shock 22 7 Circulatory assessment 24 8 Fluid management 26 9 Fluid choice: specific situations 28 10 Inotropes and vasopressors 29 11 Failure of oxygenation and respiratory failure 30 12 Oxygenation and oxygen therapy 32 13 Airways obstruction and management 34 14 Non-invasive ventilation 36 15 Endotracheal intubation 38 16 Mechanical ventilation 40 17 Respiratory management, weaning and tracheostomy 42 18 Arterial blood gases and acid-base balance 44 19 Analgesia, sedation and paralysis 46 20 Enteral and parenteral nutrition 48 21 Hypothermia and hyperthermia 50 22 SIRS, sepsis, severe sepsis and septic shock 52 23 Hospital-acquired (nosocomial) infections 54 24 End of life issues 56 Part 2 Medical. Cardiac. 25 Acute coronary syndromes I: clinical pathophysiology 58 26 Acute coronary syndromes II: investigations and management 60 27 Arrhythmias 62 28 Heart failure and pulmonary oedema 64 29 Cardiac emergencies 66 30 Deep venous thrombosis and pulmonary embolism 68 Respiratory. 31 Community-acquired pneumonia 70 32 Hospital-acquired (nosocomial) pneumonia 72 33 Asthma 74 34 Chronic obstructive pulmonary disease 76 35 Acute respiratory distress syndrome 78 36 Pneumothorax and air leaks 80 37 Respiratory emergencies 82 Renal and metabolic. 38 Acute kidney injury: pathophysiology and clinical aspects 84 39 Acute kidney injury: management and renal replacement therapy 86 40 Diabetic emergencies 88 41 Endocrine emergencies 90 Gastrointestinal. 42 Gastrointestinal haemorrhage 92 43 Acute liver failure 94 44 Acute pancreatitis 96 Neurological. 45 Acute confusional state, coma and status epilepticus 98 46 Neurological emergencies: cerebrovascular accidents 100 47 Neurological emergencies: infective 101 48 Neuromuscular conditions 102 Other systems. 49 Coagulation disorders and transfusion 104 50 Drug overdose and poisoning 106 51 The immune compromised patient 108 Part 3 Surgical. 52 Trauma 110 53 Head injury 112 54 Chest trauma 114 55 Acute abdominal emergencies 116 56 Obstetric emergencies 118 57 Burns, toxic inhalation and electrical injuries 120 Part 4 Self-assessment. Case studies and questions 122 Case studies answers 125 Appendices. Appendix I: Classifi cation of antiarrhythmic drugs 132 Appendix II: Acute injury network staging system 2008 for acute kidney injury 132 Appendix III: Rockall risk-scoring system for GI bleeds 133 Appendix IV: Child-Pugh grading 133 Appendix V: Typical criteria for liver transplantation 133 Index 135

About the Author

Richard Leach is consultant physician and Honorary Senior Lecturer at Guy's, King's and St Thomas' School of Medicine.