Acute medical and surgical problems

Greaves, Ian; Porter, Keith

doi:10.1093/med/9780198734949.003.0002

Oxford Handbook of Pre-hospital Care (2 edn)

Ian Greaves and Sir Keith Porter

https://doi.org/10.1093/med/9780198734949.001.0001

Published online:

01 November 2020

Published in print:

01 January 2021

Online ISBN:

9780191799501

Print ISBN:

9780198734949

- Copyright Page
  - Notes
  - Notes
- Foreword
  - Notes
  - Notes
- Foreword
  - Notes
  - Notes
- Preface to the second edition
  - Notes
  - Notes
- Acknowledgements
  - Notes
  - Notes
- Abbreviations
  - Notes
  - Notes
1 An approach to pre-hospital care
- Notes
- Notes
- Approach to the acute medical patient Approach to the acute medical patient
  - A Airway A Airway
  - B Breathing B Breathing
  - C Circulation C Circulation
  - D Disability D Disability
  - E Exposure E Exposure
- A symptom-based approach A symptom-based approach
  - Chest pain Chest pain
    - Ischaemic chest pain Ischaemic chest pain
      - Angina Angina
      - Myocardial infarction Myocardial infarction
    - Chest wall pain Chest wall pain
    - Pulmonary pain Pulmonary pain
      - Pneumothorax Pneumothorax
      - Pneumonia Pneumonia
      - Pulmonary embolism Pulmonary embolism
    - Gastrointestinal causes of chest pain Gastrointestinal causes of chest pain
      - Oesophageal reflux/oesophagitis Oesophageal reflux/oesophagitis
      - Peptic ulcer pain Peptic ulcer pain
    - Aortic dissection Aortic dissection
    - Other causes Other causes
      - Herpes zoster—shingles Herpes zoster—shingles
      - Cholecystitis Cholecystitis
      - Pancreatitis Pancreatitis
      - Pericarditis Pericarditis
  - Shortness of breath Shortness of breath
    - Asthma Asthma
    - Pulmonary oedema Pulmonary oedema
      - Other symptoms reflecting the underlying cause Other symptoms reflecting the underlying cause
    - COPD COPD
    - Pneumonia Pneumonia
    - Pneumothorax Pneumothorax
    - Pulmonary embolism Pulmonary embolism
    - Hyperventilation syndrome Hyperventilation syndrome
    - Respiratory compensation for a metabolic acidosis Respiratory compensation for a metabolic acidosis
- Pre-hospital investigations and monitoring Pre-hospital investigations and monitoring
  - End tidal CO₂ (ETCO₂) monitoring End tidal CO₂ (ETCO₂) monitoring
  - Pulse oximetry Pulse oximetry
    - Applications Applications
    - Limitations Limitations
- Cardiological emergencies Cardiological emergencies
  - Patient assessment Patient assessment
  - Cardiac arrest Cardiac arrest
    - Safety Safety
- Basic life support Basic life support
  - Technique of chest compressions Technique of chest compressions
  - Technique of artificial ventilation Technique of artificial ventilation
  - Technique of mouth-to-mask ventilation Technique of mouth-to-mask ventilation
  - Abandoning resuscitation Abandoning resuscitation
  - Summary of basic life support Summary of basic life support
    - Check for safety Check for safety
    - Notes Notes
  - Choking in adults Choking in adults
    - Technique of back blows Technique of back blows
    - Technique of abdominal thrusts Technique of abdominal thrusts
- Advanced life support Advanced life support
  - General comments General comments
  - Drugs in cardiac arrest Drugs in cardiac arrest
  - Patient handover Patient handover
  - Ventricular fibrillation/pulseless ventricular tachycardia Ventricular fibrillation/pulseless ventricular tachycardia
  - Treatment of shockable rhythms Treatment of shockable rhythms
  - Witnessed, monitored cardiac arrest Witnessed, monitored cardiac arrest
  - Oxygen therapy in medical conditions Oxygen therapy in medical conditions
  - Non-shockable rhythms (asystole/PEA) Non-shockable rhythms (asystole/PEA)
    - The resuscitation sequence is The resuscitation sequence is
      - ‘Four Hs’ ‘Four Hs’
      - ‘Four Ts’ ‘Four Ts’
  - Recognition of life extinct Recognition of life extinct
  - Post-cardiac arrest care Post-cardiac arrest care
  - Peri-arrest arrhythmias Peri-arrest arrhythmias
    - Peri-arrest tachycardias Peri-arrest tachycardias
    - Peri-arrest bradycardias Peri-arrest bradycardias
- Bradycardias Bradycardias
  - Sinus bradycardia Sinus bradycardia
    - ECG abnormalities ECG abnormalities
    - Clinical features Clinical features
    - Initial management Initial management
  - First degree heart block First degree heart block
    - ECG abnormalities ECG abnormalities
    - Clinical features Clinical features
    - Initial management Initial management
  - Second degree heart block Second degree heart block
    - Möbitz type 1 (Wenckebach) Möbitz type 1 (Wenckebach)
      - ECG abnormalities ECG abnormalities
      - Clinical features Clinical features
      - Initial management Initial management
    - Möbitz type 2 (irregular block) Möbitz type 2 (irregular block)
      - ECG abnormalities ECG abnormalities
      - Clinical features Clinical features
      - Initial management Initial management
    - Möbitz type 2 (2:1, 3:1, 4:1 block, etc.) Möbitz type 2 (2:1, 3:1, 4:1 block, etc.)
      - ECG abnormalities ECG abnormalities
      - Clinical features Clinical features
      - Immediate management Immediate management
  - Third degree (complete) heart block Third degree (complete) heart block
    - ECG abnormalities ECG abnormalities
    - Presenting features Presenting features
    - Immediate management Immediate management
- Tachycardias Tachycardias
  - Supraventricular tachycardia (SVT): I (AV nodal re-entrant tachycardia [AVNRT] and atrioventricular re-entry tachycardia [AVRT]) Supraventricular tachycardia (SVT): I (AV nodal re-entrant tachycardia [AVNRT] and atrioventricular re-entry tachycardia [AVRT])
    - ECG abnormalities ECG abnormalities
    - Presenting features Presenting features
    - Initial management Initial management
      - If this fails If this fails
      - If this fails If this fails
  - Atrial fibrillation Atrial fibrillation
    - ECG abnormalities ECG abnormalities
    - Presenting features Presenting features
    - Immediate management Immediate management
  - Atrial flutter Atrial flutter
    - ECG abnormalities ECG abnormalities
    - Presenting features Presenting features
    - Immediate management Immediate management
  - Ventricular tachycardia Ventricular tachycardia
    - ECG abnormalities ECG abnormalities
    - Presenting features Presenting features
    - Immediate management Immediate management
      - No pulse No pulse
      - Pulse present Pulse present
      - Runs longer than 30 seconds: Runs longer than 30 seconds:
  - Torsade de pointes Torsade de pointes
    - ECG abnormalities ECG abnormalities
    - Presenting features Presenting features
    - Immediate management Immediate management
  - Implantable cardioverter defibrillators Implantable cardioverter defibrillators
- Myocardial ischaemia Myocardial ischaemia
  - Acute coronary syndrome Acute coronary syndrome
  - Unstable angina Unstable angina
    - Symptoms Symptoms
    - Signs Signs
    - ECG abnormalities ECG abnormalities
    - Initial management Initial management
  - Acute myocardial infarction Acute myocardial infarction
    - STEMI- ST segment elevation MI STEMI- ST segment elevation MI
      - Symptoms Symptoms
      - Signs Signs
      - ECG abnormalities ECG abnormalities
      - Location of changes Location of changes
      - Immediate management Immediate management
    - Non-STEMI Non-STEMI
  - Pre-hospital thrombolysis Pre-hospital thrombolysis
    - Indications (but see local protocols) Indications (but see local protocols)
    - Contraindications Contraindications
    - Thrombolytic agents Thrombolytic agents
      - Side-effects Side-effects
- Pericarditis Pericarditis
  - Aetiology Aetiology
  - Symptoms Symptoms
  - Signs Signs
  - ECG abnormalities ECG abnormalities
  - Immediate management Immediate management
- Shingles (herpes zoster) Shingles (herpes zoster)
  - Symptoms and signs Symptoms and signs
  - Management Management
- Acute pulmonary oedema (left ventricular failure) Acute pulmonary oedema (left ventricular failure)
  - Symptoms Symptoms
    - Other symptoms reflecting the underlying cause: Other symptoms reflecting the underlying cause:
  - Signs Signs
  - Immediate management Immediate management
- Sepsis Sepsis
- Acute exacerbations of asthma Acute exacerbations of asthma
  - Classification Classification
  - Management Management
- Chronic obstructive pulmonary disease (COPD) Chronic obstructive pulmonary disease (COPD)
  - Presenting features Presenting features
  - Signs Signs
  - Initial management Initial management
- Pulmonary embolism Pulmonary embolism
  - Presenting features Presenting features
  - Signs Signs
    - In massive pulmonary embolism In massive pulmonary embolism
  - Immediate management Immediate management
  - Cardiac arrest Cardiac arrest
- Pneumothorax Pneumothorax
  - Presenting features Presenting features
  - Types of pneumothorax Types of pneumothorax
    - Simple Simple
    - Tension Tension
  - Signs Signs
  - Immediate management Immediate management
    - Simple pneumothorax Simple pneumothorax
    - Tension pneumothorax Tension pneumothorax
  - Formal chest drainage (tube thoracostomy) Formal chest drainage (tube thoracostomy)
- Hyperventilation syndrome Hyperventilation syndrome
  - Presenting features Presenting features
  - Management Management
- The unconscious patient The unconscious patient
  - ∆ Differential diagnosis ∆ Differential diagnosis
  - Approach to the unconscious patient Approach to the unconscious patient
    - Responsiveness Responsiveness
    - Airway and breathing Airway and breathing
    - Circulation Circulation
    - Disability Disability
  - Diagnostic clues in the unconscious patient Diagnostic clues in the unconscious patient
- Cerebrovascular events Cerebrovascular events
  - Cerebrovascular accident—stroke Cerebrovascular accident—stroke
    - Presenting features Presenting features
    - Immediate management Immediate management
  - Sub-arachnoid haemorrhage Sub-arachnoid haemorrhage
    - Presenting features Presenting features
    - Immediate management Immediate management
- Fitting Fitting
  - Definition Definition
  - Immediate management Immediate management
- Meningococcal meningitis and meningococcal septicaemia Meningococcal meningitis and meningococcal septicaemia
  - Meningitis Meningitis
    - Presenting features Presenting features
  - Meningococcal septicaemia Meningococcal septicaemia
  - Immediate management Immediate management
- Anaphylaxis Anaphylaxis
  - Signs and symptoms of anaphylaxis Signs and symptoms of anaphylaxis
  - Immediate management Immediate management
- Poisoning (including drugs and alcohol) Poisoning (including drugs and alcohol)
- Hypothermia Hypothermia
- Diabetic emergencies Diabetic emergencies
  - Hypoglycaemia Hypoglycaemia
    - Presenting features Presenting features
    - Immediate management Immediate management
  - Ketoacidosis Ketoacidosis
    - Presenting features Presenting features
    - Immediate management Immediate management
- The acute abdomen The acute abdomen
  - ∆ Differential diagnosis ∆ Differential diagnosis
  - Abdominal aortic aneurysm Abdominal aortic aneurysm
    - Presenting features Presenting features
    - Notes Notes
    - Immediate management Immediate management
  - Acute appendicitis Acute appendicitis
    - Presenting features Presenting features
      - Other symptoms (variable) Other symptoms (variable)
      - Notes Notes
    - Immediate management Immediate management
  - Gallbladder disease Gallbladder disease
    - Presenting features Presenting features
    - Immediate management Immediate management
  - Acute pancreatitis Acute pancreatitis
    - Presenting features Presenting features
    - Immediate management Immediate management
  - Peptic ulcer disease Peptic ulcer disease
    - Presenting features Presenting features
    - Immediate management Immediate management
  - Peritonitis Peritonitis
  - Ureteric colic (renal stones) Ureteric colic (renal stones)
    - Presenting features Presenting features
    - Immediate management Immediate management
  - Acute pyelonephritis Acute pyelonephritis
    - Presenting features Presenting features
    - Immediate management Immediate management
  - Gynaecological causes of abdominal pain Gynaecological causes of abdominal pain
  - Bowel obstruction Bowel obstruction
    - Presenting features Presenting features
    - Immediate management Immediate management
  - Mesenteric infarction Mesenteric infarction
    - Presenting features Presenting features
    - Immediate management Immediate management
  - Diverticular disease Diverticular disease
    - Presenting features Presenting features
    - Immediate management (severe or previously undiagnosed cases) Immediate management (severe or previously undiagnosed cases)
  - Medical causes of abdominal pain Medical causes of abdominal pain
  - Testicular torsion Testicular torsion
- Notes
- Notes
3 Trauma
- Notes
- Notes
4 Formulary
- Notes
- Notes
5 Management of the airway, analgesia, and anaesthesia
- Notes
- Notes
6 Poisoning
- Notes
- Notes
7 Acute psychiatric emergencies
- Notes
- Notes
8 Child health
- Notes
- Notes
9 The hostile environment
- Notes
- Notes
10 Major incident management and triage
- Notes
- Notes
11 Chemical, biological, radiological, and nuclear incidents
- Notes
- Notes
12 Emergency obstetrics, gynaecology, and care of the newborn
- Notes
- Notes
13 Patient rescue and transportation
- Notes
- Notes
- Index
  - Notes
  - Notes

Chapter

2 Acute medical and surgical problems

Get access

https://doi.org/10.1093/med/9780198734949.003.0002

Pages

53–150

Published:

November 2020

Abstract

This chapter starts with the <C>ABCDE approach to the acute medical patient, then outlines a symptom-based approach for assessment, alongside pre-hospital investigations and monitoring measures. It goes on to cover cardiological emergencies, basic and advanced life support, bradycardias and tachycardias, myocardial ischaemia, pericarditis, shingles, acute pulmonary oedema, sepsis, acute exacerbations of asthma, COPD, pulmonary embolism, pneumothorax, hyperventilation syndrome, care of the unconscious patient, cerebrovascular events, fitting, meningitis and septicaemia, diabetic emergencies, and the acute abdomen. For each topic the symptoms, clinical presentation, assessment, and treatment are outlined.

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Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always … More

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