Rapid Emergency and Unscheduled Care

Jason Lugg, Lead Nurse & Emergency Nurse Practitioner, Emergency Department, Bristol Royal Infirmary & Associate Lecturer in Emergency Care, University of the West of England. Oliver Phipps, Advanced Nurse Practitioner, North Bristol NHS Trust & Visiting Lecturer University of the West of England.

List of Contributors x

Preface xi

Acknowledgements xii

List of Abbreviations xiii

Cardiovascular Abdominal aortic aneurysm 3

Acute coronary syndrome 4

Anaphylaxis 5

Aortic dissection (thoracic) 8

Atrial fibrillation 9

Bradycardia 10

Deep vein thrombosis 12

Heart failure 13

Hypertension 14

Ischaemic lower limb 15

Myocarditis 16

Pericarditis 17

Shock 18

Tachycardia 19

Ear, nose and throat (ENT) Acute sore throat 23

Auricular haematoma 24

Epiglottitis 24

Epistaxis 25

Foreign bodies 26

Glandular fever 27

Mumps 28

Nose injury 28

Otitis externa (acute) 29

Otitis media (acute) 29

Peritonsillar abscess (quinsy) 30

Endocrine Diabetes mellitus: Type 1 35

Diabetes mellitus: Type 2 36

Diabetic ketoacidosis (DKA) 36

Hyperkalaemia 38

Hypokalaemia 38

Gastroenterology Abdominal trauma 43

Appendicitis 44

Biliary colic 45

Cholecystitis (acute) 45

Crohn’s disease 46

Diverticulitis 47

Gastroenteritis 48

Gastrointestinal bleeding (upper) 49

Gastrointestinal bleeding (lower) 52

Gastrointestinal perforation 52

Gastro‐oesophageal reflux disease (GORD) 53

Irritable bowel syndrome (IBS) 54

Pancreatitis (acute) 55

Pancreatitis (chronic) 56

Paralytic ileus 57

Peptic ulcer disease 57

Peritonitis 58

Small bowel obstruction 59

Ulcerative colitis 60

Genitourinary Acute kidney injury (AKI) 65

Chronic renal failure 66

Renal colic 67

Testicular torsion 67

Urinary tract infection (UTI) 68

Infections sepsis and infectious diseases Malaria 73

Sepsis 74

Septic arthritis 75

Typhoid 76

Mental health emergencies Mental health overview 81

Characteristics of different psychiatric illnesses 82

Acute confusion (delirium) 83

Acute psychosis 84

Acute anxiety and panic attacks 85

Deliberate self‐harm 86

Mental Health Act overview 87

Musculoskeletal Achilles tendon injuries 91

Ankle injuries 92

Back pain (acute) 93

Calcanium fractures 95

Compartment syndrome 95

Elbow injuries 96

Femoral injuries 99

Foot injuries 101

Gastrocnemius muscle tears 103

Hand injuries 104

Knee injuries 107

Neck pain: Traumatic neck sprain 110

Pelvic fractures 111

Plantar fasciitis 111

Pulled elbow 112

Shoulder and clavicle injuries 113

Tibial/fibular injuries 114

Traumatic amputation 116

Upper limb injuries 116

Volar plate injuries 118

Wrist injuries 118

Neurology Bell’s palsy 123

Encephalitis 124

Epilepsy 125

Giant cell arteritis 126

Guillain–Barré syndrome 127

Meningitis 128

Migraine 129

Minor head injuries 130

Status epilepticus 131

Stroke (cerebrovascular event) 132

Subarachnoid haemorrhage 133

Subdural haemorrhage 134

Obstetrics and gynaecology Eclampsia 139

Ectopic pregnancy 139

Hyperemesis gravidarum 141

Miscarriage 141

Pre‐eclampsia 142

Vaginal bleeding (late pregnancy) 143

Ophthalmology Acute angle‐closure glaucoma 147

Anterior uveitis 147

Blunt trauma 148

Chemical injury 149

Conjunctivitis 150

Corneal injury 150

Foreign bodies 151

Loss of vision 152

Subconjuctival haemorrhage 153

Superglue injuries 153

UV radiation injuries 154

Overdose and poisoning Alcohol misuse and intoxication 157

Carbon monoxide poisoning 158

Drug misuse 158

Paracetamol overdose 159

Poisoning 160

Respiratory Asthma 165

Chest sepsis (including pneumonia) 166

Chest wall injury 167

Chronic obstructive pulmonary disease (COPD) 168

Croup (acute laryngotracheobronchitis) 170

Cystic fibrosis 171

Flail chest 172

Haemothorax 173

Lung cancer 173

Open chest wound: Medical emergency 174

Pulmonary embolism 174

Pneumothorax (simple) 175

Tension pneumothorax: Medical emergency 176

Skin Abscesses 179

Animal bites 179

Burn to skin 180

Cellulitis 182

Dermatophyte infection of the skin: Body and groin 183

Human bite 184

Impetigo 185

Necrotising fasciitis 185

Scabies 186

Varicella infection 187

The electrocardiogram Electrocardiograph (ECG) 191

Atrial fibrillation 191

Atrial flutter 191

Asystole 192

First‐degree heart block 192

Normal sinus rhythm 192

Pulseless electrical activity (PEA) 192

Second‐degree heart block: Mobitz type 1 (Wenckebach) 193

Second‐degree heart block: Mobitz type 2 193

Sinus bradycardia 193

Sinus tachycardia 194

Supraventricular tachycardia (SVT) 194

Third‐degree heart block: Complete heart block 194

Torsade de pointes 194

Ventricular fibrillation 195

Ventricular standstill 195

Ventricular tachycardia (VT) 195

Index 197