Acute Medicine

Lisa Carroll RGN, MSc, Consultant Nurse Acute Medicine. University Hospital of North Staffordshire, UK.

Preface xi

Introduction xiii

1 Patient Assessment 1

Communication 1

History taking 3

The functional enquiry 6

The physical assessment 8

General inspection 11

Respiratory examination 12

Cardiovascular examination 14

Gastrointestinal examination 17

Neurological examination 18

Musculoskeletal examination 24

Post examination 25

Conclusion 25

2 Emergencies 27

Anaphylaxis 27

Cardio-respiratory arrest 29

Ethical Issues 36

3 Acute Poisoning and Drug Overdose 41

Deliberate self-harm 41

Paracetamol overdose 45

Aspirin overdose 48

Tricyclic antidepressant overdose 51

Heroin overdose 53

Alcohol overdose 54

The National Institute for Clinical Excellence (NICE) self-harm guideline 56

Alcohol withdrawal 58

Drug withdrawal 60

4 Infection 65

Sepsis and septic shock 65

Meningitis 67

Infective endocarditis 71

Gastroenteritis 75

Urinary tract infection (UTI) 77

Fever in the returning traveller 79

Hot swollen joints 83

Antimicrobial resistance 86

5 Respiratory Conditions 89

Asthma 89

Chronic obstructive pulmonary disease (COPD) 93

Pulmonary embolism 96

Community and hospital acquired pneumonia 100

Pneumothorax 104

Type I respiratory failure 106

Type II respiratory failure 108

6 Cardiovascular Conditions 113

Acute coronary syndromes (ACS) 113

Stable angina 113

Unstable angina 114

Non-ST elevation myocardial infarction 116

ST elevation myocardial infarction 117

DIGAMI 121

Arrhythmias 121

Bradycardia 123

Tachycardia 126

Atrial fibrillation (AF) 129

Cardiac failure 132

Deep vein thrombosis (DVT) 134

Aortic dissection 136

Cardiac tamponade 138

7 Gatrointestinal Conditions 143

Upper gastrointestinal bleeding (GI bleed) 143

Variceal bleeding 145

Acute liver failure with encephalopathy 147

Acute ulcerative colitis and crohn’s disease 149

8 Metabolic Conditions 153

Diabetic ketoacidosis (DKA) 153

Hyperosmolar non-ketotic state (HONK) 155

Hypoglycaemia 157

Hyperglycaemia in the critically ill patient 159

Hypercalcaemia 162

Hyponatraemia 164

Hypernatraemia 166

Hypokalaemia 168

Hyperkalaemia 170

Addisonian crisis 172

Thyroid crisis (thyroid storm) 174

Myxedema crisis 177

9 Neurological Conditions 181

Status epilepticus 181

Stroke 184

Transient ischaemic attacks (TIA) 186

Isolated seizure and unexplained loss of consciousness 188

Headache 190

Subarachnoid haemorrhage (SAH) 192

Spinal cord compression 195

10 Renovascular Conditions 197

Acute renal failure (ARF) 197

Accelerated (malignant) hypertension 199

11 Elderly Care 203

Hypothermia 203

Confusion 205

12 Haematological Conditions 209

Severe anaemia 209

Sickle cell crisis 212

Neutropenic sepsis 215

Blood transfusion guidance 217

13 Advanced Practice 223

An overview of advanced practice 223

The challenges of advanced practice 225

Legal perspective 225

Ethical principles 226

Informed consent 228

Assessment of capacity 229

Prescribing 231

Patient group directions 233

Conclusion 234

Appendices

Appendix I Examples of Clinical Management Plans 237

Appendix II Examples of Patient Group Directions 245

Glossary 255

Index 259