JaypeeDigital | eBook Reader

Emergency Medicine RK Singal, AK Agarwal, DG Jain, Rajesh Upadhyay

1:ABC of Emergency Room Management
- Organisation of emergency service
- The chain of care
- Initial evaluation
- Primary survey
- Resuscitation
- Secondary survey
- Definitive care
- Conclusions
2:Basics of Emergency Room Management
- Primary assessment and management of the patient
- A – Airway
- B – Breathing
- C – Circulation
- D – Disability
- E – Environment and exposure
- F – Fits
- G – Glucose
- H – History
- I–Immediate analgesia and investigations
- Secondary assessment and management
- Management rather than diagnosis
3:Management of Paediatric Problems in the Emergency Room
- Anticipate
- Activate
- Act
4:Acute Coronary Syndrome
- Pathophysiology
- Clinical evaluation
- Risk stratification in acute coronary syndromes
- Treatment
- Dedicated randomised control trials
- Conclusion (see flowchart for details)
5:Acute Myocardial Infarction and its Early Complications
- Pathophysiology
- Risk factors
- Clinical features of AMI
  - History and prodrome
  - Physical findings
- Diagnosis of acute myocardial infarction
  - Electrocardiography
- Areas of infarction
- Serum cardiac markers and the temporal profile of AMI
- Management of AMI
- Early complications of AMI
- Other complications
6:Management of Hypertensive Crises
- Definitions and terminology
- Pathophysiology
- Patients at risk
- Signs, symptoms, and diagnosis
  - History and physical examination
- Laboratory studies
- Immediate management and goals of therapy
- Treatment
  - Treatment of hypertensive emergency
  - Treatment of hypertensive urgency
- Special clinical situations
  - Summary and conclusions
7:Congestive Heart Failure
- Definition
- Aetiology and pathophysiology
- Diagnosis and evaluation of patients with heart failure
  - History
  - Physical findings
- Laboratory investigations
- BNP and CHF diagnosis: A new paradigm
- Differential diagnosis
- Management of heart failure in the emergency room
- Management of heart failure
- Conclusions
8:Narrow Complex Tachycardia
- Narrow QRS complex tachycardia (NCT):
  - Irregular narrow QRS complex tachycardia
  - Atrial fibrillation
- Diagnosis
9:Wide Complex Tachycardia
- Regular wide complex tachycardia
- ECG
- Irregular polymorphic WCT
  - Polymorphic ventricular tachycardia with normal QT
  - Polymorphic ventricular tachycardia with long QT
- Treatment
- Conclusion
10:Complete Heart Block
- Cardiac conduction system
- Definitions
- Electrocardiographic recognition
- Causes of complete heart block
- Symptoms and their underlying pathophysiology
  - Syncope
  - Stokes-Adams attacks
- Approach to patients with CHB
- Management
- Special situations
- Use of pacemakers in AMI
- Vagotonic block
  - Features of vagally-mediated bradyarrhythmias
  - Treatment
- Congenital CHB
- Paroxysmal AV block
- Inducible AV block
- CHB in presence of AF
11:Cardiac Tamponade
- Pathophysiology
- Aetiology
- Clinical features
- Variants of cardiac tamponade
- Diagnosis
- Other investigations
- Management
- Conclusion
12:Diabetic Coma
- Diabetic ketoacidosis
  - Pathogenesis of DKA
- Clinical features
- Complications of DKA therapy
- Lactic acidosis
- Hypoglycaemia
13:Thyroid Emergencies
- Thyroid endocrine basics
- Evaluation of thyroid function (laboratory and imaging)
- Thyroid storm
- Suggested Reading
  - Thyroid storm
14:Other Endocrinal Emergencies
- Addisonian crisis
- Hypercalcaemia
- Hypocalcaemia
- Hypoglycaemia
15:Acute Upper Gastrointestinal Bleeding
- Clinical presentation
- Causes of UGI bleed
- Principles of management
- UGI bleed due to other causes
16:Acute Liver Failure
- Definitions
- Complications and sequelae of ALF
- Aetiology
- Prognostic criteria
- Management
17:Management of Acute Pancreatitis
- Terminology and definitions
- Aetiology
- Clinical presentation
- Investigations to establish diagnosis
- Treatment
- Specific management of gallstone pancreatitis
  - Endoscopic treatment of acute biliary pancreatitis
  - Timing of cholecystectomy
- Late complications
- Recognition of infected necrosis
- Surgery in necrotising acute pancreatitis
- Clinical course and outcome
18:Approach to Bleeding Disorders
- Basic pathophysiology
  - Investigations which are not helpful in excluding a bleeding disorder
  - Precautions in interpreting laboratory values, and special requests to the laboratory
- Important causes of bleeding seen in medical practice
- Platelet disorders
- Thrombocytopenia
- Platelet function defects
- Acquired platelet function defects
- Inherited platelet function defects
- Coagulation disorders
- Inherited disorders
- Combined disorders
- Vascular disorders
- Summary of management in case of emergency bleeding
19:Severe and Complicated Malaria
- Complicated malaria
- Pathophysiology
- Clinical features
- Malaria in special situations
  - HIV
  - Children
- DiagnosiS
- Treatment
- Conclusion
20:Dengue Haemorrhagic Fever and Dengue Shock Syndrome
- Dengue fever
- Laboratory confirmation of diagnosis
- Unusual manifestations of DHF and DSS
- Differential diagnosis
- Monitoring of anti-shock therapy
21:Acute Meningitis
- Bacterial meningitis
- Pathogenesis
- Epidemiology and causes
- Clinical features
- Prognostic factors
- Diagnosis
- Management
- Tuberculous meningitis
- Viral meningitis
22:Septic Shock
- Definitions
- Epidemiology
- Aetiology
- Pathophysiology of septic shock
- Clinical presentation
  - Symptoms
  - Physical signs
- Differential diagnosis
- Laboratory investigations
- Management
- Vasopressors
- Prognosis
- Conclusions
23:Management of Needle Stick Injuries
- Conclusion
24:Acute Renal Failure
- Aetiology
- Spectrum of acute renal failure
- Pathogenesis
- Clinical features
- Diagnosis of ARF
  - Pre-renal azotaemia versus ATN
- ARF versus acute-on-chronic renal failure
  - Urinalysis
  - Role of renal biopsy
- Prevention of ARF
  - Resuscitation
  - Role of reno-protective drugs
- Management of ARF
- Prognosis
- Acute cortical necrosis
- Summary
25:Rapidly Progressive Glomerulonephritis
- Epidemiology
- Process of crescent formation
- Clinical features
- Classification
- Summary
26:Raised Intracranial Pressure
- Aetiology
- Clinical features
- Effects of raised ICP
- Management
  - Diagnosis
- Treatment
  - Treatment of primary cause
  - Treatment of raised ICP
    - General measures and monitoring in a critically ill patient with raised ICP
- Specific measures
27:Stroke Management in the first Six Hours
- Pathophysiology
- Diagnostic modalities
- Pre-hospital management
- Stroke units
- Management in hospital/emergency unit
- Thrombolysis or reperfusion therapy
  - Patients who are eligible for thrombolytic therapy with rt-PA20
- Intra-arterial thrombolytic therapy
- Management of intracerebral haemorrhage
- Conclusions
- Key points
  - Time is brain, evaluate quickly and confirm by CT at the earliest.
28:Status Epilepticus
- Definition
- Epidemiology
- Aetiology
- Classification
- Clinical features
- Pathogenesis of status epilepticus
- Anatomical localisation
- CNS injury
- Systemic pathophysiology
- Differential diagnosis
- Diagnostic workup
- Management
- Hospital management
- Follow-up treatment
- Refractory status epilepticus
- Prognosis
- Conclusion
29:Acute Idiopathic Inflammatory Neuropathies (AIINs)
- GBS subtypes1–3
- Incidence
- Antecedent events
- Pathology
- Immunopathogenesis
- Clinical features
- Signs and symptoms
- Special features
- The axonal forms of GBS
- Miller-Fisher syndrome (MFS)
- Pure sensory syndrome
- Acute pandysautonomia
- Recurrent GBS
- Differential diagnosis
- Course and prognosis
- Common complications of GBS5
- Diagnosis of GBS
  - Diagnosis of GBS is based on:
- Clinical profile
- CSF examination
  - Electrophysiological studies
  - Electrodiagnostic criteria of demyelination7
  - Electrodiagnostic criteria of axonal GBS
  - Other tests
- Management
- Specific therapy
  - Selection of patients for PE / IVIg therapy
  - Selection criteria are based on14
  - PE or IVIg should be considered in all patients who:
  - Plasma exchange (PE)
  - Treatment protocols and number of sittings of PE
  - Volume of PE
  - Other therapeutic modalities akin to plasma exchange
  - Intravenous immune globulin (IVIg) therapy
  - Dose and mode of administration of IVIg
  - Side effects of IVIg
  - Efficacy of IVIg
  - Plasma exchange vs. IVIg therapy
  - Combined use of PE and IVIG
  - Combined therapy of IVIg with steroids
  - Steroid therapy in GBS
  - General measures or supportive therapy in GBS
  - Assessment of respiratory function
  - Cardiovascular monitoring
  - Management of pain
  - Prophylaxis of deep vein thrombosis (DVT)
  - Physiotherapy
- Future therapies
30:Hypokalaemic Paralysis
- Familial (primary) hypokalaemic periodic paralysis (Hypo KPP)
- Thyrotoxic periodic paralysis (TPP)
- Barium poisoning
- Renal potassium loss
- Endocrine causes
- Gastrointestinal potassium loss
- Hypokalaemic paralyses – An Indian experience
31:Myasthenic Crisis
- Clinical features
- Management
- Prognosis
32:Oncologic Emergencies
- Spinal cord compression
- SVC syndrome
- Tumour lysis syndrome
- Hypercalcaemia of malignancy
- Hyperuricaemia
  - Treatment
- Lactic acidosis
- Hypoglycaemia
  - Pathophysiology
  - Therapy
- Adrenal failure
  - Clinical manifestations and management
33:Management of Acute Poisoning
- Resuscitation and initial stabilisation
- Diagnosis of type of toxin
- Non-specific treatment
- Specific therapy
- Supportive therapy
- Indications for admission
- Legal responsibilities of physicians
34:Common Poisonings in North India
- Aluminium phosphide
- Organophosphates and carbamates
- Organochlorines
- Kerosene oil
  - Clinical features
  - Management
- Phenol
  - Clinical features
  - Management
- Rodenticides
- Benzodiazepines
  - Clinical features
  - Treatment
- Ethylene dibromide
- Methanol (Methyl alcohol)
- Ethyl alcohol
- Methaemoglobinaemia-producing chemicals
- Datura
  - Clinical features
  - Management
- Cannabis
  - Clinical features
  - Management
- Oleander
  - Clinical features
  - Treatment
- Opium
  - Clinical features
  - Management
35:Snake Bite
- Clinical features
- Laboratory investigations
- Management of snake bites
- Elapid bites
- Viperine bites
- Anti-snake venom (ASV)
- Prognosis and mortality
36:Massive Haemoptysis
- Definition
- Aetiology
- Clinical assessment
  - History
  - Physical examination
- Management
- Outcome
- Conclusions
37:Acute Severe Asthma
- Acute severe asthma
- Clinical presentation
  - Assessment of severity of illness
- Management
38:Acute and Acute‒on‒Chronic Respiratory Failure
- Classification
- Aetiology and pathophysiology
- Clinical presentation
- Acute respiratory failure
  - History and physical examination
- Management
- Diagnosis
- Principles of treatment
- Acute-on-chronic respiratory failure
  - Acute vs. acute-on-chronic respiratory failure
  - Principles of treatment
- Chronic respiratory failure
  - History and physical examination
    - Manifestations of chronic hypoxaemia
    - Manifestations of chronic hypercapnia
- Management
- Diagnosis
- Principles of treatment
- Outcome
- Conclusions
39:Acute Respiratory Distress Syndrome (ARDS)
- ARDS?
- What is acute lung injury and what are the major conditions and causative factors, which are responsible for most of the episodes of ALI/ ARDS in clinical practice?
  - Mortality/morbidity
  - Age
- What are the stages of ARDS?
- What are the clinical and laboratory derangements of early and advanced ARDS?
- Is pulmonary artery catheterisation required for the diagnosis of ARDS?
- How does mechanical ventilation worsen pre-existing lung injury and produce VILI, i.e., ventilator-induced lung injury? What is the concept of epithelial cell apoptosis and organ dysfunction?
- Conclusion
40:Venous Thromboembolism (VTE), Deep Venous Thrombosis (DVT), and Pulmonary Embolism (PE)
- Diagnostic approach
  - DVT
- Physical examination
- Differential diagnosis
- Non-invasive testing for DVT
- Impedance plethysmography (IPG)
- Magnetic resonance imaging (MRI)
- Invasive contrast venography (CV)
- Other tests
- Pulmonary embolism
- The diagnostic approach to acute pulmonary embolism
- Differential diagnoses
- Pre-test probability for PE
- Diagnostic studies for PE
- Pitfalls in diagnosis of VTE
- Treatment of VTE
  - Pulmonary embolectomy
  - Venacaval filters
- Prophylaxis of VTE
41:Tension Pneumothorax
- Definition
- Predisposing factors
- Classification of pneumothorax
- Aetiological factors6, 1
- Pathophysiology
- Clinical manifestations of tension pneumothorax
- Diagnosis
  - Clinical confirmation of diagnosis
- Differential diagnosis
- Treatment
- Recurrence
- Follow-up
42:Emergencies in Rheumatology
- Classification of rheumatological emergencies
- Acute low backache
- Acute gout
- Acute arthritis
- Lupus flare
- Systemic vasculitides
- Scleroderma renal crisis
- Catastrophic antiphospholipid syndrome (CAPS)
- Erythema nodosum (EN)
- Reflex sympathetic dystrophy syndrome (RSDS)
- Conclusions
43:Severe Dehydration
- Causes of dehydration
- Types of dehydration
- Assessment of dehydration
- Laboratory investigations
- General principles of management
- Fluid resuscitation in dehydration
- Other metabolic derangements
44:Acute Abdomen in Non-Surgical Disorders
- Definition of the acute abdomen
- Types of abdominal pain
- History
- Laboratory evaluation
- Diagnostic imaging
45:Heat-related Illness
- Physiology
- Classification
- Heat cramps
- Heat exhaution
- Heat stroke
46:Acute Transfusion Reactions
- Aetiopathogenesis
- Approach
  - Investigations
- Management
- Deterrence/prevention
- Prognosis
- Medical/legal pitfalls
47:The Physician and An Emergency Patient
- Medico-legal emergency patient

INDEX

TOC
Index

×

Chapter Notes