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Oxford Handbook of Acute Medicine 4th Edition Punit
Ramrakha Digital Instant Download
Author(s): Punit Ramrakha, Kevin Moore, Amir Sam
ISBN(s): 9780198797425, 0198797427
Edition: 4
File Details: PDF, 31.71 MB
Year: 2019
Language: english
OXFORD MEDICAL PUBLICATIONS

Oxford Handbook of
Acute Medicine

ALGRAWANY
ii

Published and forthcoming Oxford Handbooks

Oxford Handbook for the Foundation Oxford Handbook of Infectious
Programme 5e Diseases and Microbiology 2e
Oxford Handbook of Acute Oxford Handbook of Integrated Dental
Medicine 4e Biosciences 2e
Oxford Handbook of Anaesthesia 4e Oxford Handbook of Humanitarian
Oxford Handbook of Cardiology 2e Medicine
Oxford Handbook of Clinical and Oxford Handbook of Key Clinical
Healthcare Research Evidence 2e
Oxford Handbook of Clinical and Oxford Handbook of Medical
Laboratory Investigation 4e Dermatology 2e
Oxford Handbook of Clinical Oxford Handbook of Medical Imaging
Dentistry 6e Oxford Handbook of Medical
Oxford Handbook of Clinical Sciences 2e
Diagnosis 3e Oxford Handbook for Medical School
Oxford Handbook of Clinical Oxford Handbook of Medical Statistics
Examination and Practical Skills 2e Oxford Handbook of Neonatology 2e
Oxford Handbook of Clinical Oxford Handbook of Nephrology and
Haematology 4e Hypertension 2e
Oxford Handbook of Clinical Oxford Handbook of Neurology 2e
Immunology and Allergy 3e Oxford Handbook of Nutrition and
Oxford Handbook of Clinical Dietetics 2e
Medicine –​Mini Edition 10e Oxford Handbook of Obstetrics and
Oxford Handbook of Clinical Gynaecology 3e
Medicine 10e Oxford Handbook of Occupational
Oxford Handbook of Clinical Pathology Health 2e
Oxford Handbook of Clinical Oxford Handbook of Oncology 3e
Pharmacy 3e Oxford Handbook of Operative
Oxford Handbook of Clinical Surgery 3e
Specialties 10e Oxford Handbook of
Oxford Handbook of Clinical Surgery 4e Ophthalmology 4e
Oxford Handbook of Complementary Oxford Handbook of Oral and
Medicine Maxillofacial Surgery 2e
Oxford Handbook of Critical Care 3e Oxford Handbook of Orthopaedics
Oxford Handbook of Dental and Trauma
Patient Care Oxford Handbook of Paediatrics 2e
Oxford Handbook of Dialysis 4e Oxford Handbook of Pain Management
Oxford Handbook of Emergency Oxford Handbook of Palliative Care 3e
Medicine 4e Oxford Handbook of Practical Drug
Oxford Handbook of Endocrinology Therapy 2e
and Diabetes 3e Oxford Handbook of Pre-​Hospital Care
Oxford Handbook of ENT and Head Oxford Handbook of Psychiatry 3e
and Neck Surgery 2e Oxford Handbook of Public Health
Oxford Handbook of Epidemiology for Practice 3e
Clinicians Oxford Handbook of Rehabilitation
Oxford Handbook of Expedition and Medicine 3e
Wilderness Medicine 2e Oxford Handbook of Reproductive
Oxford Handbook of Forensic Medicine Medicine & Family Planning 2e
Oxford Handbook of Gastroenterology Oxford Handbook of Respiratory
& Hepatology 2e Medicine 3e
Oxford Handbook of General Oxford Handbook of Rheumatology 4e
Practice 4e Oxford Handbook of Sport and Exercise
Oxford Handbook of Genetics Medicine 2e
Oxford Handbook of Genitourinary Handbook of Surgical Consent
Medicine, HIV, and Sexual Health 2e Oxford Handbook of Tropical
Oxford Handbook of Geriatric Medicine 4e
Medicine 3e Oxford Handbook of Urology 4e
Oxford Handbook of
Acute
Medicine
FOURTH EDITION

Punit S. Ramrakha
Consultant Cardiologist
Buckinghamshire Hospitals NHS Trust
and Hammersmith Hospital
London, UK

Kevin P. Moore
Professor of Hepatology
Royal Free and University College London
Medical School
University College London, UK

Amir H. Sam
Consultant Physician and Endocrinologist
Hammersmith Hospital,
and Reader in Endocrinology
Imperial College London, UK

1
ALGRAWANY
iv

1
Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Punit S. Ramrakha and Kevin P. Moore 1997, 2004, 2010, 2019
The moral rights of the authors have been asserted
First edition published 1997
Second edition published 2004
Third edition published 2010
Fourth edition published 2019
Impression: 1
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by licence or under terms agreed with the appropriate reprographics
rights organization. Enquiries concerning reproduction outside the scope of the
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address above
You must not circulate this work in any other form
and you must impose this same condition on any acquirer
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America
British Library Cataloguing in Publication Data
Data available
Library of Congress Control Number: 2018941855
ISBN 978–​0–​19–​879742–​5
Printed and bound in China by
C&C Offset Printing Co., Ltd.
Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check
the product information and clinical procedures with the most up-​to-​date
published product information and data sheets provided by the manufacturers
and the most recent codes of conduct and safety regulations. The authors and
the publishers do not accept responsibility or legal liability for any errors in the
text or for the misuse or misapplication of material in this work. Except where
otherwise stated, drug dosages and recommendations are for the non-​pregnant
adult who is not breast-​feeding
Links to third party websites are provided by Oxford in good faith and
for information only. Oxford disclaims any responsibility for the materials
contained in any third party website referenced in this work.
 v

Foreword to fourth edition

The first edition of the Oxford Handbook of Acute Medicine was published
in 1997. Since then, acute medicine has evolved as a fully established spe-
cialty within the UK, and over 95% of hospitals now have an acute med-
ical unit. Importantly, acute medicine is developing in Europe and Australia
as part of providing high-​quality care for patients presenting as a medical
emergency to hospital. Such patients now constitute the largest group of
patients occupying inpatient hospital beds. It is imperative therefore that
all staff are trained in the management of acute medical emergencies and,
importantly, have easy access to information to support the management of
this acutely unwell subgroup of patients. This textbook is clearly structured
and is supported by useful diagrams and algorithms, and hence the informa-
tion is readily accessible. The practical procedure section is comprehensive.
While many practising clinicians will not be required to undertake all these
procedures, they will be involved in discussion on these issues with patients
and relatives, and this text will be an invaluable guide.
The handbook series from Oxford University Press already provides
useful information to many clinicians working in clinical practice. Irrespective
of age or seniority, for clinicians directly involved in the early diagnosis and
management of patients who present acutely, this book will provide a con-
cise aid. The clear and up-​to-​date content of this text reflects the experi-
ence of the authors, and I am personally delighted to provide a foreword
to a book which will undoubtedly help support the growing number of
trainees working in the field of acute medicine.
Derek Bell
Professor of Acute Medicine
Imperial College London

ALGRAWANY
vi

vi

Preface

The management of acute medical emergencies is the most demanding and

rewarding aspect of medical training. The aim of this handbook is to give
confidence to junior doctors to manage acute medical problems effectively
and safely. This edition has been updated to ensure that every aspect of
the care recommended is in line with current clinical guidelines. The fourth
edition of the Oxford Handbook of Acute Medicine includes summary boxes
for the key points in the management of common medical emergencies.
These concise and practical ‘management key points’ can be a useful guide
to junior doctors in the emergency department. The layout of the book
reflects clinical practice: assessment, differential diagnosis, immediate man-
agement, and some aspects of long-​term therapy. Throughout the book,
the text commonly exceeds that required for the management of specialist
problems by the generalist. This is deliberate, but intended, to provide the
doctor with an understanding of specialist interventions, so that they are
more conversant with what is possible and what is happening to their pa-
tient. We have included a new section on acute medicine and the older
patient.
A word of advice—​patients who present acutely ill are frequently scared
and need to be kept informed and to feel safe, however busy you are. Being
admitted to hospital means you lose control of your life. Thus, it is our duty
as their doctor to make all of our patients feel safe and cared for, and to
keep them informed of plans and what is happening to them.
 vii

Acknowledgements

We would like to thank all of the contributors who provided initial drafts
of chapters which have evolved over time, as well as friends and col-
leagues who gave up their time to read a chapter and verify its accuracy.
We would also like to thank OUP for their encouragement during the re-​
writing of this book. PSR is indebted to Sanjana, Aarav, and Dhruv for their
support and motivation. KPM is indebted to Janet, Alice, and Thomas for
their continued patience when the portable computer accompanied family
holidays. Finally, we would like to acknowledge the environment at the
Hammersmith Hospital where we trained and learned that acute medicine
is both interesting and fun.

ALGRAWANY
vii
 ix

Contents

Specialist reviewers x
Symbols and abbreviations xii

1 Cardiac emergencies    1
2 Respiratory emergencies 171
3 Gastroenterological emergencies 227
4 Renal emergencies 289
5 Shock 327
6 Neurological emergencies 347
7 Infectious diseases 469
8 Emergencies in HIV-​positive patients 505
9 Diabetes and endocrine emergencies 545
10 Haematological emergencies 607
11 Rheumatological emergencies 659
12 Dermatological emergencies 691
13 Psychiatric emergencies 711
14 Drug overdoses 739
15 Practical procedures 783
16 Differential diagnoses of common presentations 863
17 Acute medicine and the older patient 891

Appendix 907
Index 915

ALGRAWANY
Other documents randomly have
different content
 Machine Learning - Cheat Sheet
Second 2021 - Institute

Prepared by: Dr. Williams

Date: August 12, 2025

Quiz 1: Case studies and real-world applications

Learning Objective 1: Ethical considerations and implications
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 2: Experimental procedures and results
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 2: Diagram/Chart/Graph]
Learning Objective 3: Comparative analysis and synthesis
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 4: Assessment criteria and rubrics
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 5: Critical analysis and evaluation
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice Problem 5: Practical applications and examples
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Note: Experimental procedures and results
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Learning outcomes and objectives
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 8: Fundamental concepts and principles
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Experimental procedures and results
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice 2: Best practices and recommendations
Note: Assessment criteria and rubrics
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Assessment criteria and rubrics
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Key terms and definitions
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 13: Theoretical framework and methodology
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 14: Diagram/Chart/Graph]
Note: Key terms and definitions
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 15: Assessment criteria and rubrics
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Problem-solving strategies and techniques
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Experimental procedures and results
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 18: Assessment criteria and rubrics
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Best practices and recommendations
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Summary 3: Historical development and evolution
Definition: Study tips and learning strategies
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Comparative analysis and synthesis
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Example 22: Interdisciplinary approaches
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Study tips and learning strategies
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Ethical considerations and implications
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Example 25: Ethical considerations and implications
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Practical applications and examples
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Best practices and recommendations
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 28: Diagram/Chart/Graph]
Practice Problem 28: Key terms and definitions
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 29: Diagram/Chart/Graph]
Important: Theoretical framework and methodology
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 30: Diagram/Chart/Graph]
Discussion 4: Comparative analysis and synthesis
Key Concept: Learning outcomes and objectives
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Learning outcomes and objectives
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 32: Experimental procedures and results
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Problem-solving strategies and techniques
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Research findings and conclusions
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 35: Theoretical framework and methodology
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Current trends and future directions
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Practical applications and examples
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 38: Interdisciplinary approaches
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Research findings and conclusions
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Results 5: Theoretical framework and methodology
Note: Learning outcomes and objectives
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Case studies and real-world applications
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Interdisciplinary approaches
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Current trends and future directions
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 44: Interdisciplinary approaches
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 45: Ethical considerations and implications
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 46: Diagram/Chart/Graph]
Definition: Key terms and definitions
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice Problem 47: Assessment criteria and rubrics
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Problem-solving strategies and techniques
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Important: Theoretical framework and methodology
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Abstract 6: Research findings and conclusions
Key Concept: Comparative analysis and synthesis
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Comparative analysis and synthesis
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 52: Study tips and learning strategies
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Learning outcomes and objectives
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Example 54: Fundamental concepts and principles
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Key Concept: Ethical considerations and implications
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 56: Current trends and future directions
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Research findings and conclusions
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Note: Practical applications and examples
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Note: Practical applications and examples
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 60: Diagram/Chart/Graph]
Results 7: Assessment criteria and rubrics
Key Concept: Current trends and future directions
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 61: Interdisciplinary approaches
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 62: Fundamental concepts and principles
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Definition: Research findings and conclusions
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice Problem 64: Case studies and real-world applications
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Note: Problem-solving strategies and techniques
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Current trends and future directions
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Practical applications and examples
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Key Concept: Best practices and recommendations
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Assessment criteria and rubrics
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Review 8: Theoretical framework and methodology
Key Concept: Key terms and definitions
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Current trends and future directions
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Experimental procedures and results
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 73: Experimental procedures and results
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Literature review and discussion
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 75: Statistical analysis and interpretation
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 76: Learning outcomes and objectives
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
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