Emergency topics Arrests Adult resuscitation b p228 Obstetric resuscitation b p238 Neonatal resuscitation b p236 Paediatric resuscitation b p234 Trauma resuscitation b p232 Emergencies Abdominal pain b p288 Aggressive behaviour b p364 Anaphylaxis b p470 Bradyarrhythmia b p256 Breathlessness b p270 Burns b p466 Chest pain b p240 Clotting abnormalities b p404 Coma b p338 Diabetic ketoacidosis (DKA) b p326 Disseminated intravascular coagulation (DIC) b p405 GI bleed b p298 Hepatic encephalopathy b p312 High INR b p404 Hyperglycaemia b p324 Hyperkalaemia b p385 Hyperosmolar non-ketotic state (HONK) b p326 Hypertension b p262 Hypoglycaemia b p322 Hypokalaemia b p385 Hypotension b p472 Hypoxia b p270 Limb pain b p444 Liver failure b p312 Overdose b p492 Paediatric seizure b p345 Psychosis b p365 Rash b p410 Red eye b p426 Reduced GCS b p338 Renal failure/kidney injury b p372 Shock b p476 Shortness of breath b p270 Stridor b p284 Stroke b p350 Tachyarrhythmia b p248 Seizures b p344 OOHHFFPP..iinnddbb BB 3300//0055//22001144 1166::1177 Normal values Despite national eff orts to standardise laboratory testing and reporting,1 exact ranges vary between hospitals, these fi gures serve as a guide. Haematology see b p566 Hb–men 130–180g/L WBC 4–11 x 109/l Hb–women 115–160g/L • NØ 2.0–7.5 x 109/l (40–75%) MCV 76–96fl • LØ 1.3–3.5 x 109/l (20–45%) Plts 150–400 x 109/l • EØ 0.04–0.44 x 109/l (1–6%) Ferritin 12–200micrograms/l B12 197–866pg/ml TIBC 42–80μmol/l Folate 2–20micrograms/l Clotting see b p567 INR 0.8–1.2 APTTr 0.8–1.2 PT 11–16s APTT 35–45s Fibrinogen 1.5–4.0g/l D–dimer <0.3mg/ml (<300ng/ml) U+Es see b p568 Na+ 133–146mmol/l Ca2+ (adjusted)2.2–2.6mmol/l K+ 3.5–5.3mmol/l PO43– 0.8–1.5mmol/l Urea 2.5–7.8mmol/l Mg2+ 0.7–1.0mmol/l Creatinine 70–150μmol/l HCO3– 22–29mmol/l Osmolality 275–295mOsmol/kg Cl– 95–108mmol/l LFTs see b p569 ALP 30–130units/l Bilirubin 3–21micrograms/l ALT 3–35units/l Albumin 35–50g/l GGT 10–55units/l Total protein 60–80g/l Other Amylase 0–120units/l CRP <5mg/l Fasting glucose 3.5–6.0mmol/l ESR <20mm/h Immunoglobulins 24–37g/l CK 25–195units/l Cholesterol <6mmol/l LDH 70–250units/l Triglycerides 0.5–1.9mmol/l PSA 0–4ng/ml Blood gases see b p584 pH 7.35–7.45 PaO2 10.6–13.3kPa Base excess ±2mmol/l PaCO2 4.7–6.0kPa 1 See (cid:27)www.pathologyharmony.co.uk __OOHHFFPP..iinnddbb CC 3300//0055//22001144 1166::1177 This page intentionally left blank OXFORD MEDICAL PUBLICATIONS Oxford Handbook for the Foundation Programme __OOHHFFPP..iinnddbb ii 3300//0055//22001144 1166::1177 Published and forthcoming Oxford Handbooks Oxford Handbook for the Foundation Programme 4e Oxford Handbook of Acute Medicine 3e Oxford Handbook of Anaesthesia 3e Oxford Handbook of Applied Dental Sciences Oxford Handbook of Cardiology 2e Oxford Handbook of Clinical and Laboratory Investigation 3e Oxford Handbook of Clinical Dentistry 5e Oxford Handbook of Clinical Diagnosis 2e Oxford Handbook of Clinical Examination and Practical Skills 2e Oxford Handbook of Clinical Haematology 3e Oxford Handbook of Clinical Immunology and Allergy 3e Oxford Handbook of Clinical Medicine – Mini Edition 8e Oxford Handbook of Clinical Medicine 9e Oxford Handbook of Clinical Pathology Oxford Handbook of Clinical Pharmacy 2e Oxford Handbook of Clinical Rehabilitation 2e Oxford Handbook of Clinical Specialties 9e Oxford Handbook of Clinical Surgery 4e Oxford Handbook of Complementary Medicine Oxford Handbook of Critical Care 3e Oxford Handbook of Dental Patient Care Oxford Handbook of Dialysis 3e Oxford Handbook of Emergency Medicine 4e Oxford Handbook of Endocrinology and Diabetes 3e Oxford Handbook of ENT and Head and Neck Surgery 2e Oxford Handbook of Epidemiology for Clinicians Oxford Handbook of Expedition and Wilderness Medicine Oxford Handbook of Forensic Medicine Oxford Handbook of Gastroenterology & Hepatology 2e Oxford Handbook of General Practice 4e Oxford Handbook of Genetics Oxford Handbook of Genitourinary Medicine, HIV and AIDS 2e Oxford Handbook of Geriatric Medicine 2e Oxford Handbook of Infectious Diseases and Microbiology Oxford Handbook of Key Clinical Evidence Oxford Handbook of Medical Dermatology Oxford Handbook of Medical Imaging Oxford Handbook of Medical Sciences 2e Oxford Handbook of Medical Statistics Oxford Handbook of Neonatology Oxford Handbook of Nephrology and Hypertension 2e Oxford Handbook of Neurology 2e Oxford Handbook of Nutrition and Dietetics 2e Oxford Handbook of Obstetrics and Gynaecology 3e Oxford Handbook of Occupational Health 2e Oxford Handbook of Oncology 3e Oxford Handbook of Ophthalmology 2e Oxford Handbook of Oral and Maxillofacial Surgery Oxford Handbook of Orthopaedics and Trauma Oxford Handbook of Paediatrics 2e Oxford Handbook of Pain Management Oxford Handbook of Palliative Care 2e Oxford Handbook of Practical Drug Therapy 2e Oxford Handbook of Pre-Hospital Care Oxford Handbook of Psychiatry 3e Oxford Handbook of Public Health Practice 3e Oxford Handbook of Reproductive Medicine & Family Planning 2e Oxford Handbook of Respiratory Medicine 3e Oxford Handbook of Rheumatology 3e Oxford Handbook of Sport and Exercise Medicine 2e Handbook of Surgical Consent Oxford Handbook of Tropical Medicine 4e Oxford Handbook of Urology 3e OOHHFFPP..iinnddbb iiii 3300//0055//22001144 1166::1177 Oxford Handbook for the Foundation Programme Fourth edition Tim Raine Clinical Fellow, Wellcome Trust Clinical Lecturer, Gastroenterology, University of Cambridge, Honorary Registrar, Addenbrooke's Hospital, Cambridge James Dawson Consultant Anaesthetist, Nottingham Stephan Sanders Assistant Specialist at University of California, San Francisco Simon Eccles Consultant in Emergency Medicine, St Thomas Hospital, London 1 __OOHHFFPP..iinnddbb iiiiii 3300//0055//22001144 1166::1177 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 © Oxford University Press 2014 The moral rights of the authors have been asserted First edition published 2005 Second edition published 2008 Third edition published 2011 Fourth edition published 2014 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 above should be sent to the Rights Department, Oxford University Press, at the 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: 2014931114 ISBN 978–0–19–968381–9 Typeset by GreenGate Publishing Services, Tonbridge, UK Printed in Italy on acid-free paper by L.E.G.O. S.p.A.—Lavis TN 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. OHHFFPP PPrreelliimmss..iinndddd iivv 3300//0077//22001144 1166::0033 v Contents Detailed contents ix Preface xvii Acknowledgements xviii Symbols and abbreviations xix Introduction xxxiv 10 tips on being a safe junior doctor xxxvi 10 tips on being a happy doctor xxxvii 1 Being a doctor 1 2 Life on the wards 65 3 History and examination 123 4 Prescribing 167 5 Pharmacopoeia 181 6 Resuscitation 223 7 Cardiovascular 239 8 Respiratory 269 9 Gastroenterology 287 10 Endocrinology 321 11 Neurology and psychiatry 337 12 Fluids and renal 371 13 Haematology 391 14 Skin and eyes 409 15 Emergency department 433 16 Procedures 509 17 Interpreting results 565 18 Appendices 599 Index 615 Common adult drug doses 646 __OOHHFFPP..iinnddbb vv 3300//0055//22001144 1166::1177 This page intentionally left blank