Index to emergency topics ‘Don’t go so fast: we’re in a hurry!’—Talleyrand to his coachman. Acute abdomen 606 Malignant hypertension 140 Acute kidney injury 298 Meningitis 822 Addisonian crisis 836 Meningococcaemia 822 Anaphylaxis 794 Myocardial infarction 796 Aneurysm, abdominal aortic 654 Needle pericardiocentesis 773 intracranial/extradural 78, 482 Neutropenic sepsis 352 gastrointestinal 256, 820 Obstructive uropathy 641 rectal 629 variceal 257, 820 Oncological emergencies 528 Antidotes, poisoning 842 Opioid poisoning 842 Arrhythmias, broad complex 128, 804 Overdose 838–44 narrow complex, SVT 126, 806 Pacemaker, temporary 776 Asthma 810 Pericardiocentesis 773 Asystole 895 Phaeochromocytoma 837 Atrial fl utter/fi brillation Pneumonia 816 Bacterial shock 790 Pneumothorax 814 Blast injury 851 Poisoning 838–44 Bradycardia 124 Potassium, hyperkalaemia 674 hypokalaemia 674 Burns 846 Pulmonary embolism 818 Cardiac arrest 894 (Fig A3) Respiratory arrest 894 (Fig A3) Cardiogenic tamponade 802 Respiratory failure 188 Cardioversion, DC 770 Resuscitation 894 (Fig A3) Central line insertion (CVP line) 774 Rheumatological emergencies 538 Cerebral oedema 830 Shock 790 Chest drain 766 Smoke inhalation 847 Coma 786 Sodium, hypernatraemia 672 Cricothyrotomy 772 hyponatraemia 672 Cyanosis 186–9 Spinal cord compression 466, 543 Cut-down 761 Status asthmaticus 810 Defi brillation 770, 894 (Fig A3) Status epilepticus 826 Diabetes emergencies 832–4 Stroke 470 Disseminated intravascular coagulopathy (DIC) 352 Superior vena cava obstruction 528 Disaster, major 850 Supraventricular tachycardia (SVT) 806 Encephalitis 824 Testicular torsion 652 Epilepsy, status 826 Thrombotic thrombocytopenic purpura Extradural haemorrhage 482 (TTP) 315 Thyroid storm 834 Fluids, IV 666, 790 Transfusion reaction 349 Haematemesis 256–7 Varices, bleeding 257, 820 Haemorrhage 790 Vasculitis, acute systemic 556 Hyperthermia 790, 838 Venous thromboembolism, leg 656 Hypoglycaemia 214, 834 pulmonary 818 Hypothermia 848 Ventricular arrhythmias 128, 804 Intracranial pressure, raised 830 Ventricular failure, left 800 Ischaemic limb 656 Ventricular fi brillation 894 (Fig A3) Malaria 416 Ventricular tachycardia 128, 804 Malignant hyperpyrexia 572 __OOHHCCMM__1100ee..iinnddbb bb 0022//0055//22001177 1199::0066 Common haematology values Haemoglobin men: 130–180g/L p324 women: 115–160g/L p324 Mean cell volume, MCV 76–96fL p326; p332 Platelets 150–400 ≈ 109/L p364 White cells (total) 4–11 ≈ 109/L p330 neutrophils 2.0–7.5 ≈ 109/L p330 lymphocytes 1.0–4.5 ≈ 109/L p330 eosinophils 0.04–0.4 ≈ 109/L p330 Blood gases pH 7.35–7.45 p670 PaO2 >10.6kPa p670 PaCO2 4.7–6kPa p670 Base excess ± 2mmol/L p670 U&ES (urea and electrolytes) Sodium 135–145mmol/L p672 Potassium 3.5–5.3mmol/L p674 Creatinine 70–100μmol/L p298–301 Urea 2.5–6.7mmol/L p298–301 eGFR >60 p669 LFTS (liver function tests) Bilirubin 3–17μmol/L p272, p274 Alanine aminotransferase, ALT 5–35IU/L p272, p274 Aspartate transaminase, AST 5–35IU/L p272, p274 Alkaline phosphatase, ALP 30–130IU/L p272, p274 (non-pregnant adults) Albumin 35–50g/L p686 Cardiac enzymes Troponin T <99th percentile of p119 upper reference limit: value depends on local assay Other biochemical values Cholesterol <5mmol/L p690 Triglycerides Fasting: 0.5–2.3mmol/L p690 Amylase 0–180 IU/dL p636 C-reactive protein, CRP <10mg/L p686 Corrected calcium 2.12–2.60mmol/L p676 Glucose, fasting 3.5–5.5mmol/L p206 Thyroid stimulating hormone, TSH 0.5–4.2mU/L p216 For all other reference intervals, see p750–7 __OOHHCCMM__1100ee..iinnddbb cc 0022//0055//22001177 1199::0066 He moved N. 48 all the brightest gems N. 24 faster and faster towards the N. 18 ever-growing bucket of lost hopes; N. 14 had there been just one more year of peace the battalion would have made N. 12 a floating system of perpetual drainage. A silent fall of immense snow came near oily N. 10 remains of the recently eaten supper on the table. We drove on in our old sunless walnut. Presently N. 8 classical eggs ticked in the new afternoon shadows. We were instructed by my cousin Jasper not to exercise by country N. 6 house visiting unless accompanied by thirteen geese or gangsters. The modern American did not prevail over the pair of redundant bronze puppies. N. 5 The worn-out principle is a bad omen which I am never glad to ransom in August. Reading tests Hold this chart (well-illuminated) 30cm away, and record the smallest type read (eg N12 left eye, N6 right eye, spectacles worn) or object named accurately. __OOHHCCMM__1100ee..iinnddbb dd 0022//0055//22001177 1199::0066 OXFORD HANDBOOK OF CLINICAL MEDICINE TENTH EDITION Ian B. Wilkinson Tim Raine Kate Wiles Anna Goodhart Catriona Hall Harriet O’Neill 3 __OOHHCCMM__1100ee..iinnddbb ii 0022//0055//22001177 1199::0066 Oxford University Press, Great Clarendon Street, Oxford OX2 6DP 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. Published in the United States by Oxford University Press Inc., New York © Oxford University Press, 2017 The moral rights of the authors have been asserted Database right Oxford University Press (maker) First published 1985 Fifth edition 2001 Tenth edition 2017 (RA Hope & JM Longmore) (JM Longmore & IB Wilkinson) (IB Wilkinson, T Raine & K Wiles) Second edition 1989 Sixth edition 2004 Third edition 1993 Seventh edition 2007 Fourth edition 1998 Eighth edition 2010 Ninth edition 2014 Translations: Chinese French Hungarian Polish Russian Czech German Indonesian Portuguese Spanish Estonian Greek Italian Romanian 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, 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 book in any other binding or cover and you must impose the same condition on any acquirer. British Library Cataloguing in Publication Data Data available Library of Congress Control Number: 2017939060 Typeset by GreenGate Publishing Services, Tonbridge, UK; printed in China by C&C Off set Printing Co. Ltd. ISBN 978-0-19-968990-3 Drugs Except where otherwise stated, recommendations are for the non-pregnant adult who is not breastfeeding and who has reasonable renal and hepatic function. We have made every eff ort to check this text, but it is still possible that drug or other errors have been missed. OUP makes no representation, express or implied, that doses are correct. Readers are urged to check with the most up to date prod- uct information, 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. For updates/corrections, see http://www.oup.co.uk/academic/series/oxhmed/updates/ __OOHHCCMM__1100ee..iinnddbb iiii 0022//0055//22001177 1199::0066 Contents Each chapter’s contents are detailed on its fi rst page Prefaces to the fi rst and tenth editions iv Acknowledgements v Symbols and abbreviations vi 1 Thinking about medicine 0 2 History and examination 24 3 Cardiovascular medicine 92 4 Chest medicine 160 5 Endocrinology 202 6 Gastroenterology 242 7 Renal medicine 292 8 Haematology 322 9 Infectious diseases 378 10 Neurology 444 11 Oncology and palliative care 518 12 Rheumatology 538 13 Surgery 564 14 Clinical chemistry 662 15 Eponymous syndromes 694 16 Radiology 718 17 Reference intervals, etc. 750 18 Practical procedures 758 19 Emergencies 778 20 References 852 Index 868 Early warning score 892 Cardiac arrest 894 __OOHHCCMM__1100ee..iinnddbb iiiiii 0022//0055//22001177 1199::0066 Preface to the tenth edition This is the fi rst edition of the book without either of the original authors—Tony Hope and Murray Longmore. Both have now moved on to do other things, and enjoy a well-earned rest from authorship. In this book, I am joined by a Nephrologist, Gas- troenterologist, and trainees destined for careers in Cardiology, Dermatology, and General Practice. Five physicians, each with very diff erent interests and approaches, yet bringing their own knowledge, expertise, and styles. When combined with that of our specialist and junior readers, I hope this creates a book that is greater than the sum of its parts, yet true to the original concept and ethos of the original authors. Life and medicine have moved on in the 30 years since the fi rst edition was published, but medicine and science are largely iterative; true novel ‘ground-breaking’ or ‘prac- tice-changing’ discoveries are rare, to quote Isaac Newton: ‘If I have seen further, it is by standing on the shoulders of giants’. Therefore, when we set about writing this edition we drew inspiration from the original book and its authors; updating, adding, and clarifying, but trying to retain the unique feel and perspective that the OHCM has provided to generations of trainees and clinicians. IBW, 2017 Preface to the fi rst edition We wrote this book not because we know so much, but because we know we remember so little…the problem is not simply the quantity of information, but the diversity of places from which it is dispensed. Trailing eagerly behind the surgeon, the student is admonished never to forget alcohol withdrawal as a cause of post- operative confusion. The scrap of paper on which this is written spends a month in the pocket before being lost for ever in the laundry. At diff erent times, and in inconvenient places, a number of other causes may be presented to the student. Not only are these causes and aphorisms never brought together, but when, as a surgical house offi cer, the former student faces a confused patient, none is to hand. We aim to encourage the doctor to enjoy his patients: in doing so we believe he will prosper in the practice of medicine. For a long time now, house offi cers have been encouraged to adopt monstrous proportions in order to straddle the diverse pinnacles of clinical science and clinical experience. We hope that this book will make this endeavour a little easier by moving a cumulative memory burden from the mind into the pocket, and by removing some of the fears that are naturally felt when starting a career in medicine, thereby freely allowing the doctor’s clinical acumen to grow by the slow accretion of many, many days and nights. RA Hope and JM Longmore, 1985 __OOHHCCMM__1100ee..iinnddbb iivv 0022//0055//22001177 1199::0066 Acknowledgements Heart-felt thanks to our advisers on specifi c sections—each is acknowledged on the chapter’s fi rst page. Thanks also to our junior readers, Charles Badu-Boateng, Clare Coggins, and Luke Walls. We especially thank all our mentors and teach- ers, and patients who provide our inspiration and remind us that one never stops learning. We acknowledge the Department of Radiology at both the Leeds Teach- ing Hospitals NHS Trust and the Norfolk and Norwich University Hospital for their kind help in providing many images, particularly Dr Edmund Godfrey, whose tire- less hunt for perfect images has improved so many chapters. Readers’ comments These have formed a vital part of our endeavour to provide an accurate, comprehensive, and up-to-date text. We sincerely thank the many stu- dents, doctors, and other health professionals who have found the time and the generosity to write to us on our Reader’s Comments Cards, in editions past, or, in more recent times, via the web. These have now become so numerous for past edi- tions that they cannot all be listed. See http://www.oup.com/uk/academic/series/ oxhmed/links for a full list, and our very heart-felt tokens of thanks. 3rd-party web addresses We disclaim any responsibility for 3rd-party content. __OOHHCCMM__1100ee..iinnddbb vv 0022//0055//22001177 1199::0066