Thomas Hughes, Bt, OBE, MSc, MBA, MRCP, FRCS, FRCEM, FBCS is a Consultant in Emergency Medicine at the John Radcliffe Hospital in Oxford and Honorary Senior Lecturer at the University of Oxford. He also works for NHS England leading national programmes on data collection and initial assessment (triage and streaming) in emergency care.

David Metcalfe, LLB, MA (Oxon), PhD, MRCP, MRCS, FRCEM, FEBEM is the inaugural Kadoorie Associate Professor of Emergency Medicine at the University of Oxford, Consultant in Emergency Medicine at the John Radcliffe Hospital, and Fellow in Pre-Hospital Emergency Medicine at Thames Valley Air Ambulance.

Preface vii

Acknowledgements viii

1 How the Emergency Department Works 2

2 Diagnosis / using tests 4

3 Diagnostic Tests 6

4 Imaging in ED 12

5 Blood Gas Analysis 14

6 Shock and Intravenous Fluids 16

7 Analgesia 18

8 Sedation and Anaesthesia 20

9 Airway and Breathing 22

10 Major Trauma 24

11 Head and Neck Injury 1 26

12 Head and Neck Injury 2 28

13 Wounds 30

14 Burns 32

15 Hand Injuries 34

16 Wrist and Forearm Injuries 36

17 Shoulder and Elbow Injuries 38

18 Back Pain 40

19 Tibia, Ankle and Foot Injuries 42

20 Hip and Knee Injuries 44

21 Abdominal Pain 46

22 Urology 48

23 Ear/Nose/Throat/Dental 50

24 Eyes 52

25 Obstetrics and Gynaecology 54

26 Toxicology 1 - General Principles 56

27 Toxicology 2 - Specific Poisons 58

28 Psychiatry 1: Self- harm 60

29 Psychiatry 2: Behavioural Disturbance 62

30 Social Factors in the ED 64

31 The Extended ED 66

32 Older Patients in the ED and Frailty 68

33 Syncope/Collapse 70

34 Slow Heart Rate and Conduction Problems 72

35 Fast Heart Rate 74

36 Cardiac Arrest 76

37 Chest Pain I - Cardiovascular 78

38 Chest Pain II - Non- Cardiovascular 80

39 Shortness of Breath 82

40 Anaphylaxis 84

41 Sepsis 86

42 Endocrine Emergencies 88

43 Gastrointestinal Symptoms 90

44 Headache 92

45 Stroke/Transient Ischaemic Attack 94

46 Seizures 96

47 Cold and Heat Injury 98

48 Pre- Hospital Medicine 100

49 Disaster/Major Incident 102

50 Pandemic 104

51 Chemical, Biological, Radiation, Nuclear and Explosive (CBRNE) Incidents 106

52 Medicolegal Aspects of ED Work 108

Index 110