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1

Price, Susanna, Roxy Senior, and Bogdan A. Popescu. Acute cardiac care. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0062.

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Echocardiography is fundamental to the assessment and management of patients with acute cardiac disease, and differs from outpatient echocardiography in some key areas. Echocardiography provides important information throughout the whole patient pathway, having been shown to change interventions in 60–80% patients in the pre-hospital setting, improve diagnostic accuracy and efficiency in the emergency room, and reveal the aetiology of unexplained hypotension in 48% of medical intensive care patients. Echocardiography is now included in the universal definition of acute myocardial infarction, a
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2

Wise, Matt, and Paul Frost. ICU treatment of acute kidney injury. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0151.

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Traditionally, the etiology of acute kidney injury (AKI) is considered in terms of prerenal, renal, and obstructive causes. However, this categorization is less useful in the ICU, where the etiology of AKI is usually multifactorial and often occurs in the context of multi-organ failure. Hypotension, nephrotoxic drugs, and severe sepsis or septic shock are the most important identifiable factors. Less frequently encountered causes include pancreatitis, abdominal compartment syndrome, and rhabdomyolysis. Primary intrinsic renal disease such as glomerulonephritis is extremely uncommon. A previous
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3

Marshall, Mark R. Intermittent acute renal replacement therapy. Edited by Norbert Lameire. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0233_update_001.

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This chapter summarizes current best practice with respect to intermittent haemodialysis and sustained low-efficiency dialysis (SLED) for those with acute kidney injury. These modalities can be delivered using a variety of technology platforms. These platforms for the most part use online dialysate, and water quality needs to be monitored and maintained to current standards. Intermittent haemodialysis and SLED provide reasonable outcomes in experienced hands, and ameliorate morbidity and mortality resulting from the ‘acute uraemic syndrome’: that is, intractable infection, non-resolving shock,
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4

Lameire, Norbert. Yellow fever, severe acute respiratory syndrome virus, and H1N1 influenza infections. Edited by Vivekanand Jha. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0190_update_001.

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Serious yellow fever infections are associated with acute kidney injury (AKI) on the basis of haemorrhagic shock with acute tubular necrosis, although a direct viral effect on renal tissue has been suggested. A single yellow fever vaccination provides sufficient immunity against the disease, negating the need for booster vaccinations every 10 years; vaccination failures are extremely rare. Severe SARS infections may be complicated by multi-organ dysfunction syndrome including AKI. Hypotension caused by nosocomial infections, gastrointestinal bleeding, or SARS per se, and rhabdomyolysis were as
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5

Waldmann, Carl, Neil Soni, and Andrew Rhodes. Shock. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199229581.003.0026.

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Shock: definition and diagnosis 446Hypovolaemic shock 450Cardiogenic shock 452Anaphylactic shock 456Septic shock: pathogenesis 458Shock, or acute circulatory failure, defines a state in which the delivery of oxygen and nutrients to the tissue is insufficient to meet basal metabolic needs, leading to tissue hypoxia, and, if persistent, to MOF and death. Shock results from tissue hypoperfusion and microcirculatory dysfunction, and should thus not be restricted to hypotension. Although frequent, hypotension is not mandatory for the diagnosis of shock. In the absence of hypotension, increased lact
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6

Sever, Mehmet Şükrü, and Raymond Vanholder. Acute kidney injury in polytrauma and rhabdomyolysis. Edited by Norbert Lameire. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0252_update_001.

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The term ‘polytrauma’ refers to blunt (or crush) trauma that involves multiple body regions or cavities, and compromises physiology to potentially cause dysfunction of uninjured organs. Polytrauma frequently affects muscles resulting in rhabdomyolysis. In daily life, it mostly occurs after motor vehicle accidents, influencing a limited number of patients; after mass disasters, however, thousands of polytrauma victims may present at once with only surgical features or with additional medical complications (crush syndrome). Among the medical complications, acute kidney injury (AKI) deserves spec
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7

Abcejo, Arnoley S., and Jeffrey J. Pasternak. Neurogenic Shock. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0072.

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Neurogenic shock is a pathophysiologic state of systemic hypoperfusion characterized by a significant decrease in systemic vascular resistance secondary to loss of sympathetic tone. Neurogenic shock is most commonly seen in the setting of acute spinal cord injury (SCI) but can also occur following significant brain injury. Interruption of sympathetic fibers causes loss of basal vascular sympathetic tone, commonly allowing unopposed parasympathetic tone. As a result, severe hypotension and bradycardia can further exacerbate neurologic injury and organ perfusion. Understanding the physiologic an
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8

Misbah, Siraj. Suspected anaphylaxis. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0075.

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A type I IgE-mediated systemic allergic reaction is characterized by a constellation of symptoms which are due to widespread histamine release and which comprise acute-onset urticaria, angioedema, bronchospasm, and hypotension. While a mild reaction may be limited to localized urticaria and/or angioedema, a full-blown allergic reaction associated with systemic features is best described as anaphylaxis. The term ‘anaphylactoid’, previously used to denote non-IgE-mediated systemic allergic reactions, is no longer recommended for use.
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9

Waldmann, Carl, Neil Soni, and Andrew Rhodes. Neurological disorders. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199229581.003.0022.

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Agitation and confusion 360Status epilepticus 362Meningitis 364Intracerebral haemorrhage 366Subarachnoid haemorrhage 368Ischaemic stroke 370Guillain–Barre syndrome 372Myasthenia gravis 374ICU neuromuscular disorders 376Tetanus 378Botulism 380Neurorehabilitation 382Hyperthermias 384Agitation and confusion are common features in critical illness. Agitation is a symptom or sign of numerous acute and chronic disease states that include pain, anxiety and delirium. Agitation is present in around half of ICU patients, with 15% experiencing severe agitation. Confusion may also be chronic or acute and
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10

Schneider, Antoine G., Neil J. Glassford, and Rinaldo Bellomo. Choice of Renal Replacement Therapy and Renal Recovery. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199653461.003.0038.

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Acute kidney injury (AKI) is a major complication of critical illness, associated with increased mortality and morbidity. Among survivors of AKI, a subset will develop the need for chronic dialysis. Chronic dialysis imposes a major physical, emotional, economic, and social burden on ICU survivors and their caregivers. Evidence suggests that the type of renal replacement therapy used in the acute setting may affect renal recovery differently. For example, intermittent haemodialysis (IHD) increases the risk of hypotension and acute volume and solute fluctuations, and such physiological events ha
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11

Idahosa, Osamudiamen, and David T. Huang. Assessment of sepsis in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0295.

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Sepsis is the presence of a known or suspected infection and a systemic inflammatory response. Severe sepsis is sepsis with acute organ dysfunction. Septic shock is a subset of severe sepsis characterized by systemic arterial hypotension or occult hypoperfusion. Severe sepsis is common, affecting more than 750 000 individuals in the United States each year with a hospital mortality of about 30%.Severe sepsis is a medical emergency that requires early identification, prompt evaluation, and treatment. The signs and symptoms of sepsis are influenced by the virulence of the pathogen, the portal of
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12

Cohen, Jeffrey A., Justin J. Mowchun, Victoria H. Lawson, and Nathaniel M. Robbins. A 44-Year-Old Male with Subacute Onset of Syncope. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190491901.003.0032.

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Syncope in a patient with orthostatic hypotension (OH) may indicate autonomic dysfunction. The definition of OH is presented. Clinical features of parasympathetic and sympathetic function are discussed. The differential of acute autonomic dysfunction includes a number of conditions. An autoimmune etiology may occur autoimmune autonomic ganglionopathy. Serologic testing can assist in this diagnosis. If autoimmune immune modulating therapies may be indicated. Autonomic neuropathy may be a paraneoplastuc syndrome. Autonomic testing can also help with documenting autonomic neuropathy as well as th
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13

Agarwal, Rajiv. Volume assessment and management in dialysis. Edited by Jonathan Himmelfarb. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0273.

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The assessment of volume among patients on dialysis is an art and a science that is evolving. The assessment of volume requires integration of multiple sources of information including the history, physical examination, and several inexact scientific methods of volume assessment. Poor assessment of volume greatly affects the well-being of dialysis patients. Both hypovolaemia and hypervolaemia are associated with uncomfortable symptoms. Hypovolaemia, for example, may be associated with intradialytic hypotension, cramping, dizziness, access thrombosis, and occult organ hypoperfusion. Hypervolaem
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14

Leach, Dr Richard, Professor Derek Bell, and Professor Kevin Moore. Introduction to acute medicine. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199565979.003.0001.

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Chapter 1 provides an introduction to acute medicine, and discusses aspects relevant to the initial, acute management phase, including recognizing and assessing the acutely unwell patient, organization of acute medical admission wards, admission and discharge guidelines, general supportive care, severity of illness scoring systems, the hypotensive patient and shock, the blue and breathless (cyanosed) patient, the oliguric patient, the confused/disorientated/‘obtunded’ patient, and the ongoing management of acutely ill patient.
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15

López-Sendón, José, and Esteban López de Sá. Mechanical complications of myocardial infarction. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0045.

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Mechanical complications after an acute infarction include different forms of heart rupture, including free wall rupture, interventricular septal rupture, and papillary muscle rupture. Its incidence decreased dramatically with the widespread use of reperfusion therapies but may occur in 2–3% of ST-elevation myocardial infarction patients, and mortality is very high if not properly diagnosed, as surgery is the only effective treatment. Echocardiography is the most important tool for diagnosis that should be suspected in patients with hypotension, heart failure, or recurrent chest pain. Awarenes
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16

López-Sendón, José, and Esteban López de Sá. Mechanical complications of myocardial infarction. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0045_update_001.

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Mechanical complications after an acute infarction include different forms of heart rupture, including free wall rupture, interventricular septal rupture, and papillary muscle rupture. Its incidence decreased dramatically with the widespread use of reperfusion therapies but may occur in 2–3% of ST-elevation myocardial infarction patients, and mortality is very high if not properly diagnosed, as surgery is the only effective treatment. Echocardiography is the most important tool for diagnosis that should be suspected in patients with hypotension, heart failure, or recurrent chest pain. Awarenes
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17

López-Sendón, José, and Esteban López de Sá. Mechanical complications of myocardial infarction. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0045_update_002.

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Mechanical complications after an acute infarction include different forms of heart rupture, including free wall rupture, interventricular septal rupture, and papillary muscle rupture. Its incidence decreased dramatically with the widespread use of reperfusion therapies but may occur in 2–3% of ST-elevation myocardial infarction patients, and mortality is very high if not properly diagnosed, as surgery is the only effective treatment. Echocardiography is the most important tool for diagnosis that should be suspected in patients with hypotension, heart failure, or recurrent chest pain. Awarenes
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18

López-Sendón, José, and Esteban López de Sá. Mechanical complications of myocardial infarction. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0045_update_003.

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Mechanical complications after an acute infarction involve different forms of heart rupture, including free wall rupture, interventricular septal rupture, and papillary muscle rupture. Its incidence decreased dramatically with the widespread use of reperfusion therapies occurring in <1% of ST-elevation myocardial infarction patients, and mortality is very high if not properly diagnosed, as surgery is the only effective treatment (Ibanez et al, 2017). Echocardiography is the most important tool for diagnosis that should be suspected in patients with hypotension, heart failure, or recurrent c
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19

Farmakis, Dimitrios, John Parissis, and Gerasimos Filippatos. Acute heart failure: epidemiology, classification, and pathophysiology. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0051.

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Acute heart failure is defined as the rapid development or change of symptoms and signs of heart failure that requires urgent medical attention and usually hospitalization. Acute heart failure is the first reason for hospital admission in individuals aged 65 or more and accounts for nearly 70% of the total health care expenditure for heart failure. It is characterized by an adverse prognosis, with an in-hospital mortality rate of 4-7%, a 2-3-month post-discharge mortality of 7-11%, and a 2-3-month readmission rate of 25-30%. The majority of patients have a previous history of heart failure and
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20

Huntbach, Julie, and Amar Alwitry. Glaucoma. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199237593.003.0007.

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The chapter begins by discussing optic nerve head anatomy and aqueous fluid dynamics, before covering the key clinical skills, namely optic nerve head assessment in glaucoma, tonometry and pachymetry , gonioscopy, and perimetry. It also covers the key areas of clinical knowledge, including ocular hypertension, primary open-angle glaucoma, acute angle closure, normal-tension glaucoma, steroid-induced glaucoma, traumatic glaucoma, inflammatory glaucomas, pseudoexfoliative and pigmentary glaucoma, neovascular glaucoma, malignant glaucoma, iridocorneal endothelial syndrome and iridocorneal dysgene
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21

Rodríguez-Iturbe, Bernardo, and Mark Haas. Post-streptococcal glomerulonephritis. Edited by Neil Turner. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0077_update_001.

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Post-streptococcal glomerulonephritis is a complication of Streptococcal infections that is responsible for classic acute nephritic syndrome, mostly seen in children. This is an acute nephritis associated with prominent fluid retention and oedema, hypertension and haematuria. Serum complement levels are diagnostically helpful as C3 levels are characteristically very low. However, many cases are much less severe and may pass unrecognized, only being identified by screening for dipstick haematuria. In children recovery is the rule but in adults, often with comorbid conditions, the prognosis is s
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