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1
Royal College of Physicians of London. Research Unit. Audit of acute medical admissions. London: RCP, 1997.
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2
Royal College of Physicians of London. Research Unit. Guidelines & audit measures for good practice in acute medical admissions. London: RCP, 1995.
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3
DeCoster, Carolyn. Alternatives to acute care. Winnipeg: Manitoba Centre for Health Policy and Evaluation, Dept. of Community Health Services, Faculty of Medicine, University of Manitoba, 1996.
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4
United States. Congress. House. A bill to amend title XVIII of the Social Security Act to prevent overpayment for hospital discharges to post-acute care services by eliminating the limitation on the number of diagnosis-related groups (DRGs) subject to the special transfer policy. Washington, D.C: United States Government Printing Office, 1999.
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5
R, Hobbs F. D., Birmingham (England) City Council e West Midlands Regional Health Authority., eds. General practitioner and patient influences on acute medical admissions: Birmingham acute admissions study. Birmingham: Department of General Practice, University of Birmingham, 1994.
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6
Waldmann, Carl, Neil Soni e Andrew Rhodes. Poisoning. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199229581.003.0025.
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Management of acute poisoning 440Acute poisoning remains one of the most common medical emergencies, 5–10% of hospital medical admissions. In the majority of cases, the drug ingestion is intentional, but the in-hospital mortality remains low (<0.5%). There are specific antidotes available for a small number of poisons and drugs; in most intoxications, basic supportive care is the main requirement and recovery follows. Internet-based information services such as Toxbase are useful: ...
7
Leach, Dr Richard, Professor Derek Bell e 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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Farmakis, Dimitrios, John Parissis, George Papingiotis e Gerasimos Filippatos. Acute heart failure. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0051_update_001.
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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 present with normal or increased blood pressure, while about half of them have preserved left ventricular ejection fraction. A high prevalence of cardiovascular or non-cardiovascular comordid conditions is further observed, including coronary artery disease, arterial hypertension, atrial fibrillation, diabetes mellitus, renal dysfunction, chronic lung disease, and anaemia.
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Mokin, Maxim, Edward C. Jauch, Italo Linfante, Adnan Siddiqui e Elad Levy, eds. Acute Stroke Management in the First 24 Hours. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190856519.001.0001.
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Diagnosis and treatment of acute stroke has advanced considerably in the past 2 decades. Most notably, in cases of ischemic stroke, intravenous alteplase has become the standard of medical treatment despite its multiple contraindications and limited time window. More recently, trials have proven that endovascular thrombectomy is superior to medical therapy alone, advancing the standard of care for patients who present with acute ischemic stroke from a large vessel occlusion and salvageable brain tissue. The treatment of hemorrhagic stroke now involves the use of novel pharmacological agents and advanced minimally invasive technology. Important changes have also occurred at the levels of hospital organization and treatment decision-making. Such changes in organization and designation of hospitals with distinct levels of stroke care and the variety of stroke protocols now requires team work of emergency medical services (EMS), Emergency Department, stroke neurologists, neurosurgeons, and neurointerventionalists. This book provides an overview of the modern medical and surgical options for the treatment of patients with acute ischemic and hemorrhagic strokes. The pivotal role of EMS in prehospital evaluation and triage of a stroke patient and the levels of stroke systems of care are discussed. In addition, the current guidelines on the management of acute stroke, with the focus on early care of acute stroke patients at the Emergency Department and the first 24 hours of hospital admission, are reviewed. Each chapter contains a discussion of common clinical scenarios including initial management steps, practical points, and common pitfalls.
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Barrera, Alvaro, Caroline Attard e Rob Chaplin, eds. Oxford Textbook of Inpatient Psychiatry. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198794257.001.0001.
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Acute inpatient mental health care remains an irreplaceable part of some people’s mental health recovery pathway, either through the severity of their difficulties or the associated risks. It can often be a traumatic experience associated with distress and vulnerability both for patients and their relatives. Modern acute inpatient psychiatric care must undoubtedly be truly multidisciplinary and part of a wider community-based system. It must emphasize dignity, compassion, and well-being as well as addressing challenges such as involuntary admissions, cultural diversity, physical comorbidities, and the needs of relatives, just to name a few. The present textbook focuses on these and related issues in a way that is relevant to frontline clinicians dealing with them daily, with medical, nursing, and legal aspects going hand in hand with topics such as team leadership or multidisciplinary work. The textbook describes inpatient services as provided in England, so it describes work that takes place within a national health service free at the point of delivery, carried out by universal primary care as well as secondary mental health care services, both operating within clinical governance structures that seek quality improvement and accountability. Crucially, both the Mental Health Act and the Mental Capacity Act provide unique legal frameworks for the care of mental ill health. The editors hope that for readers in the UK and beyond, the textbook will provide a real-life system which can be questioned and problematized and, in that way, may help to orient clinical work.
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Adam, Sheila, Sue Osborne e John Welch. The critical care continuum. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199696260.003.0001.
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This chapter provides an overview of the development and expansion of critical care, to include early intervention and enhancement of recovery. This is based on the patient’s acuity and need for intervention rather than their location. It includes early recognition of, and response to, acute deterioration in patients in order to prevent irreversible organ damage or death. The use of tools such as the National Early Warning Score (NEWS) to identify these patients is described. The chapter covers the critical care outreach and medical emergency team concepts, as well as surviving sepsis and avoiding acute kidney injury initiatives. Peri-operative optimization to mitigate the impact of surgery and the need to follow up patients post-critical care admission to enhance recovery and prevent re-admission are also included.
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Kočka, Viktor, Steen Dalby Kristensen, William Wijns, Petr Toušek e Petr Widimský. Percutaneous coronary interventions in acute coronary syndromes. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0047.
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Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following:All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hoursPatients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groupsOther patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentationLow-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testingStents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settingsTriple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk
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Kočka, Viktor, Steen Dalby Kristensen, William Wijns, Petr Toušek e Petr Widimský. Percutaneous coronary interventions in acute coronary syndromes. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0047_update_001.
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Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following:All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hoursPatients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groupsOther patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentationLow-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testingStents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settingsTriple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk
14
Kočka, Viktor, Steen Dalby Kristensen, William Wijns, Petr Toušek e Petr Widimský. Percutaneous coronary interventions in acute coronary syndromes. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0047_update_002.
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Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following: All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hours. Patients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groups. Other patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentation. Low-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testing. Stents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settings. Triple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk.
15
Kočka, Viktor, Steen Dalby Kristensen, William Wijns, Petr Toušek e Petr Widimský. Percutaneous coronary interventions in acute coronary syndromes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0047_update_003.
Texto completo da fonteResumo:
Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following: All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hours. Patients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groups. Other patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentation. Low-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testing. Stents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settings. Triple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk.
16
Farmakis, Dimitrios, John Parissis e 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 present with normal or increased blood pressure, while about half of them have a preserved left ventricular ejection fraction. A high prevalence of cardiovascular or non-cardiovascular comordid conditions is further observed, including coronary artery disease, arterial hypertension, atrial fibrillation, diabetes mellitus, renal dysfunction, chronic lung disease, and anaemia. Different classification systems have been proposed for acute heart failure, reflecting the clinical heterogeneity of the syndrome; the categorization to acutely decompensated chronic heart failure vs de novo acute heart failure and to hypertensive, normotensive, and hypotensive acute heart failure are among the most widely used and clinically relevant classifications. The pathophysiology of acute heart failure involves several pathogenetic mechanisms, including volume overload, pressure overload, myocardial loss, and restrictive filling, while several cardiovascular and non-cardiovascular causes or precipitating factors lead to acute heart failure through a single of these mechanisms or a combination of them. Regardless of the underlying mechanism, peripheral and/or pulmonary congestion is the hallmark of acute heart failure, resulting from fluid retention and/or fluid redistribution. Myocardial injury and renal dysfunction are also involved in the precipitation and progression of the syndrome.
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Jacquet, Gabrielle, e Andrea Dugas. Influenza. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0026.
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Influenza is a viral syndrome caused by a highly contagious viral infection. It presents with acute fever, respiratory symptoms, rigors, malaise, myalgia, and/or fatigue. Substantial morbidity and mortality can result in susceptible populations, including patients who are at the extremes of age; have chronic medical conditions; or are immunocompromised, pregnant, reside in a nursing home, obese, or of Native American descent. Antiviral treatment is recommended for those requiring hospital admission, those with lower respiratory tract disease, and inpatient populations at high risk for complications. In addition to causing a viral pneumonia, influenza damages the respiratory epithelium. This increases the risk of bacterial coinfection, especially in those with severe illness, pneumonia, and otitis media. Preventive recommendations include vaccination for everyone over the age of 6 months, minimizing potential exposures, attention to respiratory and hand hygiene, adherence to standard precautions, and minimizing visitors for patients in isolation for influenza.
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Harley, Kim, e Sue Jones. Neurological and spinal surgery. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199642663.003.0023.
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Neurological assessment is performed on admission for surgery, as a routine part of medical examination. This is done to diagnose whether symptoms of illness in the patient are due to neurological conditions and, if so, where in the nervous system the pathological lesions are located. Hydrocephalus is either an acute or chronic condition whereby the cerebrospinal fluid pressure rises, causing symptoms of raised intracranial pressure. Patients at risk of raised intracranial pressure should be nursed by staff trained and experienced in neurological assessment using the Glasgow coma scale. This chapter looks at neurological assessment, raised intracranial pressure, head injuries, and brain and spinal tumours. This chapter also discusses the management of subarachnoid haemorrhage, cerebral aneurysm, arteriovenous malformations, and epilepsy. Finally, the chapter provides an overview of degenerative diseases of the spine and peripheral nerve injury.
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Barclay, Philip, e Helen Scholefield. High dependency and intensive care. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713333.003.0030.
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The development of maternal critical care is essential in reducing morbidity and mortality due to a substandard level of care. The level of critical care should depend upon the patient’s severity of illness, not their physical location. Escalation to level 3 (intensive) care is uncommon in pregnancy, with a median admission rate of 2.7 per 1000 births, mainly due to hypertensive disorders of pregnancy and haemorrhage. Maternal ‘near misses’ occur more frequently, with 6.5 per 1000 births meeting Mantel’s criteria, of which 85% is due to major obstetric haemorrhage. The admission rate to maternal high dependency units (level 2 care) varies from 1% to 5%. Acute physiological scoring systems have been found to be reliable when applied to parturients receiving level 3 care but overestimate mortality. Maternal early warning scores have been derived from simplified versions of these systems, with allowance made for physiological changes seen in pregnancy. There are many different maternity scoring systems in use throughout England and Wales. All share the same principle that parameters should be recorded regularly during the hospital stay, with deviations from normal quantified, recorded, and acted upon. A chain of response is then required to ensure that suitably qualified staff, possessing appropriate critical care competencies, attend in a timely fashion. Appropriate resources must be available with equipment readily to hand and suitably trained staff so that invasive monitoring can be used. Clear admission criteria are required for level 2 care within the delivery suite and escalation to level 3, with suitable arrangements for transfer.
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Waje-Andreassen, Ulrike, e Nicola Logallo. Vascular imaging: Ultrasound. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198722366.003.0009.
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After computed tomography and computed tomography angiography or magnetic resonance imaging and magnetic resonance angiography at admission, ultrasound is the most important diagnostic tool to confirm angiographic findings and to closely follow-up patients until the clinical situation has stabilized. Thrombolysis and interventional therapy have given transcranial ultrasound a very important role in bedside monitoring of occlusions, collaterals, cerebral haemodynamics, and vasoreactivity. Detection of flow changes in sickle cell disease, circulating emboli, and right-to-left shunts may guide treatment decisions. Sonothrombolysis and targeted drug delivery are today’s research projects for acute treatment by ultrasound. Extracranial cerebrovascular ultrasound is an ‘all-round’ diagnostic tool modifying angiographic results, showing minor arterial wall disease, plaques, and plaque instability. Microembolic signals during scanning may contribute to finding the cause of stroke. In stroke prevention, ultrasound delivers the possibility for staging of arteries and improving targeted intervention. Ultrasound images may also serve as educational tools for patients to underline the need for continuous medical treatment and lifestyle changes, and may improve compliance.