Essentials 1 Rheumatological emergencies relate to the disease, extra-articular manifestations of the disease or toxicity from treatment. 2 Infection must be considered and promptly treated in patients on antirheumatic and immunosuppressive medication, including those on biological therapies. Introduction Rheumatological conditions…
Essentials 1 The decision to transfuse packed red cells should ultimately be based on the knowledge that the patient’s oxygen carrying capacity has dropped to an unacceptably low level. 2 The administration of blood products carries substantial risk. The emergency…
Essentials 1 Haemophilia is a disorder that should be managed by the emergency physician in consultation with the nearest haemophilia centre. 2 Patients should carry their treatment regimen cards with them. If they do not, they should be encouraged to…
Essentials 1 A low platelet count detected on automated blood count should always be confirmed by examination of the blood film prior to further investigation or treatment. 2 The cause of isolated thrombocytopaenia can often be determined by a careful…
Essentials 1 The risk of infection increases significantly as the absolute neutrophil count drops below 1.0 × 10 9 2 Life-threatening neutropaenia is most likely due to impaired haematopoiesis. 3 A detailed medication history is vital to the ‘workup’…
Essentials 1 Anaemia is a condition in which the absolute number of red cells in the circulation is abnormally low. 2 Anaemia is not a diagnosis: it is a finding, which should prompt a search for an underlying cause. 3…
Essentials 1 Sodium disorders are relatively common in hospitalized patients and elderly people. 2 The brain is most at risk from acute hyponatraemia because the osmotically expanded intracellular volume may induce increased intracranial pressure (hyponatraemic encephalopathy). 3 Treatment of hyponatraemia…
Essentials 1 Acid–base homeostasis is one of the most tightly regulated systems within the body. It is maintained by buffering, respiratory and renal mechanisms. 2 Most acid–base disturbances are complex and require a systematic approach to determine underlying processes. 3…
Essentials 1 The thyroid and adrenal emergencies that pose an acute threat to life are thyroid storm, myxoedema coma and acute adrenal insufficiency. Diagnosis of these conditions requires a high index of suspicion and treatment frequently must be initiated on…
Essentials 1 Diabetic ketoacidosis (DKA) consists of the triad of ketonaemia, hyperglycaemia and acidaemia—a high anion-gap metabolic acidosis. 2 DKA is caused by insulin omission or error, intercurrent illness (including infection) or is a presenting feature of new diabetes. 3…