Essentials 1 Cardiac arrhythmias require urgent attention, as some are life-threatening and can lead to sudden death. 2 The most important initial evaluation is for haemodynamic stability. Patients who are hemodynamically stable should have a 12-lead electrocardiogram (ECG), whereas unstable…
Essentials 1 Severe acute pulmonary oedema (APO) is associated with high morbidity and mortality. 2 APO is a pathophysiological state characterized by a maldistribution of fluid; most patients do not have fluid overload. 3 Diagnosis relies on a thorough history,…
Essentials 1 Every patient with possible acute coronary syndrome (ACS) must have a 12-lead ECG performed and interpreted as soon as possible, ideally within 10 minutes after arrival, to identify whether he or she may benefit from reperfusion therapy. 2…
Essentials 1 The life-threatening differential diagnoses of acute coronary syndrome (ACS, [CR] ), pulmonary embolism (PE; Chapter 5.5 ) and thoracic aortic dissection ( Chapter 5.10 ) should be considered in all presentations of chest pain. 2 ACS is common,…
Essentials 1 Staphylococcus aureus is the most frequent pathogen in all age groups. 2 Surgery, trauma and diabetes predispose to chronic infection in adults. 3 Diagnosis may be difficult, relying on a combination of clinical features, imaging studies and microbiological…
Essentials 1 Most calcaneal fractures are intra-articular; they are associated with a Bohler angle of less than 20 degrees and are at risk of developing compartment syndrome. 2 Major talar fractures have a significant risk of subsequent avascular necrosis. 3…
Essentials 1 Ankle injuries are common and occur as isolated injuries or in relation to high-energy multitrauma. 2 Lateral malleolar fractures are the most common ankle fracture. 3 The Ottawa ankle rules (OAR) are used to determine the need for…
Essentials 1 Tibial shaft fractures are the commonest long bone fracture, with the subcutaneous nature of the tibia leaving it vulnerable to open injury. 2 Neurovascular injury and compartment syndrome are risks in tibial shaft fractures. 3 Proximal fibular fractures…
Essentials 1 The knee is the most commonly injured joint in the body. 2 Knee injuries often occur in the young, usually associated with sport. 3 The mechanism of injury is an essential part of the history. 4 Immediate joint…
Essentials 1 Early reduction of femoral fractures and immobilization in traction reduces mortality. 2 Haemorrhagic shock is a major complication; with a closed femoral fracture the average blood loss is 1200 mL. 3 Fractures of the femoral shaft are associated…