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 viiAcknowledgements viii1 How the Emergency Department Works 22 Diagnosis / using tests 43 Diagnostic Tests 64 Imaging in ED 125 Blood Gas Analysis 146 Shock and Intravenous Fluids 167 Analgesia 188 Sedation and Anaesthesia 209 Airway and Breathing 2210 Major Trauma 2411 Head and Neck Injury 1 2612 Head and Neck Injury 2 2813 Wounds 3014 Burns 3215 Hand Injuries 3416 Wrist and Forearm Injuries 3617 Shoulder and Elbow Injuries 3818 Back Pain 4019 Tibia, Ankle and Foot Injuries 4220 Hip and Knee Injuries 4421 Abdominal Pain 4622 Urology 4823 Ear/Nose/Throat/Dental 5024 Eyes 5225 Obstetrics and Gynaecology 5426 Toxicology 1 – General Principles 5627 Toxicology 2 – Specific Poisons 5828 Psychiatry 1: Self- harm 6029 Psychiatry 2: Behavioural Disturbance 6230 Social Factors in the ED 6431 The Extended ED 6632 Older Patients in the ED and Frailty 6833 Syncope/Collapse 7034 Slow Heart Rate and Conduction Problems 7235 Fast Heart Rate 7436 Cardiac Arrest 7637 Chest Pain I – Cardiovascular 7838 Chest Pain II – Non- Cardiovascular 8039 Shortness of Breath 8240 Anaphylaxis 8441 Sepsis 8642 Endocrine Emergencies 8843 Gastrointestinal Symptoms 9044 Headache 9245 Stroke/Transient Ischaemic Attack 9446 Seizures 9647 Cold and Heat Injury 9848 Pre- Hospital Medicine 10049 Disaster/Major Incident 10250 Pandemic 10451 Chemical, Biological, Radiation, Nuclear and Explosive (CBRNE) Incidents 10652 Medicolegal Aspects of ED Work 108Index 110

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 viiAcknowledgements viii1 How the Emergency Department Works 22 Diagnosis / using tests 43 Diagnostic Tests 64 Imaging in ED 125 Blood Gas Analysis 146 Shock and Intravenous Fluids 167 Analgesia 188 Sedation and Anaesthesia 209 Airway and Breathing 2210 Major Trauma 2411 Head and Neck Injury 1 2612 Head and Neck Injury 2 2813 Wounds 3014 Burns 3215 Hand Injuries 3416 Wrist and Forearm Injuries 3617 Shoulder and Elbow Injuries 3818 Back Pain 4019 Tibia, Ankle and Foot Injuries 4220 Hip and Knee Injuries 4421 Abdominal Pain 4622 Urology 4823 Ear/Nose/Throat/Dental 5024 Eyes 5225 Obstetrics and Gynaecology 5426 Toxicology 1 – General Principles 5627 Toxicology 2 – Specific Poisons 5828 Psychiatry 1: Self- harm 6029 Psychiatry 2: Behavioural Disturbance 6230 Social Factors in the ED 6431 The Extended ED 6632 Older Patients in the ED and Frailty 6833 Syncope/Collapse 7034 Slow Heart Rate and Conduction Problems 7235 Fast Heart Rate 7436 Cardiac Arrest 7637 Chest Pain I – Cardiovascular 7838 Chest Pain II – Non- Cardiovascular 8039 Shortness of Breath 8240 Anaphylaxis 8441 Sepsis 8642 Endocrine Emergencies 8843 Gastrointestinal Symptoms 9044 Headache 9245 Stroke/Transient Ischaemic Attack 9446 Seizures 9647 Cold and Heat Injury 9848 Pre- Hospital Medicine 10049 Disaster/Major Incident 10250 Pandemic 10451 Chemical, Biological, Radiation, Nuclear and Explosive (CBRNE) Incidents 10652 Medicolegal Aspects of ED Work 108Index 110

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 viiAcknowledgements viii1 How the Emergency Department Works 22 Diagnosis / using tests 43 Diagnostic Tests 64 Imaging in ED 125 Blood Gas Analysis 146 Shock and Intravenous Fluids 167 Analgesia 188 Sedation and Anaesthesia 209 Airway and Breathing 2210 Major Trauma 2411 Head and Neck Injury 1 2612 Head and Neck Injury 2 2813 Wounds 3014 Burns 3215 Hand Injuries 3416 Wrist and Forearm Injuries 3617 Shoulder and Elbow Injuries 3818 Back Pain 4019 Tibia, Ankle and Foot Injuries 4220 Hip and Knee Injuries 4421 Abdominal Pain 4622 Urology 4823 Ear/Nose/Throat/Dental 5024 Eyes 5225 Obstetrics and Gynaecology 5426 Toxicology 1 – General Principles 5627 Toxicology 2 – Specific Poisons 5828 Psychiatry 1: Self- harm 6029 Psychiatry 2: Behavioural Disturbance 6230 Social Factors in the ED 6431 The Extended ED 6632 Older Patients in the ED and Frailty 6833 Syncope/Collapse 7034 Slow Heart Rate and Conduction Problems 7235 Fast Heart Rate 7436 Cardiac Arrest 7637 Chest Pain I – Cardiovascular 7838 Chest Pain II – Non- Cardiovascular 8039 Shortness of Breath 8240 Anaphylaxis 8441 Sepsis 8642 Endocrine Emergencies 8843 Gastrointestinal Symptoms 9044 Headache 9245 Stroke/Transient Ischaemic Attack 9446 Seizures 9647 Cold and Heat Injury 9848 Pre- Hospital Medicine 10049 Disaster/Major Incident 10250 Pandemic 10451 Chemical, Biological, Radiation, Nuclear and Explosive (CBRNE) Incidents 10652 Medicolegal Aspects of ED Work 108Index 110