text delivers a most refreshing and informative account of the basic science and the clinical practice of acute care. The chapters are designed to cover the common topics in acute care, and have been written to allow the reader to apply basic principles to clinical scenarios, and to address areas which are commonly troublesome or about which myths and misunderstandings are rife … case studies support each chapter and accurately reflect day to day clinical problems – the answers to these are very practical.’ Hospital Doctor.
‘This book should be made compulsory reading for all new doctors! I bought it after reading a review on the net and have never regretted it once, it certainly deserves the praised heaped on it so far. The book concentrates on explaining the altered physiology in illness and the science behind different interventions, like fluid therapy, oxygen, inotropes (for example, explaining the physics of each type of oxygen mask and hence their appropriate use in different situations) giving you the intellectual ammunition needed when asked to review that patient who ‘doesn't look right’ in the small hours of the morning. The section on blood gases is essential for those (like me) who struggle in their interpretation – this chapter, like all others, is followed by a great self‐assessment section with highly detailed explanations for all answers. Far removed from the more common protocol/algorithm‐based guidebooks on the market, this book will make you think more and understand more. Buy it’. Amazon reviewer.
‘Quite simply brilliant. I love this book and recommend it to everyone. It's the only book I've come across that really explains ABGs, fluid resus, inotropes, etc. It covers all the stuff you need to know that isn’t taught in medical school curricula. I actually lost my copy when someone borrowed it from me, but this book is so good I might just buy another one!’ Amazon reviewer.
Introduction
…in the beginning of the malady it is easy to cure but difficult to detect, but in the course of time, not having been either detected or treated … it becomes easy to detect but difficult to cure.
— Niccolo Machiavelli, The Prince
It’s almost 15 years since the publication of the second edition of Essential Guide to Acute Care and a few more since one of the authors (NC) asked her boss at the time (PC) and a friend (KF) to help her write a book on ‘everything you need to know but no‐one told you’ about the care of acutely ill adults. In that time, it has been a best‐selling book used by doctors in training, critical care outreach teams, nurses and allied health professionals working in acute areas, medical students, and clinical teachers. Many things have changed since the second edition: new oxygen guidelines, updated practices in fluid balance and volume resuscitation, new definitions of sepsis, and ‘acute kidney injury’ instead of ‘renal failure’ among others. This edition has been extensively rewritten and updated, including a new author (RP), but we have done our best to retain the informal, easy‐to‐read style that made this book so popular with readers.
There are many books on the management of patients who are acutely ill, but all have a traditional ‘recipe’ format. Readers look up a diagnosis and the management is summarised. Few of us are trained how to deal with the generic altered physiology that accompanies acute illness. The result is that many doctors are unable to deal logically with patients in physiological decline and this often leads to suboptimal care.
In surveys of junior doctors of all specialties, few can explain how different oxygen masks work, the different reasons why PaCO2 rises, what a fluid challenge is, and how to effectively treat organ failure. This book contains information you really need to know but is not found in standard textbooks. Throughout the text are ‘mini‐tutorials’ that explain latest thinking or controversies. Self‐assessment case histories and references are included at the end of each chapter. We have dropped the Appendix on practical procedures in this edition and instead recommend the NEJM videos in clinical medicine.* It is our aim that this book will provide a foundation for learning how to care effectively for acutely ill adults. We hope you enjoy using it, we have certainly learned and enjoyed the process of rewriting it!
Nicola Cooper, Paul Cramp, Kirsty Forrest, and Rakesh Patel
January 2020
Note
1 * www.nejm.org/multimedia/medicalvideos
Acknowledgements
Thanks goes to Dr Nick Harrison, Fellow in Anaesthesia at the Monash Medical Centre, Clayton, Australia, for his help in highlighting several areas in the fluid balance chapter that needed updating since the last edition.
We would also like to thank our families, and all the medical students, nursing staff, and junior doctors we have taught whose understanding and questions have shaped our writing.
Foreword to the Second Edition
The story behind this unique little book started many years ago when one of the authors (NC) took up a post in intensive care medicine in order to learn how to deal with sick patients. Everything she learned was immediately applicable to the general wards or the emergency department. Sick patients are everywhere! It is a sad fact that even though doctors in the acute specialties deal with sick patients all the time, they often do not do it very well. That is starting to change, and one of the reasons it is starting to change is because many people (the authors included) campaigned for acute care to be a core component of training for all doctors in the UK.
This book has been written out of a passion to explain in simple terms ‘everything you really need to know but no‐one told you’ about the recognition and management of a sick adult. Unlike most medical books, this one does not give you a list of things to do, nor does it bore you with small print. This book helps you understand what you need to do and why. The second edition has been extensively rewritten and updated, with algorithms and references in a clear, simple format. The authors are medical educators as well as busy clinicians who envisage that the book will be used by teachers as well as learners. I recommend it highly.
Alastair McGowan OBE FRCPE FRCP FRCS FRCA FCEM
Consultant in Emergency Medicine
Past President of the Faculty of Accident and Emergency Medicine, UK
Units Used in This Book
Standard international (SI) units are used throughout this book, with metric units in brackets where these differ. Below are some reference ranges for common blood results. Reference ranges vary from lab to lab.
| Test | Metric units | Conversion factor | SI units |
| Sodium | 135–145 meq/L | 1 | 135–145 mmol/L |
| Potassium |
3.5–5.0
|
