bluuebunny/crossref_metadata_2025 huggingface dataset:
The spectrum of disease in double outlet right ventricle
Authors: Ho Andrew , Bharucha Tara
Published: August 2020

Although often used as a diagnosis in its own right, double outlet right ventricle is more accurately merely a description of the ventriculo-arterial connection in a congenitally malformed heart, and use of the term must always be allied with further description of the anatomy. In this chapter we describe a term infant born at 3.4 kg following an antenatal diagnosis of double outlet right ventricle (DORV) with noncommitted ventricular septal defect (VSD), side-by-side great arteries and pulmonary stenosis. There was a duct-dependent pulmonary circulation in the neonatal period, and the infant underwent placement of a Blalock-Taussig shunt. Following multi-modality cardiac imaging, he underwent to complete surgical repair at 16 months of age, with VSD enlargement, tunnelled closure of the VSD to commit the left ventricle to the aorta, and augmentation of the pulmonary outflow tract. Through the chapter, we emphasise the importance of a detailed anatomical description and thorough investigation in this family of defects, in order to allow an understanding of the physiology, clinical behaviour and the management options available for individual patients. Learning points in the chapter include discussion regarding the definitions of DORV, detailed descriptions of the major anatomical groups and a synopsis of the more common surgical options.
Cardiac transplantation
Authors: Kucera Filip , Burch Michael
Published: August 2020

A 4-year-old girl was diagnosed with idiopathic dilated cardiomyopathy and started on medical therapy. Following stability for several weeks, she was readmitted for significant symptoms of worsening of heart failure. There was limited improvement on intravenous diuretics and, as such, was unable to be weaned off intravenous inotropic support. She was therefore listed for ventricular assist device insertion as a bridge to cardiac transplant. She was urgently listed for a heart transplant. The post-operative course after Berlin Heart™ left ventricular assist device implantation was uneventful, and within a short while, she was transferred to the cardiac ward. Two months later, despite appropriate anticoagulation, she had symptoms of left-sided weakness as a result of an ischaemic stroke. Fortunately, she made a full recovery. She received a donor heart and, following transplantation, was admitted to cardiac intensive care on adrenaline and milrinone. Despite initial signs of mild cardiac dysfunction on echocardiography, her cardiac function normalized within a few days. In addition, she was treated with medical therapy for early post-transplant hypertension. The first cardiac biopsy showed no signs of rejection and she had no evidence of cytomegalovirus or Epstein–Barr virus infection. After 10 days, she was transferred back to the cardiology ward and was subsequently discharged home, with follow-up in the transplant clinic. Three months later, she returned back to school.
Supraventricular tachycardia
Authors: Regan Will , Mangat Jasveer
Published: August 2020

This chapter is a case-based discussion of the management of supraventricular tachycardia (SVT) in children. The case illustrates the challenges of medical management of SVT in neonatal life and infancy, both in terms of acute presentation, as well as longer-term medical care and outpatient monitoring to reduce recurrences of paroxysmal tachycardias as the child grows. Ultimately, the child benefits from an electrophysiology study (EPS) and catheter ablation. The chapter more broadly covers the varying clinical presentations of SVT in children and common treatment strategies employed. The electrophysiological mechanisms of SVT commonly seen in children are outlined. There is a review of the evidence behind the medical management of SVT in children, including a practical guide on the choice of anti-arrhythmic medication for different mechanisms of tachycardia, based on current guidelines. Finally, the chapter summarizes the invasive treatment option of EPS and ablation in children.
Solitary indeterminate single ventricle with aortic atresia
Authors: Wong James , Razavi Reza
Published: August 2020

A newborn baby weighing 2.3 kg presented to the children’s emergency department with signs of respiratory distress. Initial assessment demonstrated poor peripheral perfusion, weak peripheral pulses and an elevated blood lactate level. Transcutaneous saturations were 85% on air. There was tachycardia, which was out of proportion to tachypnoea. A chest radiograph showed an abnormal cardiac silhouette. After consulting with the regional paediatric cardiology team, the child was commenced on a prostaglandin infusion and a transfer was arranged. Transthoracic echocardiography demonstrated a functionally single ventricle of indeterminate origin with aortic atresia. A decision was made to proceed towards single ventricle palliation. Due to the child’s small size, banding of the branch pulmonary arteries was performed and the child remained on prostin infusion as an interim procedure. A Norwood operation was performed at 2 months of age. A 5-mm Sano conduit was inserted. The child was discharged from hospital at 3.5 months of age. Without an antenatal diagnosis, infants with aortic atresia or severe aortic stenosis and single ventricle physiology present early in the postnatal period with features of cardiogenic shock. Fluid resuscitation and administration of prostaglandin are essential. Unless echocardiography is available locally, the diagnosis may not be confirmed until transfer has been made to a cardiology centre. Usually echocardiography is sufficient to make the diagnosis, although additional imaging modalities, such as computed tomography, cardiac magnetic resonance, or cardiac catheterization, are occasionally required. The Norwood procedure is used as a palliative stepwise strategy. Mortality has improved dramatically in the last 30 years; however, there remains a burden of morbidity. This case explores the diagnosis, strategy, and common pitfalls often encountered in managing children with this new diagnosis.
Challenges of percutaneous pulmonary valve implantation
Authors: Chen Robin HS , Jivanji Salim , Khambadkone Sachin
Published: August 2020

This case study looks at a common pathway in the management of a patient with truncus arteriosus. The chapter follows the various considerations in decision-making and the conundrums in contemplating an intervention in the right ventricular outflow tract. The chapter explores the evidence available in determining an intervention and the suitability in consideration for a percutaneous approach. It further explores the various conduits used in the creation of a ‘right ventricle to pulmonary artery’ conduit and the resulting challenges associated with them, the pre-procedural workup, the benefits and risks in the percutaneous approach, and the various valves (specifically the Melody® valve) currently available.
Challenges in the management of coarctation of the aorta
Authors: Jivanji Salim , Chen Robin HS , Rosenthal Eric
Published: August 2020

A postnatally diagnosed child underwent stenting of his native coarctation of the aorta after initial conservative management. After successful treatment of his coarctation, he was followed up regularly and was noted to develop hypertension. Subsequent investigations confirmed that he required further dilatation of his stent in view of somatic growth. Cardiac catheterization revealed an aneurysm at the site of the previous stenting. Given his aberrant right subclavian artery (ARSCA), the procedure was terminated with a view to the best method of treatment. He subsequently underwent re-stenting of his coarctation, with protection of his ARSCA with a balloon over a wire. The chapter explores the challenges in managing this condition using angioplasty, stenting, or surgery, and the common pitfalls that are encountered in the life of patients with this condition.
Infective endocarditis
Authors: Jivanji Salim , Adamji Rubya , Rigby Michael
Published: August 2020

A young patient with previously repaired mixed aortic valve disease presented to his local hospital with symptoms and signs consistent with infective endocarditis. Following confirmation of Streptococcus viridans in his blood cultures, he underwent initial antibiotic treatment, followed by surgical resection of his right ventricular outflow tract vegetation. This chapter examines the difficulty in making a diagnosis of infective endocarditis, the devastating nature of its course, and the challenges in managing this condition. Finally, it explores the association of infective endocarditis with poor dental hygiene, the importance of promoting effective oral hygiene, and the evolving evidence in the use of antibiotic prophylaxis.
Transposition of the great arteries: to switch or not to switch?
Authors: Day Thomas , Cheung Michael
Published: August 2020

This chapter outlines the case of an infant with transposition of the great arteries (TGA), with an anatomy unsuitable for the standard arterial switch. The chapter outlines the cardiac lesions that are commonly associated with TGA and the reasons why some infants cannot undergo arterial switch. Common points of confusion in TGA are clarified, including the coronary anatomy, the physiology of mixing, and clinical signs. Useful tips regarding echocardiography and balloon atrial septostomy are included. Finally, the chapter describes alternative surgical strategies, including Rastelli, réparation à l’étage ventriculaire (REV), and Nikaidoh procedures.
Long QT syndrome: beyond making a diagnosis
Authors: Norrish Gabrielle , Kaski Juan Pablo
Published: August 2020

Long QT syndrome (LQTS) is an uncommon, but important, cause of ventricular arrhythmias. The diagnosis is straightforward in symptomatic patients with marked QT prolongation on a resting 12-lead electrocardiogram (ECG). However, in many patients, the ECG findings are dynamic, and to make the diagnosis, clinicians need to be aware of suggestive features. The greatest challenge in managing these patients is risk stratification for a sudden arrhythmic event. Beta-blockers have been shown to reduce the risk for ventricular arrhythmias in all genotype-positive patients, regardless of 12-lead ECG findings. For patients in whom beta-blockers are contraindicated, left cardiac sympathetic denervation may be a useful therapy. Implantable cardioverter–defibrillators have a role to play in preventing sudden cardiac death, although their use should be balanced with associated complications and psychological impact. Population screening for LQTS remains controversial. Screening of first-degree relatives in sudden arrhythmic death syndrome is recommended, but population screening is not currently undertaken in the United Kingdom.
Near syncope is not always benign
Authors: Theocharis Paraskevi , Bini Roberta
Published: August 2020

A ‘not uncommon’ episode of near syncope in a 6-year-old child is the starting point for cardiology screening of pulmonary hypertension, a rare condition in paediatrics, posed two questions—was SVT secondary to right heart failure that is secondary to pulmonary hypertension? Or was SVT precipitated by right heart failure in the presence of pulmonary hypertension? The chapter goes on to describe the meticulous and extensive screening necessary to establish the correct diagnosis, aiming to ascertain the presence, type, and severity of pulmonary hypertension. The differential diagnosis is fundamental to the therapeutic strategies. There is no cure. Palliative procedures and drug therapy improve symptoms and prolong life, but eventually the disease progresses. When the response to therapeutic strategies decreases and symptoms worsen, the only option that remains is bilateral lung transplantation.
Cardiac evaluation of a child with stridor
Authors: Morrison Louise , McCrossan Brian A
Published: August 2020

This is the case of a 6-month-old boy who is diagnosed with, and treated for, a vascular ring, following several admissions to paediatric intensive care with difficult respiratory symptoms and ongoing failure to thrive. This case highlights the diagnostic challenge presented by these patients. Cardiovascular causes of paediatric airway compression are often under-recognized, with consequent delay in diagnosis. Although they are much less common than other causes of stridor, such as laryngomalacia or other tracheo-bronchial anomalies, chronic airway compression in childhood from vascular malformations carries significant morbidity and mortality. It is readily treatable and should not be overlooked. A high index of suspicion for mechanical compression should be maintained in small children with recurrent obstructive respiratory signs and symptoms or the older child presenting with dysphagia. The most prevalent vascular anomalies resulting in airway compression are a double aortic arch, right aortic arch with an aberrant left subclavian artery, innominate artery compression, left aortic arch with an aberrant right subclavian artery (rarely), and pulmonary artery sling. Rarely, complex congenital heart disease, itself leading to dilatation of the cardiac structures, may precipitate airway compromise, as in tetralogy of Fallot with an absent pulmonary valve syndrome or conditions with significant atrioventricular valve regurgitation causing left atrial enlargement. A dilated ascending aorta may compress the trachea, producing similar symptoms likewise with a cervical aortic arch with an aberrant sublclavian artery and ipsilateral ligamentum arteriosus. Such cases require a comprehensive diagnostic workup. Investigations include plain chest X-ray, echocardiogram, direct microlaryngoscopy and bronchoscopy, and CT angiography or cardiac MRI. A normal laryngoscopic examination should warrant further investigation in the presence of ongoing symptoms. An appreciation of aortic arch embryology is important in interpreting echocardiography and cross-sectional imaging in relation to the role of airway compression. Management often necessitates multidisciplinary collaboration among specialties, including ear, nose, and throat (ENT) specialists, paediatric cardiologists, respiratory physicians, intensivists, and cardiothoracic surgeons. Definitive treatment depends on the underlying pathology but usually involves surgical decompression or aortopexy. A proportion of patients will continue to exhibit symptoms following surgical release, due to ongoing weakness of the airway, and in severe cases may require ongoing respiratory support.
Coronary artery fistula
Authors: Duignan Sophie , Breatnach Colm , Kenny Damien
Published: August 2020

This is a case of a 14-year-old boy who attended the emergency department with fever, cough, and arthralgia. Examination revealed hepatomegaly and a continuous murmur. Blood cultures were positive on three separate occasions for meticillin-sensitive Staphylococcus aureus, and a diagnosis of infective endocarditis, with an intra-atrial thrombus complicating a coronary artery fistula, was made. The intracardiac thrombus was functioning as a septic nidus, and the patient had cavitating lung nodules likely representing septic emboli. The patient underwent thrombolytic therapy to eradicate the thrombus and recovered following a prolonged course of intravenous antibiotics and low-molecular weight heparin. Several months later, he electively underwent transcatheter device closure of the coronary artery fistula. This case discusses the definition and types of fistulae; the pathophysiology, presentation, and complications associated with this condition; the investigations and diagnosis; and finally the management options for patients with coronary artery fistulae. The nuances involved in the management of these cases are discussed, including the debate regarding indications for closure.
Ebstein’s anomaly
Authors: Vazquez-Garcia Laura , Rigby Michael
Published: August 2020

Ebstein’s anomaly (EA) is a rare malformation of the tricuspid valve (TV), characterized by apical displacement of the annular attachments of the septal and inferior (mural) leaflets into the right ventricular (RV) cavity, with varying degrees of adherence to the underlying myocardium. The natural history is quite variable and depends on the severity and presence of associated arrhythmias, which plays a significant role with regard to the prognosis. Prenatal diagnosis is associated with higher perinatal mortality, as these usually represent the severe end of the disease spectrum. Different surgical strategies have been employed, although the cone operation, introduced in the past decade, has significantly changed the surgical approach and improved the outcomes of these patients. This chapter presents the case of a newborn with an antenatal diagnosis of EA who presented with severe cyanosis and major arrhythmias at birth requiring intensive care management for the first month of life. After some years of being relatively asymptomatic, he re-presented with recurrent arrhythmias and decreased exercise tolerance, requiring multiple interventions. His clinical course and management are presented, together with a detailed review of this disease from the anatomical aspects to its diagnosis and medico-surgical management.
Kawasaki disease
Authors: Alsaied Tarek , Tretter Justin T , Redington Andrew N
Published: August 2020

Kawasaki disease is the most common acquired heart disease in children in developed countries. Coronary involvement is reported in 30% of patients with no treatment and decreases to 5% with intravenous immunoglobulin treatment. Given the significant risk for coronary involvement, understanding the long-term prognosis is paramount to guide outpatient follow-up and treatment. This chapter presents the case of a 20-month-old child with Kawasaki disease and giant coronary aneurysms. The chapter reviews the diagnostic criteria and coronary imaging aspects, delves into the treatment options and prognosis, including immunoglobulin treatment.
Pulmonary hypertension associated with congenital heart disease
Authors: Coleman Ryan , Chartan Corey , Varghese Nidhy
Published: August 2020

The spectrum of pulmonary hypertension associated with congenital heart disease (PH-CHD) is broad and complex. The most common aetiologies are related to left-to-right shunts, resulting in volume loading of the pulmonary circulation (precapillary pulmonary hypertension) and left-sided obstructive disease (post-capillary pulmonary hypertension). However, in addition to these basic classifications are patients with absent pulmonary arteries, large septal defects, duct-dependent lesions, cardiomyopathies, and, perhaps the most challenging, patients with single ventricle physiology lacking a subpulmonic ventricle. It is therefore imperative that physicians taking care of children with PH-CHD are well versed not only in the different physiologies present in these children, but also in those that result from their respective surgical palliations as well and how these flows and pressures relate to their pulmonary vascular disease burden. This chapter presents the case of a child with trisomy 21 and congenital heart disease who presented late to medical care and required significant modulation of her pulmonary vascular bed to successfully undergo surgical correction. The child’s clinical course, an overview of PH-CHD and its diagnosis and management, and important therapeutic considerations are presented.
Metabolic syndrome and diabetes
Authors: Saely Christoph H.
Published: August 2020

The metabolic syndrome (MetS) and even more so diabetes confer a significantly increased risk of cardiovascular disease. A multifactorial approach is required to improve the prognosis of patients with the MetS or diabetes. Glucose control is essential to reduce microvascular diabetes complications and, over long periods of time, may also lower the risk of cardiovascular events in patients with diabetes. As in other patient populations, lowering low-density lipoprotein (LDL) cholesterol and treating arterial hypertension are paramount interventions to reduce cardiovascular event risk in patients with the MetS and diabetes. Most patients with diabetes must be considered at a very high risk of cardiovascular events, which qualifies them for low LDL cholesterol targets. Antiplatelet therapy is recommended for patients with the MetS or diabetes in secondary prevention; it may also be considered for primary prevention patients with diabetes who are at high or very high risk; it is not recommended for primary prevention in diabetes patients at moderate risk. Because the MetS or diabetes confers an extremely high risk of cardiovascular events once cardiovascular disease is established, it is extremely important to intervene early to prevent these patients from developing cardiovascular disease.
Chronic stable angina
Authors: Lanza Gaetano Antonio , De Vita Antonio
Published: August 2020

Treatment of patients with chronic stable angina has two main objectives: to improve clinical outcome and to reduce angina symptoms. Prognosis is mainly improved by a reduction in cardiovascular risk factor burden, which may be achieved by appropriate lifestyle changes and, for some risk factors (e.g. hypercholesterolaemia, hypertension, diabetes), appropriate pharmacological therapy (including, in particular, statins and renin–angiotensin–aldosterone system inhibitors) and use of antithrombotic agents. Symptoms can be improved by a variable combination of traditional (beta-blockers, calcium channel blockers, nitrates) and novel (e.g. ivabradine, ranolazine) anti-ischaemic drugs, which may act through reduction in myocardial oxygen consumption and/or improvement of myocardial perfusion.
Heart transplantation
Authors: Gustafsson Finn , Rossing Kasper
Published: August 2020

Heart transplantation remains the treatment of choice for end-stage heart failure refractory to conventional treatment. Long-term outcome is excellent, and median survival currently exceeds 13 years. The main causes of death late after transplantation are cardiac allograft vasculopathy and cancer. Medical therapy after transplantation is complex, including immunosuppressive therapy to reduce the risk of graft rejection and prophylaxis against viral and protozoal infections, as well as adjunctive therapy to treat common comorbidities, for instance hypertension. Pharmacological therapy of comorbid conditions requires specific consideration to clinically important interactions with immunosuppressive drugs.
Cardiomyopathy
Authors: Boffa Giovanni
Published: August 2020

Hypertrophic cardiomyopathy (HCM) is characterized by the presence of increased left ventricular (LV) wall thickness that is not explained by loading conditions. The LV diastolic function is impaired in the majority of patients, and resting or provocable LV outflow tract obstruction is often present. The management of HCM is directed towards minimizing symptoms, improving LV diastolic function, and reducing LV outflow tract obstruction. Beta-blockers reduce myocardial oxygen demand and improve LV filling via their negative chronotropic and inotropic effects. Moreover, they decrease LV outflow tract obstruction. The calcium channel blockers verapamil and diltiazem can be used when beta-blockers are contraindicated or ineffective. Diuretics improve dyspnoea in patients with increased pulmonary capillary pressure, and their use is mandatory if signs of fluid retention are present. The role of non-pharmacological treatment (surgery, electrical and mechanical device implantation) is important in specific groups of patients. Dilated cardiomyopathy is defined by the presence of LV dilatation and systolic dysfunction in the absence of abnormal loading conditions or coronary artery disease. Treatment of symptomatic patients should follow the therapeutic algorithm proposed by European Society of Cardiology guidelines on heart failure. First-line treatment includes diuretics, angiotensin-converting enzyme (ACE) inhibition (or angiotensin receptor blockade), beta-blockade, and aldosterone antagonism. The complex neprilysin inhibitor sacubitril/valsartan is recommended to replace ACE inhibitors in patients who remain symptomatic despite optimal treatment. The If channel inhibitor ivabradine should be considered for patients in sinus rhythm and with a resting heart rate of >70 bpm. ICD implantation with cardiac resynchronization function, LV assist devices, and heart transplantation are indicated in selected patients.
Toxicology
Authors: Wyatt Jonathan P. , Taylor Robert G. , de Wit Kerstin , Hotton Emily J. , Illingworth Robin J. , Robertson Colin E.
Published: August 2020

This chapter in the Oxford Handbook of Emergency Medicine encompasses toxicology in the emergency department (ED). It examines poisons in general, including diagnosis, supportive care, reducing absorption, and antidotes. Specific poisoning is explored in detail, through opioid, salicylate, paracetamol, tricyclic antidepressant, benzodiazepine, clomethiazole, phenothiazine, barbiturate, lithium, sulfonylurea, beta-blocker, calcium channel antagonist, digoxin, angiotensin-converting enzyme (ACE) inhibitor, theophylline, salbutamol, iron, ethanol, methanol, ethylene glycol, paraquat, petrol, paraffin, organophosphate, cyanide, carbon monoxide, chlorine, and CS gas (tear gas) poisoning. Chemical incidents are discussed, as well as accidental poisoning from plants, berries, mushrooms, and button batteries. It also examines novel psychoactive substances (NPS), recreational drugs, serotonin syndrome, and body packers.
Environmental emergencies
Authors: Wyatt Jonathan P. , Taylor Robert G. , de Wit Kerstin , Hotton Emily J. , Illingworth Robin J. , Robertson Colin E.
Published: August 2020

This chapter in the Oxford Handbook of Emergency Medicine investigates environmental emergencies in the emergency department (ED). It starts by examining the presentation and management of hypothermia, frostbite, and non-freezing cold injury. It examines drowning, near drowning, and diving emergencies, and also explores heat illness, electrical injury, and radiation accident.
Analgesia and anaesthesia
Authors: Wyatt Jonathan P. , Taylor Robert G. , de Wit Kerstin , Hotton Emily J. , Illingworth Robin J. , Robertson Colin E.
Published: August 2020

This chapter in the Oxford Handbook of Emergency Medicine investigates analgesia and anaesthesia in the emergency department (ED). It looks at options for relieving pain, such as the analgesics aspirin, paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), morphine and other opioids, Entonox®, and ketamine, and explores analgesia for trauma and other specific situations. It discusses local anaesthesia (LA) and local anaesthetic toxicity, including use of adrenaline (epinephrine) and general principles of local anaesthesia. It explores blocks such as Bier’s block, local anaesthetic nerve blocks, intercostal nerve block, digital nerve block, median and ulnar nerve blocks, radial nerve block at the wrist, dental anaesthesia, nerve blocks of the forehead and ear, fascia iliaca compartment block, femoral nerve block, and nerve blocks at the ankle. It examines sedation, including drugs for intravenous sedation and sedation in children, and discusses general anaesthesia in the emergency department, emergency anaesthesia and rapid sequence induction, difficult intubation, and general anaesthetic drugs.
Wounds, fractures, and orthopaedics
Authors: Wyatt Jonathan P. , Taylor Robert G. , de Wit Kerstin , Hotton Emily J. , Illingworth Robin J. , Robertson Colin E.
Published: August 2020

This chapter in the Oxford Handbook of Emergency Medicine investigates wounds, fractures, and orthopaedics in the emergency department (ED). It reviews classification and assessment of skin wounds, puncture wounds, and foreign bodies, and discusses wound cleaning, closure, aftercare, infected wounds, bites and stings, tetanus, and needlestick injury. It explores fractures, including open (compound) fracture and dislocation (and subluxation), casts and their problems, and osteoporosis, as well as soft tissue injury, physiotherapy in the ED, and fracture clinic and alternatives. It describes different areas of fracture and injury in detail, including hand, thumb, scaphoid, and carpal injury, Colles’ fracture, Smith’s fracture, Barton’s and reverse Barton’s fracture, wrist injury, forearm fracture, elbow injury, humeral fracture, shoulder dislocation, clavicle injury, neck injury, facial wounds, pelvic fracture, hip dislocation, sacral and coccygeal fracture, femur fracture, knee injury, tibial and fibular shaft fracture, pretibial laceration, calf and Achilles tendon injury, ankle injury, foot fracture and dislocation, toe injury, low back pain, arthritis, and eponymous fractures.
Paediatric emergencies
Authors: Wyatt Jonathan P. , Taylor Robert G. , de Wit Kerstin , Hotton Emily J. , Illingworth Robin J. , Robertson Colin E.
Published: August 2020

This chapter in the Oxford Handbook of Emergency Medicine investigates paediatric emergencies in the emergency department (ED). It reviews acute bronchiolitis, whooping cough, tuberculosis, cystic fibrosis, and pneumonia, and explores fits in children, status epilepticus, febrile convulsions, and funny turns. It describes diabetic ketoacidosis, urinary tract infection (UTI), haematuria, acute kidney injury, poisoning, gastroenteritis, abdominal pain in children, inguinal and scrotal swellings, foreskin problems, and zip entrapment. It discusses limping, painful hips, osteochondritis, and paediatric trauma and injury prevention, and reviews resuscitation of the injured child, head injury, spinal injury, trauma, wounds, fractures and dislocations, limb injuries, and normal X-rays. It discusses fracture and injury of the shoulder, humeral shaft, supracondylar humeral fracture, elbow, forearm, wrist, hip, and femoral fracture, knee and tibial fracture, and ankle and foot injuries. It investigates child abuse, including bruising, fractures, head injuries, burns, neglect, emotional abuse, and sexual abuse, and how to manage suspected child abuse.
Organizing Your Environment
Authors: Bartulec Christine , Freedman Rachel , Hughes Amy , Janjanin Sanja , McCormick Bruce , Morriss Wayne , Reis Andrea
Published: August 2020

One of the challenges when moving from a high- to low-resource setting is having to take more direct responsibility for your own drugs and equipment than you may be used to. In some circumstances you may be starting from nothing and may have limited time to get ‘up and running’. The chapter focuses on practical aspects of setting up an anaesthetic service in resource-poor locations. It contains sections on the minimum expected standards for drugs, equipment, and staffing. As well the operating theatre environment it also contains sections on setting up an emergency room (ER), critical care area, and recovery area, as well as guidance on triage of patients.
Drugs and transfusion
Authors: Blum Phil , Bowden Chris , Coonan Tom
Published: August 2020

The chapter covers drugs in common use in resource-poor settings that may be unfamiliar to anaesthetists practising in high-resource settings, primarily ketamine and the volatile anaesthetic agents halothane and ether. Ketamine is one of the core drugs in use in resource-poor environments and as such a significant proportion of the chapter is given over to it: how it works, side effects and how to attenuate them and useful ketamine ‘recipes’. It also contains advice on ‘workarounds’ when other familiar drugs are unavailable, e.g. vasopressors, muscle relaxants. Lastly, blood transfusion is a major difficulty in most parts of the world and this chapter gives practical advice on dealing with this reality.
The Difficult Airway
Authors: Craven Rachael , McKendry Rachel
Published: August 2020

The difficult airway can be challenging to deal with in any setting. In resource-poor environments pathologies are often advanced, specialist equipment may be absent and trained assistance may be lacking, adding to the challenge. The chapter offers practical advice on assessment, planning, and management of difficult airways under these circumstances. Useful techniques considered include spontaneously breathing ketamine anaesthesia, airway topicalization for awake airway management techniques, blind nasal intubation, and awake tracheostomy. Common airway pathologies that may be encountered are described. Practical considerations regarding decision making for tracheostomy, care of tracheostomy on the ward, and management of tracheostomy emergencies are also discussed.
Paediatric Anaesthesia
Authors: Boyd Nick , Desalu Ibironke , Evans Faye , Firth Paul , Hodges Sarah , Nabukenya Mary , Nabulindo Susane , Walker Isabeau
Published: August 2020

In high-resource settings most paediatric anaesthesia is undertaken by specialist or subspecialist practitioners. In remote and resource-poor settings it is usual for anaesthetists to care for all ages of patient, and paediatrics can therefore form a large part of the non-specialist’s workload. The chapter contains essential knowledge for the non-specialist paediatric anaesthetist, including equipment sizing, drug doses, and fluid therapy, mostly in handy ‘quick-look’ tables. The presentation and management of common perioperative comorbidities such as malnutrition and sickle cell anaemia are also discussed. The bulk of the chapter covers practical advice on anaesthesia for a range of common paediatric and neonatal surgeries.
Why I became an occupational physician …
Authors: Gunnyeon Bill
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind Bill Gunnyeon’s decision to pursue a career in occupational medicine. It takes us through his pilot beginnings at the University Air Squadron at Dundee University where he was studying medicine, and subsequent move to the position of RAF Medical Officer.
Those extra moments
Authors: Felton Jean Spencer
Published: August 2020

Dedicated to the memory of the late Pilot Officer William C Gunnyeon, RAF (1929–53) In Those extra moments Jean Spencer Felton briefly explores the limited time between doctors and patients, the lack of weight given to emotional, familial, or other situational contexts influencing wellness, and the power of asking about and listening to the patient’s broader life problems.
Why I became an occupational physician …
Authors: Veys C.A.
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind C.A. Veys’s decision to pursue a career in occupational medicine. It takes us through his initial interest in worker health after visiting a factory with his father at the end of WW2, to his subsequent career in industry health.
Thackrah’s grave
Authors: Hardy Graham
Published: August 2020

In Thackrah’s grave Graham Hardy briefly explores the life and death of Charles Turner Thackrah, the Leeds surgeon who was the first to make a systematic study of occupational diseases.
Sócrates
Authors: Hobson John
Published: August 2020

In Socrates John Hobson briefly explores the life and work of a well-known Brazilian footballer, including his political activism and campaigns for better sports conditions.
Why I became an occupational physician …
Authors: Lloyd Stewart
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind John Hobson’s decision to pursue a career in occupational medicine. It takes us through his beginnings as an NHS ENT surgeon and later position as a medical officer in the Royal Fleet Auxiliary (RFA) Service.
Why I became an occupational physician …
Authors: Venables Katherine M.
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind Katherine M. Venables’s decision to pursue a career in occupational medicine. It takes us through her beginnings in respiratory medicine in the 1970s and her later move to epidemiological medicine and occupational health.
Fifty years ago: ‘A Mobile Consulting Room’
Authors: Hughes G.O.
Published: August 2020

In A Mobile Consulting Room (Report on a Demonstration given at the Annual Provincial Meeting of the Association, Manchester, July, 1954) G.O. Hughes briefly explores NorthWestern Gas Board’s mobile consulting room that solved the problem of providing medical services to numerous employees spread over a large area.
Excellent credit rating
Authors: Challenor John
Published: August 2020

In Excellent credit rating John Challenor briefly explores the various ‘credit ratings’ of his patients.
Two words and a man
Authors: Seaton Anthony
Published: August 2020

In Two words and a man Anthony Seaton briefly explores the meaning of the word ‘professionalism’ and the life of the founder of the London School of Hygiene and Tropical Medicine, Patrick Manson.
Why I became an occupational physician …
Authors: Sorrell John
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind John Sorrell’s decision to pursue a career in occupational medicine. It takes us from his move from rural general practice to the Civil Service Occupational Health Service, through to setting up as an independent occupational physician.
Born to Run?
Authors: Hobson John
Published: August 2020

In Born to Run? John Hobson briefly explores the evolution and biology behind human running.
How one pre-employment decision nearly changed the world order
Authors: Williams Nerys
Published: August 2020

In How one pre-employment decision nearly changed the world order Nerys Williams briefly explores the medical and military background of a well-known revolutionist.
DDA 1995, 2005 or 605?
Authors: Sayed Hanaa
Published: August 2020

In DDA 1995, 2005 or 605? Hanaa Sayed briefly explores the Five Pillars of Islam and how they catered to those with disabilities thousands of years prior to modern laws preventing workplace disability discrimination (Disability Discrimination Act 1995 (DDA, 1995)).
Fifty years ago: ’The work of the Research Advisory Committee’
Authors: Malcolm D.
Published: August 2020

This series provides a selection of articles from the past. In Fifty years ago: ’The work of the Research Advisory Committee’ D. Malcolm briefly explores the work of the Research Advisory Committee, who assist in initiating research, making connections, and promoting the interests of those working in occupational health research.
Why I became an occupational physician …
Authors: Wright David
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind David Wright’s decision to pursue a career in occupational medicine. It takes us through his beginnings in surgery and how a placement in the army sparked an interest in occupational medicine.
Why I became an occupational physician …
Authors: Agius Raymond
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind Raymond Agius’s decision to pursue a career in occupational medicine. It takes us through his early days experimenting with chemicals in his parent’s basement, interest in the causes of disease while at medical school, and eventual move to the Institute of Occupational Medicine.
Occupational health in India
Authors: Brecker Naomi
Published: August 2020

In Occupational health in India Naomi Brecker briefly explores her discoveries about the unmet needs of workplace health in India after a two-week trip to Hyderabad, including health and safety legislation, accidents at work, and occupational diseases.
On tenterhooks
Authors: Seaton Anthony
Published: August 2020

In On tenterhooks Anthony Seaton briefly explores a study on wool workers and lung disease he conducted at the Institute of Occupational Medicine.
Why I became an occupational physician …
Authors: Coggon D.
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind David Coggon’s decision to pursue a career in occupational medicine. It takes us through his beginnings as a Cambridge maths student, transfer to medicine and epidemiology, and later move to occupational medicine.
Why I became an occupational physician …
Authors: McCallum R. Ian
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind R. Ian McCallum’s decision to pursue a career in occupational medicine. It takes us through his early specialization in lung diseases, move to a new department of Industrial Health, and research in a wide variety of topics, including pneumoconiosis, lead poisoning, antimony toxicology, compressed air disease, and the long-term effects of diving.
Occupational hazard of rubber tapping
Authors: Mets J.T.
Published: August 2020

In Occupational hazard of rubber tapping J.T. Mets briefly explores how he treated two young men after they were attacked by a tiger whilst collecting rubber in the forests of Sumatra, Indonesia.
Fifty years ago: ‘Occupational health: An employer’s view’
Authors: Viner R.
Published: August 2020

This series provides a selection of articles from the past. In Fifty years ago: ‘Occupational health: An employer’s view’ R. Viner briefly explores the need for healthier working conditions, such as reduced employee populations and proximity of medical facilities.
Clinical research
Authors: Seaton Anthony
Published: August 2020

In Clinical research Anthony Seaton briefly explores the acquisition of medical knowledge through curiosity lead, self-driven research in order to better the understanding of clinical questions.
Why I became an occupational physician …
Authors: Snashall David
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind David Snashall’s decision to pursue a career in occupational medicine. It takes us through his many occupational experiences, both personal and medical, whilst travelling the world.
Fifty years ago: ‘Assessment of the ability to work of the “Unfit” ‘
Authors: Lee Kenneth
Published: August 2020

This series provides a selection of articles from the past. In Fifty years ago: Assessment of the ability to work of the ‘Unfit’ Kenneth Lee briefly explores what may be considered in assessing someone as being fit or unfit to work, and the importance that it entails.
Billy Liddell
Authors: Seaton Anthony
Published: August 2020

In Billy Liddell Anthony Seaton briefly explores his childhood hero, the footballer Billy Liddell, and the connections between his sporting career and his diagnosis of Parkinson’s and Alzheimer’s disease.
Fifty years ago: ‘General practice and industrial medicine in the United States’
Authors: Pentney B.H.
Published: August 2020

This series provides a selection of articles from the past. In Fifty years ago: ‘General practice and industrial medicine in the United States’ B.H. Pentney briefly explores the trend towards compensation in occupational medicine, and how it may be a hindrance to the practice.
A memorable patient
Authors: Gibson Mike
Published: August 2020

In A memorable patient Mike Gibson briefly explores a patient who once came to see him with tiredness and shortness of breath, and the technology that helped him to carry on working and living.
Why I became an occupational physician …
Authors: Cooke Morris
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind Morris Cooke’s decision to pursue a career in occupational medicine. It takes us through how he fell into the profession after being invalided from the Royal Army Medical Corps.
Why I am doing the GCC again
Authors: Hebditch Vanessa
Published: August 2020

In Why I am doing the GCC again Vanessa Hebditch briefly explores the Global Corporate Challenge, and how getting out and doing more exercise such as walking, can benefit team morale and boost personal happiness.
Why I became an occupational physician …
Authors: Symington Ian S.
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind Ian S. Symington’s decision to pursue a career in occupational medicine. It takes us through his first experience of work-related disease in Glasgow Western Infirmary’s respiratory unit, and the asthma patient who inspired an interest in occupational health.
Tales of Kieran: The occupational physician’s odyssey 4—Vanadium
Authors: Hunter J.A.
Published: August 2020

In Tales of Kieran: The occupational physician’s odyssey 4: Vanadium J.A. Hunter briefly explores the humorous encounters with his occupational physician friend Kieran. This article recounts Kieran’s new interest in vanadium poisoning after finding out a colleague had been burning Venezuelan bitumen.
Directly read
Authors: Challenor John
Published: August 2020

In Directly read John Challenor briefly explores the writing of the surgeon and author Gabriel Weston, who wrote about her life as a medical student and young surgeon.
Why I became an occupational physician …
Authors: Harries Peter
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind Peter Harries’ decision to pursue a career in occupational medicine. It takes us through his student days under Donald Hunter, and how his time in the Naval National Service led to a study that changed working practices in dockyards.
Fifty years ago: ‘Parameters of occupational health in America’
Authors: Wright H. Beric
Published: August 2020

This series provides a selection of articles from the past. In Fifty years ago: ‘Parameters of occupational health in America’ H. Beric Wright briefly explores the short supply of occupational specialists in the UK and America, how to attract and train the right doctors, and how to progress in the field and maintain high standards.
More genetics for medical students?
Authors: Seaton Anthony
Published: August 2020

In More genetics for medical students? Anthony Seaton briefly explores genetic versus environmental causes of (and solutions for) ill health, and the disparity between the resources devoted to each.
A practical demonstration of Boyle’s Law
Authors: Gibson Mike
Published: August 2020

In A practical demonstration of Boyle’s Law Mike Gibson briefly explores his involvement in an experiment to test prototype respirators with the Altitude Research Section of the RAF Institute of Aviation Medicine.
Lest we forget
Authors: Hobson John
Published: August 2020

In Lest we forget John Hobson briefly explores the memory of a morning carrying out medicals on workers in an oil refinery in Belgium, and reflects on Belgium’s past.
Why I became an occupational physician …
Authors: Slovak Andy
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind Andy Slovak’s decision to pursue a career in occupational medicine. It takes us through his parents’ arrival in the UK from Czechoslovakia in the 40s, his childhood ties to chemistry and manufacturing, and later move towards medicine.
Fifty years ago: ‘A poisons information service’
Authors: Goulding Roy
Published: August 2020

This series provides a selection of articles from the past. In Fifty years ago: ‘A poisons information service’ the author briefly explores a service set up in the 1960s to offer advice on medicinal, veterinary, agricultural, horticultural, and household poisoning, and after some debate, industrial poisoning.
Why I became an occupational physician …
Authors: Engel Hans
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind H. Engel’s decision to pursue a career in occupational medicine. It takes us through his move from Nazi Germany to a British Medical School, service in the Armed Forces, and later move to industrial medicine.
An elusive occupational toxin
Authors: Engel Hans
Published: August 2020

In An elusive occupational toxin Hans Engel briefly explores the cases of neutropenia found at his workplace at Ford Motor Co., and his search to find a cause and cure.
Fifty years ago: ‘The Proposed New Constitution’
Authors: Anon
Published: August 2020

This series provides a selection of articles from the past. In Fifty years ago: ‘The Proposed New Constitution’ the author briefly explores the new constitution of the Council of the Association of occupational medicine.