Acute Medicine, Poisoning and Emergencies

This module covers the structured ABCDE assessment of the acutely unwell adult, adult basic life support with an automated external defibrillator, and the recognition and immediate management of anaphylaxis and tension pneumothorax. It prepares final-year medical and pharmacy students and foundation doctors for the emergency practice activities that follow, using UK practice and British National Formulary dosing as teaching examples.

1. The ABCDE Approach to the Acutely Unwell Adult, Including Recognition of Tension PneumothoraxPreview

   This first lesson in the resuscitation and anaphylaxis module sets out the structured ABCDE assessment of an acutely unwell adult in UK hospital practice. It covers airway patency and opening manoeuvres, breathing assessment with oxygen and monitoring, circulation including recognition of shock and obtaining peripheral intravenous access, disability assessment, and exposure with attention to dignity and temperature. Tension pneumothorax is used throughout as the worked example of a treatable cause of deterioration: its mechanism, the clinical signs that should trigger suspicion, and the principle that immediate decompression must not wait for chest imaging. Emphasis is placed on calling for help early, reassessing after every intervention, and safe handover. Doses and techniques mentioned are teaching examples; local protocols and current formularies govern actual practice.

   10 min
2. Adult Basic Life Support and Automated External Defibrillation

   This lesson covers the adult basic life support sequence for a collapsed patient: confirming cardiac arrest, calling for help, delivering effective chest compressions, ventilating with a bag-valve mask, and using an automated external defibrillator safely. It explains team roles during resuscitation, handover to advanced life support, and the physiological reasons why early defibrillation and minimal interruption of compressions improve survival. Teaching examples use UK practice and British National Formulary conventions; local protocols and formularies vary.

   10 min
3. Recognising Anaphylaxis and Giving Intramuscular Adrenaline

   Anaphylaxis is a severe, life-threatening systemic hypersensitivity reaction that develops rapidly and can kill within minutes. This lesson covers how to recognise it from the history and examination, and how to separate it from other acute reactions such as vasovagal syncope, acute severe asthma, panic and sepsis. The focus is immediate treatment with intramuscular adrenaline as taught in UK practice: the adult dose, the injection site, the repeat interval and what to do when there is no response. It also covers positioning, high-flow oxygen, intravenous fluid resuscitation, when adjunctive drugs such as antihistamines and glucocorticoids have a place, common triggers including beta-lactam antibiotics, and the observation period after recovery because of the risk of a biphasic reaction. Doses given are teaching examples; always follow current national guidance, local protocols and the BNF.

   10 min
4. Case: Tension Pneumothorax after Motorcycle Collision
   20 min
5. Prescribing: Anaphylaxis to Intravenous Co-amoxiclav
   15 min
6. OSCE station: Adult Basic Life Support with Automated External Defibrillator
   11 min
7. OSCE station: Inserting a Peripheral Intravenous Cannula
   11 min
8. Quiz: Resuscitation and Anaphylaxis: The ABCDE Approach, Adult Life Support and Immediate Emergencies
   8 min

This module covers the assessment of the poisoned patient, toxidromes and initial management, then the recognition and treatment of paracetamol overdose using acetylcysteine and the treatment nomogram, opioid toxicity and naloxone, lithium toxicity and its precipitants, and prescribing for alcohol withdrawal. It is written for final-year medical and pharmacy students and foundation doctors in UK practice, using BNF dosing and NICE-style guidance.

1. Assessing the Poisoned Patient: History, Examination and Initial Management

   This lesson covers a structured approach to the patient with suspected poisoning. It explains how to take a focused poisoning history, including agents, dose, time, route and co-ingestants, and how to examine for vital sign abnormalities and classic toxidromes. It then covers risk assessment, key investigations and initial management priorities, including airway protection, breathing and circulation support, and the role of activated charcoal. The lesson closes by introducing the principles of antidote prescribing that underpin later lessons on paracetamol, opioids and lithium.

   10 min
2. Paracetamol Overdose and Acetylcysteine: Risk Assessment and the Nomogram

   This lesson covers paracetamol overdose in adults, focusing on risk assessment and the use of acetylcysteine. It begins with the pharmacokinetics and toxicology of paracetamol, including the role of NAPQI and glutathione depletion. It then explains how to assess acute and staggered overdoses, including history, timing and dose. The paracetamol treatment nomogram is described in detail, with guidance on plotting concentrations and interpreting results. High-risk groups, such as patients with malnutrition, chronic alcohol use or enzyme induction, are identified. The lesson then reviews acetylcysteine: its mechanism, indications, dosing regimens, monitoring and adverse effects. Regional and formulary differences in nomogram thresholds and acetylcysteine protocols are noted. The lesson is designed for final-year medical and pharmacy students and foundation doctors preparing for finals and the Prescribing Safety Assessment.

   10 min
3. Opioid and Lithium Toxicity and Alcohol Withdrawal: Naloxone, Precipitants and Benzodiazepine Prescribing

   This final lesson in the module covers three common acute medicine presentations. It starts with opioid toxicity: recognising the toxidrome and giving naloxone by careful titration, then deciding who needs prolonged observation or a repeat bolus or infusion because naloxone is shorter acting than most opioids. It then covers lithium toxicity, the precipitants that raise serum lithium, including dehydration, NSAIDs, ACE inhibitors and thiazides, and the principles of management, monitoring and when enhanced elimination is considered. The last section covers prescribing for alcohol withdrawal, using a benzodiazepine in either a symptom-triggered or fixed-dose regimen, with thiamine and attention to fluids and electrolytes. Teaching doses are examples only; always check current national guidance and your local formulary.

   10 min
4. Case: Paracetamol Overdose in a Young Woman: A Clinical Case
   20 min
5. Case: A 34-year-old man found unresponsive with pinpoint pupils and a respiratory rate of 6
   20 min
6. Case: Lithium Toxicity and ACE Inhibitor Interaction
   20 min
7. Prescribing: Alcohol Withdrawal in a 48-Year-Old Man
   15 min
8. Quiz: Poisoning and Antidotes: Assessment, Paracetamol, Opioids, Lithium and Alcohol Withdrawal
   9 min

The third module in Acute Medicine, Poisoning and Emergencies. It covers prescribing maintenance and replacement intravenous fluids in adults, recognising acute kidney injury and deciding which drugs to hold, treating hyperkalaemia, and interpreting an arterial blood gas in acute-on-chronic respiratory failure. Written for final-year medical and pharmacy students and foundation doctors preparing for finals and the Prescribing Safety Assessment, using British National Formulary dosing as teaching examples and noting where practice varies with local formularies and protocols.

1. Prescribing Intravenous Fluids in Adults: Maintenance and Replacement

   This lesson prepares final-year medical and pharmacy students and foundation doctors to prescribe intravenous fluids safely in adults. It covers typical daily maintenance requirements for water, sodium, potassium and glucose, and how illness, surgery, fever, sepsis and organ dysfunction alter them. It compares balanced crystalloids with 0.9% sodium chloride, then explains how to assess and replace ongoing losses from diarrhoea, vomiting, bleeding and high-output stomas. The lesson focuses on the nil-by-mouth patient, common maintenance fluid prescribing errors, and the need to reassess after every bag. Teaching examples are not a substitute for local protocols, current formularies or clinical judgment.

   10 min
2. Acute Kidney Injury and Hyperkalaemia: Recognition, Drugs to Hold and Emergency Treatment

   Acute kidney injury is common in hospital patients and often iatrogenic. This lesson covers how to stage AKI using serum creatinine and urine output criteria, and how to separate pre-renal, intrinsic renal and post-renal causes at the bedside. It then sets out immediate priorities: assess volume status, treat sepsis and obstruction, stop nephrotoxins and review every regular drug. Drugs commonly held or reviewed include ACE inhibitors and ARBs, NSAIDs, diuretics, metformin, spironolactone and other potassium-sparing agents, plus aminoglycosides and contrast. The second half covers hyperkalaemia: which ECG changes matter, the emergency sequence of calcium, insulin with dextrose, nebulised salbutamol, bicarbonate and potassium binders, monitoring requirements, and when renal replacement therapy is needed. Doses shown are teaching examples only; local protocols and formularies take precedence.

   10 min
3. Interpreting an Arterial Blood Gas: Acid-Base Disorders, Compensation and Acute-on-Chronic Type 2 Respiratory Failure

   Arterial blood gases guide some of the most time-critical decisions in acute medicine, so they must be read in a fixed order. This lesson builds a stepwise method: assess oxygenation, identify the primary acid-base disorder from pH and PaCO2, judge whether the bicarbonate response is appropriate compensation, calculate the anion gap and delta ratio, and look for mixed disorders. The method is then applied to type 1 and type 2 respiratory failure, to controlled oxygen targets in acute-on-chronic obstructive pulmonary disease, and to the fluid, drug and ventilation decisions that follow. Target ranges and drug examples are teaching illustrations; local protocols, current formularies and prescribing information take precedence.

   10 min
4. Case: Acute Kidney Injury in an Older Patient with Diarrhoea
   20 min
5. OSCE station: Prescribing IV Maintenance Fluids for a 70 kg Man Nil by Mouth
   11 min
6. OSCE station: Interpretation of Blood Results: Acute Kidney Injury and Hyperkalaemia in a Patient on Ramipril and Spironolactone
   11 min
7. OSCE station: Interpreting an Arterial Blood Gas in Acute-on-Chronic Type 2 Respiratory Failure
   11 min
8. Quiz: Fluids, Electrolytes and the Kidney: Intravenous Fluids, Acute Kidney Injury, Hyperkalaemia and Blood Gases
   8 min

This module covers three time-critical presentations in acute medicine: upper gastrointestinal and variceal haemorrhage, convulsive status epilepticus, and subarachnoid haemorrhage. It focuses on prioritising resuscitation alongside definitive treatment, choosing and dosing drugs safely from the British National Formulary, and recognising where guidance and drug availability differ across the UK. Doses given are teaching examples only. It follows the earlier modules on resuscitation, poisoning, and fluids and electrolytes.

1. Upper Gastrointestinal and Variceal Haemorrhage: Resuscitation, Risk Assessment and Pharmacological Therapy

   Upper gastrointestinal bleeding, presenting as haematemesis, coffee-ground vomiting or melaena, is a common acute medical emergency whose mortality remains substantial, particularly when varices are the source. This lesson takes an ABCDE approach to assessment and resuscitation, explains restrictive red cell transfusion, and uses the Glasgow-Blatchford score to guide admission, discharge and endoscopy timing. It then covers drug therapy when variceal bleeding is suspected or confirmed: intravenous terlipressin, prophylactic antibiotics such as ceftriaxone, and intravenous proton pump inhibitors for non-variceal bleeding. Complications, monitoring and regional variation in drug availability, formulary choice and service configuration are noted. Doses quoted are teaching examples only; local protocols, current formularies and prescribing information govern practice. Content is for education and training and is not a substitute for professional clinical judgment.

   10 min
2. Status Epilepticus: The Benzodiazepine Ladder and Second-Line Antiepileptics

   This lesson covers convulsive status epilepticus in adults as a time-critical emergency. It starts with recognition and the clock-driven sequence: airway protection, oxygen, positioning, capillary glucose and correction of hypoglycaemia, plus identification of causes such as missed antiepileptic doses, alcohol withdrawal and infection. The core is the benzodiazepine ladder: intravenous lorazepam or diazepam, when to repeat, maximum cumulative doses, and buccal or intramuscular midazolam when intravenous access fails. Second-line drugs follow when seizures persist, including levetiracetam, phenytoin and sodium valproate, with points on rate, compatibility and cautions. The lesson ends with refractory status epilepticus and anaesthetic agents in critical care. Doses are teaching examples only; check local protocols and the BNF.

   10 min
3. Thunderclap Headache and Subarachnoid Haemorrhage: Recognition and Early Management

   A single lesson for final-year medical and pharmacy students and foundation doctors on the thunderclap headache and subarachnoid haemorrhage. It covers how to take the history and examine the patient when a headache reaches maximum intensity within seconds, then works through the diagnostic pathway: urgent non-contrast CT within six hours of onset, lumbar puncture for xanthochromia when CT is delayed or negative, and the reasons each test can mislead. The lesson then sets out early drug management in UK practice, including oral or intravenous nimodipine, cautious blood pressure control, and analgesia, followed by the timing and content of the neurosurgical referral. It closes with the complications that change outcome, rebleeding and delayed cerebral ischaemia, and the monitoring that detects them.

   10 min
4. Case: A 63-year-old man with haematemesis and melaena
   20 min
5. Case: Managing Acute Variceal Haemorrhage in a Patient with Alcohol-Related Cirrhosis
   20 min
6. Case: Status Epilepticus in a Young Adult with Missed Antiepileptic Doses
   20 min
7. Case: Thunderclap Headache: A Case of Subarachnoid Hemorrhage
   20 min
8. Quiz: Gastrointestinal and Neurological Emergencies: Upper GI and Variceal Bleeding, Status Epilepticus, and Subarachnoid Haemorrhage
   9 min