Cardiovascular Emergencies (BMJ)
Cardiovascular Emergencies (BMJ)
By Crispin Davies & Yaver Bashir
Preface:
Cardiovascular emergencies account for 30–40% of an acute medical workload that has grown inexorably over the last two decades. The same period has also witnessed unprecedented changes in the classification, investigation and treatment of acute cardiac problems, driven by advances in basic sciences, pharmacology and technology, but above all by a proliferating body of evidence from controlled trials. Nowhere has the shift from the traditional laissez-faire philosophy towards increasingly aggressive, interventionist approaches been more apparent than in the field of acute coronary syndromes. In 1980, the management of myocardial infarction consisted of little more than bed rest, analgesia and monitoring, while many physicians did not even recognise unstable angina as a distinct entity. Today, the same patients have to be guided through diverse and complex care pathways involving the use of potent but potentially hazardous drugs, and with much greater emphasis on invasive investigation and percutaneous revascularisation. For clinicians in the front line, the price of this progress has been that the management of common cardiovascular emergencies is now more complex and
pressurised than in the past, requiring complex clinical judgements and frequent liaison with tertiary cardiac centres about the transfer of critically ill patients. Bed shortages, performance targets (for example, ‘door-to-needle’ times) and the growing threat of litigation have further compounded their anxieties. It is therefore hardly surprising that most junior doctors and general physicians from non-cardiac specialities regard this as perhaps the most stressful and demanding area of emergency medicine.
In producing ‘Cardiovascular Emergencies’ we have sought to fill a perceived gap in the literature. Standard internal medicine and cardiology textbooks have often failed to reflect the pace of change in this field and are too cumbersome for general reading. At the other end of the spectrum, emergency medicine pocket handbooks cater to the most junior medical staff, providing guidance on immediate management – of necessity, their format tends to be relatively didactic and does not allow more detailed consideration of the often complex issues surrounding management of these conditions. This book is intended to provide such essential background reading primarily for junior medical staff involved in acute general medical takes and specialist registrars in cardiology, intensive care or accident/emergency medicine. However, the subject matter may also be of interest to trainees in cardiothoracic surgery and anaesthesia, medical students and nurses working in cardiology wards, CCU or acute medical admissions units.
Wherever possible, we have adopted a problem-orientated, stepwise approach to more closely reflect the way in which disorders present to clinicians in real-life, rather than the systematic layout of traditional textbooks. Mindful of modern bed pressures, due emphasis has been given to avoiding or shortening hospital admissions. No textbook can obviate the need for hard clinical experience or keeping abreast of the literature but our aim is to provide junior doctors with a basic framework for continuing professional development in this crucial area of acute medicine.
Crispin Davies
Yaver Bashir
About the Authors:
Crispin Davies, Assistant Professor/Attending Cardiologist, Oregon Health Sciences University, Portland, USA
Yaver Bashir, Consultant Cardiologist, John Radcliffe Hospital, Oxford, UK
Download Link:
http://www.4shared.com/file/73225788/a94c8717/AZulikecom-_Cardio_Vascular_Emergencies.html
Password: CVE.AZulike
By Crispin Davies & Yaver Bashir
Preface:
Cardiovascular emergencies account for 30–40% of an acute medical workload that has grown inexorably over the last two decades. The same period has also witnessed unprecedented changes in the classification, investigation and treatment of acute cardiac problems, driven by advances in basic sciences, pharmacology and technology, but above all by a proliferating body of evidence from controlled trials. Nowhere has the shift from the traditional laissez-faire philosophy towards increasingly aggressive, interventionist approaches been more apparent than in the field of acute coronary syndromes. In 1980, the management of myocardial infarction consisted of little more than bed rest, analgesia and monitoring, while many physicians did not even recognise unstable angina as a distinct entity. Today, the same patients have to be guided through diverse and complex care pathways involving the use of potent but potentially hazardous drugs, and with much greater emphasis on invasive investigation and percutaneous revascularisation. For clinicians in the front line, the price of this progress has been that the management of common cardiovascular emergencies is now more complex and
pressurised than in the past, requiring complex clinical judgements and frequent liaison with tertiary cardiac centres about the transfer of critically ill patients. Bed shortages, performance targets (for example, ‘door-to-needle’ times) and the growing threat of litigation have further compounded their anxieties. It is therefore hardly surprising that most junior doctors and general physicians from non-cardiac specialities regard this as perhaps the most stressful and demanding area of emergency medicine.
In producing ‘Cardiovascular Emergencies’ we have sought to fill a perceived gap in the literature. Standard internal medicine and cardiology textbooks have often failed to reflect the pace of change in this field and are too cumbersome for general reading. At the other end of the spectrum, emergency medicine pocket handbooks cater to the most junior medical staff, providing guidance on immediate management – of necessity, their format tends to be relatively didactic and does not allow more detailed consideration of the often complex issues surrounding management of these conditions. This book is intended to provide such essential background reading primarily for junior medical staff involved in acute general medical takes and specialist registrars in cardiology, intensive care or accident/emergency medicine. However, the subject matter may also be of interest to trainees in cardiothoracic surgery and anaesthesia, medical students and nurses working in cardiology wards, CCU or acute medical admissions units.
Wherever possible, we have adopted a problem-orientated, stepwise approach to more closely reflect the way in which disorders present to clinicians in real-life, rather than the systematic layout of traditional textbooks. Mindful of modern bed pressures, due emphasis has been given to avoiding or shortening hospital admissions. No textbook can obviate the need for hard clinical experience or keeping abreast of the literature but our aim is to provide junior doctors with a basic framework for continuing professional development in this crucial area of acute medicine.
Crispin Davies
Yaver Bashir
About the Authors:
Crispin Davies, Assistant Professor/Attending Cardiologist, Oregon Health Sciences University, Portland, USA
Yaver Bashir, Consultant Cardiologist, John Radcliffe Hospital, Oxford, UK
Download Link:
http://www.4shared.com/file/73225788/a94c8717/AZulikecom-_Cardio_Vascular_Emergencies.html
Password: CVE.AZulike
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