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Ovid: Oxford Handbook of Accident and Emergency Medicine

Editors: Wyatt, Jonathan P.; Illingworth, Robin N.; Clancy, Michael J.; Munro, Philip T.; Robertson, Colin E. Title: Oxford Handbook of Accident and Emergency Medicine, 2nd Edition Copyright ©2005 Oxford University Press > Back of Book > Resources > Appendices Appendices Normal values Note that ‘normal’ values in adults may vary slightly between labs. Normal values in pregnancy are shown on p551. Arterial blood gas analysis

H+ 35–45 nanomol/litre
pH 7.35–7.45
pO2 (on air) >10.6 kPa
pCO2 4.5–6.0 kPa
bicarbonate 24–28 mmol/litre
base excess ±2 mmol/litre

Biochemistry

ALT 5–35 iu/litre
albumin 35–50 g/litre
alkaline phosphatase 30–300 iu/litre
AST 5–35 iu/litre
bicarbonate 24–30 mmol/litre
bilirubin 3–17 micromol/litre
calcium (total) 2.12–2.65 mmol/litre
calcium (ionised) 1–1.25 mmol/litre
chloride 95–105 mmol/litre
CK 25–195 iu/litre
creatinine 70–150 micromol/litre
glucose (fasting) 3.5–5.5 mmol/litre
osmolality 278–305 mosmol/kg
potassium 3.5–5.0 mmol/litre
sodium 135–145 mmol/litre
urea 2.5–6.7 mmol/litre
urate (women) 150–390 micromol/litre
urate (men) 210–480 micromol/litre

Haematology

RBC (women) 3.9–5.6 × 1012/litre
RBC (men) 4.5–6.5 × 1012/litre
Hb (women) 11.5–16.0 g/dL
Hb (men) 13.5–18.0 g/dL
Hct (women) 0.37–0.47
Hct (men) 0.40–0.54
MCV 76–96 femtoL
WCC 4.0–11.0 × 109/litre
neutrophils 2.0–7.5 × 109/litre (40–75% of WCC)
lymphocytes 1.5–4.0 × 109/litre (20–40% of WCC)
monocytes 0.2–0.8 × 109/litre (2–10% of WCC)
eosinophils 0.04–0.40 × 109/litre (1–6% of WCC)
basophils <0.1 × 109/litre (<1% of WCC)
platelets 150–400 × 109/litre
prothrombin time 12–15s
APTT 23–42s
ESR (women) < (age in yrs+10)/2mm/h
ESR (men) < (age in yrs)/2mm/h

Metric conversion Length

1 m = 3 feet 3.4 inches 1 foot = 0.3048 m
1 cm = 0.394 inch 1 inch = 25.4 mm

Weight

1 kg = 2.20 pounds 1 stone = 6.35 kg
1 gram = 15.4 grains 1 pound = 0.454 kg
1 ounce = 28.4 g

Volume 1 litre = 1.76 UK pints = 2.11 US liquid pints 1 UK pint = 20 fluid ounces = 0.568 litre 1 US liquid pint = 16 fluid ounces = 0.473 litre 1 teaspoon ≈ 5 mL 1 tablespoon ≈ 15 mL Temperature T° in °C = (T° in Fahrenheit -32) × 5/9 Pressure 1 kPa = 7.6 mmHg Golden rules of A&E There may be exceptions to every rule, but do think very carefully before breaking the following rules:

  • Allow patients to ‘tell their story’ or at least a summary of it
  • Turn up on time for every shift
  • Beware patients who are ‘handed over’ to you
  • Ensure each shift contains regular refreshment breaks
  • A&E staff work as a team—thank members appropriately
  • Treat patients as you would want your own relatives to be treated
  • Treat the patient (not just the investigation result)
  • Always listen to nagging doubts
  • Do not work beyond your expertise: when in doubt, seek senior advice
  • If someone gives you advice, record what it was and who gave it
  • Do not bring patients back for a second opinion—get a first opinion
  • Referral means referral and is usually a one-way process
  • When making notes, write legibly, record times and print your name
  • Remember to record what explanation and advice you have given
  • Do not try to ‘work through’ illness
  • If you feel yourself becoming angry, take a deep breath and a short break
  • If a fellow professional is rude to you, it may reflect stress on his or her part
  • Discuss with a senior before contemplating breaking patient confidentiality
  • When providing evidence, avoid giving an opinion outside your expertise
  • If a patient has ↓ GCS, check BMG
  • Glass + skin wound = X-ray
  • Beware using tourniquets on digits and limbs
  • Check visual acuity for all eye problems
  • X-ray high velocity eye injuries (eg hammering)
  • Always check and document anatomical snuffbox tenderness in wrist injuries
  • ‘Worst headache ever’ mandates exclusion of subarachnoid haemorrhage
  • Call an anaesthetist early in possible airway burns
  • Never assume ↓ GCS is due to alcohol alone (especially with head injury)
  • Admit patients with even minor head injury but no one at home
  • Admit patients with minor head injury if they take anticoagulants
  • Bleeding disorder + head injury = discuss with a haematologist
  • Do not place chest tubes through stab or bullet wounds
  • Take it seriously if mum says her baby (or child) is simply ‘not right’
  • Consider meningococcal disease when faced with unexplained skin rashes
  • Remember the possibility of NAI in atypical paediatric presentations
  • If NAI is a possibility, inform a senior and/or specialist at once
  • Do not try to age bruises
  • Ask about allergies before giving drugs
  • Always re-check drug doses (especially in children)
  • Each time you see a new condition, read up about it

Chart

Acid-base nomagram in the interpretation of arterial blood-gases

ECG Ruler

Figure. ECG Ruler

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