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Emergency topics

Arrests
Adult resuscitation E pp. 232–3
Obstetric resuscitation E p. 244
Neonatal resuscitation E pp. 242–3
Paediatric resuscitation E pp. 238–40
Trauma resuscitation E pp. 236–7
Emergencies
Abdominal pain E p. 294
Aggressive behaviour E p. 370
Anaphylaxis E pp. 484–5
Bradyarrhythmia E p. 262
Breathlessness E p. 276
Burns E pp. 480–1
Chest pain E p. 246
Clotting abnormalities E p. 418
Coma E pp. 344–5
Diabetic ketoacidosis (DKA) E p. 330
Disseminated intravascular coagulation (DIC) E p. 417
GI bleed E p. 304
Hepatic encephalopathy E p. 318
High INR E p. 418
Hyperglycaemia E p. 330
Hyperkalaemia E p. 399–403
Hyperosmolar non-ketotic state (HONK) E p. 332
Hypertension E p. 268
Hypoglycaemia E p. 328
Hypokalaemia E pp. 399–403
Hypotension E p. 488–9
Hypoxia E p. 276
Limb pain E p. 458

Liver failure E p. 318
Overdose E p. 506
Paediatric seizure E p. 349
Psychosis E p. 378–81
Rash E p. 424
Red eye E pp. 440–2
Reduced GCS Epp. 344–5
Renal failure/kidney injury E p. 386
Shock E pp. 490–5
Shortness of breath E p. 276
Stridor E p. 290
Stroke E p. 354
Tachyarrhythmia E p. 254
Seizures E p. 348


Normal values
Despite national efforts to standardise laboratory testing and reporting,
exact ranges vary between hospitals, these figures serve as a guide.
Haematology see E p. 580
Hb–men
Hb–women

130–180g/L
115–160g/L

WBC

MCV

76–96fl

Plts

150–400 x 10 /l

Ferritin
TIBC

12–200micrograms/l B12
42–80µmol/l
Folate

• NØ
• LØ
9

• EØ

4–11 x 109/l
2.0–7.5 x 109/l
(40–75%)
1.3–3.5 x 109/l
(20–45%)
0.04–0.44 x
109/l (1–6%)
197–866pg/ml
2–20micrograms/l

Clotting see E p. 581

INR
PT
Fibrinogen

0.8–1.2
11–16s
1.5–4.0g/l

APTTr
APTT
D–dimer

0.8–1.2
35–45s
<0.3mg/ml
(<300ng/ml)

Ca2+ (adjusted)
PO43–
Mg2+
HCO3–
Cl–

2.2–2.6mmol/l
0.8–1.5mmol/l
0.7–1.0mmol/l
22–29mmol/l
95–108mmol/l

30–130units/l

3–35units/l
10–55units/l

Bilirubin
Albumin
Total protein

3–21micrograms/l
35–50g/l
60–80g/l

0–120units/l
3.5–6.0mmol/l
24–37g/l
<6mmol/l
0.5–1.9mmol/l

CRP
ESR
CK
LDH
PSA

<5mg/l
<20mm/h
25–195units/l
70–250units/l
0–4ng/ml

PaO2

PaCO2

10.6–13.3kPa
4.7–6.0kPa

U+Es see E p. 582
Na+
K+
Urea
Creatinine
Osmolality

133–146mmol/l
3.5–5.3mmol/l
2.5–7.8mmol/l
70–150µmol/l
275–295mOsmol/kg

LFTs see E p. 583
ALP
ALT
γGT
Other
Amylase
Fasting glucose
Immunoglobulins
Cholesterol
Triglycerides

Blood gases see E pp. 598–9

pH
Base excess

7.35–7.45
±2mmol/l


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Oxford Handbook for the

Foundation
Programme
Fifth Edition
Tim Raine
Consultant Gastroenterologist,
Cambridge University Hospitals NHS Foundation Trust, UK

George Collins
Cardiology Registrar
Barts Health NHS Trust, UK

Catriona Hall
General Practitioner,
James Wigg Practice, Kentish Town, London, UK

Nina Hjelde
Anaesthetic registrar,
Manchester University NHS Foundation Trust, UK

Consultant Editors

James Dawson
Consultant Anaesthetist,
Nottingham University Hospitals NHS Trust, UK

Stephan Sanders
Assistant Professor, UCSF School of Medicine, USA

Simon Eccles
Consultant in Emergency Medicine, St Thomas Hospital, UK

1


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Second Edition published in 2008
Third Edition published in 2011
Fourth Edition published in 2014
Fifth Edition published in 2018

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v

Preface
It seems that every new edition of this book has arrived fresh on the tail
of some major change impacting the training and lives of junior doctors
in the NHS. Previous new appointments into the Foundation Programme
had to contend with the traumas of the introduction of ‘Modernising
Medical Careers’. More recently, we have seen the treatment of junior
doctors reach the national media once more with the new junior doctors’
contract and the ensuing, unprecedented industrial relations dispute of
2015–​2016. If there is a theme, beyond the constant upheaval that our
junior doctors are being subjected to, it is the increasing void between
those delivering healthcare on the ‘shop floor’ and those planning what
is best for the health service, often based upon misinformation and misunderstanding. In a landscape where a Secretary of State for Health so
wilfully misquotes data as to lead to questions regarding his honesty and
his intelligence, what message of hope can we send to newly appointed
junior doctors? And as we wrote in a previous preface, through all of this
turbulence, the fact remains that the leap from being a final year medical
student to a junior doctor remains immense. No matter what elements
may be introduced to final year curricula, or to Foundation Programme
inductions, the psychological and professional gear-​shift is a change that
many feel unprepared for. Overnight the new doctor inherits huge responsibility, an incessantly active bleep, and an inflexible working rota.
But something else happens, overnight. The new doctor also becomes
a valued member of the medical team, someone who patients look to
for help and someone with the capacity to provide that help to both patients and their relatives. Despite changes in training structure, the new
doctor has the potential and flexibility to learn and shape a career in just
about any area of medicine they wish to pursue. And if the assault of
politicians might well distress some, take solace in over two decades of

UK polling data, showing doctors as representing the profession consistently rated highest for trustworthiness, with politicians languishing consistently at the very opposite end of the spectrum.
Nevertheless, such is the burden that comes with the new professional
status, that nothing can make the transition that a student doctor must
go through easy. At the very least, we hope that this book can act as a
guide, a manager of expectations, but above all else, as a companion
on this difficult journey. Carry the book with you. Turn to it when you
feel most exposed or most worried. We have tried to make sure that,
whatever the situation, there will be at least something that you can read
and use to start you off along the right path. And if there isn’t? Don’t
panic—​make sure you have spoken with someone senior, and take heed
of the advice on p. xxviii. Finally, when the dust has settled, please take
the time to let us know and to help us continue to improve this book by
sending comments and suggestions to:
TR, 2017

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To every doctor who’s ever stood there thinking:
‘What on earth do I do now?’


vii

Acknowledgements
The authors would like to say a huge ‘thank you’ to many people for

their wisdom, knowledge, and support:
• Tim thanks Lucy for her patience and support and Beatrice, Felix, and
Max for their carefree good humour
• George would like to thank Mel, Mark and Charlie, whose support
and space made this authorship possible
• Catriona would like to thank her former Foundation colleagues for
their friendship, encouragement, and resilience, and her colleagues in
General Practice for their mentorship and unfailing support
• Nina would like to dedicate this work to her husband for his endless
support through yet another one of her ventures
Specific thanks for assistance with specialist material go to Dr Daniel
Neville (Respiratory), Dr Sam O’Toole (Endocrinology), Dr Simon Vann
Jones (Psychiatry), Drs Bjorn Thomas and Duncan Leadbetter (Skin and
eyes), and Dr Elaine Church (Emergencies).
This book builds upon the efforts of authors of all previous editions.
In particular, we are grateful for the vision of Simon Eccles and the hard
work of James Dawson and Stephan Sanders, without whom this book
would never have come to be.
We would also like to thank all the staff at Oxford University Press
for their help and for making our writing into a book. In particular, Liz
Reeve and Kate Smith for their terrific efforts and support in making
the OHFP5e such a pleasure to work on, along with the rest of the
OUP team:
•Michael Hawkes
• Fiona Chippendale



ix

Contents
Symbols and abbreviations 
Introduction 
10 tips on being a safe junior doctor 
10 tips on being a happy doctor 
1 Being a doctor 
2 Life on the wards 
3 History and examination 
4Prescribing 
5Pharmacopoeia 
6Resuscitation 
7Cardiovascular 
8Respiratory 
9Gastroenterology 
10Endocrinology 
11Neurology 
12Psychiatry 
13Fluids and renal 
14Haematology 
15Skin and eyes 
16Emergency department 
17Procedures 
18Interpreting results 
Appendices 
Index 

x
xxv
xxvii
xxviii

1
67
125
169
183
225
245
275
293
327
343
369
385
405
423
447
523
579
613
629


x

Symbols and
abbreviations
definition
K
topics covered elsewhere
I

cross reference
E
supplementary information
T
2emergency
3don’t dawdle
Mwebsite
iincreased
ddecreased
lleading to
plus/​minus
±
>greater than
♀female
♂male
accident and emergency
A+E
abdominal aortic aneurysm
AAA
arterial blood gas
ABG
ankle–​brachial pressure index
ABPI
ABxantibiotics
acute care common stem
ACCS
angiotensin-​converting enzyme inhibitor(s)
ACEi
academic clinical fellowship

ACF
ACRalbumin:creatinine ratio
acute coronary syndrome
ACS
adrenocorticotrophic hormone
ACTH
antidiuretic hormone
ADH
activities of daily living
ADL
automated external defibrillator/​anti-​epileptic drug
AED
atrial fibrillation
AF
acid-​fast bacilli
AFB
αFP (AFP) α-​fetoprotein
acquired immunodeficiency syndrome
AIDS
acute kidney injury
AKI
acute lymphoblastic leukaemia
ALL


Symbols and abbreviations

ALP
ALS
ALT

AML
AMPH
AMPLE

alkaline phosphatase
Advanced Life Support®
alanine aminotransferase
acute myeloid leukaemia
approved mental health professional
Allergies; Medications; Past medical history; Last meal;
Events leading to presentation
ANA
antinuclear antibody
ANCA
antineutrophil cytoplasmic antibody
AoMRC Academy of Medical Royal Colleges
APanteroposterior
APH
antepartum haemorrhage
APLS
Advanced Paediatric Life Support
APTT
activated partial thromboplastin time
AR
aortic regurgitation
ARB
angiotensin receptor blocker
ARDS
acute respiratory distress syndrome
ARVC

arrhythmogenic right ventricular cardiomyopathy
AS
aortic stenosis
ASA
American Society of Anesthesiologists
ASAP
as soon as possible
ASD
atrial septal defect
AST
aspartate transaminase
ATangiotensin
ATLS
Advanced Trauma Life Support
ATN
acute tubular necrosis
AVatrioventricular
AVNatrioventricular node
AVR
aortic valve replacement
AXR
abdominal X-​ray
Babarium
BALbronchoalveolar lavage
BBB
bundle branch block
BCG
bacille Calmette–​Guérin (TB vaccination)
bd
bis die (twice daily)

BEbase excess
β-​hCG
β-​human chorionic gonadotrophin
BIH
benign intracranial hypertension
BiPAP
biphasic positive airways pressure
BKA
below knee amputation
BLS
Basic Life Support

xi


xii

Symbols and abbreviations

BM

Boehringer Mannheim meter (capillary blood glucose) or
bone marrow
BMA
British Medical Association
BMI
body mass index
BNF
British National Formulary
BNP

brain natriuretic peptide
BP
blood pressure
BPH
benign prostatic hypertrophy
BXbiopsy
C+S
culture and sensitivity
Cacarcinoma
Ca2+calcium
CABG
coronary artery bypass graft
CAD
coronary artery disease
CAH
congenital adrenal hyperplasia
CAPD
continuous ambulatory peritoneal dialysis
CBD
case-​based discussion/​common bile duct
CBG
capillary blood glucose
CBT
cognitive behavioural therapy
CCF
congestive cardiac failure
CCG
clinical commissioning group
CCT
Certificate of Completion of Training

CCU
coronary care unit
CDcontrolled drug
CDT
Clostridium difficile toxin
CEA
carcinoembryonic antigen
CEPOD Confidential Enquiry into Perioperative Deaths
CEX
Clinical Evaluation Exercise
cf compared with
CHD
coronary heart disease
CIcontraindication
CJD
Creutzfeldt–​Jakob disease
CKcreatine kinase
CK-​MB
heart-​specific creatine kinase (MB-​isoenzyme)
CKD
chronic kidney disease
CLL
chronic lymphocytic leukaemia
CLO
Campylobacter-​like organism
CML
chronic myeloid leukaemia
CMVcytomegalovirus
CNS
central nervous system

CO
carbon monoxide


Symbols and abbreviations

CO2
carbon dioxide
COAD
chronic obstructive airway disease
COC
combined oral contraceptive
COPD
chronic obstructive pulmonary disease
CPAP
continuous positive airway pressure
CPK
creatine phosphokinase
CPN
community psychiatric nurse
CPR
cardiopulmonary resuscitation
CQC
care quality commission
CRP
C-​reactive protein
CRT
capillary-​refill time/​cardiac resynchronization therapy
CSFcerebrospinal fluid
CSU

catheter specimen of urine
CT
computed tomography/​Core Training/Core Trainee
CTCA
CT coronary angiogram
CTGcardiotocograph
CTPA
CT pulmonary angiogram
CVA
cerebrovascular accident
CVP
central venous pressure
CVScardiovascular system
CXR
chest X-​ray
dday(s)
D+C
dilatation and curettage
D+V
diarrhoea and vomiting
DBS
Disclosure and Barring Service
DC
direct current
DCCV
direct current cardioversion
DCM
dilated cardiomyopathy
DEXA
dual-​energy X-​ray absorptiometry (DXA)

DH
drug history/​Department of Health
DHS
dynamic hip screw
DI
diabetes insipidus
DIB
difficulty in breathing
DIC
disseminated intravascular coagulation
DIPJ
distal interphalangeal joint
DKA
diabetic ketoacidosis
DLB
dementia with Lewy bodies
DM
diabetes mellitus
DMARD disease-​modifying anti-​rheumatic drug
DNA
deoxyribonucleic acid/​did not attend
DNAR
do not attempt resuscitation

xiii


xiv

Symbols and abbreviations

DOAC
DoB
DOPS
DRE
DSM-​5

direct oral anticoagulant
date of birth
Direct Observation of Procedural Skills
digital rectal examination
Diagnostic and Statistical Manual of Mental Disorders
5th edition
DTP
diphtheria, tetanus, and pertussis
DUduodenal ulcer
DVLA
Driver and Vehicle Licensing Agency
DVT
deep vein thrombosis
d/​w
discuss(ed) with
Dxdiagnosis
EBM
evidence-​based medicine
EBV
Epstein–​Barr virus
ECGelectrocardiogram
Echoechocardiogram
ECV

external cephalic version
ED
emergency department (formerly A+E)
EDD
expected due date (pregnancy)
EEGelectroencephalogram
EMD
electromechanical dissociation or pulseless electrical
activity (PEA)
EMGelectromyogram
ENP
emergency nurse practitioner
ENT
ear, nose, and throat
EOeosinophil
EPOerythropoietin
ERCP
endoscopic retrograde cholangiopancreatography
ERPC
evacuation of retained products of conception
ESM
ejection systolic murmur
ESR
erythrocyte sedimentation rate
ESRF
end-​stage renal failure
ETendotracheal
EtOH
ethanol (alcohol)
ETTendotracheal tube

EUA
examination under anaesthetic
EVD
extra-​ventricular drain
EWTD
European Working Time Directive
F1/​F2
Foundation year one/​two
FAST
focused assessment with sonography in trauma
FBforeign body


Symbols and abbreviations

FBC
FDP
FEV1
FFP
FH
FiO2
FNA
FOB
FOOSH
FP
FPP
FRC
FSH
FTSTA
FVC

G+S
G6PD
GA
GB
GBS
GCS
GFR
γGT (GGT)
GH
GI
GMC
GN
GORD
GOSWH
GP
GTN
GTT
GU(M)
h
h@N
HAART
HAI
HAV
Hb
HbA1c
HBV

full blood count
fibrin degradation product
forced expiratory volume in one second

fresh frozen plasma
family history/foetal heart
fraction of inspired oxygen
fine needle aspiration
faecal occult blood
fall on outstretched hand
Foundation Programme
flexible pay premia
functional residual capacity
follicle stimulating hormone
fixed-term specialty training appointment
forced vital capacity
group and save
glucose-6-phosphate dehydrogenase
general anaesthetic
gall bladder
Group B Streptococcus/Guillain–Barré syndrome
Glasgow Coma Scale
glomerular filtration rate
gamma-glutamyl transpeptidase
growth hormone/gynae history
gastrointestinal
General Medical Council
glomerulonephritis
gastro-oesophageal reflux disease
guardian of safe working hours
general practitioner
glyceryl trinitrate
glucose tolerance test
genitourinary (medicine)

hour(s)
hospital at night
highly active antiretroviral therapy
hospital-acquired infection
hepatitis A virus
haemoglobin
glycosylated haemoglobin
hepatitis B virus

xv


xvi

Symbols and abbreviations

HCA
healthcare assistant
HCC
hepatocellular carcinoma
hCG
human chorionic gonadotrophin
HCM
hypertrophic cardiomyopathy
HCSA
Hospital Consultants and Specialists Association
HCThaematocrit
HCV
hepatitis C virus
HDL

high-​density lipoprotein
HDU
high dependency unit
HEE
Health Education England
HELLP
haemolysis, elevated liver enzymes, low platelets
(syndrome)
HHS
hyperglycaemic hyperosmolar state
HIV
human immunodeficiency virus
HLA
human leucocyte antigen
HMMA
4-​hydroxy-​3-​methoxymandelic acid (phaeochromocytoma)
HOCM
hypertrophic obstructive cardiomyopathy
HONK
hyperosmolar non-​ketotic state
HPA
Health Protection Agency
HPC
history of presenting complaint
HR
heart rate/​human resources
HRCT
high-​resolution computed tomography scan
HRT
hormone replacement therapy

HSP
Henoch–​Schönlein purpura
HSV
herpes simplex virus
HTNhypertension
HUS
haemolytic uraemic syndrome
HVS
high vaginal swab
I+D
incision and drainage
IBD
inflammatory bowel disease
IBS
irritable bowel syndrome
ICD
implantable cardiac defibrillator
ICD-​10
International Classification of Diseases 10th revision
ICP
intracranial pressure
ICS
inhaled corticosteroid
ICU
intensive care unit
ID
identification/​infectious diseases
IE
infective endocarditis
IFG

impaired fasting glucose
Igimmunoglobulin
IGT
impaired glucose tolerance


Symbols and abbreviations

IHD
ischaemic heart disease
ILS
Immediate Life Support
IMintramuscular
Imp
impression (clinical)
INintranasal
INH
by inhalation
INR
international normalized ratio
ITP
idiopathic thrombocytopenic purpura
ITU
intensive care unit/​intensive therapy unit
IUinternational unit
IUCD
intrauterine contraceptive device
IUP
intrauterine pregnancy
IVintravenous

IVDU
intravenous drug user
IVI
intravenous infusion
IVP
intravenous pyelogram
IVU
intravenous urogram
Ixinvestigation(s)
JDC
Junior Doctors’ Committee of BMA
JVP
jugular venous pressure
K-​nail
Küntscher nail
kPakilopascal
KUB
kidneys, ureter, bladder (X-​ray)
K-​wire
Kirschner wire
Llitre(s)
LA
local anaesthetic/​left atrium
LABA
long-​acting β-​agonist
LACS
lacunar circulation stroke
LAD
left axis deviation/​left anterior descending
LAMA

long acting muscarinic agonist
LBBB
left bundle branch block
LDH
lactate dehydrogenase
LDL
low-​density lipoprotein
LETB
Local Education and Training Board
LFT
liver function test
LH
luteinizing hormone
LHRH
luteinizing hormone releasing hormone
LIF
left iliac fossa
LMA
laryngeal mask airway
LMN
lower motor neuron
LMP
last menstrual period

xvii


xviii

Symbols and abbreviations

LMWH
low-​molecular-​weight heparin
LNlymph node
LØlymphocyte
LOC
loss of consciousness
LP
lumbar puncture
LRTI
lower respiratory tract infection
LSCS
lower segment Caesarean section
LTFT
less than full-time training
LTOT
long-​term oxygen therapy
LUQ
left upper quadrant
LVEF
left ventricular ejection fraction
LVF
left ventricular failure/​left ventricular function
LVH
left ventricular hypertrophy
MAOI
monoamine oxidase inhibitor
mane
in the morning
MAP

mean arterial pressure
M,C+S
microscopy, culture, and sensitivity
MCPJ
metacarpal phalangeal joint
MCV
mean cell volume
MDR
multi-​drug resistant
MDTmultidisciplinary team
MDU
Medical Defence Union
ME
myalgic encephalitis
MEWS
Modified Early Warning Score
mgmilligram(s)
MI
myocardial infarction
minminute(s)
mLmillilitre(s)
MMC
Modernising Medical Careers
mmH2O millimetres of water
mmHg
millimetres of mercury
MMR
measles, mumps, and rubella
MMSE
Mini-​mental State Examination

MND
motor neuron disease
MPS
Medical Protection Society
MR
mitral regurgitation/​modified release/​magnetic resonance
MRA
mineralocorticoid receptor antagonist
MRCP
magnetic resonance cholangiopancreatography
MRI
magnetic resonance imaging
MRSA
meticillin-​resistant Staphylococcus aureus
MS
multiple sclerosis/​mitral stenosis


Symbols and abbreviations

MSF
multisource feedback
MSSA
meticillin-​sensitive Staphylococcus aureus
MST
morphine sulfate
MSU
mid-​stream urine
MTPJ
metatarsal phalangeal joint

mthmonth(s)
MVR
mitral valve replacement
N+V
nausea and vomiting
NAD
nothing abnormal detected
NAI
non-​accidental injury
NBM
nil by mouth
NEB
by nebulizer
NGnasogastric
NHS
National Health Service
NHSI
NHS improvement
NICE
National Institute for Health and Care Excellence
NICU
neonatal intensive care unit
NJnasojejunal
NNUneonatal unit
NØneutrophil
NOAC
non-​vitamin K antagonist oral anticoagulant
nocteat night
NPA
nasopharyngeal aspirate

NPSA
National Patient Safety Agency
NSAID
non-​steroidal anti-​inflammatory drug
NSTEMI
non-​ST-​elevation myocardial infarction
NTN
national training number
NVD
normal vaginal delivery
NYHA
New York Heart Association
OAosteoarthritis
Obsobservations
OCD
obsessive–​compulsive disorder
OCP
oral contraceptive pill/​ova, cysts and parasites
od
omni die (once daily)
ODoverdose
OGDoesophagogastroduodenoscopy
OHA
Oxford Handbook of Anaesthesia
OHAM
Oxford Handbook of Acute Medicine
OHCC
Oxford Handbook of Critical Care
OHCLI
Oxford Handbook of Clinical and Laboratory Investigation

OHCM
Oxford Handbook of Clinical Medicine

xix


xx

Symbols and abbreviations

OHCS
Oxford Handbook of Clinical Specialties
OHEM
Oxford Handbook of Emergency Medicine
OHFP
Oxford Handbook for the Foundation Programme
OHGP
Oxford Handbook of General Practice
OHOG
Oxford Handbook of Obstetrics and Gynaecology
om
omni mane (in the morning)
on
omni nocte (at night)
ORIF
open reduction and internal fixation
OSA
obstructive sleep apnoea
OSCE
objective structured clinical examination

OT
occupational therapy
OTC
over the counter
Ppulse
PAposteroanterior
PaCO2
partial pressure of arterial carbon dioxide
PACS
partial anterior circulation stroke/​picture archiving and
communication systems
PAD
peripheral arterial disease
PANpolyarteritis nodosa
PaO2
partial pressure of arterial oxygen
PAT
Peer Assessment Tool
PBC
primary biliary cirrhosis
PCA
patient-​controlled analgesia
pCO2
partial pressure of carbon dioxide
PCOS
polycystic ovary syndrome
PCR
polymerase chain reaction
PCT
primary care trust

PCV
packed cell volume
PD
Parkinson’s disease
PDA
patent ductus arteriosus
PE
pulmonary embolism
PEA
pulseless electrical activity
PEEP
positive end-​expiratory pressure
PEFR
peak expiratory flow rate
PERLA
pupils equal and reactive to light and accommodation
PET
positron emission tomography
PICU
paediatric intensive care unit
PID
pelvic inflammatory disease
PIP
peak inspiratory pressure
PIPJ
proximal interphalangeal joint
PMETB
Postgraduate Medical Education and Training Board (obsolete)

Symbols and abbreviations

past medical history
pre-​menstrual tension
paroxysmal nocturnal dyspnoea
peripheral nervous system
per os (by mouth)
partial pressure of oxygen
products of conception
posterior circulation stroke
postoperative nausea and vomiting
plaster of Paris/​progesterone-​only pill
postpartum haemorrhage
proton pump inhibitor
per rectum (by rectum)
pre-​registration house officer (old training system but still
occasionally used)
pro re nata (as required)
PRN
premature rupture of membranes (pregnancy)
PROM
polycythaemia rubra vera
PRV
prostate-​specific antigen/​prescribing safety exam
PSA
past surgical history
PSH
PTprothrombin time
parathyroid hormone
PTH

passed urine/​peptic ulcer
PU
peptic ulcer disease
PUD
pyrexia of unknown origin
PUO
plasma viscosity/​per vagina
PV
peripheral vascular disease
PVD
quater die sumendus (four times daily)
qds
rheumatoid arthritis
RA
RASTradioallergosorbant test
right bundle branch block
RBBB
red blood cell
RBC
red cell distribution width
RDW
rapid eye movement (sleep stage)
REM
RFrheumatic fever
Rhrhesus
RhFrheumatoid factor
right iliac fossa
RIF
range of movement
ROM

review of systems
ROS
RRrespiratory rate

PMH
PMT
PND
PNS
PO
pO2
PoC
POCS
PONV
POP
PPH
PPI
PR
PRHO

xxi


xxii

Symbols and abbreviations

RSrespiratory system
RSI
rapid sequence induction
RTA

road traffic accident
RTI
road traffic incident
RUQ
right upper quadrant
RVH
right ventricular hypertrophy
Rxprescription
ssecond(s)
SABA
short-​acting β-​agonist
SAH
sub-​arachnoid haemorrhage
SALT
speech and language therapy
SAMA
short acting muscarinic agonist
SARS
severe acute respiratory syndrome
SatsO2 saturation
SBE
sub-​acute bacterial endocarditis
SBP
systolic blood pressure
SCsubcutaneous
SCBU
special care baby unit
SCC
squamous cell carcinoma
SE

side effects
SH
social history
SHDU
surgical high dependency unit
SHO
senior house officer (old training system but still
widely used)
SIADH
syndrome of inappropriate antidiuretic hormone secretion
SIRS
systemic inflammatory response syndrome
SJS
Stevens–​Johnson syndrome
SLsublingual
SLE
systemic lupus erythematosus
SOA
swelling of ankles
SOB
short of breath
SOBAR
short of breath at rest
SOBOE
short of breath on exertion
SOL
space-​occupying lesion
SOT
shape of training
SpO2

oxygen saturation in peripheral blood
SpR
specialist registrar (old training system but still widely used)
SR
slow release/​sinus rhythm
SSRI
selective serotonin re-​uptake inhibitor
STAT
statim (immediately)
ST
Specialty Training/​Trainee