' the beginning of the malady it is easy to cure but difficult to detect, but in the course of time, not having been either detected or treated ... it becomes easy to detect but difficult to cure.'

Niccolo Machiavelli, The Prince

This book is aimed at trainees in internal medicine, surgery, anaesthesia, intensive care, and emergency medicine - people who deal with acutely ill adults. Final year medical students and nursing staff in critical care areas will also find this book extremely useful.

There are many books on the management of patients who are acutely ill, but all have a traditional "recipe" format. One looks up a diagnosis and the management is summarised. Few of us are trained how to deal with the generic altered physiology that can accompany acute illness. The result is that many doctors are unable to deal logically with patients in physiological decline and this often leads to suboptimal care.

In our surveys of doctors of all specialties, few can explain how different oxygen masks work, the difference between hypercapnic respiratory failure and "CO2 retention", what a fluid challenge is and how to effectively treat organ failure.

This book contains information that you really need to know and that is not found in a standard textbook. Throughout the text are "mini-tutorials" that explain the latest thinking or controversies. Case histories and problemsolving exercises are included at the end of each chapter. Further reading is included for more information. It is our aim that this book should provide a foundation in learning how to care effectively for those who are acutely ill.

Nicola Cooper and Paul Cramp

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