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The management of acute medical emergencies is the most demanding and rewarding aspect of medical training. The aim of this handbook is to give confidence to junior doctors to manage acute medical problems effectively and safely. This edition has been updated to ensure that every aspect of the care recommended is in line with current clinical guidelines. The fourth edition of the Oxford Handbook of Acute Medicine includes summary boxes for the key points in the management of common medical emergencies. These concise and practical ‘management key points’ can be a useful guide to junior doctors in the emergency department. The layout of the book reflects clinical practice: assessment, differential diagnosis, immediate management, and some aspects of long- term therapy. Throughout the book, the text commonly exceeds that required for the management of specialist problems by the generalist. This is deliberate, but intended, to provide the doctor with an understanding of specialist interventions, so that they are more conversant with what is possible and what is happening to their patient. We have included a new section on acute medicine and the older patient. A word of advice— patients who present acutely ill are frequently scared and need to be kept informed and to feel safe, however busy you are. Being admitted to hospital means you lose control of your life. Thus, it is our duty as their doctor to make all of our patients feel safe and cared for, and to keep them informed of plans and what is happening to them.