Adult Medical Emergency Handbook - Scottish Intensive Care Society

i
rehab team or the BHF nurse, and/or the community heart manual
facilitators. As a rough guide, patients referred for group exercise
should be able to complete stage 1 (3 minutes) of full Bruce
protocol. Treadmill testing.
Phase III programmes are offered at Astley Ainslie Hospital,
Western General Hospital and St John’s Hospital.
OTHER POTENTIAL PROBLEMS IN THE
PERI-INFARCT PERIOD
ALCOHOL WITHDRAWAL
There is an alcohol withdrawal policy (see Lothian Joint Formulary) and
chapter 12.
NICOTINE WITHDRAWAL
Evidence suggests that transdermal nicotine, and nicotine gum should
not be withheld from patients who suffer an MI unless there is evidence
of ongoing ischaemia (Goldstein, Niaura, 2000). The safety of NRT
in those with unstable angina or post MI within 2 weeks has not yet
been studied but cardiac complications should be lower than with
smoking.
A risk/benefit assessment should be made with each individual patient.
Patients struggling with the withdrawal effects of nicotine should be
offered treatment for the first 48 hours, or until haemodynamically
stable, using benzodiazepines, as for alcohol withdrawal. The risks of
NRT should be explained using written information about the specific
product they will use. They should sign a statement in the case
notes indicating that they have read this information and accept
responsibility for its use. They should also agree not to smoke
whilst on NRT.
Patients should be seen by the smoking cessation nurse
when considering starting NRT in the setting of a recent acute
coronary syndrome.
116 adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11