Adult Medical Emergency Handbook - Scottish Intensive Care Society

Recommendations

Info

i • Maintenance anti-arrhythmic therapy following restoration of sinus rhythm depends on the arrhythmia substrate for SVT prophylaxis. VT prophylaxis centres around the use of betablockers and/or amiodarone. Some patients may require ICD implantation. Long-term management of these patients should always be discussed with a consultant cardiologist. • Most anti-arrhythmic drugs can cause sinus bradycardia or AV block. For patients with impaired LV function, beta-blockers should be introduced at a low dose (e.g bisoprolol 1.25mg daily) and titrated gradually. Amiodarone is effective for VT treatment and prophylaxis in these patients. Class Ic drugs such as flecainide and propafenone are contraindicated in heart failure/LV impairment. • Overdrive pacing may be considered for resistant or recurrent ventricular arrhythmias. VT or VF are commonly triggered within the first 48 hours of acute MI. In this situation recurrence after the acute event is uncommon and no specific prophylaxis is needed. VT or VF occurring more than 48 hours after acute MI is more sinister; this may indicate the development of a chronic arrhythmia substrate. These patients need assessment with a view to revascularisation and either antiarrhythmic drug treatment or an ICD. Do not hesitate to seek a senior cardiology opinion in the case of troublesome dysrhythmias - ‘cocktails’ of anti-arrhythmics cause more problems than they solve. TORSADE-DE-POINTES TACHYCARDIA Characterised by rapid, broad QRS complexes twisting around the baseline giving the appearance of changing QRS morphology and axis. It is a form of polymorphic VT and can be mistaken for VF. It is often self terminating and recurrent. Its recognition is important because the aetiology and treatment differs from monomorphic VT. Diagnosis Consider Torsade when the following are present: • Polymorphic VT. • Prolonged QT interval. • Initiation of tachycardia with long-short coupling intervals. adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11 123
Causes • Bradycardia • Electrolyte disturbances - hypokalaemia/hypomagnesaemia/ hypocalcaemia. • Tricyclic antidepressants. • Certain anti-psychotics (e.g. thioridazine). • IV erythromycin. • Antihistamines (e.g. terfenadine). • Anti-arrhythmic drugs - amiodarone, sotalol, disopyramide, procainamide etc. • Myocardial ischaemia. • Inherited long QT syndrome (may be family history of synocope, sudden death or “epilepsy” in association with any of the above). Management • The primary treatment of drug induced Torsade is intravenous magnesium infusion • Withdraw any drug known to prolong QT interval • Consider the use of temporary atrial or ventricular pacing. • Intravenous isoprenaline (2.25 mg isoprenaline sulphate in 500 mL 5% dextrose infused at 10-30ml per hour) is an effective shortterm treatment. Use with caution in patients with angina or heart failure, and discuss management with cardiologist. VENTRICULAR FIBRILLATION Characterised by a chaotic electrical pattern with no discernible cardiac rhythm. Follow cardiac arrest algorithm. 124 adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
Page 1 and 2:
Adult Medical Emergencies EDITOR Dr
Page 3 and 4:
WGH IN CARDIAC ARREST & LIFE THREAT
Page 5 and 6:
RIE USEFUL BLEEP NUMBERS MED REG (w
Page 7 and 8:
ST JOHN’S THEATRES 1-9 1 ........
Page 9 and 10:
OTHER USEFUL TELEPHONE NUMBERS NAME
Page 11 and 12:
Management of First Seizure in Adul
Page 13 and 14:
Addison’s Disease ...............
Page 15 and 16:
EDITOR’S INTRODUCTION The Adult M
Page 17 and 18:
DISCLAIMER Every effort has been ma
Page 19 and 20:
GENERAL POINTS Medicines • Doses
Page 21 and 22:
i as far as is reasonably possible.
Page 23 and 24:
i GOOD DOCUMENTATION • Write legi
Page 25 and 26:
• Prescribe liquids by writing th
Page 27 and 28:
Figure 1 Figure 2 Figure 3 Figure 4
Page 29 and 30:
MAKING A DECISION ABOUT RESUSCITATI
Page 31 and 32:
THE PATIENT WHO IS NOT COMPETENT TO
Page 33 and 34:
i PATIENT DEATHS • See patients w
Page 35 and 36:
CHECKLIST OF REQUIREMENTS This chec
Page 37 and 38:
ORGAN DONATION Transplants are one
Page 39 and 40:
i Always consider telephoning the G
Page 41 and 42:
i review arrangements. Include: a)
Page 43 and 44:
Immediate investigations are those
Page 45 and 46:
i i NOTES ON INITIAL ASSESSMENT ALG
Page 47 and 48:
i Exposure, evidence and examinatio
Page 49 and 50:
i i 2b. ILLNESS SEVERITY ASSESSMENT
Page 51 and 52:
Observation Chart Date chart commen
Page 53 and 54:
i Illness Severity and Diagnosis (R
Page 55 and 56:
i Watch for the development of card
Page 57 and 58:
SHOCK Definition & Classification
Page 59 and 60:
i Cuff BP by machine may be extreme
Page 61 and 62:
If no bleeding and platelets
Page 63 and 64:
TRANSFUSION REACTION Figure 1: Algo
Page 65 and 66:
of infusing only 5-10mls of blood.
Page 67 and 68:
Table 3: Drugs that may be required
Page 69 and 70:
i i SEPSIS AND SEPTIC SHOCK Sepsis
Page 71 and 72:
ANTIBIOTIC MINI-GUIDE FOR ADULTS
Page 73 and 74: i i • Remember to look for intra-
Page 75 and 76: i • Commence basic life support (
Page 77 and 78: ALGORITHM FOR FIRST MEDICAL RESPOND
Page 79 and 80: ACUTE PAIN MANAGEMENT The effective
Page 81 and 82: i DO YOU NEED HELP ? Contact the Ac
Page 83 and 84: i • Angina (rate related): treat
Page 85 and 86: DATE: Dear “FIRST SEIZURE” APPO
Page 87 and 88: Review Collapse Algorithm Identifie
Page 89 and 90: Loss of consciousness YES Perform:
Page 91 and 92: 07.00 to 17.00 Asymptomatic Normal
Page 93 and 94: i i ADULT ADVANCED LIFE SUPPORT: No
Page 95 and 96: i NON SHOCKABLE RHYTHMS Cardiac arr
Page 97 and 98: • Patients should be pain free an
Page 99 and 100: ACUTE CORONARY SYNDROMES In order t
Page 101 and 102: IMMEDIATE MANAGEMENT OF ACUTE CORON
Page 103 and 104: CHEST PAIN PATHWAY - NHS LOTHIAN OP
Page 105 and 106: LOTHIAN PRIMARY PCI/PRE-HOSPITAL TH
Page 107 and 108: i Thrombolysis Since the clinical b
Page 109 and 110: Reperfusion therapy not administere
Page 111 and 112: i i MILD-MODERATE LEFT VENTRICULAR
Page 113 and 114: i i Do not hesitate to seek a Cardi
Page 115 and 116: account any subsequently prescribed
Page 117 and 118: i rehab team or the BHF nurse, and/
Page 119 and 120: i i i Referral to ICU should follow
Page 121 and 122: ATRIAL FLUTTER Characterised by rap
Page 123: i Seek senior cardiology advice reg
Page 127 and 128: i i In anterior infarction the deve
Page 129 and 130: abnormalities develop i.e. second o
Page 131 and 132: i VASCULAR EMERGENCIES ACUTE THORAC
Page 133 and 134: i ACUTE STROKE Stroke is a Medical
Page 135 and 136: STROKE DIFFERENTIAL DIAGNOSIS: COND
Page 137 and 138: ACUTE STROKE INTEGRATED CARE PATHWA
Page 139 and 140: ST JOHN’S HOSPITAL CARE PATHWAY A
Page 141 and 142: Role of D-dimer D-Dimer is helpful
Page 143 and 144: i Thrombolysis bolus alteplase (rtP
Page 145 and 146: i MANAGEMENT OF THE ACUTELY ISCHAEM
Page 147 and 148: i Chapter 4 RESPIRATORY EMERGENCIES
Page 149 and 150: i i • Decreased respiratory and h
Page 151 and 152: i i • Co-morbidity. • Multiloba
Page 153 and 154: other factors. Consult local antibi
Page 155 and 156: Antibiotics • Amoxicillin (amoxyc
Page 157 and 158: MANAGEMENT OF SPONTANEOUS PNEUMOTHO
Page 159 and 160: • Look at the CXR and mark intuba
Page 161 and 162: pack. Advance slowly along the infi
Page 163 and 164: Figure 1a - preparing to insert a c
Page 165 and 166: i i MANAGEMENT OF CHEST DRAINS •
Page 167 and 168: Features of a major bleed? • Tach
Page 169 and 170: i i Contact GI Registrar. ROCKALL S
Page 171 and 172: i i • Blood, urine and ascitic fl
Page 173 and 174: • For alcoholic liver disease: th
Page 175 and 176:
Known IBD • Exclude infection. Mi
Page 177 and 178:
• Are any drugs implicated e.g. o
Page 179 and 180:
ACUTE PANCREATITIS Determine severi
Page 181 and 182:
then it would be more appropriate t
Page 183 and 184:
RIE/WGH ACUTE SURGICAL ADMISSION IN
Page 185 and 186:
i i VASCULAR: renal artery disease
Page 187 and 188:
• Examine the urine: proteinuria
Page 189 and 190:
i 1. IMMEDIATE ACTION: STABILISATIO
Page 191 and 192:
METABOLIC ACIDOSIS CAUSES OF METABO
Page 193 and 194:
i MANAGEMENT OF DIABETIC KETOACIDOS
Page 195 and 196:
i Electrolyte replacement • Despi
Page 197 and 198:
• Screen for myocardial infarctio
Page 199 and 200:
• Monitor respiratory rate, ECG,
Page 201 and 202:
Consider Precipitating Factors: •
Page 203 and 204:
likely to be either GKI or sliding
Page 205 and 206:
• If capillary blood glucose is g
Page 207 and 208:
COMMON SYMPTOMS OF HYPOGLYCAEMIA Au
Page 209 and 210:
Always discuss with the metabolic r
Page 211 and 212:
• Abdominal pain • Depression
Page 213 and 214:
• Hypoparathyroidism, surgical.
Page 215 and 216:
i TREATMENT Oral • Sando K 2-3 ta
Page 217 and 218:
• Measurement of plasma renin act
Page 219 and 220:
Flow Chart for the assessment and m
Page 221 and 222:
Chapter 7 NEUROLOGICAL EMERGENCIES
Page 223 and 224:
AETIOLOGY OF COMA Primary neurologi
Page 225 and 226:
EPILEPTIC SEIZURES Epilepsy is a sy
Page 227 and 228:
i DRUGS Initial treatment is with D
Page 229 and 230:
INDICATIONS FOR INTUBATION AND VENT
Page 231 and 232:
LIKELY ORGANISMS • Depend on age,
Page 233 and 234:
TENTORIAL HERNIATION AND CONING •
Page 235 and 236:
• CT scan if focal neurology, rai
Page 237 and 238:
• Assessment of cognition can be
Page 239 and 240:
ACUTE AGITATED CONFUSION IN AN OLDE
Page 241 and 242:
• Drugs: - polypharmacy (>4 drugs
Page 243 and 244:
i Chapter 9 EMEGENCIES IN HAEMATOLO
Page 245 and 246:
on waking, and may be aggravated by
Page 247 and 248:
EMERGENCIES IN PALLIATIVE CARE Emer
Page 249 and 250:
SEIZURES IN PALLIATIVE CARE Seizure
Page 251 and 252:
NALOXONE IN PALLIATIVE CARE Naloxon
Page 253 and 254:
CARE OF THE DYING PATIENT If you th
Page 255 and 256:
THE ROLE OF JUNIOR MEDICAL STAFF IN
Page 257 and 258:
• Ensure adequate ventilation. Tr
Page 259 and 260:
• Paracetamol and salicylate conc
Page 261 and 262:
MANAGEMENT OF COMMON POISONINGS Par
Page 263 and 264:
i i treatment schedule should be us
Page 265 and 266:
i Toxicity Serious toxicity from pu
Page 267 and 268:
conscious level. • Correct electr
Page 269 and 270:
• Correct metabolic acidosis with
Page 271 and 272:
i SEPSIS • Any age, any joint, ma
Page 273 and 274:
Reactive Arthritis • Bed rest plu
Page 275 and 276:
N.B. Remember spontaneous bacterial
Page 277 and 278:
i ALCOHOL WITHDRAWAL MANAGEMENT Ens
Page 279 and 280:
ACUTE DISTURBANCE Guide for medical
Page 281 and 282:
detention certificate must state th
Page 283 and 284:
a person there. Under an EDC, treat
Page 285 and 286:
Appendix 1 SHARING DIFFICULT INFORM
Page 287 and 288:
1. Write down or review what you ar
Page 289 and 290:
CHECKLIST OF REQUIREMENTS This chec
Page 291 and 292:
i • Reactions vary: distress, ang
Page 293 and 294:
• Damaged syringes and siphonage:
Page 295 and 296:
Start-up time (Syringe pumps) What
Page 297 and 298:
• HR increases by 17% and stroke
Page 299 and 300:
PAEDIATRIC FBAO TREATMENT Assess se
Page 301 and 302:
CONSENT TO MEDICAL TREATMENT FOR CH
Page 303 and 304:
CONTRACEPTION AND ABORTION It would
Page 305 and 306:
c) Drugs and catheterisation pack -
Page 307 and 308:
INSTRUCTIONS FOR ANAESTHETIST + ODP
Page 309 and 310:
DRUGS - CIRCULATING NURSE 1. MAKE S
Page 311 and 312:
HELP - NURSE / RESIDENT The followi
Page 313 and 314:
RECOVERY & FURTHER TREATMENT With r
Page 315 and 316:
MAJOR HAEMORRHAGE PROTOCOL 314 adul
Page 317:
Useful links The Anaphylaxis campai
show all

Adult Medical Emergency Handbook - Scottish Intensive Care Society

Create successful ePaper yourself

Delete template?

Save as template?