Adult Medical Emergency Handbook - Scottish Intensive Care Society

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WGH blood bank phone is 32419.
RIE blood issue phone is #27501/27502/27503.
SJH bloodbank phone is 53354
Investigations
• Plain CXR and AXR (loss of psoas shadow, calcified aneurysm).
• Portable ultrasound scan if there is any element of doubt regarding
the diagnosis.
(The use of CT scanning to establish the diagnosis of a ruptured/
leaking AAA is both time-consuming and unhelpful.)
Prognosis
Overall >75% mortality and 50% operative mortality.
Hardmans Criteria (guide to overall prognosis)
• Age >76
• Loss of consciousness
• Haemoglobin 180
• ECG ischaemia
3 or more of the above on admission indicates a very poor outcome.
Transfer from WGH or SJH
• The patient should be transferred by the most senior middle-grade
doctor of the receiving speciality. For patients referred to the
waiting Surgeons this will be the SHO or SpR on call for General
Surgery. For patients referred to Medicine (e.g. as renal colic) this
will be the SHO or Specialist Registrar on call for Acute Medicine.
• If a patient requires transfer to the Royal Infirmary, there should
be no delay and all transfers should be ‘blue lighted’ with an
appropriate SHO/Registrar.
The only definitive management of these patients is early
surgery. It is our aim to maintain cardiovascular stability using
low volume resuscitation to allow transfer, but speed is pivotal to
good outcome.
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
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