Adult Medical Emergency Handbook - Scottish Intensive Care Society

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7. <strong>Care</strong> of patient with an intercostal drain • Rapid full expansion of a completely collapsed lung may lead to pulmonary oedema. For very large effusions, clamp the tube for 1 hour after 1.5 litres have drained, before allowing free drainage. Make sure all staff are aware the tube is clamped and what time the clamp is to be removed. • Instruct the patient to keep water bottle below waist level, to remember it is attached and not to pull it accidentally. • For mobile patients, a weighted metal stand should be used to carry the bottle and to prevent it falling over. • Prescribe adequate analgesia (pethidine or morphine may be required) – remember the surgical “injury” you have caused is equivalent to a stab wound. • Adjustment of position: If drain is too far in, it is acceptable using sterile technique and after careful antiseptic swabbing, to loosen the retaining stitch and retract the drain a few cm before resecuring it, taking care not to withdraw so far that the side holes leave the pleural space. • The drain should NEVER be advanced further into the chest after the initial insertion – this carries infection forward into the pleural space. • Only clamp a chest drain if draining a very large effusion (see above), if the bottle breaks or the tube becomes disconnected. • If a patient with a chest drain in situ requires transfer by ambulance a trained nurse with experience in the management of chest drains must be part of the escortAlastair Innes, April, 2007 adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11 161
Figure 1a - preparing to insert a conventional drain Incision Lower end of suture Lung Visceral pleura Parietal pleura See next page Rib Intercostal muscle ‘Load’ chest drain onto forceps Reassure and prepare the patient (note position of suture) Form dissection with forceps 162 adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
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Adult Medical Emergencies EDITOR Dr
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WGH IN CARDIAC ARREST & LIFE THREAT
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RIE USEFUL BLEEP NUMBERS MED REG (w
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ST JOHN’S THEATRES 1-9 1 ........
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OTHER USEFUL TELEPHONE NUMBERS NAME
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Management of First Seizure in Adul
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Addison’s Disease ...............
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EDITOR’S INTRODUCTION The Adult M
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DISCLAIMER Every effort has been ma
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GENERAL POINTS Medicines • Doses
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i as far as is reasonably possible.
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i GOOD DOCUMENTATION • Write legi
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• Prescribe liquids by writing th
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Figure 1 Figure 2 Figure 3 Figure 4
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MAKING A DECISION ABOUT RESUSCITATI
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THE PATIENT WHO IS NOT COMPETENT TO
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i PATIENT DEATHS • See patients w
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CHECKLIST OF REQUIREMENTS This chec
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ORGAN DONATION Transplants are one
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i Always consider telephoning the G
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i review arrangements. Include: a)
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Immediate investigations are those
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i i NOTES ON INITIAL ASSESSMENT ALG
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i Exposure, evidence and examinatio
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i i 2b. ILLNESS SEVERITY ASSESSMENT
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Observation Chart Date chart commen
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i Illness Severity and Diagnosis (R
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i Watch for the development of card
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SHOCK Definition & Classification
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i Cuff BP by machine may be extreme
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If no bleeding and platelets
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TRANSFUSION REACTION Figure 1: Algo
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of infusing only 5-10mls of blood.
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Table 3: Drugs that may be required
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i i SEPSIS AND SEPTIC SHOCK Sepsis
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ANTIBIOTIC MINI-GUIDE FOR ADULTS
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i i • Remember to look for intra-
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i • Commence basic life support (
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ALGORITHM FOR FIRST MEDICAL RESPOND
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ACUTE PAIN MANAGEMENT The effective
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i DO YOU NEED HELP ? Contact the Ac
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i • Angina (rate related): treat
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DATE: Dear “FIRST SEIZURE” APPO
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Review Collapse Algorithm Identifie
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Loss of consciousness YES Perform:
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07.00 to 17.00 Asymptomatic Normal
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i i ADULT ADVANCED LIFE SUPPORT: No
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i NON SHOCKABLE RHYTHMS Cardiac arr
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• Patients should be pain free an
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ACUTE CORONARY SYNDROMES In order t
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IMMEDIATE MANAGEMENT OF ACUTE CORON
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CHEST PAIN PATHWAY - NHS LOTHIAN OP
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LOTHIAN PRIMARY PCI/PRE-HOSPITAL TH
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i Thrombolysis Since the clinical b
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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 and 124: i Seek senior cardiology advice reg
Page 125 and 126: Causes • Bradycardia • Electrol
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: pack. Advance slowly along the infi
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
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• Hypoparathyroidism, surgical.
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i TREATMENT Oral • Sando K 2-3 ta
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• Measurement of plasma renin act
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Flow Chart for the assessment and m
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Chapter 7 NEUROLOGICAL EMERGENCIES
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AETIOLOGY OF COMA Primary neurologi
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EPILEPTIC SEIZURES Epilepsy is a sy
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i DRUGS Initial treatment is with D
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INDICATIONS FOR INTUBATION AND VENT
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LIKELY ORGANISMS • Depend on age,
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TENTORIAL HERNIATION AND CONING •
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• CT scan if focal neurology, rai
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• Assessment of cognition can be
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ACUTE AGITATED CONFUSION IN AN OLDE
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• Drugs: - polypharmacy (>4 drugs
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i Chapter 9 EMEGENCIES IN HAEMATOLO
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on waking, and may be aggravated by
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EMERGENCIES IN PALLIATIVE CARE Emer
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SEIZURES IN PALLIATIVE CARE Seizure
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NALOXONE IN PALLIATIVE CARE Naloxon
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CARE OF THE DYING PATIENT If you th
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THE ROLE OF JUNIOR MEDICAL STAFF IN
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• Ensure adequate ventilation. Tr
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• Paracetamol and salicylate conc
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MANAGEMENT OF COMMON POISONINGS Par
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i i treatment schedule should be us
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i Toxicity Serious toxicity from pu
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conscious level. • Correct electr
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• Correct metabolic acidosis with
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i SEPSIS • Any age, any joint, ma
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Reactive Arthritis • Bed rest plu
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N.B. Remember spontaneous bacterial
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i ALCOHOL WITHDRAWAL MANAGEMENT Ens
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ACUTE DISTURBANCE Guide for medical
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detention certificate must state th
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a person there. Under an EDC, treat
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Appendix 1 SHARING DIFFICULT INFORM
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1. Write down or review what you ar
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CHECKLIST OF REQUIREMENTS This chec
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i • Reactions vary: distress, ang
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• Damaged syringes and siphonage:
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Start-up time (Syringe pumps) What
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• HR increases by 17% and stroke
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PAEDIATRIC FBAO TREATMENT Assess se
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CONSENT TO MEDICAL TREATMENT FOR CH
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CONTRACEPTION AND ABORTION It would
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c) Drugs and catheterisation pack -
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INSTRUCTIONS FOR ANAESTHETIST + ODP
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DRUGS - CIRCULATING NURSE 1. MAKE S
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HELP - NURSE / RESIDENT The followi
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RECOVERY & FURTHER TREATMENT With r
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MAJOR HAEMORRHAGE PROTOCOL 314 adul
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Useful links The Anaphylaxis campai
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Adult Medical Emergency Handbook - Scottish Intensive Care Society

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