Adult Medical Emergency Handbook - Scottish Intensive Care Society

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If the patient is shocked, begin resuscitation at the same time as
undertaking investigations- O 2 , fluids and iv access, analgesia, catheter
as necessary and call for senior help. See chapter 2.
Diagnosis and resuscitation are simultaneous processes in
the shocked patient
Baseline investigations : • FBC, U&E, glucose, LFTs, amylase, G&S
• ABG, lactate
• Urinalysis
• Exclude pregnancy if relevant
• Erect CXR- if possibility of perforation
(only positive in 50%)
• AXR- if obstructed
• CRP- remember can lag behind clinical
features
Decisions to be made
• Does the patient require a laparotomy?
• What is the timescale of this?
• Is more resuscitation or investigation required?
If the patient is bleeding this will usually need surgical control, but if
the patient is obstructed with metabolic derangement there is normally
time for fluid replacement. This process of preoptimisation needs to
be actively managed and will benefit from management in HDU/ICU.
PITFALLS
• Medical causes of abdominal pain including DKA, pneumonia and
Herpes Zoster.
• Much of the abdominal cavity is not easily accessible to palpation
– the pelvis and much of the supracolic compartment
URGENT SURGERY
• Ensure blood is cross matched if required.
• Operating surgeon should liase with theatre and anaesthetist and
obtain consent from patient if appropriate.
• Make plans for post op care early- will the patient need
management in ICU or HDU?
ICU and Anaesthetics opinions should be sought early to
allow planning of and delivery of optimal perioperative care.
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
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