Adult Medical Emergency Handbook - Scottish Intensive Care Society

GENERAL POINTS
Medicines
• Doses are for adults unless otherwise indicated.
• While every effort has been made to check doses, if doubt exists
consult the BNF.
• The Lothian Joint Formulary should be consulted for local
prescribing advice/guidance. All adverse events involving black
triangle (recently marketed) and serious adverse events involving
any drugs should be reported to the MHRA using yellow cards
which are available in paper form in all BNF’s and also online via
the Trust intranet or at http://www.mhra.gov.uk
• European law requires the use of the Recommended International
Nonproprietary Name (rINN) for medicinal substances. In most
cases the British Approved Name (BAN) and rINN were identical.
Where the two differed, the BAN was modified to accord with the
rINN with the important exceptions of adrenaline and noradrenaline.
The new BANs are used in this text.
Infections
• The University Hospitals Division and St John’s antimicrobial
guidelines offer excellent advice on treatment choice: these are
updated regularly.
• Clinical Microbiological advice is available 24/7. Foundation
doctors should discuss with their own registrar first.
Specialist Referral
• Throughout the text advice on criteria for specialist referral is
given, along with contact numbers for specific hospital sites.
• If the patient is pregnant discuss with the Obstetric registrar on call.
• Consider early referral for ICU or HDU care (see assessing illness
severity Chapter 2) when appropriate.
Decisions to be made for every admission
• Medicines: consider which long term medicines should be
continued and which with-held eg stop vasodilators in sepsis or in
hypovolaemia, diuretics in dehydrated.
• Remember to assess the need for DVT prophylaxis in all
patients. Consult Divisional guideline for venous thromboembolism
prophylaxis and treatment, or local protocol where appropriate.
• Consider the resuscitation status of each patient at admission:
discuss with the consultant responsible. Document on the specific
Do Not Attempt Resuscitation (DNAR) sheet and include in
18 adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11