Adult Medical Emergency Handbook - Scottish Intensive Care Society

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ADULT ADVANCED LIFE SUPPORT ALGORITHM Shockable VF/VT Defibrillate x 1 150j biphasic Immediately resume CPR for 2 minutes Unresponsive? Open Airway Look for signs of life Call 2222: Cardiac Arrest team CPR 30:2 Until defibrillator/monitor attached Assess rhythm During CPR Correct reversible causes If not already: • Check: electrode/paddle positions & contact • Attempt/verify: airway & O2, IV access • Give uninterrupted compressions when airway secured • Give adrenaline 1mg every 3-5 minutes • Consider: Amiodarone, (Magnesium) Atropine/pacing/buffers • Hypoxia • Hypovolaemia • Hyper/hypokalaemia & metabolic disorders • Hypothermia • Tension pneumothorax • Tamponade, Cardiac • Toxic/therapeutic disturbances • Thrombosis (coronary or pulmonary) Non Shockable PEA/Asystole Immediately resume CPR for 2 minutes The ALS Algorithm for the management of cardiac arrests in adults. i NOTE that each successive step is based on the assumption that the one before has not Any protocols, guidelines, algorithms are subject to review and resulted in restoration of circulation. updating. Ensure you are using the current version. Ask: does this protocol/guideline apply to the individual patient I am seeing now? adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11 1
WGH IN CARDIAC ARREST & LIFE THREATENING EMERGENCY CALL 2222 HOSPITAL AT NIGHT OFFICE/COORDINATOR 33322 USEFUL TELEPHONE NUMBERS BIOCHEMISTRY GENERAL ENQUIRIES ............ 31909/31910 EMERGENCIES (6PM ...................................... Bleep: 8452 HAEMATOLOGY GENERAL ENQUIRIES ............ 31910/31911 COAGULATION ........................ 31171 BLOOD BANK .......................... 31912 Bleep: 8477 >5pm MICROBIOLOGY SPECIMEN RECEPTION ............................. 26806/26807 >5pm Bleep 2900 CARDIOLOGY/ECG ECG/ECHO .............................. 31852 BLEEP ...................................... 8206 CORONARY CARE UNIT ................................................. 31839 STROKE REGISTRAR ............................. Bleep: 8699 (via Swithchboard out of hours) DCN ALL HEAD & SECRETARIES ......................... 32022 (X-ray appts.) SPINE CT/MRI (FOR URGENTS & RESULTS) MRI secretary ........................... 32026 CT SCANNING ......................... Body 32068/head 32036 CT SECRETARY ....................... 32066 MAIN X-RAY REPORTING ........................... 32315 (Main CT) EMERGENCY (ALL DAY) ......... 33121 Bleep8204 (X-ray Radiographer) INTENSIVE CARE ................................................. 31664/31665 ANAESTHETIST IN AN EMERGENCY ............... 8155 DCN ................................................. 8519 NEW STICKIES (ADMISSIONS) ADMISSIONS OFFICE ............. 33304 ARAU RECEPTION ............................. 31331 TROLLEYS ............................... 31335 DOCTORS ROOM ................... 31334/31313 RESUS ..................................... 31336 ARAU XRAY ............................. 31337 BED MANAGEMENT OFFICE BLEEP/ PAGE ............. 8100 FOOD DINING ROOM/MANAGER ...... 31373/31364 DAY BED AREA NURSES STATION ................... 31329 COMPUTERS WHEN THEY GO WRONG ....... 85050 PATHOLOGY ENQUIRIES .............................. 31960 PORTERS ROOM/BLEEP ......................... 31534/8116 DCN BLEEP ............................. 8252 ARU PORTERS BLEEP ............ 8133 NUCLEAR MEDICINE V/Q OR BONE SCAN ............... 32038/Fax: 32033 THEATRES MAIN (RECEPTION) ................. 31669 ENDOSCOPY ........................... 31695 DCN ......................................... 31693/31694 PHARMACY DISPENSARY ........................... 31210 SATURDAY ............................... Through switchboard PSYCHIATRY REFERRAL SECRETARY ......... 31834 AIR TUBE PROBLEMS ............................. 33333 (Estates) INFECTION CONTROL ................................................. 31984 MORTUARY WGH ................................................. 31972 Bleep: 8225 2 adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
Page 1: Adult Medical Emergencies EDITOR Dr
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
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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
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i i MILD-MODERATE LEFT VENTRICULAR
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i i Do not hesitate to seek a Cardi
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account any subsequently prescribed
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i rehab team or the BHF nurse, and/
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i i i Referral to ICU should follow
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ATRIAL FLUTTER Characterised by rap
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i Seek senior cardiology advice reg
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Causes • Bradycardia • Electrol
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i i In anterior infarction the deve
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abnormalities develop i.e. second o
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i VASCULAR EMERGENCIES ACUTE THORAC
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i ACUTE STROKE Stroke is a Medical
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STROKE DIFFERENTIAL DIAGNOSIS: COND
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ACUTE STROKE INTEGRATED CARE PATHWA
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ST JOHN’S HOSPITAL CARE PATHWAY A
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Role of D-dimer D-Dimer is helpful
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i Thrombolysis bolus alteplase (rtP
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i MANAGEMENT OF THE ACUTELY ISCHAEM
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i Chapter 4 RESPIRATORY EMERGENCIES
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i i • Decreased respiratory and h
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i i • Co-morbidity. • Multiloba
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other factors. Consult local antibi
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Antibiotics • Amoxicillin (amoxyc
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MANAGEMENT OF SPONTANEOUS PNEUMOTHO
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• Look at the CXR and mark intuba
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pack. Advance slowly along the infi
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Figure 1a - preparing to insert a c
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i i MANAGEMENT OF CHEST DRAINS •
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Features of a major bleed? • Tach
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i i Contact GI Registrar. ROCKALL S
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i i • Blood, urine and ascitic fl
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• For alcoholic liver disease: th
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Known IBD • Exclude infection. Mi
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• Are any drugs implicated e.g. o
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ACUTE PANCREATITIS Determine severi
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then it would be more appropriate t
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RIE/WGH ACUTE SURGICAL ADMISSION IN
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i i VASCULAR: renal artery disease
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• Examine the urine: proteinuria
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i 1. IMMEDIATE ACTION: STABILISATIO
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METABOLIC ACIDOSIS CAUSES OF METABO
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i MANAGEMENT OF DIABETIC KETOACIDOS
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i Electrolyte replacement • Despi
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• Screen for myocardial infarctio
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• Monitor respiratory rate, ECG,
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Consider Precipitating Factors: •
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likely to be either GKI or sliding
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• If capillary blood glucose is g
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COMMON SYMPTOMS OF HYPOGLYCAEMIA Au
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Always discuss with the metabolic r
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• 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
Page 237 and 238:
• 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
Page 249 and 250:
SEIZURES IN PALLIATIVE CARE Seizure
Page 251 and 252:
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
Page 265 and 266:
i Toxicity Serious toxicity from pu
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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
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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
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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
Page 289 and 290:
CHECKLIST OF REQUIREMENTS This chec
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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
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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
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Adult Medical Emergency Handbook - Scottish Intensive Care Society

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