Adult Medical Emergency Handbook - Scottish Intensive Care Society

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i FURTHER TREATMENT TO CONSIDER If you suspect an OPIATE OVERDOSE (drug paraphernalia at scene, track marks, pinpoint pupils, reduced respiratory rate) give NALOXONE as per Toxicology chapter. If you suspect a BENZODIAZEPINE OVERDOSE (previous prescriptions of benzodiazepines, empty drug boxes, reduced respiratory rate). manage as per Toxicology chapter. If you suspect MENINGITIS (neck stiffness, rash or fever) give INTRAVENOUS ANTIBIOTICS: Ceftriaxone 2g IV. See meningitis section. FURTHER INVESTIGATIONS TO CONSIDER If the cause of the coma is not immediately evident, further investigation is usually required. Consider; • CT brain: once circulation is stable and the airway is secure • Drug levels: toxicology screen • Lumbar puncture: cell count, protein, glucose, culture. Early advice from a neurologist and/or neurosurgeon and/or intensive care physician may be crucial. ONGOING CARE OF THE UNCONSCIOUS PATIENT • Monitoring of conscious level, blood pressure, pulse, ECG and oxygen saturations • DVT prophylaxis: heparin may be contraindicated • Pressure sore prevention • Nutrition adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11 221
AETIOLOGY OF COMA Primary neurological disease • Trauma • Intra-cranial haemorrhage: SAH, intra-cerebral, sub/extradural • Arterial/venous infarction • Infection: meningitis, encephalitis, cerebral abscess • Other structural: tumours • Epilepsy: postictal non-convulsive status epilepticus • Psychogenic Secondary to systemic disease • Toxic (drugs/alcohol) • Liver or renal failure • Hypoxia/hypercarbia • Wernicke’s encephalopathy Metabolic • Hypertensive encephalopathy • Hypoglycaemia • Hyperglycaemia • Hyponatraemia • Hypocalcaemia GLASGOW COMA SCALE Eye Opening Best verbal response Best motor response 1 None 1 None 1 None 2 To pain 2 Sounds only 2 Abnormal extension response to pain 3 To voice 3 Incoherent Words 3 Abnormal flexion response to pain 4 Spontaneous 4 Confused speech 4 Withdrawal from a painful stimulus 5 Normal conversation 5 Localises a painful stimulus T = intubated patients 6 Normal Add up the score for each component of the scale, and report them separately. Localisation to pain is defined as reaching above the clavicle to a painful stimulus given above the neck. 222 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
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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
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
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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
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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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Page 215 and 216: i TREATMENT Oral • Sando K 2-3 ta
Page 217 and 218: • Measurement of plasma renin act
Page 219 and 220: Flow Chart for the assessment and m
Page 221: Chapter 7 NEUROLOGICAL EMERGENCIES
Page 225 and 226: EPILEPTIC SEIZURES Epilepsy is a sy
Page 227 and 228: i DRUGS Initial treatment is with D
Page 229 and 230: INDICATIONS FOR INTUBATION AND VENT
Page 231 and 232: LIKELY ORGANISMS • Depend on age,
Page 233 and 234: TENTORIAL HERNIATION AND CONING •
Page 235 and 236: • CT scan if focal neurology, rai
Page 237 and 238: • Assessment of cognition can be
Page 239 and 240: ACUTE AGITATED CONFUSION IN AN OLDE
Page 241 and 242: • Drugs: - polypharmacy (>4 drugs
Page 243 and 244: i Chapter 9 EMEGENCIES IN HAEMATOLO
Page 245 and 246: on waking, and may be aggravated by
Page 247 and 248: EMERGENCIES IN PALLIATIVE CARE Emer
Page 249 and 250: SEIZURES IN PALLIATIVE CARE Seizure
Page 251 and 252: NALOXONE IN PALLIATIVE CARE Naloxon
Page 253 and 254: CARE OF THE DYING PATIENT If you th
Page 255 and 256: THE ROLE OF JUNIOR MEDICAL STAFF IN
Page 257 and 258: • Ensure adequate ventilation. Tr
Page 259 and 260: • Paracetamol and salicylate conc
Page 261 and 262: MANAGEMENT OF COMMON POISONINGS Par
Page 263 and 264: i i treatment schedule should be us
Page 265 and 266: i Toxicity Serious toxicity from pu
Page 267 and 268: conscious level. • Correct electr
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Page 271 and 272: 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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