Adult Medical Emergency Handbook - Scottish Intensive Care Society

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i If cranial CT scan is required secure ABCD first. This will involve invasive monitoring and ventilation. i SUBARACHNOID HAEMORRHAGE Acute bleed into the subarachnoid space, may also have intracerebral component. • 80%: aneurysmal • 10%: no known vascular cause (perimesencephalic) • 5%: avms, tumours etc. PRESENTATION • Acute onset (severe) headache (usually maximal instantly or within few minutes). • Transient or persisting loss of consciousness. • Epileptic seizures. • Vomiting • Focal neurological signs. • Meningism is uncommon in the early stages; irritability common. • Fever is uncommon in the early stages. • Limb and cranial nerve signs; subhyaloid retinal haemorrhages. • Hypertension and tachycardia. • Pulmonary oedema may occur early. • 20% SAH present with headache alone. Contact the Neurology Registrar on-call via switchboard WGH. MANAGEMENT • Airway: assess, maintain, give high concentration oxygen if hypoxic. • Breathing: assess and support. Laryngoscopy and intubation cause severe hypertension and may precipitate rebleeding. Unless the patient has arrested or cannot be ventilated intubation should not be attempted except with an appropriate anaesthetic technique by an experienced clinician. • Circulation: assess, support, gain IV access. Most patients will be hypertensive: no attempt should be made to reduce blood pressure as it is critical to maintenance of cerebral perfusion pressure. adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11 227
INDICATIONS FOR INTUBATION AND VENTILATION IN SAH • Airway or breathing compromised. • Hypoxaemia not corrected by high concentration oxygen. • GCS 8 or less. • Hypoventilation and PaCO 2 >6kPa. • Hyperventilation and PaCO 2
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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
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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
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
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
Page 213 and 214: • Hypoparathyroidism, surgical.
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 and 222: Chapter 7 NEUROLOGICAL EMERGENCIES
Page 223 and 224: AETIOLOGY OF COMA Primary neurologi
Page 225 and 226: EPILEPTIC SEIZURES Epilepsy is a sy
Page 227: i DRUGS Initial treatment is with D
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
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
Page 275 and 276: N.B. Remember spontaneous bacterial
Page 277 and 278: 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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