Adult Medical Emergency Handbook - Scottish Intensive Care Society

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- Ensure 2 0 stroke prevention and treatment measures are in place. • Multifactorial intervention for falls prevention in all: - Exercise and balance training by physiotherapy. - Reduce medication as far as possible and reduce or stop any contributing drugs e.g. diuretics, antithypertensives, SSRIs or anti-anginals. - Reduce postural hypotension: • ensure not anaemic • reduce or stop any contributing drugs • teach the patient to rise carefully from bed or chair • consider TED stockings • in extreme cases, seek expert advice regarding drug treatment to maintain or raise BP - Safety education and home hazard assessment by OT - Correct visual impairment • Refer to Lothian Joint Formulary guidelines on osteoporosis. • Commence treatment with a weekly bisphosphonate and Adcal D3 in those with proven osteoporosis and those with 2 or more previous fragility fractures. adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11 241
i Chapter 9 EMEGENCIES IN HAEMATOLOGY , ONCOLOGY & PALLIATIVE CARE 1. NEUTROPENIC SEPSIS Definitions Neutropenia: neutrophil count of less than 1.0 x 109 /l. Fever: isolated temperature greater than 38.5oC or 2 recordings greater than 38.0oC two hours apart. (NOTE: patients may be neutropenic and septic with a normal/low temperature. If recent chemotherapy and unwell then assume neutropenic sepsis until proven otherwise). Presenting features • Generalised constitutional symptoms are common (lethargy, rigors, confusion). Patients can go from being well to being in life threatening septic shock in just a few hours. Neutropenia markedly alters the host’s immune response and makes infection more difficult to detect. • Ask about respiratory, urinary, oropharyngeal and lower GI symptoms. Enquire about recent instrumentation/dental work. • Does the patient have a Hickman Line? Ask about recent line use and whether there is pain around the line. Patients with febrile neutropenia MUST receive antibiotics even if there are no localising signs of infection. Assessment Look for: • Signs of shock e.g. tachypnoea, tachycardia, hypotension, altered mental state. • Fever • Detailed examination for any localising signs of infection. Management AIM FOR FIRST DOSE OF IV ANTIBIOTICS AS SOON AS POSSIBLE BUT AT THE LATEST WITHIN 1 HOUR OF ADMISSION – if septic following chemotherapy then confirmation of neutropenia is not needed before first antibiotics • Assess ABCDE. Treat as in Chapter 2. • Give high concentration oxygen by mask. 242 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
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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
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 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 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: • Drugs: - polypharmacy (>4 drugs
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
Page 279 and 280: ACUTE DISTURBANCE Guide for medical
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Page 283 and 284: a person there. Under an EDC, treat
Page 285 and 286: Appendix 1 SHARING DIFFICULT INFORM
Page 287 and 288: 1. Write down or review what you ar
Page 289 and 290: CHECKLIST OF REQUIREMENTS This chec
Page 291 and 292: 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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