Adult Medical Emergency Handbook - Scottish Intensive Care Society

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PRACTICAL PROCEDURES
A number of practical techniques and procedures are detailed in the
electronic version of this handbook. These notes are not meant to
substitute for practical instruction in the correct method of carrying
out these procedures. They will however be useful reminders and
should ensure that details are not overlooked.
• Never undertake a procedure unsupervised when inexperienced.
• If difficulties are encountered, stop and call for help.
• Before starting consider the need for a coagulation screen and
blood grouping.
• Explain the procedure to the patient and prepare the patient
appropriately (see chest drain insertion as an example). Familiarise
yourself with the patient’s anatomy and position the patient before
scrubbing up.
• Always record details of the time of day and nature of the procedure in
the notes together with the required monitoring asked of nursing staff.
• In the event of an unexpected change in the patient’s clinical
condition remember possible complications especially hypoxia,
vasovagal effects, haemorrhage, anaphylaxis and infection.
Peripheral IV access: antecubital cannulation is painful, irritant
and potentially dangerous. Avoid unless no alternative.
TALKING WITH PATIENTS AND RELATIVES
• Talking with, and listening to, patients and their relatives is
important.
• Be open and honest.
• Do not be afraid to say you don’t know the answer to a question.
• Seek advice from a senior member of staff when unsure.
• Record details of the interview in the case notes with written
details of the information transmitted and the names of those
present (doctor, nurse, relatives).
• Try to see relatives as soon as possible after admission to seek
and document important information about the medical and social
aspects of the acutely ill or confused patient.
Guidelines on the approach to breaking bad news can be found
in Appendix 1.
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
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