Adult Medical Emergency Handbook - Scottish Intensive Care Society

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For example it may be considered appropriate for a child to consent to a straight forward procedure such as setting a broken limb but not when considering treatments for more complex illnesses. If a doctor, dentist or other medical practitioner takes the view that the child has the capacity to consent, then only the child can consent or refuse consent. Although it would always be considered good practice for parents and if appropriate other family members to be included in the decision process. It is important that all professionals who work with children are aware of the rights of the child rather than thinking that adults are the only people who have rights and whose views matter. Who consents if not the child or young person? If the medical practitioner does not think that the child is legally capable of consenting, the adults who could give consent would be as follows: • Birth parents who have not lost their rights and responsibilities through adoption. A court could overrule the parents rights to consent or not to medical care, but this is very rare. • Unmarried fathers do not automatically have parental responsibilities but carers rights. • People who normally “care” for the child may also consent to medical treatment in certain circumstances. This is if the carer is over 16 years of age and the child is not capable of consenting and the carer has no knowledge that a parent of the child would refuse consent. • School teachers and those under the age of 16 cannot give consent. It is also usual that in the event of the child being in care the local authority will have asked parents to sign a consent form, consenting to any required treatment. • If the child is awaiting adoption then the local authority has all parental responsibilities for the child and the birth parents have no rights. CONFIDENTIALITY This is always a difficult area. The general opinion is that if a child is considered able to consent or refuse treatment, the child must also be entitled to patient confidentiality. It would always be considered good practice that the child and parents were included in any discussion. This would have to be done only if the child gave consent to it. adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11 301
CONTRACEPTION AND ABORTION It would be a breach of confidentiality if a doctor told a parent that their child had sought advice on contraception without the prior consent of the child. The only exception is where the child is at risk and information may be disclosed in order to protect the child. When the girl is under 16, it could be argued that in seeking contraception she is “at risk” of being a victim of a sexual offence, but it is not always appropriate to inform the police or social services. Similarly with abortion, consent to abortion or refusal of such consent is a matter for the young person, unless the girl has severe learning difficulties. Considerable support and counselling would be considered good practice and reasonable attempts to involve the family only if the child agrees. It is ultimately up to the girl to decide for herself and not up to her parents. Bibliography British Agencies for Adoption and Fostering (1998) Practice Note 38. Consent to <strong>Medical</strong> Treatment for Children in Scotland. Lothian Health (1998) Children and Young People’s Health Strategy. 302 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
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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
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• 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
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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
Page 281 and 282: detention certificate must state th
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
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: CONSENT TO MEDICAL TREATMENT FOR CH
Page 305 and 306: c) Drugs and catheterisation pack -
Page 307 and 308: INSTRUCTIONS FOR ANAESTHETIST + ODP
Page 309 and 310: 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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