Adult Medical Emergency Handbook - Scottish Intensive Care Society

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7. BLOOD SAMPLES:- • Blood gases • Potassium • Clotting screen • 10ml lithium heparin - for later analysis of creatine phosphokinase and myoglobin (At start / height / end of crisis) • 20ml urine - for myoglobin (At start / height / end of crisis) ANAESTHETIC ROOM NURSE ( OR OTHER FAST RUNNER ) GET MALIGNANT HYPERTHERMIA BOX LOCATIONS – RIE : GENERAL/Orthopaedic Theatre Recovery - Clean Utility Area – lower shelf or ICU (Ward 118) Clean Utility Area – Work surface corner WGH : ICU - Drug cupboard No 5. WGH ICU also keeps another 12 vials of Dantrolene and 8x100ml vials of sterile water for reconstitution as a back up. Take them with you to save a second journey. PAEP : Central Drug Store opposite Theatre 1 Anaesthetic room. RHSC : Main Theatre – The middle of the recovery room by the emergency trolley. ROODLANDS HOSPITAL : Main Theatre – in the safe in the ‘back corridor’ St. JOHN’S HOSPITAL LIVINGSTON : In the Theatre Suite – Recovery Room on dedicated trolley. Contents Dantrolene Sodium : 12 Vials x 20mg Water for injection : 8 bottles x 100ml 1 bottle opener : For rapid filling of syringes using a quill 4 drawing up quills 12 luer lock 60 ml syringes 12 white needles 2 sponges for surface cooling 1 set Malignant Hyperthermia Protocol sheets adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11 307
DRUGS - CIRCULATING NURSE 1. MAKE SURE THAT THE FOLLOWING ARE HANDY :- • <strong>Emergency</strong> drug box • Syringes needles and giving sets • 0.9% Normal Saline (NOT RINGER LACTATE), 5% Dextrose, 8.4% Bicarbonate • Foley catheter and equipment for urinary catheterisation • Basin / bucket to hold cool water for use with the sponges in the MH kit 2. Remind the anaesthetist to ask the surgeon to insert a urinary catheter when he has finished sewing up. 3. Take charge of the MALIGNANT HYPERTHERMIA BOX when it arrives: Make up Dantrolene 1-2 mg kg-1 (SPEED IS IMPORTANT) :- Add 60ml sterile water for injection to each vial. The box contains quills and a bottle opener to speed up filling the syringes Shake vials well to dissolve the dantrolene. (Average initial adult dose is 4 - 6 ampoules rapidly IV.) 4. Check that you have in theatre: • Mannitol 20% • Dextrose 20% or 50% • Insulin • Furosemide 5. Frequently ensure that stocks of IV fluids are not running out. 6. Arrange for more DANTROLENE to be brought to theatre from pharmacy . Note : You will need another 800ml (8 x100ml bottles) of sterile water for injection per box of 12 Dantrolene vials. Dispensary open hours: RIE Monday to Friday 0830-1830 Ext 22911 Saturday 0830-1500 Ext 22911 Sunday 1000-1400 Ext 22911 WGH Monday to Friday 0845-1700 Ext 31461 (or page #6421 or bleep 5535) Saturday 0900-1230 Ext 31210 Outwith these times contact the on-call pharmacist via the switchboard If necessary more Dantrolene can be mobilised from other hospitals. (See page 8.) - Ask Pharmacist to co-ordinate 308 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
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NALOXONE IN PALLIATIVE CARE Naloxon
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CARE OF THE DYING PATIENT If you th
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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
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Page 265 and 266: i Toxicity Serious toxicity from pu
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Page 271 and 272: i SEPSIS • Any age, any joint, ma
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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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Page 299 and 300: PAEDIATRIC FBAO TREATMENT Assess se
Page 301 and 302: CONSENT TO MEDICAL TREATMENT FOR CH
Page 303 and 304: CONTRACEPTION AND ABORTION It would
Page 305 and 306: c) Drugs and catheterisation pack -
Page 307: INSTRUCTIONS FOR ANAESTHETIST + ODP
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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