Adult Medical Emergency Handbook - Scottish Intensive Care Society

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COOLING - ASSISTANT SURGEON / RESIDENT / ODP SPEED IS VITAL Cool patient by sponging with cool water over as much of the body as possible. This cools the patient by an evaporative heat loss process. Two sponges are in the MH box. (The anaesthetist may arrange cardiac bypass pump cooling if required.) Important Further Information : The following are no longer recommended for the treatment malignant Hyperthermia : 1. Ice cooling is no longer recommended as it can cause intense vasoconstriction which retains body heat and can raise the core body temperature even more. Frostbite with loss of extremities could also occur. 2. Gastric or peritoneal lavage. adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11 309
HELP - NURSE / RESIDENT The following people should be contacted : RIE : 1. Supervising Consultant / On Call Consultant 2. Contact ward 118 ICU team in RIE (ext 2118) to arrange emergency transfer and admission. 3. The Assistant Operations Manager to report that the Malignant Hyperthermia policy plan has been actioned (RIE Bleep 2118 ) WGH : 1. WGH Consultant on call. <strong>Emergency</strong> Anaesthetist (Bleep 8155) 2. ICU Consultant on call. ICU team to arrange emergency transfer and admission (ext 31664/31665) 3. SHO on call (Bleep No 8112) 4. Theatre Assistant Operations Manager to report that the Malignant Hyperthermia policy plan has been actioned (Bleep # 6122) PAEP : 1. Contact ward 118 ICU team in RIE (ext 2118) to arrange emergency transfer and admission. 2. Inform Clinical Lead. 3. Theatre Assistant Operations Manager to report that the Malignant Hyperthermia policy plan has been actioned (Bleep # 1600) ROODLANDS HOSPITAL : 1. Contact ward 118 ICU team in RIE (ext 2118) to arrange emergency transfer and admission. 2. Inform Clinical Lead. 3. Theatre Assistant Operations Manager to report that the Malignant Hyperthermia policy plan has been actioned. 310 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
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• 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
Page 273 and 274: Reactive Arthritis • Bed rest plu
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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
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 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 and 308: INSTRUCTIONS FOR ANAESTHETIST + ODP
Page 309: DRUGS - CIRCULATING NURSE 1. MAKE S
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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Adult Medical Emergency Handbook - Scottish Intensive Care Society

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