Adult Medical Emergency Handbook - Scottish Intensive Care Society

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LOCATIONS OF SUPPLIES OF DANTROLENE IN THE LOTHIAN AREA Large back-up supplies are available from the pharmacies in RIE, WGH & St Johns - Pharmacy will mobilise these sources if necessary ROYAL HOSPITAL FOR SICK CHILDREN 12 vials of 20mg In Main Theatre - Middle of recovery room by emergency trolley. WESTERN GENERAL HOSPITAL 12 vials of 20mg In ICU - in MH Box in‘Drug Cupboard No 5’. 12 vials of 20mg In ICU - in‘Drug Cupboard No 5’ as back-up. 12 vials of 20mg WGH Pharmacy ROODLANDS HOSPITAL 12 vials of 20mg In Main Theatre - in safe in ‘back corridor’. ROYAL INFIRMARY OF EDINBURGH 96 vials of 20mg In Pharmacy Dept - Drug store, injection store. 12 vials of 20mg ICU Ward - At Nurses Station, top shelf. 12 vials of 20mg General/Orthopaedic Theatre Recovery Room - Clean Utility Area - lower shelf. St. JOHN’S HOSPITAL LIVINGSTON 12 vials of 20mg In Theatre Suite - Recovery Room on dedicated trolley. adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11 311
RECOVERY & FURTHER TREATMENT With rapid diagnosis and treatment most cases of Malignant Hyperthermia will recover. After the initial crisis has been stabilised the patient should be admitted to an intensive care unit noting the following : RETRIGGERING - May occur. Oral Dantrolene ( if possible ) should be given for 48hours : 4mg/kg/day in divided doses. Unnecessary stress should be avoided as this can trigger Malignant Hyperthermia. HYPOTHERMIA - Can be induced by overvigorous cooling during recovery. DIURESIS - Should be maintained to reduce the possibility of myoglobin induced renal failure. BLEEDING DISORDERS - A DIC type coagulopathy is common. PULMONARY OEDEMA - Is common. MUSCLE OEDEMA - Compartment Syndrome may require fasciotomy. (Spinal anaesthesia is often the method of choice for this) Consider other diagnoses - Myopathy / Ecstasy ingestion / Neuroleptic Malignant Syndrome Patients suspected of having Malignant Hyperthermia and their blood relatives should be referred later for formal investigation to :- Malignant Hyperthermia Services University Dept. of Anaesthesia St. James’s University Hospital Leeds LS9 7TF LEEDS MALIGNANT HYPERTHERMIA HOTLINE : 07947 609 601 312 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
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• 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 285 and 286: Appendix 1 SHARING DIFFICULT INFORM
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Page 289 and 290: CHECKLIST OF REQUIREMENTS This chec
Page 291 and 292: i • Reactions vary: distress, ang
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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 and 310: DRUGS - CIRCULATING NURSE 1. MAKE S
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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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