Adult Medical Emergency Handbook - Scottish Intensive Care Society

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Table 2 continued IMMEDIATE REACTION CATEGORY 3: LIFE-THREATENING 1. Maintain airway and give high concentration (60-100%) oxygen by mask. 2. Stop the transfusion. Replace the giving set and keep the IV line open with 0.9% saline. 3. Manage as anaphylaxis protocol and ensure help is coming: stridor, wheeze and hypotension require treatment with oxygen and im adrenaline. Critical care admission will be necessary. 4. Notify the Consultant Haematologist and the Hospital Transfusion Laboratory immediately. 5. Send the blood unit with the giving set, freshly collected blood samples with appropriate request form to the Hospital Transfusion Laboratory for investigations. 6. Check a fresh urine sample visually for signs of haemoglobinuria. 7. Commence a 24 hour urine collection and fluid balance chart and record all intake and output. Maintain fluid balance. 8. Assess for bleeding from puncture sites or wounds, if DIC suspected seek expert advice. 9. Reassess: • Treat bronchospasm and shock as per protocol. • Acute renal failure or hyperkalaemia may require urgent renal replacement therapy. 10. If bacteraemia is suspected (rigors, fever, collapse, no evidence of a haemolytic reaction), take blood cultures and give broad spectrum antibiotics with Pseudomonas cover: Piperacillintazobactam 4.5G tds IV plus gentamicin 7mg/kg od IV (ideal bodyweight). Discuss with haematologist on call. adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11 65
Table 3: Drugs that may be required in the management of Acute Transfusion Reactions RELEVANT EFFECTS DRUGS & DOSES NOTES Name Route & Dosage Oxygen 60-100% 1st line Bronchodilator Adrenaline 500 micrograms 1st line Vasopressor im repeated after 5 mins if no better, or worse Expand blood 0.9% - If patient 1st line volume Saline, hypotensive, Gelofusine 20ml/kg over 5 minutes Reduce fever Paracetamol Oral or rectal 2nd line and inflamm- 10 mg/kg Avoid aspirin atory response containing products if patient has low platelet count Inhibits Chlorphen- IV 0.1 mg/kg 2nd line histamine amine mediated (Chlorphenresponses iramine) Inhibits Salbutamol By 5mg nebuliser 2nd immune line mediated Amino- Use under bronchospasm phyllline expert guidance Vasopressor Adrenaline 5-10ml/hr Use only under Bronchodilator 6mg in 100ml 5% dextrose (6%) expert guidance 66 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 ...............
Page 15 and 16: EDITOR’S INTRODUCTION The Adult M
Page 17 and 18: DISCLAIMER Every effort has been ma
Page 19 and 20: GENERAL POINTS Medicines • Doses
Page 21 and 22: i as far as is reasonably possible.
Page 23 and 24: i GOOD DOCUMENTATION • Write legi
Page 25 and 26: • Prescribe liquids by writing th
Page 27 and 28: Figure 1 Figure 2 Figure 3 Figure 4
Page 29 and 30: MAKING A DECISION ABOUT RESUSCITATI
Page 31 and 32: THE PATIENT WHO IS NOT COMPETENT TO
Page 33 and 34: i PATIENT DEATHS • See patients w
Page 35 and 36: CHECKLIST OF REQUIREMENTS This chec
Page 37 and 38: ORGAN DONATION Transplants are one
Page 39 and 40: i Always consider telephoning the G
Page 41 and 42: i review arrangements. Include: a)
Page 43 and 44: Immediate investigations are those
Page 45 and 46: i i NOTES ON INITIAL ASSESSMENT ALG
Page 47 and 48: i Exposure, evidence and examinatio
Page 49 and 50: i i 2b. ILLNESS SEVERITY ASSESSMENT
Page 51 and 52: Observation Chart Date chart commen
Page 53 and 54: i Illness Severity and Diagnosis (R
Page 55 and 56: i Watch for the development of card
Page 57 and 58: SHOCK Definition & Classification
Page 59 and 60: i Cuff BP by machine may be extreme
Page 61 and 62: If no bleeding and platelets
Page 63 and 64: TRANSFUSION REACTION Figure 1: Algo
Page 65: of infusing only 5-10mls of blood.
Page 69 and 70: i i SEPSIS AND SEPTIC SHOCK Sepsis
Page 71 and 72: ANTIBIOTIC MINI-GUIDE FOR ADULTS
Page 73 and 74: i i • Remember to look for intra-
Page 75 and 76: i • Commence basic life support (
Page 77 and 78: ALGORITHM FOR FIRST MEDICAL RESPOND
Page 79 and 80: ACUTE PAIN MANAGEMENT The effective
Page 81 and 82: i DO YOU NEED HELP ? Contact the Ac
Page 83 and 84: i • Angina (rate related): treat
Page 85 and 86: DATE: Dear “FIRST SEIZURE” APPO
Page 87 and 88: Review Collapse Algorithm Identifie
Page 89 and 90: Loss of consciousness YES Perform:
Page 91 and 92: 07.00 to 17.00 Asymptomatic Normal
Page 93 and 94: i i ADULT ADVANCED LIFE SUPPORT: No
Page 95 and 96: i NON SHOCKABLE RHYTHMS Cardiac arr
Page 97 and 98: • Patients should be pain free an
Page 99 and 100: ACUTE CORONARY SYNDROMES In order t
Page 101 and 102: IMMEDIATE MANAGEMENT OF ACUTE CORON
Page 103 and 104: CHEST PAIN PATHWAY - NHS LOTHIAN OP
Page 105 and 106: LOTHIAN PRIMARY PCI/PRE-HOSPITAL TH
Page 107 and 108: i Thrombolysis Since the clinical b
Page 109 and 110: Reperfusion therapy not administere
Page 111 and 112: i i MILD-MODERATE LEFT VENTRICULAR
Page 113 and 114: i i Do not hesitate to seek a Cardi
Page 115 and 116: 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
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MANAGEMENT OF COMMON POISONINGS Par
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i i treatment schedule should be us
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i Toxicity Serious toxicity from pu
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conscious level. • Correct electr
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• Correct metabolic acidosis with
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i SEPSIS • Any age, any joint, ma
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Reactive Arthritis • Bed rest plu
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N.B. Remember spontaneous bacterial
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i ALCOHOL WITHDRAWAL MANAGEMENT Ens
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ACUTE DISTURBANCE Guide for medical
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detention certificate must state th
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a person there. Under an EDC, treat
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Appendix 1 SHARING DIFFICULT INFORM
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1. Write down or review what you ar
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CHECKLIST OF REQUIREMENTS This chec
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i • Reactions vary: distress, ang
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• Damaged syringes and siphonage:
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Start-up time (Syringe pumps) What
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• HR increases by 17% and stroke
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PAEDIATRIC FBAO TREATMENT Assess se
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CONSENT TO MEDICAL TREATMENT FOR CH
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CONTRACEPTION AND ABORTION It would
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c) Drugs and catheterisation pack -
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INSTRUCTIONS FOR ANAESTHETIST + ODP
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DRUGS - CIRCULATING NURSE 1. MAKE S
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HELP - NURSE / RESIDENT The followi
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RECOVERY & FURTHER TREATMENT With r
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MAJOR HAEMORRHAGE PROTOCOL 314 adul
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Useful links The Anaphylaxis campai
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Adult Medical Emergency Handbook - Scottish Intensive Care Society

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