Adult Medical Emergency Handbook - Scottish Intensive Care Society

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Inclusion Criteria Exclusion Criteria MANAGEMENT OF FIRST SEIZURE IN ADULTS History Table (please tick if relevant) • Patients >16yrs
Review Collapse Algorithm Identified cause for syncope Manage appropriately No Does the patient have: • Cardiac Failure • Ischaemic Heart Disease • History VT/VF • Valvular Heart Disease • ECG abnormality • Exertional syncope • Significant assoc injury No Does the patient have: • Associated chest pain • Associated palpitations • Family history of sudden death • Frequent syncopal episodes • No presyncopal warning No Age more than 60 CSM @ not contraindicated Yes CSM for 5 sec on sequential sides results in: • Ventricular pause >3 sec • Fall in systolic BP >50 mmHg Yes Refer cardiology @ Carotid Sinus Massage contraindicated if: Carotid Bruit present; recent CVA, TIA or MI (6 months) MANAGEMENT OF SYNCOPE Yes Yes Yes Admit to monitored bed No No Yes Consider admission D/W senior colleague Frequent episodes No ECG abnormalities • Bifascicular block • Second or complete heart block • Sinoatrial block • QRS > 120ms • QTc > 450ms • Bradycardia
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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
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 and 66: of infusing only 5-10mls of blood.
Page 67 and 68: Table 3: Drugs that may be required
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: DATE: Dear “FIRST SEIZURE” APPO
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
Page 117 and 118: i rehab team or the BHF nurse, and/
Page 119 and 120: i i i Referral to ICU should follow
Page 121 and 122: ATRIAL FLUTTER Characterised by rap
Page 123 and 124: i Seek senior cardiology advice reg
Page 125 and 126: Causes • Bradycardia • Electrol
Page 127 and 128: i i In anterior infarction the deve
Page 129 and 130: abnormalities develop i.e. second o
Page 131 and 132: i VASCULAR EMERGENCIES ACUTE THORAC
Page 133 and 134: i ACUTE STROKE Stroke is a Medical
Page 135 and 136: 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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