Adult Medical Emergency Handbook - Scottish Intensive Care Society

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ALGORITHM FOR AUTOMATED EXTERNAL DEFIBRILLATION Shock advised 1 Shock 150 J biphasic Immediately resume CPR 30:2 for 2 min Unresponsive Open airway Not breathing normally CPR 30:2 Until AED is attached AED assesses rhythm Continue until the victim starts to breathe normally Call for help Send or go for AED Call 2222 No shock advised Immediately resume CPR 30:2 for 2 min adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11 93
i NON SHOCKABLE RHYTHMS Cardiac arrest in asystole and PEA may result from a number of causes other than ischaemic heart disease (see page 47). These are potentially reversible causes of cardiac arrest. They should also be regarded as preventable causes of cardiac arrest, in that their recognition and treatment prior to cardiac arrest can prevent deterioration. • On this side of the algorithm CPR is conducted for 2 minute periods whilst considering and treating any of the above. • The airway should be secured, IV access obtained and adrenaline 1mg given IV every 3-5 minutes. (alternate cycles). • After 2 minutes of CPR the ECG rhythm is re-assessed. • If a rhythm compatible with cardiac output is present check the pulse. • If VF/pulseless VT is present follow that side of the algorithm. Otherwise, continue with loops of the right hand path of the algorithm for as long as it is appropriate to continue active resuscitation attempts. Drugs • A single dose of Atropine 3mg IV is given in asystole to block vagal activity, and in PEA with a ventricular rate under 60 beats per minute. • Adrenaline is given 1mg IV every 3-5 minutes (as above). Pacing External or transvenous pacing is unsuccessful in asystole but may be effective in ventricular asystole where p waves are still evident. Percussion pacing may also be effective. External pacing defibrillators can be found at the following locations: RIE: A&E, CAA, CCU, General and Cardiothoracic ICU’s & HDU’s SJH: A&E and Ward 24 WGH: ARAU, ICU, all HDU’s, ECG, Wards 15, 26, 43 & 54 Liberton Hospital 94 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)
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 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: i i ADULT ADVANCED LIFE SUPPORT: No
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
Page 137 and 138: ACUTE STROKE INTEGRATED CARE PATHWA
Page 139 and 140: ST JOHN’S HOSPITAL CARE PATHWAY A
Page 141 and 142: Role of D-dimer D-Dimer is helpful
Page 143 and 144: 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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