By Graham Robert Nimmo
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Extra resources for Adult Medical Emergencies Handbook
Relatives should never be given the impression that their wishes override those of the patient. They can give information about the patient’s wishes but should not be burdened with the decision unless their status as proxy for the patient has been legally established. PATIENTS WITH A DNAR ORDER AT HOME OR BEING DISCHARGED HOME • It is the medical and nursing team’s responsibility to ensure that the family are aware of the existence of the DNAR form and know what to do in the event of the patient’s death.
Call Senior help. • Use pressure infusors and blood warmers for rapid, high volume fluid resuscitation. i If the patient is very peripherally vasoconstricted and hypovolaemic don’t struggle to get a 14G (brown) cannula in. Put in two 18G cannulae (green) and start fluid resuscitation through both. CALL FOR HELP • Machine derived cuff blood pressure is inaccurate at extremes of BP and in tachycardias (especially AF). • Manual sphygmomanometer BP is more accurate in hypotension. • In severe hypotension which is not readily corrected with fluid early consideration should be given to arterial line insertion and vasoactive drug therapy: GET HELP.
Review. 0 Lothian Guidelines Cancer-related pain: Acute pain Initiate Edinburgh Pain Assessment Tool (EPAT©) for pain score of 4 or above. Use Palliative Care Guidelines. Use Acute Pain Guidelines. PERSISTENT MODERATE OR SEVERE PAIN, WHICH DISTRESSES PATIENT: REFER. SEE FLOW CHART OVER. © Quality Improvement Scotland (QIS) Illness Severity Criteria Subgroup, February 2005. adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11 51 Illness Severity and Diagnosis (Risk of Deterioration) • As the ABCD is secured a specific diagnosis is sought with the ‘Targeted Examination’ and specific treatment can then be instituted.
Adult Medical Emergencies Handbook by Graham Robert Nimmo