By Graham Robert Nimmo
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Additional info for Adult Medical Emergencies Handbook
INVOLVE ICU EARLY These guidelines are intended to facilitate referral of acutely ill patients for consideration of Intensive Care, High Dependency care and treatment of major organ system failure. HDU consultant) SJH - 54063/54056 BLEEP 561 WGH - Ward 20: Call ICU Consultant EXAMPLES OF PATIENTS Surgical problems • Perforated, ischaemic or infarcted bowel (both upper and lower). • Acute pancreatitis. • Sepsis from the gastro-intestinal, biliary or urinary tract. • Respiratory or cardiorespiratory failure after any operation.
Please note that if a patient is found to have red cell antibodies there will be some delay in finding compatible blood. • In the context of an acute bleed, blood may be transfused as quickly as required to attain haemodynamic stability. • When transfusing anaemic patients with no acute bleed then it is given more slowly, in general 2 to 4 hourly. g. 40 mg with alternate bags. • Large transfusions may impair clotting and cause thrombocytopenia. e. 5 x normal, APTT >2 x normal, platelets <50. • If an additional transfusion is required more than three days later, then a new sample must be sent for cross match (this is not necessary if more blood is requested within 72 hours of initial crossmatch).
The consultant/GP responsible for the patient’s care has the authority to make the final decision, but it is wise to reach a consensus with the patient, staff and relevant others. • It is not necessary to burden the patient with resuscitation decisions if the clinical team is as certain as it can be that CPR realistically will not have a medically successful outcome and the clinician is not obliged to offer CPR in this situation. This must never prevent continuing communication with the patient and relevant others about their illness, including information about CPR, if they wish this.
Adult Medical Emergencies Handbook by Graham Robert Nimmo