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A Nurse's Survival Guide to Acute Medical Emergencies Updated Edition


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Table of Contents

Abbreviations Introduction: Immediate assessment of the critically ill ABCDE: Immediate assessment and intervention Early warning: Track and Trigger National Early Warning Score Communication - NEWS and SBAR Cardiology Acute severe breathlessness Cardiac failure Heart muscle damage Valvular disease Rhythm disturbance Types of heart failure Left heart failure Right heart failure Congestive cardiac failure Right heart failure and COPD Diastolic heart failure Clinical features and management of cardiac failure Acute left ventricular failure Acute on chronic congestive cardiac failure Ischaemic heart disease Chest pain Acute coronary syndromes, NSTEMIs and Unstable Angina Sudden cardiac death Atrial fibrillation and arterial emboli Causes of atrial fibrillation Importance of atrial fibrillation Complications of atrial fibrillation Diagnosis of atrial fibrillation Management of atrial fibrillation Infective endocarditis Drugs in the management of acute heart disease Respiratory medicine The breathless patient: the general approach Respiratory failure Type I and Type II respiratory failure Principles of treatment Acute severe asthma Mechanisms Assessment of acute severe asthma Management of acute severe asthma Chronic obstructive pulmonary disease Mechanisms Management of acute exacerbations of COPD Non-invasive ventilation Pneumonia Assessment The severity score in pneumonia: CURB-65 Management of pneumonia Antibiotics Spontaneous pneumothorax Nursing the patient with a chest drain Acute neurological problems Ensuring the safety of the patient Prioritising the initial management: GCS and ABCDE Managing 'medical' and 'neurological' coma Responding to neurological deterioration Stroke and stroke-like emergencies Cerebral infarction Transient ischaemic attacks Intracerebral haemorrhage Subarachnoid haemorrhage Subdural haemorrhage Extradural haemorrhage Nursing the patient with a stroke: the first 24 h Meningococcal meningitis Acute severe headache Subarachnoid haemorrhage Lumbar puncture Sudden loss of consciousness: faints and fits The basic mechanisms: syncope The basic mechanisms: epileptic seizures Pseudoseizures (non-epileptic seizures) Acute paralysis of the lower limbs Spinal cord compression Guillain-Barre syndrome Gastroenterology Nausea and vomiting underlying mechanisms Nausea and vomiting in acute medical conditions Acute upper gastrointestinal haemorrhage Management of upper gastrointestinal haemorrhage Portal hypertension and the management of oesophageal varices Acute liver failure and hepatic encephalopathy Acute jaundice Acute abdominal pain Acute diarrhoea: sources and courses Infective diarrhoea Clostridium difficile diarrhoea Infective diarrhoea versus acute ulcerative colitis Medical conditions presenting with gastrointestinal symptoms Diabetic complications Diabetes on the Acute Medical Unit: the general approach Normal blood sugar control and the nature of diabetes An overview of Type I and Type II diabetes Acute medical conditions associated with diabetes Diabetic renal disease Diabetic neuropathy Cardiovascular disease Cerebrovascular disease Peripheral vascular disease Blood sugar control in adverse medical situations Variable Rate Intravenous Insulin Infusion (VRIII) or GKI DIGAMI regimen Diabetic Keto Acidosis (DKA) Hyperosmolar non-ketotic diabetic coma (HONK) Hypoglycaemia Infective complications in diabetes: the acute diabetic foot Thromboembolic disease Thrombosis and thromboembolisation Mechanisms Superficial thrombophlebitis Deep vein thrombosis Pulmonary thromboembolism Tests to identify thromboembolic disease Management of pulmonary thromboembolism Nursing the patient with a suspected DVT Other causes of a swollen painful leg Cellulitis Necrotising fasciitis Management of a DVT Anticoagulation therapy Deliberate self-harm, alcohol and substance abuse Deliberate self-harm General principles Care of the unconscious patient: ABCDE The patient who refuses treatment Specific overdoses Benzodiazepines Paracetamol poisoning Antidepressant overdose Carbon monoxide poisoning Alcohol abuse Acute alcohol-withdrawal syndrome Cocaine 303 Ecstasy Heroin abuse Needle stick injuries Hospital-acquired methicillin-resistant Staphylococcus aureus infections Violent incidents The 'social admission' Common errors and omissions in the admission of elderly patients Taking a history from the patient Taking a history from a third party Falls The cause of falls Assessment after a fall Immobility Immediate safety of the patient: ABCDE Assessing the cause: establish the full history Delirium Dementia Nursing home admissions Ethical issues and the elderly sick The emergency admission of patients with a terminal disease Multisystem failure Shock: the basic mechanisms Cardiogenic shock Hypovolaemic shock Redistributive (low-resistance) shock Acute severe hypotensive collapse The importance of immediate resuscitation Ensuring adequate oxygen delivery to vital organs Oxygen therapy The blood pressure Inserting a CVP line Fluid challenge Surviving sepsis Anaphylactic reaction Emergency blood transfusion in shock Transfusion reactions Massive blood transfusion Acute kidney injury Management: resuscitation begin with 'ABCDE' Emergency (acute renal failure) management of hyperkalaemia Establishing a management plan Sudden collapse and cardiac arrest Chain of survival Basic life support After basic life support Do not attempt resuscitation Bereavement on the Acute Medical Unit Emerging problems: outbreaks and deliberate releases - SARS, toxins and biological agents How infection spreads Severe acute respiratory syndrome Case definition of SARS Other emerging infections Unusual illnesses - deliberate release of infectious and chemical agents Deliberate release of infectious agents General principles Examples of potential pathogens and initial symptoms Poisoning with nerve agents Key nursing skills in outbreaks and deliberate releases Index

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