Nursing Medical Emergency Patients

Philip Jevon, Beverley Ewens, Melanie Humphreys

• Publisher: Wiley-Blackwell
• Year: 2010
• Print ISBN: 9781405120555
• eBook ISBN: 9781444327281
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

Nursing Medical Emergency Patients is a practical guide to the nursing care and management of patients with medical emergencies involving system failure. Following an initial chapter on assessment, the authors adopt a system-by-system approach, with an emphasis on the clinical features of medical emergencies, their assessment, diagnosis and treatment.

Nursing Medical Emergency Patients is a vital resource for all nurses working with medical emergency patients, and provides an essential companion to both Monitoring the Critically Ill Patient and Treating the Critically Ill Patient.

• Accessible and reader friendly
• Integrates theory with practice
• Adopts an evidence based approach
• Includes chapter objectives, 'best practice' boxes and case studies
• Refers to National guidelines and key initiatives e.g. outreach teams
• Includes legal and ethical issues

1 Overview of the Treatment of Medical Emergencies

Philip Jevon

INTRODUCTION

Medical emergencies can be life-threatening. Prompt recognition and effective early treatment of a patient with a medical emergency is paramount if deterioration of the patient is to be prevented and the chances of recovery are to be maximised. The aim of this book is to understand the treatment of medical emergencies.

The assessment and treatment of any patient with a medical emergency should follow the ABCDE approach advocated by the Resuscitation Council UK (Resuscitation Council UK, 2006). In this chapter a brief overview to this generic approach will be provided (a more detailed and comprehensive guide can be found in Treating the Critically Ill Patient, Jevon, 2007) and throughout the book its importance will be continually emphasised.

The aim of this chapter is to provide an overview to the treatment of medical emergencies.

LEARNING OUTCOMES

At the end of the chapter the reader will be able to:

list what emergency equipment should be available,

describe the assessment of a patient with a medical emergency,

state the aim of treating a patient with a medical emergency.

EMERGENCY EQUIPMENT

Wherever patients with medical emergencies are treated, procedures should be in place to ensure that all the essential monitoring and emergency equipment and emergency drugs/fluids are immediately available, accessible and in good working order (Jevon, 2001).

Oxygen

Facilities should be available for the delivery of high concentrations of oxygen: either piped oxygen to a wall-outlet behind the patient’s bed (preferable), or a portable oxygen cylinder, fitted with a variable oxygen-flow-rate meter capable of delivering up to 15 litres/min (Figure 1.1). There should also be adequate stocks of various oxygen-delivery devices, particularly non-rebreathe masks (see Figure 1.4, below).

Figure 1.1 A wall mounted oxygen cylinder, fitted with a variable oxygen-flow-rate meter capable of delivering up to 15 litres/min

Suction

Every clinical area should have access to a portable suction device. In addition, it is preferable if a wall-mounted suction device is available behind each patient’s bed (Figure 1.2). As suction is sometimes required immediately in a life-threatening situation, it is standard practice to store appropriate suction connection tubing, together with suction catheters (rigid and flexible), with the suction source; that is, suction can be quickly administered.

Monitoring devices

At the very least, an ECG monitor and a pulse oximeter should be available. Other monitoring facilities, for example capnography, may also be required in some clinical areas.

Figure 1.2 A wall-mounted suction device

Cardiopulmonary resuscitation trolley

A carefully set out and fully stocked cardiac arrest trolley is paramount, following Resuscitation Council guidelines (Box 1.1) (Resuscitation Council UK, 2004). The trolley should be spacious, sturdy, easily accessible and mobile; ideally each trolley in a healthcare establishment should be identically stocked to avoid confusion. A defibrillator should be immediately available and, where appropriate, for example on general wards, it should have an automatic or advisory facility (Jevon, 2001). Defibrillators with external pacing should be strategically located, for example in emergency departments, intensive care units (ICUs) and coronary care units (CCUs).

Box 1.1 Cardiopulmonary resuscitation equipment that should be available

Airway equipment

• Pocket mask with oxygen port (should be widely available in all clinical areas)
• Self-inflating resuscitation bag with oxygen reservoir and tubing (ideally, the resuscitation bag should be single-use; if not, it should be equipped with a suitable filter)
• Clear face masks, sizes 3, 4 and 5
• Oropharyngeal airways, sizes 2, 3 and 4
• Nasopharyngeal airways, sizes 6 and 7
• Portable suction equipment
• Yankauer suckers
• Tracheal suction catheters, sizes 12 and 14
• Laryngeal mask airways (LMAs; sizes 4 and 5), or ProSeal LMAs (sizes 4 and 5), or Combitube (small)
• Magill forceps
• Tracheal tubes, oral, cuffed, sizes 6, 7 and 8
• Gum elastic bougie or equivalent device
• Lubricating jelly
• Laryngoscope handles (×2) and blades (standard and long blade)
• Spare batteries for laryngoscope and spare bulbs (if applicable)
• Fixation for tracheal tube (e.g. ribbon gauze/tape)
• Scissors
• Selection of syringes
• Oxygen mask with reservoir (non-rebreathing) bag
• Oxygen cylinders
• Cylinder key

Circulation equipment

• Defibrillator (shock advisory module and or external pacing facility to be decided by local policy)
• ECG electrodes
• Defibrillation gel pads or self-adhesive defibrillator pads (preferred)
• Selection of intravenous cannulae
• Selection of syringes and needles
• Cannula fixing dressings and tapes
• Seldinger central venous catheter kit
• Intravenous infusion sets
• 0.9% sodium chloride, 1000 ml × 2
• Arterial blood gas syringes
• Tourniquet

Drugs

(a) Immediately available prefilled syringes

• Adrenaline (epinephrine) 1 mg (1 : 10,000) × 4
• Atropine 3 mg × 1
• Amiodarone 300 mg × 1

(b) Other readily available drugs

IV injections

• Adenosine 6 mg × 10
• Adrenaline 1 mg (1 : 10,000) × 4
• Adrenaline 1 mg (1 : 1000) × 2
• Amiodarone 300 mg × 1
• Calcium chloride 10 ml of 100 mg/ml × 1
• Chlorphaniramine 10 mg × 2
• Furosemide 50 mg × 2
• Glucose 10% 500 ml × 1
• Hydrocortisone 100 mg × 2
• Lignocaine 100 mg
• Magnesium sulphate 50% solution 2 g (4 ml) × 1
• Midazolam 10 mg × 1
• Naloxone 400 mg × 5
• Normal saline, 10 ml ampoules
• Potassium chloride for injection (see National Patient Safety Agency Alert, www.npsa.nhs.uk)
• Sodium bicarbonate 8.4%, 50 ml × 1

Other medications/equipment

• Salbutamol (5 mg × 2) and ipratropium bromide (500 mg × 2) nebules
• Nebulizer device and mask
• Glyceryl trinitrate spray
• Aspirin 300 mg

Additional items

• Clock
• Gloves/goggles/aprons
• Audit forms
• Sharps container and clinical waste bag
• Large scissors
• Alcohol wipes
• Blood sample bottles
• A sliding sheet or similar device should be available for safer handling

Source: Resuscitation Council UK (2004).

Routine checking of emergency equipment

All emergency equipment should be checked routinely following local protocols. It is recommended that cardiopulmonary resuscitation equipment should be checked on a daily basis by each ward or department responsible for it (Resuscitation Council UK, 2000). A system for daily documented checks of the equipment inventory should be in place (Jevon, 2001). The electronic equipment should be stored, maintained and checked following the manufacturer’s recommendations and those of the local electrobiomedical engineers’ department (EBME).

ASSESSMENT OF A PATIENT WITH A MEDICAL EMERGENCY

ABCDE assessment

A patient with a medical emergency will be critically ill. The Resuscitation Council UK (2006) has issued gu...

Table of contents

• Cover
• Title Page
• Copyright
• Contributors
• Foreword
• Acknowledgements
• Contents
• Chapter 1 - Overview of the Treatment of Medical Emergencies
• Chapter 2 - Respiratory Emergencies
• Chapter 3 - Cardiac Emergencies
• Chapter 4 - Cardiovascular Emergencies
• Chapter 5 - Shock
• Chapter 6 - Neurological Emergencies
• Chapter 7 - Acute Renal Failure
• Chapter 8 - Gastrointestinal Emergencies
• Chapter 9 - Endocrine Emergencies
• Chapter 10 - Poisoning
• Chapter 11 - Critical Care Outreach Service
• Chapter 12 - Ethical and Legal Issues
• Index