A Nurse's Survival Guide to Acute Medical Emergencies Updated Edition (3^rd Ed.)
A Nurse's Survival Guide Series

Are you a nurse, a physician's associate or a medical student in an acute or emergency unit?

This is your indispensable primer of acute medical care - a pocket guide to caring for patients with acute medical conditions.

This book will help you to

• care for patients in the first critical 24 hours of admission
• manage patients using the most up-to-date evidence based approach
• understand the most common emergency medical conditions and their underlying disease mechanisms
• handle the patient's assessment , understand the observations and manage their disease
• easily obtain clear practical advice
• know what to tell the patient and relatives using jargon-free language
• access information on SARS, avian influenza and bio-terrorism

This updated edition

• contains improved sections on stroke care, diabetes and sepsis,
• introduces the NEWS 2 observation chart
• has revised its case histories in line with current practice

This updated edition:

contains improved sections on stroke care, diabetes and sepsis,

introduces the NEWS 2 observation chart

has revised its case histories in line with current practice

Abbreviations

1. 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

2. 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

3. 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

4. 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-Barré syndrome

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

Undergraduate nursing students, newly registered nurses, post-registration nurses

Allied health professionals and students