By Graham Robert Nimmo
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Additional resources for Adult Medical Emergencies Handbook
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. Disability • Glasgow coma scale (GCS): document all three components accurately with best eye, best verbal and best motor responses. • Recommended painful stimuli are supraorbital pressure or Trapezius pinch.
Surname 3. First name 4. Date of birth 5. Gender 6. Location 7. Signature of requesting doctor (or appropriately trained nurse practitioner) 8. Name of person taking sample (if different from above) 9. If the patient identification number is unavailable, please include postcode adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11 61 TRANSFUSION REACTION Figure 1: Algorithm for Acute Transfusion Reactions CAT Stop the transfusion. Recheck the blood component with the paFent.
THE ROLE OF THE RELATIVES/RELEVANT OTHERS • A competent patient’s permission must be sought before any discussion takes place with the relevant others. • 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.