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

1. Introduction: Immediate assessment of the critically ill

1.1. ABCDE: Immediate assessment and intervention

1.2. Early warning: Track and Trigger

1.3. National Early Warning Score

1.4. Communication – NEWS and SBAR


2. Cardiology

2.1. Acute severe breathlessness

2.2. Cardiac failure

2.3. Heart muscle damage

2.4. Valvular disease

2.5. Rhythm disturbance

2.6. Types of heart failure

2.7. Left heart failure

2.8. Right heart failure

2.9. Congestive cardiac failure

2.10. Right heart failure and COPD

2.11. Diastolic heart failure

2.12. Clinical features and management of cardiac failure

2.13. Acute left ventricular failure

2.14. Acute on chronic congestive cardiac failure

2.15. Ischaemic heart disease

2.16. Chest pain

2.17. Acute coronary syndromes, NSTEMIs and Unstable Angina

2.18. Sudden cardiac death

2.19. Atrial fibrillation and arterial emboli

2.20. Causes of atrial fibrillation

2.21. Importance of atrial fibrillation

2.22. Complications of atrial fibrillation

2.23. Diagnosis of atrial fibrillation

2.24. Management of atrial fibrillation

2.25. Infective endocarditis

2.26. Drugs in the management of acute heart disease


3. Respiratory medicine

3.1. The breathless patient: the general approach

3.2. Respiratory failure

3.3. Type I and Type II respiratory failure

3.4. Principles of treatment

3.5. Acute severe asthma

3.6. Mechanisms

3.7. Assessment of acute severe asthma

3.8. Management of acute severe asthma

3.9. Chronic obstructive pulmonary disease

3.10. Management of acute exacerbations of COPD

3.11. Non-invasive ventilation

3.12. Pneumonia

3.13. Assessment

3.14. The severity score in pneumonia: CURB-65

3.15. Management of pneumonia

3.16. Antibiotics

3.17. Spontaneous pneumothorax

3.18. Nursing the patient with a chest drain


4. Acute neurological problems

4.1. Ensuring the safety of the patient

4.2. Prioritising the initial management: GCS and ABCDE

4.3. Managing 'medical' and 'neurological' coma

4.4. Responding to neurological deterioration

4.5. Stroke and stroke-like emergencies

4.6. Cerebral infarction

4.7. Transient ischaemic attacks

4.8. Intracerebral haemorrhage

4.9. Subarachnoid haemorrhage

4.10. Subdural haemorrhage

4.11. Extradural haemorrhage

4.12. Nursing the patient with a stroke: the first 24 h

4.13. Meningococcal meningitis

4.14. Acute severe headache

4.15. Subarachnoid haemorrhage

4.16. Lumbar puncture

4.17. Sudden loss of consciousness: faints and fits

4.18. The basic mechanisms: syncope

4.19. The basic mechanisms: epileptic seizures

4.20. Pseudoseizures (non-epileptic seizures)

4.21. Acute paralysis of the lower limbs

4.22. Spinal cord compression

4.23. Guillain–Barré syndrome


5. Gastroenterology

5.1. Nausea and vomiting underlying mechanisms

5.2. Nausea and vomiting in acute medical conditions

5.3. Acute upper gastrointestinal haemorrhage

5.4. Management of upper gastrointestinal haemorrhage

5.5. Portal hypertension and the management of oesophageal varices

5.6. Acute liver failure and hepatic encephalopathy

5.7. Acute jaundice

5.8. Acute abdominal pain

5.9. Acute diarrhoea: sources and courses

5.10. Infective diarrhoea

5.11. Clostridium difficile diarrhoea

5.12. Infective diarrhoea versus acute ulcerative colitis

5.13. Medical conditions presenting with gastrointestinal symptoms


6. Diabetic complications

6.1. Diabetes on the Acute Medical Unit: the general approach

6.2. Normal blood sugar control and the nature of diabetes

6.3. An overview of Type I and Type II diabetes

6.4. Acute medical conditions associated with diabetes

6.5. Diabetic renal disease

6.6. Diabetic neuropathy

6.7. Cardiovascular disease

6.8. Cerebrovascular disease

6.9. Peripheral vascular disease

6.10. Blood sugar control in adverse medical situations

6.11. Variable Rate Intravenous Insulin Infusion (VRIII) or GKI

6.12. DIGAMI regimen

6.13. Diabetic Keto Acidosis (DKA)

6.14. Hyperosmolar non-ketotic diabetic coma (HONK)

6.15. Hypoglycaemia

6.16. Infective complications in diabetes: the acute diabetic foot


7. Thromboembolic disease

7.1. Thrombosis and thromboembolisation

7.2. Mechanisms

7.3. Superficial thrombophlebitis

7.4. Deep vein thrombosis

7.5. Pulmonary thromboembolism

7.6. Tests to identify thromboembolic disease

7.7. Management of pulmonary thromboembolism

7.8. Nursing the patient with a suspected DVT

7.9. Other causes of a swollen painful leg

7.10. Cellulitis

7.11. Necrotising fasciitis

7.12. Management of a DVT

7.13. Anticoagulation therapy


8. Deliberate self-harm, alcohol and substance abuse

8.1. Deliberate self-harm

8.2. General principles

8.3. Care of the unconscious patient: ABCDE

8.4. The patient who refuses treatment

8.5. Specific overdoses

8.6. Benzodiazepines

8.7. Paracetamol poisoning

8.8. Antidepressant overdose

8.9. Carbon monoxide poisoning

8.10. Alcohol abuse

8.11. Acute alcohol-withdrawal syndrome

8.12. Cocaine

8.13. Ecstasy

8.14. Heroin abuse

8.15. Needle stick injuries

8.16. Hospital-acquired methicillin-resistant Staphylococcus aureus infections

8.17. Violent incidents


9. The 'social admission'

9.1. Common errors and omissions in the admission of elderly patients

9.2. Taking a history from the patient

9.3. Taking a history from a third party

9.4. Falls

9.5. The cause of falls

9.6. Assessment after a fall

9.7. Immobility

9.8. Immediate safety of the patient: ABCDE

9.9. Assessing the cause: establish the full history

9.10. Delirium

9.11. Dementia

9.12. Nursing home admissions

9.13. Ethical issues and the elderly sick

9.14. The emergency admission of patients with a terminal disease


10. Multisystem failure

10.1. Shock: the basic mechanisms

10.2. Cardiogenic shock

10.3. Hypovolaemic shock

10.4. Redistributive (low-resistance) shock

10.5. Acute severe hypotensive collapse

10.6. The importance of immediate resuscitation

10.7. Ensuring adequate oxygen delivery to vital organs

10.8. Oxygen therapy

10.9. The blood pressure

10.10. Inserting a CVP line

10.11. Fluid challenge

10.12. Surviving sepsis

10.13. Anaphylactic reaction

10.14. Emergency blood transfusion in shock

10.15. Transfusion reactions

10.16. Massive blood transfusion

10.17. Acute kidney injury

10.18. Management: resuscitation begin with 'ABCDE'

10.19. Emergency (acute renal failure) management of hyperkalaemia

10.20. Establishing a management plan

10.21. Sudden collapse and cardiac arrest

10.22. Chain of survival

10.23. Basic life support

10.24. After basic life support

10.25. Do not attempt resuscitation

10.26. Bereavement on the Acute Medical Unit


11. Emerging problems: outbreaks and deliberate releases – SARS, toxins and biological agents

11.1. How infection spreads

11.2. Severe acute respiratory syndrome

11.3. Case definition of SARS

11.4. Other emerging infections

11.5. Unusual illnesses – deliberate release of infectious and chemical agents

11.6. Deliberate release of infectious agents

11.7. General principles

11.8. Examples of potential pathogens and initial symptoms

11.9. Poisoning with nerve agents

11.10. Key nursing skills in outbreaks and deliberate releases