EMERGENCY

PROMPT
CARDS
 3 RFH ED Phone Numbers 41 Hypercalcaemia

4 RFH Trust Phone Numbers 42 Hyperkalaemia

TNETNOC FO ELBA
5 ALS: Adult ALS Algorithm 43 HHS (Prev HONK)

6 ALS 4H's, 4T's: Reversible Causes 44 Hypocalcaemia

7 ALS: Special Circumstances 45 Hypokalaemia

8 ALS: Adult Emergency Drugs 46 Intraosseous Insertion

9 ALS: Post Resuscitation Care 47 Isoprenaline Infusion

10 ALS: Anaphylaxis 48 Lateral Canthotomy

11 ALS: Bradycardia 49 Local Anaesthetic Toxicity

12 ALS: Tachycardia 50 Major Haemorrhage

13 ALS: Choking (Adult) 51 NIV: CPAP vs BiPAP

14 APLS: Paediatric ALS Algorithm 52 NIV: BiPAP Set Up

15 APLS: Paediatric Emergency Drug Chart 53 NIV: CPAP Set Up

16 APLS: Paediatric Choking 54 Noradrenaline Infusion

17 Newborn Life Support 55 Pacing: External

18 ACS: STEMI Territories 56 Palliative Care in the ED

19 Arterial line: Insertion and Set Up 57 Penile Aspiration

20 Asthma 58 Pericardiocentesis

21 Atrial Fibrillation 59 Pneumothorax - Spontaneous

22 Burns: Initial Management 60 Pre-Eclampsia

23 Cardioversion 61 Post Partum Haemorrhage

24 Central Line Insertion 62 Pulmonary Embolism: Thrombolysis

25 Chest drain Insertion (Seldinger) 63 Pulmonary Oedema

26 Chest Drain Insertion (Trauma) 64 Rapid Tranquilisation

27 Chest Drain Insertion (Trauma) 65 Resuscatative Hysterotomy

28 Cricothyroidectomy 66 Sedation

29 Delivery of a Baby 67 Sepsis

30 DKA 68 Status Epilepticus

31 Drug Assisted Intubation (Prev RSI) 69 Stroke

32 DAI: Drug Doses 70 Thoracotomy

33 DAI: Unanticipated Difficult Intubation 72 Toxicology: Paraceatmol OVerdose

34 DAI: Setting Up The Ventilator 73 Toxicology: Summary Emergency Mx

35 Eclampsia 74 Toxicology: Toxidromes

36 Ectopic Pregnancy 75 Tracheostomy: Emergency Mx

37 Epistaxis 76 Appendix 1: Burns Guidelines from the LSEBN

38 ECMO 88 Appendix 2: Trauma Guidelines from the

39 Fascia Iliaca Block TACTIC Group

40 GI Bleed

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 2

D R UG DOSES:
Adrenaline 1mg (10ml 1:10,000 IV)
Shockab le - after third shock, then every alternate c y c l e
Non-shockable - as soon as able, then every alterna t e c y c l e

Amiodarone 300mg bolus IV after the third shock ( d i l u t e d t o 2 0 m l w i t h 5 % d e x t r o s e )

Further dose of 150mg after 5th shock if VF/VT pers i s t s

Magnesium Sulphate 2g 50% mgSO4 IV over 1-2 mi n s i n T o r s a d e s ( 2 g = 8 m m o l = 4 m l s )

REF:
https://www.resus.org.uk/sites/default/files/2020-01/G2015_Adult_ALS.pdf

RESUS PROMPT CARDS: TALIA BARRY, VICKI COWLING V1.1

 D R U G D O S E S L I STED HERE ARE FOR PATIENTS IN CARDIAC ARREST ONLY, IF ROSC DO NOT
USE THESE DOSES/SPEEDS OF ADMINISTRATION

Hypoxia (History)
A L S A l g o r i t h y m - 100% o2 achieving good chest wall movement

H y p o v o l e m i a ( H istory, Hb on VBG)
I V F , c o n s i d e r b l o od and major haemorhage call

H y p o / H y p e r k a l a emia/Glu/Ca++/Mg+ (VBG, history)

H y p e r k a l a e m i a : 10mls 10% Calcium Chloride IV bolus
T h e n s h i f t w i t h 1 0 units actrapid in 50mls 50% dextrose rapid IV push,
I f s e v e r e a c i d o s i s or renal failure consider 50ml 8.4% sodium bicarbonate rapid IV push,
Consider dialysis
H y p o k a l a e m i a : FOR USE ONLY IN CARDIAC ARREST - 2mmol K+/min for 10 minutes then 10
m m o l o v e r 5 - 1 0 mins + replace MgSO4 (2g 50% MgSO4, over 1-2 minutes )
Hypercalcemia:
Hypocalcaemia:
H y p e r m a g n e s a e mia:
H y p o m a g n e s a e mia:

H y p o t h e r m i a / H yperthermia (Temperature)
H y po t h e r m i a : A mend ALS algorithm drug dosing as per hypothermia (see next page) and
consider ECMO
H y p e r t h e r m i a : S t art active cooling, if malignant hyperthermia use dantrolene (see next page)

T h r o m b o s i s - c o ronary or pulmonary ( History, Pre-Hospital ECG, Echo can assist but RV

d i l a t a t i o n d o e s n ot automatically mean PE)
C o r o n a r y : N e e d s PCI
P u l m o n a r y: A l t e plase 50mg IV bolus then consider a further dose of 50mg after 30 m ins CPR
i f n o R O S C . I f f i b rinolytics given perform CPR for 60-90 mins (consider using an auto pulse)
C o n s i d e r e x t r a c o rporeal CPR +/- surgical or mechanical thrombectomy

T e n s i o n p n e u m othorax (History and exam, consider US)

N e e d l e d e c o m p r ession 5th IC space just anterior to the mid axillary line or thoracostomy and
t h e n d e f i n i t i v e c hest drain (can use

T a m p o n a d e ( C a r diac US)
P e r i c a r d i o c e n t e s is - consider thoracotomy in traumatic cardiac arrest.

T o x i ns ( H i s t o r y )
C o n s i d e r a n t i d o t es if applicable (see toxins page for more info), treatment usually supportive
I n T C A o v e r d o s e: give Sodium Bicarbonate 50mmol (50ml of an 8.4% solution) - DO NOT give
s i m u l t a n e o u s l y b y the same route as calcium solutions
I n C a l c i u m C h a n nel Blocker overdose: IV Calcium Chloride 10ml IV Bolus

REF:
Advanced Life Support Manual 7th Edition Nov 2015 Resuscitation Council (UK)

RESUS PROMPT CARDS: TALIA BARRY, VICKI COWLING V1.1

Dr o w n i n g
Ea r l y i n t u b a t i o n , d ry chest prior to placement of defib pads, suctioning, check temperature, IV
flu i d s

Hy p e r t h e r m i a
>4 0 . 6 ℃ = s e v e r e a nd high risk of death if not cooled
CO O L I N G : A c t i v e ( cooled fluids, lavage, cooling blankets) and passive (remove clothing, fans, ice
pa c k s i n g r o i n ) , c a n consider ECMO
If M A L I G N A N T H Y P ERTHERMIA: consider dantrolene (2-3mg/Kg initially then 1mg/Kg repeated if
ne e d e d - m a x 1 0 m g/Kg) , rapidly and persistently correct acidosis, electrolytes and arrhtymias -
av o i d C a l c i u m C h a nnel blockers asthey interact with dantrolene

Hypothermia
<2 8 ℃ = s e v e r e , 2 8 -32 ℃ = moderate, 32-35 ℃ = mild
M e a s u re t e m p w i t h low reading thermometer (ideally oesophageal)
SH O C K S : 3 s h o c k s , if VF persists delay shocks until temp >28 ℃
D R U G S : W i t h h o l d until warmed to 30 ℃, then double intervals between medications unt il >35 ℃
PA C I N G : D o n o t p a ce unless re-warmed
RE W A R M I N G : P a s s ive (remove wet cloths, blankets) and active (warmed IVF, peritoneal lavage,
hu m i d i f i e d w a r m air)
AD J U N C T S : C o n s i d er ECMO/bypass if <32 ℃ and K+ <8 mmol/L
TE R M I N A T I N G R E S US: Check for signs of life for 1 min, can only confirm death once >35 ℃

Pr e g n an c y
Ea r l y i n t u b a t i o n
D i s p l a c e u t e r u s o n ce >20/40: Manually displace the uterus to the left or if table will tilt place in
15 - 3 0 % l a t er a l t i l t (DO NOT use pillows and wedges if performing CPR as firm surface required
fo r q u al i t y C P R )
En s u r e I V o r I O a c cess its placed above the diaphragm
Pr e p a r e f o r r e s u s c itative hysterectomy (emergency c-section) if intial resuscitation attempts
fa i l :
- C o n t a c t O + G , anaesthetics and neonatology
- U n d e r 2 0 w e e ks: No need to consider
- 2 0 - 2 3 w e e k s : Fetus unlikely to be viable but delivery will increase liklihood of maternal
resuscitation
- > 2 4 w e e k s : I n i tiate delivery to help save life of both baby and mother

Co n s i d e r a d d i t i o n al differentials: pre-eclampsia/amniotic fluid embolism/PE

REF:
Advanced Life Support Manual 7th Edition Nov 2015 Resuscitation Council (UK)
Malignant Hyperthermia CrisisAAGBI Safety Guideline, https://anaesthetists.org/Portals/0/PDFs/Guidelines%20PDFs/
Guideline_malignant_hyperthermia_laminate_2011_final.pdf?ver=2018-07-11-163754-770&ver=2018-07-11-163754-770
RESUS PROMPT CARDS: TALIA BARRY, VICKI COWLING V1.1
REF:
https://www.resus.org.uk/sites/default/files/2020-01/G2015_Adult_ALS.pdf

RESUS PROMPT CARDS: TALIA BARRY, VICKI COWLING V1.1

REF:
https://www.resus.org.uk/sites/default/files/2020-05/G2015_Post-resuscitation-care.pdf

RESUS PROMPT CARDS: TALIA BARRY, VICKI COWLING V1.1

REF:
https://www.resus.org.uk/sites/default/files/2020-06/G2010Poster_Anaphylaxis.pdf

RESUS PROMPT CARDS: TALIA BARRY, VICKI COWLING V1.1

D R UG DOSES:
Atropine: 500mcg IV bolus (max bolus 600mcg) up t o m a x 3 m g

I soprenaline: 1-5mcg/min infusion: 200mcg isopre n a l i n e i n 1 m l a n d 1 m g i n 5 m l ( 1 : 5 0 0 0 ) v i a l s

Add 1mg to 50ml of compatible IV fluid 5% dextrose , A d m i n i s t e r a t 0 - 6 0 m l / h r ( 0 - 2 0 m c g / m i n )

Adrenaline: 1-10 mcg/min

To make 10mcg/ml wh ilst awaiting formal infusion: T a k e 1 m l o f a 1 : 1 0 , 0 0 0 a d r e n a l i n e m i n i j e t a n d d i l u t e t o 10ml with N
Saline o r, ta ke 1 x 10ml syr inge of 1:10,000 adre nal i n e an d i n je c t i nt o a 1l it r e ba g N s al in e - m a r k i t c a r e f u l ly

Alterna tives: Aminophylline, Dopamine, Glucagon , G l y c o p y r r o l a t e

REF:
https://www.resus.org.uk/sites/default/files/2020-05/G2015_Adult_bradycardia.pdf

RESUS PROMPT CARDS: TALIA BARRY, VICKI COWLING V1.1

D R UG DOSES:
Adenosine: 6mg, 12mg, 12mg
Contraindications: Asthma, COPD, any arrhythmia i n v o l v i n g a n a c c e s s o r y p a t h w a y ( e g W P W )
Amiodarone: 300mg over 20-60 mins then 900mg o v e r 2 4 h r s
Contraindications: Acute porphyrias
B-blockers: Metoprolol 2-5mg IV Propranolol 100 mc g / k g I V
Contraindications: Asthma, COPD, 2nd or 3rd degr e e h e a r t b l o c k , h y p o t e n s i o n , C C F
Digoxin: 500mcg IV loading dose
Contraindications: Hypercalcaemia, hypokalaemia, h y p o m a g n a e s i a , , h y p o x i a
Flecanide: 50mg oral or 2mg/kg iv (max 150mg)
Contraindications: Structurally abnormal heart. Us e w i t h c a u t i o n , i n v o l v e c a r d i o l o g y a s c a n t r i g g e r h a e m o d ynamic
i nstability
Verapamil: 5mg IV
Contraindications: Acute porphyrias, accessory pat h w a y a r r y t h m i a s

REF:
https://www.resus.org.uk/sites/default/files/2020-05/G2015_Adult_tachycardia.pdf

RESUS PROMPT CARDS: TALIA BARRY, VICKI COWLING V1.1

REF:
https://www.resus.org.uk/sites/default/files/2020-05/G2015_Adult_Choking_Treatment.pdf

RESUS PROMPT CARDS: TALIA BARRY, VICKI COWLING V1.1

D R UG DOSES:
SEE NEX T PAGE

REF:
https://www.resus.org.uk/sites/default/files/2020-05/Paediatric_ALS.pdf

RESUS PROMPT CARDS: TALIA BARRY, VICKI COWLING V1.1

REF:
https://www.resus.org.uk/sites/default/files/2020-03/PETchart-18-05-16.pdf
RESUS PROMPT CARDS: TALIA BARRY, VICKI COWLING V1.1
REF:
https://www.resus.org.uk/sites/default/files/2020-05/G2015_Paediatric_Choking_Treatment.pdf

RESUS PROMPT CARDS: TALIA BARRY, VICKI COWLING V1.1

D R UG DOSES:
via cannula, umbilical vein (preferentially) or IO

Adrenaline 10mcg/Kg (0.1ml/Kg of 1:10,000 solution ) I f n o t e f f e c t i v e a d o s e o f u p t o 3 0 m c g / k g m a y b e t r i e d .

Glucose 10% 2.5mls/Kg
N. Saline (0.9%) 10ml/Kg
Sodium bicarbonate 4.2% 2-4mls/Kg.

REF:
https://www.resus.org.uk/sites/default/files/2020-05/G2015_NLS.pdf

RESUS PROMPT CARDS: TALIA BARRY, VICKI COWLING V1.1

 ACS: STEMI TERRITORIES

An t er i o r : D o n’t m is s We lle ns wa ve s (de e p T inv o r bipha s ic T in V 2-3), c a n

dis a ppe a r wit h c he s t pa in a nd r e a ppe a r onc e pa in r e s o lve s but indic a t e c r it ic a l
L AD o c c lus io n a nd wa r r a nt e m e r ge nc y P CI t o pr e ve nt pr ogr e s s io n t o ST E MI

I n f er i o r : Ca n be a s s o c ia t e d wit h R V or pos t e r io r infa r c t ion

20% de ve lo p he a r t blo c ks a nd br a dya r r hyt hm ia s t ha t a r e us ua lly t r a ns ie nt a nd
r e s po nd t o a t r o pine

Po s t er i o r : As s o c ia t e d infe r io r a nd la t e r a l ST E MI’s
P r e s e nt wit h ST de pr e s s io n, us ua lly in V 1-V 3: hor izont a l ST de pr e s s io n, t a ll
br o a d R wa ve s , upr ight T wa ve s , dom ina nt R wa ve

R i gh t Ven t r i c u l a r : U p t o 40% infe r io r ST E MI’s a r e c o m plic a t e d by a R V infa r c t

R t s ide d MI’s c a n be ha r d t o s po t but lo o k for :
ST e le va t io n V 1
ST e le va t io n in le a d III > II
ST e le va t io n V 1>V 2
ST e le va t io n V 1 wit h ST de pr e s s io n V 2
D o a R t s ide d E CG
R V infa r c t io ns r e quir e pr e -lo a d (a vo id nit r a t e s a nd give 250m l bo lus e s IV F )

Lat er a l : T Inve r s io n in a V L c a n be t he only init ia l s ign

R T SI D E D E C G : POST E R I OR E C G :

R E F:
https://rebelem.com/rebel-review/rebel-review-29-coronary-anatomy-ecg-leads/coronary-anatomy-ecg-leads/
https://litfl.com/right-ventricular-infarction-ecg-library/
https://litfl.com/posterior-myocardial-infarction-ecg-library/
R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 18
 ARTERIAL LINE: INSERTION AND SET UP

In di c at i o n s
Need for inva s ive BP m onit or ing
Need fr equent blood s a m pling

C o n t r a-i n di c at i o n s
No c olla t er a l a r t er ia l flow (fa iled Allen’s T es t )
Over lying s kin infec t ion

Risks
Bleeding, infec t ion, pa in, fa ilur e, da m a ge t o ot her s t r uc t ur e,
dis t a l is c hem ia if no c olla t er a l flow, developm ent of ps eudo
a neur ys m s

E qu i pmen t
St er ile gloves + m a s k, Loc a l Ana es t het ic (+ s yr inge, dr a wing up needle a nd or a nge needle),
Chlor opr ep, Ar t er ia l line, Medium dr es s ing pa c k: s t er ile field a nd s t er ile ga uze, Syr inge t o t a ke
blood if r equir ed, Sut ur e, T ega der m , Pr epa r ed t r a ns duc er (or s t opc oc k if not a va ila ble)

Pr epar e T r an s du c er
Open t he pr es s ur e m onit or ing s et
Connec t t o 1L ba g N Sa line a nd flus h ent ir e line
Pla c e N Sa line in a pr es s ur e ba g a nd a im for a n a ut om a t ed
s low infus ion (1-3m L / h) of pr es s ur is ed s a line
At t a c h a r t line c a ble t o pr es s ur e m onit or ing s et a nd
m onit or

Pr o c edu r e
T a ke ver ba l c ons ent if a ppr opr ia t e
F ind a n a r t er ia l puls e on eit her wr is t - per for m Allens t es t
t o c onfir m r a dio/ ulna r c olla t er a l flow
Wa s h ha nds a nd us e s t er ile gloves
Clea n a r ea wit h Chlor a pr ep
E ns ur e s t er ile field (c ons ider inc opa d on t he floor under pr oc edur e field)
Un-s hea t h t he a r t line needle, pier c e t he s kin a s if per for m ing a n ABG ins er t ing needle int o
ves s el
Onc e fla s hba c k, hold s t ill a nd t hr ea d t he guidewir e t hr ough (s hould m ove fr eely wit h no
r es is t a nc e) t hen r em ove needle KE E PING HOL D OF T HE GUIDE WIR E
R a ilr oa d t he a r t er ia l line s hea t h over t he guidewir e unt il ins er t ed t o hub
R em ove t he guidewir e, ens ur e a s pir a t ing well (or blood obvious ly pum ping out ), t a ke ABG
s a m ple +/ - blood s a m ples
Put s t opc oc k on end (or t r a ns duc er c onnec t ion if r ea dy) a nd s ut ur e inpla c e, t hen onc e
t r a ns duc er c onnec t ed c over wit h T ega der m

C al i br at e T r an s du c er - Ca libr a t e (‘zer oing’) onc e c onnec t ed t o pa t ient

E ns ur e t he t r a ns duc er pr es s ur e t ubing a nd flus h s olut ion a r e c or r ec t ly a s s em bled a nd fr ee
of a ir bubbles
Pla c e t r a ns duc er a t level of t he r ight a t r ium
‘Off t o pa t ient , open t o a ir (a t m os pher e)’
Pr es s ‘zer o’ -> s et s a t m os pher ic pr es s ur e a s zer o r efer enc e point
Whenever pa t ient pos it ion is a lt er ed t he t r a ns duc er height s hould be a lt er ed

R E F:

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 19

 ASTHMA

R E F:
See base of table
R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 20
 ATRIAL FIBRILLATION

Unstable? ---> move to the ALS algorithm for tachycardia (with pulse)

Common causes:
I f s t a bl e:
Cardiac (e.g. hypertension, valvular heart
A-E a s s e s s m e nt ; lo o k fo r unde r lying c a us e disease, heart failure, ischaemic heart
disease)
Respiratory (e.g. chest infection, lung
Opt i o n s t o r edu c ed h ear t r at e:
cancer)
- IV F luid bo lus e s (unle s s ove r lo a de d) Systemic (e.g. excessive alcohol intake,
- IV MgSO4 2g o ve r 20-30m ins hyperthyroidism, electrolyte abnormalities,
infection, diabetes mellitus)
(if le a ds t o hypo t e ns io n s t o p o r r e duc e r a t e )
- T r e a t e m e r ge nt unde r lying c a us e s ; Se ps is , Alc o ho l wit hdr a wa l , E le c t r o lyt e s
a bno r m a lit ie s (Che c k V BG ), P a in/ a nxie t y
- Co ns ide r giving r e gula r AF m e dic a t io n if a lr e a dy o n t r e a t m e nt
- Co ns ide r r a t e vs r hyt hm c o nt r o l

R hyt hm c o nt r ol
- Co ns ide r if r e ve r s ible c a us e , ons e t <48hr s , he a r t fa ilur e c a us e d by AF
- @ t he R F H c ont a c t c a r dio lo gy fo r a s s is t a nc e (2027)
R a t e c o nt r ol
- Or a l 1s t line : Bis o pr o lo l 2. 5m g OD o r dilt ia ze m 60m g T D S
- 2nd line : D igo xin (500m c g lo a ding do s e wit h r pt a t 6-12 hr s if r e quir e d) t he n
o r a l m a int e na nc e
- IV Me t o pr o lo l, V e r a pa m il, D igo xin, F le c a inide , Am io da r one (s e e t a c hyc a r dia
a lgo r it hm pa ge fo r do s e s a nd c o nt r a indic a t io ns )
Co ns ide r ne e d fo r a nt ic oa gula t io n

I f s u i t a bl e f o r di s c h a r ge (s t a bl e, H R <110) en s u r e:
Ade qua t e m a int e na nc e t r e a t m e nt
As s e s s m e nt fo r a nt ic o a gula t io n
Appr o pr ia t e fo llo w up G P / Ca r dio lo gy

@ t h e R FH :
Fo r mo r e i n f o o n r ef er r a l a n d f o l l o w u p s ee f u l l R FH AF G u i del i n e

ANT I C OAG ULAT I ON:

Ca r dio ve r s ion:
If no c o nt r a indic a t io ns s t a t t inza pa r in pr io r t o c a r dio ve r s io n (or a s a p a ft e r if
e m e r ge nt )

U po n dis c ha r ge :
Ca lc ula t e CHA2D S2-V ASc (if >2 in wo m e n o r >1 in m e n c o ns ide r a nt ic oa gula t io n)
a nd HAS-BL E D (if >2 c o ns ide r r is ks vs be ne fit s o f a nt ic o a gula t ion)

Opt io ns : T inza pa r in, D OAC, Wa r fa r in

R E F:
NICE AF guidance
RFH AF Guideline
R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 21
 BURNS: INITIAL MANAGEMENT SUMMARY

Bu r n s 1s t Ai d:
- R un under c ool wa ter for 20 m ins (s till of benefit if bur n ha s oc c ur r ed within 3 hr s )
- Ana lges ia (a ls o c over wound t o a s s is t with pa in r elief even if not yet debr ided or not r ea dy t o
a pply for m a l dr es s ing)
- Debr ide a ll blis t er s > 6m m , ens ur e a dequa te a na lges ia fir s t (vit a l to r educ e infec t ion r is k but
a ls o t o delinea t e bur n - m a y be m uc h bigger t ha n s us pec t ed)
- E ns ur e t et a nus up t o da te (a ntibiot ic s only if bur n infec ted - not r out ine pr a c t ic e)
- Dr es s with non-a dher ent dr es s ing wit h a s ec onda r y a bs or bent la yer (e. g gelonet + a la yer of
ga uze)

Bu r n s R es u s c i t at i o n
(F ollow AT L S/ ALS Guidelines if r equir ed but key point s for bur ns a r e s um m a r is ed below):

A - If s us pec ted Sm oke Inha la tion or Air wa y Com pr om is e give oxygen a nd s eek a na es thet ic
r eview ea r ly, (Cons ider need for c -s pine pr ot ec t ion if c onc ur r ent tr a um a )

B - Cons ider inha la tion injur y a nd inha la t ion of CO or toxins (give 100% o2, if la c t a t e > 7
c ons ider c ya nide pois oning)

C - If bur ns ≥ 15% T BSA in a dult s or ≥ 10% T BSA in c hildr en s t a r t fluid r es us c ita t ion wit h
Ha r t m a nn’s a s per Pa r kla nd F or m ula : 4m l/ Kg/ % bur n. Give ½ over fir s t 8hr s fr om t im e of bur n,
give ½ over 2nd 16hr s . Add a dditiona l m a int ena nc e fluids if pa t ient s NBM. Ca t het er is e a nd
m a int a in s tr ic t fluid ba la nc e doc um enta t ion.

D - Chec k BM. Cons ider tr a um a tic injur y t o hea d a nd s pine if r eleva nt .

E - Keep pa t ient wa r m (hypot her m ia c a n oc c ur r a pidly). If for ur gent tr a ns fer c ons ider NBM.
Per for m bur ns fir s t a id if pos s ible dur ing r es us c it a t ion. Look for a dditiona l injur ies .

Chem ic a l bur ns with hydr ofluor ic a c id a r e life t hr ea tening t o pa t ient r ega r dles s of s ize due t o
m a s s ive lea c hing of c a lc ium a nd hea lt hc a r e pr ovider s a r e a t r is k of expos ur e dur ing t r ea t m ent.
Cont a c t Bur ns im m edia t ely for a dvic e.

FOR MOR E I N-D EPTH I NFO AND T R EATMENT OF SPEC I FI C BUR NS PLEASE SEE
THE LSEBN I NFO SHEET S LOC ATED I N THE APPEND I X 1 OF THI S D OC UMENT

R E FE R R AL C R I T E R I A:
Cons ider if >3% T ot a l Body Sur fa c e Ar ea (T BSA) Pa r tia l T hic knes s (PT )
bur n in a dult s or >1% T BSA PT in Childr en.

R ef er al l :
Neona t a l bur ns (r ega r dles s of s ize)
All c hildr en ‘unwell’ with a bur n (c ons ider T oxic Shoc k Syndr om e)
Bur ns a s s oc ia t ed wit h non a c c ident a l injur y or s a fegua r ding
c onc er ns
Deep der m a l a nd full t hic knes s (F T ) bur ns C ONT AC T D E T AI LS:
Cir c um fer ent ia l bur ns to lim bs or tr unk or nec k
Bur ns wit h inha la tion injur y WWW. T R I PS. NH S. UK
Bur ns a s s oc ia t ed wit h elec tr ic a l s hoc k a nd c hem ic a l bur ns
Bur ns to fa c e, ha nds , per ineum , feet
C H E LSE A &
Bur ns not hea led wit hin 2 weeks
WE ST MI NST E R H OSPI T AL
Bur ns wit h a ny ot her injur ies
Bur ns wit h s ignific a nt c om or bidity or pr egna nc yInfec t ed bur ns AD ULT S 0203 315 2500
Bur ns wit h m eta bolic dis tur ba nc e C H I LD R E N 0203 315 3706
Any ot her c a s e if c linic a l c onc er n: IF IN DOUBT , DISCUSS
R E F:
Taken from LSEBN Adult Burn Referral Guidelines
R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 22
 CARDIOVERSION

In di c at i o n s
Uns t a ble t a c hyc a r dia (ta c hyc a r dia plus s hoc k/ s ync ope/ hea r t fa ilur e/ MI)

E qu i pmen t
Defibr illa t or
3 c linic ia ns inc luding 1 qua lified t o per for m s eda t ion
Seda t ion c hec klis t a nd equipm ent , m onitor ing, dr ugs

Pr o c edu r e
(Ca n be done by E D but involve a nes t hetic s / IT U if needed)
At lea s t 3 c linic ia ns pr es ent - a ir wa y/ dr ugs / defib
Pla c e defib pa ds a nd defib E CG lea ds ont o the pa tient
Connec t t o m onitor : E CG, BP (with 1-3m in c yc le), Sa t s , a nd Ca pnogr a phy
Give high flow 02
IV a c c es s - IV F pr epa r ed inc a s e bolus needed
Seda t ion: opt ions inc lude fenta nyl +/ - m ida zola m OR fenta nyl +/ - pr opofol, a lwa ys us e dr ugs
you' r e fa m ilia r with a nd a r e a ppr opr ia te for c linic a l c ondit ion

Ca r diover s ion (c a n deliver up to 3 s ync hr onis ed s hoc ks )

1. T ur n defib on
2. Selec t m a nua l m ode
3. Confir m
4. Pr es s ‘s ync ’ on the defib m a c hine (s ync will a ppea r befor e t he num ber of joules )
5. Set volta ge to 120 joules (r educ ed by pr es s ing downwa r d a r r ow)
6. Deliver s ync hr onis ed s hoc k - r em em ber t o keep pr es s ing unt il s hoc k deliver y, it m a y t a ke
a c ouple of s ec onds a s the m a c hine ha s t o find t he r ight tim e to deliver the s hoc k
7. If fa ils give 2nd s hoc k 150J , 3r d s hoc k 200J - if no effec t involve c a r diology a nd c ons ider
300m g a m ioda r one over 10-20m ins wit h r epea t s hoc k a fter a m ioda r one

Get 12 lea d E CG pos t pr oc edur e

R E F:
Advanced Life Support Manual 7th Edition Nov 2015 Resuscitation Council (UK)
R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 23
 CENTRAL LINE INSERTION

I n di c at i o n s
Cent r a l a c c es s r equir ed for blood, fluids , elec t r olyt es , inotr opes
If la r ge volum e r es us c it a t ion r equir ed c ons ider va s c a t h ins er t ion

C o n t r ai n di c at i o n s
Signific a nt c oa gulopa t hy, r a is ed ICP

Risks
Ha em ot hor a x, ha em a tom a , pneum ot hor a x, infec tion

E qu i pmen t
Ultr a s ound Ma c hine + Cent r a l line s eldinger kit + Ma s k + Ster ile Gloves
Lignoc a ine + N. Sa line (50m l ba g or s ever a l 10m l flus hes )
4 x bungs , Sc a lpel, Sut ur e
R oya l F r ee Hos pita l Cent r a l Line Pa c k inc ludes t he following:
1 x 5m l s yr inge + dr a wing up needle
Gr een a nd or a nge needle
1 x 20m l a nd 1 x 10m l s yr inges
Chlor pr ep
St er ile field + dr a pe
Gown + ha nd t owel
Ult r a s ound s ter ile pr obe c over + Ster ile US gel
Ops it e

Pr e-pr o c edu r e
Cons ent
Put hea d down (if pa t ient a ble t o t oler a t e)
E ns ur e helpful a s s is t a nt
F lus h lines wit h s a line a nd c los e a ll por t s exc ept br own por t
Identify loc a t ion: Int er na l jugula r vein, s ubc la via n vein,
fem or a l vein

Pr o c edu r e
Identify t he vein
At ta c h s eldinger needle t o s yr inge a nd ins er t int o vein
When a s pir a t ing fr eely, t a ke s yr inge off a nd pa s s guidewir e int o vein (wa t c h m onit or in c a s e
wir e a dva nc es t oo fa r a nd c a us es a r r hythm ia )
R em ove needle KE E PING HOLD OF T HE GUIDE WIR E
Ma ke a s m a ll s kin inc is ion with t he s c a lpel t o a llow the dila t or t o enter s kin
Pa s s t he dila t or over t he needle t hen r em ove (onc e dila t or r em oved it will c a us e s om e bleeding)
Pa s s t he c ent r a l line over t he guidewir e a nd onc e ins er ted t a ke out the guidewir e a nd flus h a ll
por ts
Add infus ion lines or bungs to ea c h lum en
Dr a w V BG t o c onfir m venous pla c em ent
Sut ur e in pla c e a nd c over wit h ops it e

Po s t pr o c edu r e X R t o c hec k line pla c em ent

R E F:
Advanced Life Support Manual 7th Edition Nov 2015 Resuscitation Council (UK)
A review in emergency central venous catheterization, Osaree Akaraborworn, Chinese Journal of TraumatologyVolume 20, Issue 3,
June 2017, Pages 137-140 https://www.sciencedirect.com/science/article/pii/S1008127516301596

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 24

 CHEST DRAIN INSERTION (SELDINGER)

I n di c at i o n s f o r a s el di n ger c h es t dr ai n :
Pneum ot hor a x
- Chec k BT S c r it er ia , is it a m ena ble t o c ons er va t ive m a na gem ent or a s pir a t ion
E ffus ions

Pr e pr o c edu r e c h ec k l i s t :
Move pa t ient t o R es us
Chec k obs er va t ions s t a ble, ens ur e m onit or ing in s it u a nd good IV a c c es s
Confir m indic a t ion - would a s pir a t ion s uffic e?
Does it need t o be done now? (in-hour s bet t er t ha n out of hour s )
Is t her e a s killed oper a t or or do you need help?
Confir m s ide - c hec k im a ging/ bed s ide US
Chec k c oa gula t ion s t a t us
Wr it t en c ons ent
Adequa t e a na lges ia - c ons ider ket a m ine for s eda t ion (in whic h c a s e follow s eda t ion pr ot oc ol
a nd ens ur e a dequa t e s t a ff pr es ent )

E qu i pmen t :
Chlor a pr ep, dr a pes , lignoc a ine, s a m ple bot t les if a n effus ion (bioc hem , c yt ology, MC a nd S),
s ut ur es wit h c ur ved needle, dr a in bot t le wi t h wat er added , s eldinger kit , a n a s s is t a nt

Pr o c edu r e:
Confir m loc a t ion in s a fe t r ia ngle
As ept ic t ec hnique/ c lea n/ dr a pe/ PPE
Lignoc a ine - 10m ls 1-2% +/ - IV a na lges ia or 0. 5m g/ kg ket a m ine
Confir m a s pir a t ion of fluid/ a ir
Sm a ll inc is ion wit h s c a lpel, int r oduc e needle a nd a s pir a t e unt il in pleur a l c a vit y
F eed guide wir e t hr ough, no fur t her t ha n 30c m , s ec ur e wir e a t a ll t im es a nd r em ove t he
int r oduc er
Ins er t dila t or over guide wir e, r em ove dila t or a nd put dr a in s hea t h over t he guide wir e up t o
12-14c m t hen r em ove guide wir e
If a n effus ion a t t a c h 3-wa y t a p a nd t a ke s a m ples
At t a c h dr a in t o under wa t er s ea l a nd s ec ur e wit h s ut ur e, c lea r t ega der m dr es s ing over
ins er t ion s it e a nd a ddit iona l t a pe m es ent er y a t dis t a l dr a in, c hec k dr a in s winging (a nd
bubbling in pneum ot hor a x)

Po s t pr o c edu r e:
CX R , obs er va t ions , dr a in s winging/ bubbling, a ny blood?
Wr it e up not es a nd ha ndover t o a dm it t ing s pec ia lly, ens ur e r egula r a na lges ia wr it t en up

SAFE T R I ANG LE :

R E F:
https://www.oxfordmedicaleducation.com/clinical-skills/procedures/intercostal-drain/

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 25

 CHEST DRAIN INSERTION (TRAUMA)

I n di c at i o n s f o r a t r au ma c h es t dr ai n :
Moder a t e or la r ge pneum ot hor a x (in t he c ont ext of t r a um a )
V is ible Ha em ot hr oa x on CX R
Com bined Ha em opneum ot hor a x

Pr e pr o c edu r e c h ec k l i s t :
Move pa t ient t o R es us , c ons ider t r a um a c a ll
Cont inue r es us c it a t ion, ens ur e m onit or ing in s it u, good IV a c c es s a nd c ons ider need for blood
Confir m indic a t ion - s om e s m a ller hea m o/ pneum t hor a c es c a n be m a na ged c ons er va t ively if in
doubt dis c us s wit h c ons ult a nt in c ha r ge or MT C
Is t her e a s killed oper a t or or do you need help?
Confir m s ide - c hec k im a ging/ bed s ide US
Chec k c oa gula t ion s t a t us - do you need t o r ever s e a nt ic oa gula t ion
Cons ent
Adequa t e a na lges ia - lignoc a ine a nd c ons ider ket a m ine for s eda t ion (in whic h c a s e follow
s eda t ion pr ot oc ol a nd ens ur e a dequa t e s t a ff pr es ent )

E qu i pmen t :
Chlor a pr ep, Sur gic a l Gloves , Lignoc a ine,
Ches t dr a in kit : Ga uze, 10 bla de s c a lpel, blunt for c eps , s ut ur e,
Ches t dr a in (28-40),
T a pe a nd dr es s ings for s ec ur ing dr a pes ,
Dr a in bot t le wi t h wat er added , An a s s is t a nt

Pr o c edu r e (s ee pi c t u r es o ver l eaf ):

Confir m loc a t ion in s a fe t r ia ngle:
5t h int er c os t a l s pa c e, jus t a nt er ior t o t he m id a xilla r y line
As ept ic t ec hnique/ c lea n/ dr a pe/ PPE
Lignoc a ine +/ - a na lges ia +/ - 0. 5m g/ kg ket a m ine
Cla m p pr oxim a l c hes t dr a in
(t o s t op fluid flowing out dur ing ins er t ion)
Ma ke 2-3c m inc is ion a long upper r ib m a r gin
Blunt dis s ec t t hr ough s ubc ut a neous t is s ue
over upper r ib bor der unt il in pleur a l c a vit y
Per for m finger t hor a c os t om y
F eed for c eps int o t ip of dr a in a nd a dva nc e
dr a in int o pleur a l s pa c e unt il a ll dr a in holes
a r e int r a t hor a c ic
At t a c h dr a in t o under wa t er s ea l a nd r elea s e
t he c la m p, s ec ur e wit h s ut ur e, c lea r t ega der m
dr es s ing over ins er t ion s it e a nd a ddit iona l t a pe
m es ent er y a t dis t a l dr a in, c hec k dr a in s winging
(a nd bubbling in pneum ot hor a x)

Po s t pr o c edu r e:
CX R , obs er va t ions , dr a in s winging/ bubbling, a ny blood?
Wr it e up not es a nd ha ndover t o a dm it t ing s pec ia lly, ens ur e r egula r a na lges ia wr it t en up

Mas s i ve H aemo t h o r ax :
Defined a s >1500m l or 200m l/ hr for 2hr s
Cont a c t c a r diot hor a c ic s / t hea t r e a nd c ont inue t r a ns fus ion

R E F:
https://www.oxfordmedicaleducation.com/clinical-skills/procedures/intercostal-drain/
http://www.emdocs.net/wp-content/uploads/2016/09/Screen-Shot-2016-09-23-at-4.15.51-AM.png
R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 26
 CHEST DRAIN INSERTION (TRAUMA)

R E F:
https://www.oxfordmedicaleducation.com/clinical-skills/procedures/intercostal-drain/
http://www.emdocs.net/wp-content/uploads/2016/09/Screen-Shot-2016-09-23-at-4.15.51-AM.png
R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 27
 CRICOTHYROIDECTOMY

PLAY BY PLAY :

R E F:
https://das.uk.com/files/das2015intubation_guidelines.pdf
https://first10em.com/cricothyroidotomy/cric-smacc-bite/
R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 28
 DELIVERY OF A BABY

R E F:
https://stmungos-ed.com/obstetrics/normal-labour

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 29

 DIABETIC KETOACIDOSIS

D i a gn o s i s
L a c k o f ins ulin le a ding t o :
Bloo d ke t o ne s > 3
U r ina r y ke t o ne s > 2+
G luc o s e >11P H <7. 3 HCO3 <18 a nd / o r BE >-10

Ma n a gemen t
V BG , blo o ds , CX R , ur ine dip, BHCG , c ult ur e s if pyr e xia l, E CG
2 x IV a c c e s s
IV fluids : 1s t ba g 0. 9% Sa line o ve r 1 ho ur
F ixe d r a t e ins ulin 0. 1 unit s / kg/ ho ur (m a ke up 50 unit s a c t r a pid in 50m ls no r m a l s a line -
m a x do s e 15 unit s / ho ur )
Co nt inue lo ng a c t ing ins ulin (but s t o p a ny a ut o m a t e d pum ps )
Ho ur ly V BG a nd ke t o ne s , 4-ho ur ly U a nd E
E a r ly dis c us s io n wit h IT U if c o nc e r ns
CT he a d if ? c e r e br a l o e de m a
T hr o m bo pr o phyla xis

Fl u i d
Sys t o l i c BP <90 - 500m l bo lus no r m a l s a line 0. 9% , r e pe a t if r e m a ins hypo t e ns ive
T he n 1 lit r e no r m a l s a line o ve r 1 ho ur
Co ns ide r K+ r e pla c e m e nt a s be lo w, if BM <15 s t a r t 10% de xt r o s e 125m l/ hr
Sys t o l i c BP>90 - 1 lit r e nor m a l s a line 0. 9% o ve r 1 ho ur

K+
> 6. 5 G ive 10 unit s a c t r a pid in 50m ls 50% de xt r o s e plus 10m ls 10% c a lc ium gluc o na t e
5. 5-6. 4 - no a c t io n
3. 5-5. 4 - 40 m m o ls K+ o ve r 4 ho ur s
<3. 5 s t a r t 40 m m o ls K+ but c ons ide r c e nt r a l line t o give 20 m m o ls / ho ur

T R E AT ME NT AI MS:
Gluc ose fa ll 3-5mol/ hr
Ketone fa ll 0. 5mmol/ hr
HCO3- r ise 3mmol/ hr
K+ r ema in 4 - 5. 5
If mixed DKA/ HHS (osmola lity >320) a im osmola lity fa ll 3-5 mosm/ kg/ hr

C ONSI D ER ATI ON FOR I C U:

Blood ketones > 6mmol/ L, Bic a r b < 5mmol/ L, pH < 7. 0, K+ < 3. 5mmol/ L, GCS < 12 O2
sa ts < 92% on a ir (a ssuming nor ma l ba seline r espir a tor y func tion) Systolic BP<
90mmHg, E lder ly, Pr egna nt, Hea r t or kidney fa ilur e, Other ser ious c o-mor bidities

R E F:
Joint British Diabetes Societies Inpatient Care GroupThe Management of Diabetic Ketoacidosis in Adults. 2nd Edition, Update:
September 2013, https://www.diabetes.org.uk/resources-s3/2017-09/Management-of-DKA-241013.pdf
R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 30
 DRUG ASSISTED INTUBATION

PR E -ASSE SS
L E MON + Ma lla m pa t i
Is t his going t o a pr edic t ed diffic ult a ir wa y?
Cons ider m a r king c r ic ot hyr oid, get diffic ult a ir wa y kit
Do you need m or e s enior s uppor t ?

POSI T I ON
Hea d up, r a m ped, s niffing t he m or ning a ir
If t r a um a - do you need MIL S?

PH YSI OLOG I C AL OPT I MI SAT I ON

R ever s e Hypovola em ia / Hypot ens ion:
F luids r unning or pr im ed,
Cons ider m et a r a m inol a nd nor a dr ena line/ a dr ena line s uppor t
Pr e-oxygena t e: wa t er s c ir c uit + na s a l c a nnula

MONI T OR I NG
E CG, O2 s a t s , Ca pnogr a phy, BP - 1-3 m in c yc les (c ons ider a r t er ia l line)

E QUI PME NT
Oxygen, s uc t ion, OPA, NPA, L MA, L a r yngos c ope, E T T x 2, lube, bougie, 10m l s yr inge, t ube t ie,
s c a lpel

D R UG S
IV a c c es s x 2
St a nda r d DAI dr ugs (s ee below)
E m er genc y dr ugs (s ee below)
Pos t int uba t ion s eda t ion:
Pr opofol 1% (10m g/ m l), fill 50m l s yr inge a nd put t hr ough s yr inge dr iver a t r a t e 10m l/ hr -
a djus t a c c or dingly

T E AM BR I E F
V er ba lis e pla n A, B a nd C
T ea m ques t ions / c onc er ns
L oc a t e diffic ult a ir wa y t r olley

D R UG ASSI ST E D I NT UBAT I ON OPT I ONS:

1: 1: 1 - F ent a nyl 1m c g/ Kg, Ket a m ine 1-2m g/ Kg, R oc ur onium 1m g/ Kg
Ana lges ia : F ent a nyl 1m c g/ kg
Induc t ion: Ket a m ine 1-2m g/ kg, Pr opofol 50-200m g IV
Pa r a lys is : R oc ur onium 1m g/ kg

E ME R G E NC Y D R UG S:
Met a r a m inol 0. 5-1m g bolus (m a ke up 0. 5m g/ m l s olut ion in 10m l s yr inge),
E phedr ine 3m g IV bolus es (30m g in 10m ls t her efor e 3m g = 1m ll)
At r opine 0. 5m g bolus

C OMPLI C AT I ONS:
La r yngos pa s m : 02, BV M wit h PE E P, deepen s eda t ion/ pr oc eed wit h R SI
Hypot ens ion: us ua lly t r a ns ient , fluid bolus / m et a r a m inol
Br a dyc a r dia : a t r opine 500-600m c g bolus

R E F:

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 31

 DRUG ASSISTED INTUBATION: DRUG DOSES

R OY AL C OLLE G E OF ANAE ST H E T I C S: ANAE ST H E T I C D R UG C R I B SH E E T

R E F:
https://rcoa.ac.uk/sites/default/files/documents/2019-11/ANAESTHETIC_DRUG_CRIB_SHEET-8.pdf

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 32

 DRUG ASSISTED INTUBATION:

UNANTICPIATED DIFFICULT INTUBATION

I F MOR E ANAST H E T I C H E LP NE E D E D E ME R G E NT LY :
Ca ll 2222 a nd a sk for a n ' a na esthetic emer genc y c a ll'

R E F:
https://das.uk.com/files/das2015intubation_guidelines.pdf

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 33

 DRUG ASSISTED INTUBATION:

SETTING UP THE VENTILATOR

Ma c hine us ua lly in s t a ndby m o de , pr e c a libr a t e d - if no t fo llo w c a libr a t io n

ins t r uc t io ns o n s c r e e n pr io r t o s t a r t ing, t he n:

Pr es s ‘Adu l t / Ped’ t o input ne w pa t ie nt de t a ils

Bot h P a e dia t r ic a nd Adult pa t ie nt s c a n us e t he s a m e t ubing (P a e d-Adult t ubing)

- jus t dia l down t he he ight
F o r ne o na t e s o r infa nt s unde r 20kg us e s e pa r a t e ne o na t a l t ubing, o nc e
a t t a c he d a diffe r e nt t a b will o pe n a nd t he ne o na t a l s e t t ings c a n be o pe ne d

Pr es s ‘Mo des ’ a nd s e le c t r e quir e d m o de (us ua lly ASV m o de a s it a llo ws pa t ie nt

t o t a ke a br e a t h whils t ve nt ila t o r a ugm e nt s t he ir o wn ‘pe r fo r m a nc e ’. Co m bine s
bo t h pr e s s ur e a nd vo lum e c o nt r ol. )

C h o o s e MALE o r FE MALE
T o s e le c t e it he r t ouc h s c r e e n o r t ur n gr e e n dia l a nd t he n pr e s s t he dia l t o
c onfir m

I n pu t h ei gh t i n c m (us e a t a pe m e a s ur e t o c he c k he ight s ho uld be ha nging up)

U s e dia l t o s e le c t , a lt e r a nd t he n c o nfir m he ight input
Ma c hine will c a lc ula t e t he ide a l bo dy we ight a nd t he r e fo r e t he t ida l
vo lum e (6-8m ls / kg)

I n i t i a l s et t i n gs :
F i02 100% (a nd t he n we a n do wn a s a ble )
P E E P 5 (a nd inc r e a s e d a s pe r AR D SNe t )
U s e dia l t o s e le c t , a lt e r a nd t he c o nfir m e a c h input

Pr es s ST AR T

R E F:

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 34

 ECLAMPSIA

T AK E N FR OM:
GUIDE LINE S F OR T HE MANAGE ME NT OF SE V E R E PR E -E CLAMPSIA AND E CLAMPSIA.
GUIDE LINE S & AUDIT IMPLE ME NT AT ION NE T WOR K (GAIN), 2010.

R E F:
https://www.rqia.org.uk/RQIA/files/84/8425a24b-5ceb-448d-b214-3be15e19bd32.pdf

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 35

 ECTOPIC PREGNANCY

Si gn s a n d Sympt o ms :
Abdo pa in - e s pe c ia lly if s igns of pe r it o nis m or lo c a lis ing t o e it he r lowe r
qua dr a nt
P V ble e ding (no t a lwa ys )
Sho ulde r t ip pa in
Ha e m o dyna m ic ins t a blit y (1s t s ign m a y be pos t ur a l dr o p)
D izzine s s / s ync o pe
U ne xpla ine d a na e m ia
Any pr e gna nt pa t ie nt wit h a bdo m ina l pa in who ha s no t ha d a ut e r ine pr e gna nc y
c o nfir m e d

I n c r ea s ed r i s k i f :
P r e v e c t o pic , IU D , pr e v ST D , pr e v fa llo pia n t ube s ur ge r y, pr e v s t e r ilis a t io n,
s m o ke r ,
R e m e m be r po s s ibilit y o f dua l pr e gna nc y in IV F (int r a ut e r ine pr e g o n U S but
a ddit io na l e c t o pic )

I n ves t i ga t i o n s :
HCG (U r ine or s e r um )
F BC
G +S
U SS
F AST s c a n if uns t a ble

Immedi a t e Ma n a gemen t :
A t o E As s e s s m e nt
IV a c c e s s x 2
Ana lge s ia
IV F
Co ns ide r ne e d fo r bloo d t r a ns fus io n o r m a jo r ha e m o r r ha ge
U r ge nt G yna e r e vie w: If uns t a ble ne e d s ur ge r y

R E F:

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 36

 EPISTAXIS

Pr es s u r e:
P inc h no s e a nd a pply pr e s s ur e ove r s oft t is s ue

V BG / obs if s us pe c t ing s ignific a nt blo o d lo s s

C a u t er y:
Suc t io n o r a s k pa t ie nt t o blo w no s e
Ide nt ify s it e of ble e ding a nd c a ut e r is e wit h s ilve r nit r a t e a nd ‘do nut ’.
NE V E R c a ut e r is e bot h s ide s o f t he s e pt um a s it a ffe c t s bloo d s upply

Appl y t o pi c a l medi c a t i o n :
Sa t ur a t e ga uze wit h T X A (c a n c o ns ide r a dr e na line / T X A)

Pa c k i n g:

An t er i o r n a s a l pa c k i n g
R a pid r hino - im m e r s e in s a line a nd pla c e hor izo nt a lly, infla t e s lo wly wit h a ir
(us ua lly 5-10m l) unt il go o d s e a l but no t t o o unc o m fo r t a ble .
If o ngo ing ble e ding c o ns ide r pos t e r io r ble e d.

Po s t er i o r pa c k i n g
Slo ws ble e ding fr o m a pos t e r io r s o ur c e .
F o le y c a t he t e r s c a n be us e d a s a
t e m po r a r y s o lut io n in t he E D .
Size 12 o r 14 ga uge c a t he t e r s s ho uld be
a dva nc e d one a t a t im e t hr o ugh t he
no s t r il, a lo ng t he flo o r o f t he no s e int o
t he na s o pha r ynx unt il s e e n in t he pha r ynx.
E a c h ba llo on s ho uld be infla t e d wit h
5-10 m ls wa t e r a nd ge nt le t r a c t io n a pplie d.

ONC E NASAL PAC C K I NG I N SI T U:

@ t h e R FH, r ef t o ENT at UC LH 07415 624966

R E F:
http://www.emdocs.net/emergency-department-management-posterior-epistaxis/

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 37

 ECMO: EXTRACORPOREAL MEMBRANE OXYGENATION

USE S:
It is a t e c hnique t ha t oxyge na t e s blo o d o ut s ide t he bo dy a nd c a n be us e d fo r
po t e nt ia lly r e ve r s ible s e ve r e c a r dio - r e s pir a t or y fa ilur e whe n c onve nt iona l
ve nt ila t io n is una ble t o o xyge na t e t he blo od a de qua t e ly.
E CMO is a highly s pe c ia lis e d t e c hnique , whic h ne e ds t he input of int e ns ive c a r e
s pe c ia lis t s , c a r dio t ho r a c ic s ur ge o ns a s we ll a s E CMO-t r a ine d nur s e s a nd
pe r fus io n s c ie nt is t s .

AI MS:
in r e s pir a t o r y fa ilur e t o a llo w t he injur e d lung t o r e c o ve r whils t a vo iding
c e r t a in r e c o gnis e d c o m plic a t io ns a s s oc ia t e d wit h c o nve nt iona l ve nt ila t io n, high
r is k a nd o nly us e d a s a m a t t e r o f la s t r e s o r t in diffic ult c a s e s .
T he pr o c e dur e invo lve s r e m o ving blo o d fr o m t he pa t ie nt , t a king s t e ps t o a vo id
c lo t s fo r m ing in t he blo od, a dding o xyge n t o t he blo o d a nd pum ping it
a r t ific ia lly t o s uppo r t t he lungs .

I ND I C AT I ONS:

Ac u t e s ever e r es pi r a t o r y f a i l u r e: ven o -ven o u s E C MO

P a t ie nt <65 ye a r s o ld wit h r e ve r s ible c a us e o f r e s pir a t o r y fa ilur e a nd no
s e ve r e c o m or bidit ie s
V e nt ila t or y s uppo r t m us t ha ve be e n t r ia lle d a nd m a xim is e d
V e nt ila t or t im e <7 da ys
If a ll o f t he a bove a nd pa t ie nt ha s fa ile d t o r e s po nd, c o ns ide r E CMO

C i r c u l a t o r y f a i l u r e - c a r di ac o r i gi n : ven o -ar t er i a l E C MO
P a t ie nt <65 ye a r s o ld wit h a r e ve r s ible c a us e of c a r dia c fa ilur e a nd no
s e ve r e c o m or bidit ie s
D ia gno s is m us t be pr im a r y c a r dia c fa ilur e e it he r c a r dio ge nic s hoc k or
pulm o na r y e m bo lus
Che c k a ll c o nve nt io na l s uppo r t m o da lit ie s a r e m a xim is e d
If s ho c k pe r s is t s de s pit e m a xim a l t he r a py a nd a bo ve c r it e r ia fulfille d,
im ple m e nt t he E CMO r e fe r r a l pr o c e s s

R E FE R R AL PR OC E SS @ T H E R FH :
PAE D I AT R I C S:
D is c us s wit h CAT S
Ne a r e s t c e nt r e s = R o ya l Br o m pt on Ho s pit a l (02073528121) a nd G OSH
(02074059200)

AD ULT S:
D is c us s wit h IT U a t R F H
Ne a r e s t c e nt r e s = Br o m pt on (02073528121) a nd P a pwo r t h (01223638000)
R E F:

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 38

 FASCIA ILIACA BLOCK

D R UG D OSE S:
Lignoc a ine for loc a l bleb

Bupivic a ine 0. 25% 2-2. 5m g/ kg

OR
R opivic a ine up t o 2m g/ kg
Dilut e t o 25-50m ls

R E F:
ht t ps : / / im g. gr e pm e d. c o m / uplo a ds / 4598/ a na s t he s io lo gy-ge r ia t r ic s -pr o c e dur e -ne r ve blo c k-e m e r ge nc ym e dic ine -
o r igina l. jpe g
R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 39
 GI BLEED

UG I B

A-E Appr o a c h :
P r o t e c t a ir wa y, o xyge na t e , e ns ur e 2 x la r ge bo r e a c c e s s a nd G +S s e nt , c ons ide r
e na c t ing m a jo r ha e m o r r ha ge pr o t o c o l
Co ns ide r r e ve r s a l o f a nt ic o a gula nt s
As s e s s fo r a ddit io na l dia gno s is (s uc h a s s e ps is o r live r fa ilur e )

Fo r R es u c i t a t i o n :
St a r t IV fluid 500m l
Aim Ha e m o glo bin 7-8 - m ight o nly r e quir e fluid r e s us c it a t io n
O ne ga t ive blo o d in fr idge in E D , c o ns ide r o t he r blo od pr o duc t s e . g. pa c k 1
D o NOT give T X a a s s t a nda r d (unle s s a dvis e d fo r r e ve r s a l o f a nt ic o a gula nt s or
a s pa r t of t he m a jo r t r a ns fus io n bundle )
Co ns ide r a P P I - om e pr a zo le IV 40-80m g o r pa nt o pr a zo le 40m g IV

I f s u s pec t ed va r i c eal bl eed:

Ce ft r ia xo ne 2g IV
T e r lipr e s s in 2g IV - do a n E CG fir s t a s it va s oc ons t r ic t s a nd m a y c a us e
is c ha e m ia , give r e duc e d 0. 5m g do s e if his t o r y IHD

Fo r def i n i t i ve man a gemen t (OG D ):

D is c us s wit h m e dic s +/ - o n c a ll e ndo s c o py/ ga s t r o t e a m

@ R FH :
If kno wn o r s us pe c t e d va r ic e a l ble e d - r e f he pa t o logy (m e dic s OOH)
If no n va r ic e a l - r e f t o ga s t r o e nt e r o logy (m e dic s OOH)
If r e quir e s OG D in hour s r e fe r t o s pe c ia lis t t e a m a s a bo ve but OOH a ll
e m e r ge nc y e ndos c o py is do ne by he pa t o lo gy.

Invo lve ICU if ha e m odyna m ic a lly uns t a ble o r ongo ing t r a ns fus ion r e quir e m e nt

Lo wer G I Bl eed

F o llo wing (o r dur ing) init ia l r e s us c it a t io ns c o nt a c t s ur ge ons : de finit ive

t r e a t m e nt = c o lo no s c o py o r s ur ge r y (o r if a c t ive ble e ding po int a ngiogr a phy
a nd e m bo lis a t io n)

Co ns ide r CT a ngio gr a m only if a c t ive ly ble e ding (if no t a c t ive ly ble e ding t he r e
will be no vis ible ble e ding point ) a nd c o nt a c t int e r ve nt io na l r a diology a s s o on
a s CT a va ila ble a s will r e vie w CT t he m s e lve s t o s e e if a m e na ble fo r
e m bolis a t io n.

R E F:

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 40

 HYPERCALCAEMIA

R E F:
Author Dr Rajesh Kumar, ED Consultant
R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 41
 HYPERKALAEMIA

R E F:
Author Dr Rajesh Kumar, ED Consultant
R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 42
 HHS: HYPEROSMOLAR HYPERGYCAEMIC STATE

D i a gn o s i s
T ype 2 dia be t ic s (o r ne w dx D M II)
G luc o s e >30m m o l/ L
Hype r os m o la lit y, s e r um o s m o la lit y >320m Os m / kg (Os m o la lit y = 2Na +gluc o s e +ur e a )
D e hydr a t io n a nd hypo vola e m ia

Oft e n a ls o :
Minim a l ke t o nur ia (bloo d ke t o ne s <3, ur ina r y <2)
No r m a l P H but c a n be a c idot ic
D e c r e a s e d G CS/ c o nfus io n

Ma n a gemen t
A-E As s e s s m e nt
IV a c c e s s IV F : 0. 9% s a line 1 lit r e o ve r 1hr (m o r e s lo wly if CCF , m o r e r a pid if SBP < 90)
Co r r e c t K+ (o nly if K+ <5. 5)
Ins ulin a t 0. 05 unit s / kg/ hr ONL Y if ke t o ne s >2 (ur ine ), >1 (blo o d)
Aim fo r BM 10-15m m m ol/ L - If BM <15, s t a r t 10% de xt r o s e a t 125m ls / hr a s we ll a s 0. 9%
s a line
Ant ibio t ic s a nd a nt ie m e t ic s a s ne e de d
St o p m e t fo r m in/ diur e t ic s
L MWH - t inza pa r in pr o phyla xis 4, 500unit s s c if >50 kg we ight
Se pt ic s c r e e n
NG t ube
Ho ur ly fluid ba la nc e m o nit o r ing e it he r via c a t he t e r o r ur ine o ut put m e a s ur ing

I n ves t i ga t i o n s
G luc o s e a nd Se r um o s m o la lit y
V e no us blo o d ga s
Blo o d/ ur ina r y ke t o ne s
R o ut ine blo o ds a nd c ult ur e s
Se pt ic s c r e e n
E CG
BHCG if fe m a le a nd <55
Me nt a l s t a t e e xa m ina t io n
R pt G l u c o s e, U+E a n d Os mo l a l i t y h r l y i n i t i a l l y

T R E AT ME NT AI MS:

Nor ma lise osmola lity (R educe by 3-8mOsm/ Kg/ hr )

R epla ce fluid a nd electr olyte losses (+ve fluid ba la nc e 2-3L by 6hr s)
Nor ma lise blood glucose (R educe gluc ose no mor e tha n 5mmol/ hr )
Pr event thr ombosis

R E F:
The management of the hyperosmolar hyperglycaemic state (HHS) in adults with diabetes, Joint British Diabetes Societies Inpatient
Care GroupAugust 2012, https://diabetes-resources-production.s3-eu-west-1.amazonaws.com/diabetes-
storage/migration/pdf/JBDS-IP-HHS-Adults.pdf
R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 43
 HYPOCALCAEMIA

R E F:
Author Dr Rajesh Kumar, ED Consultant
R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 44
 HYPOKALAEMIA

R E F:
Author Dr Rajesh Kumar, ED Consultant
R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 45
 INTRAOSSEOUS INSERTION

I O T I PS:
Don’t put t he s a m ples in the pod without la belling IO a nd c a lling t he la b fir s t
Don’t r un s a m ples t hr ough the ga s m a c hine
Anyt hing c a n go thr ough t he IO inc luding blood but needs t o be under pr es s ur e (c onnec t t o
pr es s ur e ba g or s queeze)

Needle s izes a r e oppos ite to c a nnula s (yellow is BIG)

In a dult s infilt r a t ing 1m l lignoc a ine pr ior to flus hing c a n help ea s e pa in of us e - us e ext r em e
c a ut ion wit h dos ing this in c hildr en, follow CAT S guida nc e

Bes t s it e for pa eds is dis t a l fem ur (unles s c hild is older )

Bes t s it e in a dult s is hum er a l hea d (c los er to hea r t )

R E F:
Taken from The Southampton Oxford Retrieval Team (SORT) IO guidance, https://www.sort.nhs.uk/Media/Guidelines/Intraosseous-IO-insertion-guide.pdf
https://www.teleflex.com/usa/en/product-areas/emergency-medicine/intraosseous-access/arrow-ez-io-system/literature/Emergency-Medicine-Pocket-Guide_MC-
000609Rev2.pdf

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 46

 ISOPRENALINE INFUSION

Ac t i o n :
St im ula t e s B1 a nd B2 a dr e no r c e pt o r s t o inc r e a s e c a r dia c out put by m yoc a r dia l
c o nt r a c t ilit y a nd he a r t r a t e

If t he r e is s ys t e m ic hypo t e ns io n/ c e r e br a l hypo pe r fus ion/ he a r t fa ilur e / life -

t hr e a t e ning a r r yt hm ia , s t a r t m e dic a l t he r a py unt il t e m po r a r y pa c ing is init ia t e d

Ce nt r a l a c c e s s is pr e fe r r e d but c a n be give n pe r iphe r a lly

U s e is o pr e na line in c a ut io n wit h pa t ie nt s wit h is c ha e m ic he a r t dis e a s e ,

dia be t e s , hype r t e ns io n a nd hype r t hyr oidis m

R E F:

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 47

 LATERAL CANTHOTOMY

R E F:
Taken from St Mungo's: https://stmungos-ed.com/surgical/canthotomy

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 48

 LOCAL ANAESTHETIC TOXICITY

R ESUS D R UG C UPBOAR D +
BOT T OM D R AW FI B T R OLLE Y

D R UG D OSE S:
STR ENGTH MAXI MUM D OSES D UR ATI ON
Lignoca ine 1% (10mg/ ml) 3mg/ kg 1hr
Lignoca ine 2% (20mg/ ml) 3mg/ kg 1hr
Lignoca ine 1% with a dr ena line 7mg/ kg 1. 5hr
Bupivoca ine 0. 25% (2. 5 mg/ ml) 2mg/ ml 4hr
Bupivoca ine 0. 5% (5mg/ ml) 2mg/ ml 4hr
Pr iloca ine 1% (10mg/ ml) 6mg/ ml 1hr

E a r ly signs toxicity: Lip tingling, pa r esthesia or ta c hyca r dia

R E F:
Guideline_management_severe_local_anaesthetic_toxicity_v2_2010
https://em3.org.uk/foamed/9/7/2018/lightning-learning-local-anaesthetic-toxicity
R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 49
 MAJOR HAEMORRHAGE

Ca ll 2222 a nd de c la r e ' Mas s i ve H aemo r r h age'

As s ign s o m e o ne t o c o m m unic a t e wit h t he la b (x74018 o r x33406)

Or de r e it he r :
P a c k 1 (us e d fo r non-t r a um a )
Or
P a c k 2 (us e d fo r T r a um a )
If yo u r e quir e a n a ddit io na l pa c k, a lwa ys o r de r pa c k 2

Ide nt ify de dic a t e d T r a ns fus io n L e a d t o e ns ur e blo o d pr o duc t s o r de r e d,

r e c e ive d, ha nging a nd r unning.

T r a ns fus io n le a d s ho uld lia is e wit h t e a m le a de r a s t o wha t is ne e de d a nd

e ns ur ing a djunc t s give n a s r e quir e d a nd inve s t iga t io ns c o nt inue d.

R E F:
RFH Major Haemorrhage Policy for Use in Adults_v1.2
https://freenet2.royalfree.nhs.uk/documents/preview/45718/5251-major-haemorrhage-for-adults-policy-rfl-final-v1-2-upd-doc
R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 50
 NIV: CPAP VS BIPAP

C PAP
- Supplie s c o ns t a nt fixe d po s it ive pr e s s ur e t hr ough ins pir a t io n a nd e xpir a t ion
- Ca n be de live r e d wit h o r wit ho ut 02
- R e c r uit s lung vo lum e by ke e ping br o nc hio le s a nd a lve o li ope n, e na bling
inc r e a s e d ga s e xc ha nge

Bi PAP
- Supplie s a c o ns t a nt po s it ive pr e s s ur e dur ing e xpir a t io n (E P AP ) plus a highe r
po s it ive pr e s s ur e dur ing ins pir a t io n (IP AP )
- R e c r uit s lung vo lum e a nd he lps wit h ve nt ila t io n, a s s is t ing pa t ie nt t o br e a t h in
a nd r e duc ing t he ir wo r k o f br e a t hing

R E F:

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 51

 NIV: BIPAP SET UP

I n di c at i o n s E n s u r e Adequ a t e Medi c a l T h er a py
Ac ut e exa c COPD
Pr i o r t o s t a r t i n g Bi PAP
pH<7. 35
pCO2 > 6. 0
02
Ma xim a l m edic a l ther a py c om pleted Nebu l i s er s : s a lbut a m o l a nd a t r o ve nt
Senior r eview St er o i ds : hydr o c or t is o ne 100m g IV
An t i bi o t i c s : fo llo w lo c a l guide line s
E x c l u s i o n c r i t er i a
(@ t he R F H if CAP c o -a m oxic la v a nd
Pneum ot hor a x (get CX R ASAP )
Per i-a r r es t c la r it hr o m yc in, if HAP a m o xic illin +
Air wa y obs tr uc t ed t e m o c illin)
As t hm a (exc ept in c ons ulta t ion wit h IT U)
Met a bolic a c idos is
I V br o n c h o di l a t o r s i f i n di c a t ed
R ec ent GI or fa c ia l s ur ger y
F a c ia l/ a ir wa y bur ns or t r a um a
Ami n o ph yl l i n e: 5m g/ kg lo a ding dos e
V om it ing or a s pir a t ion (if no t a lr e a dy t a king t he ophylline )
infus ion 500-700m c g/ kg/ hr o r
R el at i ve ex c l u s i o n s 300m c g/ kg/ hr in e lde r ly
Sec r et ions
Sa l bu t a mo l : infus io n 5m c g/ m inut e
GCS <8
BP<90 s ys t olic (3-20m c g/ m inut e r a nge )
Bulla e

Mo n i t o r i n g
Puls e oxim et r y, E CG + BP,
ABG - pr e a nd a ft er 30m ins / 1 hour / 2 hour s / 4 hour s

Set t i n gs
E ns ur e a good s ea l a r ound the m a s k:

Pr o bl ems
Ca n im pede venous r etur n a nd dr op BP
Ca n c a us e pr es s ur e da m a ge over nos e a nd fa c e
Wa t c h out for ba r otr a um a a t high pr es s ur es
R E F:

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 52

 NIV: CPAP SET UP

I n di c a t i o n s
T ype 1 r e s pir a t o r y fa ilur e / pne um o nia
OSA
Ac ut e pulm o na r y o e de m a
Che s t wa ll t r a um a a nd hypo xia (r a r e ly)

E x c l u s i o n C r i t er i a
P ne um o t ho r a x ( ge t CX R ASAP )
L o w G CS
V o m it ing/ a s pir a t io n
Co nfus io n/ a git a t io n
Bo we l o bs t r uc t io n
F a c ia l/ a ir wa y bur ns o r t r a um a
R e c e nt uppe r G I o r fa c ia ls ur ge r y
Ca n’t pr o t e c t a ir wa y

Mo n i t o r i n g
P uls e o xim e t r y, E CG + BP ,
ABG - pr e a nd a ft e r 30m ins / 1 ho ur / 2 ho ur s / 4 ho ur s

Set t i n gs
St a r t a t 5c m H20
Inc r e a s e gr a dua lly (E P AP )
D o no t e xc e e d 25c m H20
E ns ur e a go o d s e a l a r o und t he m a s k

R E F:

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 53

 NORADRENALINE INFUSION

Alpha a nd Be t a a go nis t
(inc r e a s e d SV R / a ft e r lo a d
a nd pe r fus io n pr e s s ur e ,
inc r e a s e d va s o c o ns t r ic t ion
a nd he nc e pr e lo a d, ino t r o py
a nd c hr o no t r o py)

D os e :
0. 1-1m c g/ kg/ m inut e IV ,
t a r ge t MAP 65m m Hg

P r e fe r r e d us e in
s e ps is / ne ur o ge nic s ho c k

Adve r s e e ffe c t s :
hype r t e ns io n, r e fle x
br a dyc a r dia ,
hype r glyc a e m ia , pe r iphe r a l
is c ha e m ia , inc r e a s e d
a ft e r lo a d a nd be t a e ffe c t s
m a y inc r e a s e m yo c a r dia l
wo r k a nd 02 c o ns um pt io n

T i ps o n s t ar t i n g i n o t r o pes

In a n em er genc y you c a n a dd 1m l of 1: 10, 000 a dr ena line (c a r dia c a r r es t m in jet ) into 1litr e
nor m a l s a line 0. 9% a nd r un it a s r equir ed to m a int a in HR a nd BP
Pa t ient s on inot r opes need c entr a l a c c es s either inter na l jugula r or fem or a l vein, you c a n us e
per ipher a l a c c es s or IO initia lly but c entr a l a c c es s is m uc h pr efer r ed

Alter na tive inot r opes :

Adr ena line, Dobuta m ine, Dopa m ine, Meta r a m inol, E phedr ine, Phenylephr ine, Is opr ena line,
V a s opr es s in
R E F:
https://www.rcem.ac.uk/docs/Sepsis/CEM4719-Noradrenaline-v2-%20Infusion%20Reference%20Guide.pdf

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 54

 PACING: EXTERNAL

I n di c at i o n s :
E xt r em e br a dyc a r dia / br a dyc a r dia + a dver s e fea tur es (s hoc k/ s ync ope/ MI/ CCF )
F a ilur e of m edic a l tr ea t m ent : a t r opine 500m c g up t o 3m g, is opr ena line 5m c g/ m in, a dr ena line
2-10 m c g/ m inut e, c ons ider a m inophylline, dopa m ine, gluc a gon, glyc opyr r ola t e

E qu i pmen t : Defibr illa t or , 3 c linic ia ns inc 1 qua lified to per for m s eda t ion, s eda t ion c hec klis t a nd
equipm ent , m onit or ing, dr ugs

St eps :
(Ca n be done by E D but involve a nes t het ic s / IT U if needed)
At lea s t 3 c linic ia ns pr es ent - a ir wa y/ dr ugs / defib (c ons ider 2222 if r equir ed)
Pla c e defib pa ds ont o t he pa t ient r ight pec tor a l a nd a pic a l pos it ion or a nter opos ter ior (left
a nt er ior c hes t wa ll a nd lower left s c a pula a nd s pine)
Connec t t o m onit or : E CG, BP (wit h 1-3m in c yc le), Sa t s , a nd Ca pnogr a phy
Give high flow 02
IV a c c es s , IV F pr epa r ed inc a s e bolus needed
Seda t ion: opt ions inc lude fenta nyl +/ - m ida zola m OR fenta nyl +/ - pr opofol, a lwa ys us e dr ugs
you' r e fa m ilia r wit h a nd a r e a ppr opr ia t e for c linic a l c ondit ion

E xt er na l pa c ing
i. F lip down pla s t ic c over r ight lower c or ner defib m a c hine
ii. T ur n dia l c ounter c loc kwis e t o s elec t ‘Pa c ing’ a nd pr es s ‘Ma nua l Mode’
iii. Pr es s ‘Confir m ’
iv. R a t e a ut om a t ic a lly s et t o 70 - r educ e to 60
v. Dia l up m A t o 40 t hen inc r ea s e by inc r em ent s of 10m A unt il elec t r ic a l c a pt ur e (a QR S
following ea c h pa c ing s pike)
vi. Chec k for pa lpa ble per ipher a l puls e, c ontinue t o inc r ea s e m A unt il puls e felt
(m ec ha nic a l c a pt ur e)
vii. Inc r ea s e fur ther 10m A a s a s a fet y net

Chec k BP
E ns ur e a dequa t e a na lges ia
Cont a c t c a r diology (2027) for definit ive m a na gem ent (in hour s Ba r net, OOH R F H or Ba r t s )

i ii iii v

PI T FALLS:
Pa t ient needs t o be wa r m , c hec k V BG a nd elec t r olyt es , s ee is opr ena line/ r es us dr ugs s ec t ion for
infus ion info

R E F:

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 55

 PALLIATIVE CARE IN THE ED

SUG G EST ED D R UG D OSES

Pa i n :
Mo r ph i n e* 2. 5-5m g s c ho ur ly P R N

D ys pn o ea :
Mo r ph i n e* 2. 5-5m g s c e ve r y 4 ho ur s P R N

Agi t a t i o n :
Mi da zo l am 2. 5-5m g s c ho ur ly P R N

Sec r et i o n s :
G l yc o pyr r o n i u m 0. 2m g s c e ve r y 4 ho ur s P R N

Na u s ea :
H a l o per i do l 1. 5m g s c e ve r y 4 ho ur s P R N

*If e G F R <30 us e o xyc o do ne 1. 25-2. 5m g s c ho ur ly P R N

If a lr e a dy us ing o pia t e s , us e ⅙ of pa t ie nt s t ot a l a m o unt us e d in 24 hour s

H OW T O SE T UP A SY R I NG E D R I VE R :

R E F:

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 56

 PENILE ASPIRATION

R E F:
CoreEM

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 57

 PERICARDIOCENTESIS

R E F:
Taken from St Mungo's: https://stmungos-ed.com/surgical/pericardiocentesis

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 58

 PNEUMOTHORAX - SPONTANEOUS

UPD AT E S T O 2010 BT S G UI D E LI NE S

R C T (NE J M 2020 J an 30)

Co ns e r va t ive m a na ge m e nt o f pr im a r y s po nt a ne ous pne um o t hor a x is NOT
WOR SE t ha n int e r ve nt io na l m a na ge m e nt , wit h a lo we r r is k of s e r io us a dve r s e
e ve nt s

R FH a dvi c e
D is c us s wit h r e s pir a t o r y t e a m in ho ur s o r E D c ons ult a nt out of hour s
D r a ins a r e ke pt in r e s us - a s pir a t io n kit a nd c he s t dr a in bot h a va ila ble

R E F:
Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010
https://www.bsuh.nhs.uk/library/wp-content/uploads/sites/8/2020/06/BTS-pneumothorax-guideline.pdf
R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 59
 PRE-ECLAMPSIA

Si gn s :
P r e gna nc y > 20/ 40 m o s t c om m o nly
Sys t o lic BP >160, MAP >120,
P r o t e inur ia 1+ o n r e a ge nt s t r ip,
Abno r m a l blo o ds : c r e a t inine >90, low pla t e le t s <150, r a is e d AL T >70

Sympt o ms o f s ever e pr e-ec l a mps i a / i mpen di n g ec l a mps i a :

F a c ia l a nd pe r iphe r a l o e de m a , vis ua l dis t ur ba nc e s , he a da c he , c he s t pa in,
vo m it ing
Ca n r a pidly pr o gr e s s t o e c la m ps ia invo lving s e izur e s

Ma n a gemen t o f s ever e h yper t en s i o n :

Che c k BP e ve r y five m inut e s unt il MAP is <120m m Hg o r BP ≤ 140/ 90
Or a l a nt i-hype r t e ns ive s :
1s t line la be t a lol (2nd line nife dipine , 3r d line m e t hyldopa )
If no im pr o ve m e nt a ft e r 30 m inut e s o r a l t r e a t m e nt s t a r t IV o r r e pe a t P O dos e in
c o njunc t io n wit h o bs t e t r ic s
Ca t he t e r
F luid ba la nc e
U r ge nt O+G Cons ult

C o n s i der Ma gn es i u m i f :
P r e -e c la m ps ia wit h s e ve r e hype r t e ns io n t ha t do e s no t r e s pond t o t r e a t m e nt o r
is a s s o c ia t e d wit h o ngo ing o r r e c ur r ing s e ve r e he a da c he s , vis ua l s c o t o m a t a ,
na us e a o r vo m it ing, e piga s t r ic pa in, o ligur ia a nd s e ve r e hype r t e ns ion, a s we ll a s
pr o gr e s s ive de t e r io r a t ion in la bo r a t o r y blo o d t e s t s s uc h a s r is ing c r e a t inine or
live r t r a ns a m ina s e s o r fa lling pla t e le t c o unt , o r fa ilur e o f fe t a l gr owt h o r
a bno r m a l do pple r findings .

If fit t ing s t a r t Ma gne s ium 4g IV o ve r 10 m inut e s fo llowe d by a n infus io n a t 1g

pe r ho ur .
Ca ll for he lp a nd m o ve t o t he E c la m ps ia a lgo r it hm .

D R UG D OSE S:
Or a l a nt ihype r t e ns ive s
L a be t a lo l: 200m g po s t a t , c a n be r e pe a t e d a t 30 m ins if no r e s po ns e
Nife dipine : 10m g MR o r a lly (BP t o be t a ke n e ve r y 10 m ins for ½ a n ho ur a s nife dipine c a n le a d t o a m a r ke d dr o p in BP )

IV a nt ihype r t e ns ive s
L a be t a lo l: 50m g bo lus o ve r 1 m inut e , (c a n be r e pe a t e d a ft e r 5 m ins up t o a m a xim um of 200m g)If IV infus io n ne e de d:
s t a r t a t 20m g/ ho ur , c a n be do uble d e ve r y 30 m ins up t o a m a xim um of 160m g/ hour
Hydr a la zine : U s e if s e ve r e a s t hm a but c a n dr o p BP , (c o ns ide r giving 500m l Cr ys t a llo id be fo r e or a s giving 1s t do s e
hydr a la zine )

IV Ma gne s ium IV lo a ding do s e o f 4g o ve r 5 t o 15 m inut e s , follo we d by a n infus ion o f 1 g/ ho ur m a int a ine d for 24 ho ur s .

R E F:
Hypertension in pregnancy: diagnosis and management. NICE guideline Published: 25 June 2019
www.nice.org.uk/guidance/ng133
R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 60
 POST PARTUM HAEMORRHAGE

R E F:
Mavrides E, Allard S, Chandraharan E, Collins P, Green L, Hunt BJ, Riris S, Thomson AJ on behalfof the Royal College of
Obstetricians and Gynaecologists. Prevention and manag ement of postpartum haemorrhage.BJOG 2016;124:e106–e149
R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 61
 PULMONARY EMBOLISM: THROMBOLYSIS

I n ves t i ga t i o n s :
D dim e r - o nly a ft e r a s s e s s m e nt o f c linic a l pr o ba bilit y do no t wa it for t his in
uns t a ble pa t ie nt s , ho we ve r if ne ga t ive c o ns ide r a lt e r na t ive dia gnos is
CT P A
V Q (r e na l c o m pr o m is e / yo ung/ br e a s t fe e ding/ pr e gna nt but NOT if like ly Covid)
P OC ult r a s ound (E CHO)
E CG

T H R OMBOLY SI S

T hr o m bo lys is is t he fir s t line t r e a t m e nt fo r m a s s ive P E a nd m a y be ins t it ut e d o n

c linic a l gr o unds a lo ne if c a r dia c a r r e s t is im m ine nt .
Inva s ive a ppr o a c he s (t hr om bus fr a gm e nt a t ion a nd IV C filt e r ins e r t ion) s hould be
c ons ide r e d whe r e fa c ilit ie s a nd e xpe r t is e a r e r e a dily a va ila ble o r if t hr om bo lys is
c ont r a indic a t e d.

Ma s s i ve PE : D e fine d a s - c o lla ps e / hypo t e ns io n, hypo xia , e ngo r ge d ne c k ve ins , R V

s t r a in a nd c a n be dia gno s e d wit h CT P A or E CHO + E CG

C o n t r a i n di c a t i o n s
Abs o l u t e R el a t i ve
P r io r int r a c r a nia l ha e m o r r ha ge Se ve r e unc o nt r olle d HT N (SBP >180, DBP >110)
Kno wn c e r e br a l ne o pla s m >10 m ins CP R
Is c ha e m ic s t r oke <3 m ont hs Hx o f is c ha e m ic s t r o ke > 3 m o nt hs
Sus pe c t e d a o r t ic dis s e c t ion R e c e nt int e r na l ha e m o r r ha ge
Ac t ive ble e ding/ ble e ding dia t he s is No n c o m pr e s s ible va s c ula r punc t ur e
Signific a nt t r a um a <3 m o nt hs P r e gna nc y
Ac t ive pe pt ic ulc e r
Cur r e nt us e o f a nt ic o a gula nt s
D o s i n g gu i da n c e
PE c a u s i n g c a r di ac a r r es t o r per i -a r r es t :
50m g IV bo lus a lt e pla s e o ve r 1-2m ins (Se e AL S Algo r it hm )
Ma s s i ve PE bu t n o t per i -a r r es t :
Alt e pla s e 10m g bo lus o ve r 1-2m ins t he n 90m g o ve r 2hr s
If pt le s s t ha n 65kg do not e xc e e d 1. 5m g/ kg, but init ia l 10m g bolus r e m a ins
unc ha nge d

Su bma s s i ve PE (P E + R V dys func +/ - m yo c a r dia l injur y but wit ho ut hypot e ns ion) :

No e vide nc e fo r t hr o m bo lys is , unle s s m ult iple a dve r s e pr ognos t ic indic a t o r s -
dis c us s individua l c a s e s wit h r e s p or c a r dio if c onc e r n.
(U s ua lly s t a r t e d o n a n unfr a c t io na t e d he pa r in infus ion. )

R E F:
https://thorax.bmj.com/content/58/6/470

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 62

 PULMONARY OEDEMA

Ba s i c s :

Sit pa t ie nt up
P ut o n high flo w 02 if s a t s <95% or pt SOB (c a n r e duc e in COP D )

Goals:

im pr o ve o xyge na t io n
Ma int a in BP
Addr e s s unde r lying c a us e

Bes t evi den c e:

G T N infus io n (if BP >90), c a n s t a r t S/ L nit r a t e s if IV a c c e s s no t e s t a blis he d,

t he n s t a r t IV infus io n a t 10-20m c g/ m in, inc r e a s ing e ve r y 3-5 m inut e s by 5-
10m c g/ m in a s BP a llo ws

CP AP (e ns ur ing CX R be fo r e s t a r t ing)

F ur os e m ide o nly if fluid o ve r lo a de d

- 20-40m g IV ; c o ns ide r highe r do s e s in t ho s e a lr e a dy o n r e gula r fr us e m ide
- t a ke s a t le a s t 1 ho ur t o ha ve diur e t ic e ffe c t

If no im pr o ve m e nt , ino t r o pe s (do but a m ine )

Co ns ide r dia lys is if r e na l fa ilur e

R E F:
Taken from: RCEM learning CPO

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 63

 RAPID TRANQUILISATION

I ND I C AT I ONS:
Ac ut e Be ha vio ur a l Dis t ur ba nc e ; c o m bina t io n o f de le r ium , s e ve r e a git a t io n,
a ggr e s s ive be ha vio ur , a ut o no m ic dys func t io n, hype r t he r m ia .

AI M:
R a pid s e da t io n t o a llow inve s t iga t ion a nd t r e a t m e nt . High r is k of de a t h; fr o m
m e t a bo lic a c idos is , r ha bdo m yo lys is , m ult i-o r ga n fa ilur e , D IC a nd
a r r hyt hm ia s . R is ks inc r e a s e t he lo nge r a pa t ie nt is he ld in r e s t r a int s .

SE D AT I ON:
E ns ur e a de qua t e s t a ff a nd e quipm e nt (m o ve t o r e s us , c he c k a ir wa y
e quipm e nt , ge t e no ugh s t a ff, e ns ur e t he r ight s t a ff; s e c ur it y, a na e s t he t ic s ,
ICU e t c )
Be nzo dia ze pine s a r e 1s t line , R CE M r e c o m m e nds ke t a m ine a s 2nd line a nd
a vo ida nc e o f ha lo pe r ido l if po s s ible due t o inc r e a s e d r is k o f a r r hyt hm ia .
If a n R SI is r e quir e d: a vo id e ve n s ho r t pe r io ds o f a pno e a a s c a n le a d t o a n
inc r e a s e in a c ido s is a nd a r r hyt hm ia s .

MONI T OR I NG :
R e quir e s t r e a t m e nt in r e s us c it a t io n a r e a a nd m a y r e quir e a s s is t a nc e fr om
ICU / a na e s t he t ic s .

BASE LI NE I NVE ST I G AT I ONS:

Co r e t e m pe r a t ur e , F ull s e t of o bs e r va t io ns , V BG , E CG , F BC, Clo t t ing, U +E , L F T ,
Ca lc ium , CK, T F T , G luc o s e +/ - CT He a d.

T R E AT ME NT :
T r e a t a c ido s is , r ha bdo m yolys is , a c t ive c o o ling if t e m pe r a t ur e a bo ve 39C
(a vo id pa r a c e t a m ol if hype r t he r m ic ).
Subs t a nc e a bus e c o m m o ne s t c a us e but a c t ive ly s e a r c h fo r o t he r c a us e s
inc luding he a d t r a um a , s e ps is , m e ningo e nc e pha lit is , a lc o hol or G HB
wit hdr a wa l a nd e le c t r o lyt e a bno r m a lit ie s .

D R UG D OSE S:
Al ways u s e dr u gs yo u ar e
f ami l i ar wi t h, if c onfident
ket a m ine m a y pr ovide a m or e
pr edic t a ble r es pons e.

Ha lf init ia l dos ing in t he

elder ly (>65) or in na ive to
a nt ips yc hot ic m edic a t ions
(c ons ider a qua r t er of dos es
in the elder ly a nd t itr a te
s lowly).

R E F:
Taken from: RCEM learning session ABD

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 64

 RESUSCATATIVE HYSTEROTOMY

R E F:
https://stmungos-ed.com/obstetrics/hysterotomy

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 65

 SEDATION

Minim a l vs m oder a t e vs deep vs gener a l vs dis s oc ia tive

E D s eda t ion s hould be m inim a l or m oder a te.
T he pa t ient s hould not los e t he a ir wa y unles s t his is pla nned a nd involves a na es thetic
a s s is t a nc e by E D or by t he a na es t het ic / IT U t ea m .
Keta m ine s eda t ion fa lls under the deep c a t egor y due t o it s potentia l c om plic a t ions but
c a n be s a fely us ed in r es us .
Any s eda tion m us t involve a n exper ienc ed a nd t r a ined c linic ia n who is s igned off for the
pr oc edur e.
Monit or ing a nd fa c ilit ies r equir ed: E CG, oxim et r y, c a pnogr a phy, BP, diffic ult a ir wa y
tr olley, 02, s uc t ion, tr olley t ha t c a n be tipped, IV a c c es s , IV fluids , s eda tion pr ofor m a
Pa t ient s s hould not be dis c ha r ged unt il t hey a r e a t ba s eline level of c ons c ious nes s wit h
nor m a l obs er va t ions .
F a s t ing - not needed for m inim a l s eda tion (ent onox) but s hould be 2 hour s c lea r fluids
a nd 6 hour s s olids for m oder a t e a nd onwa r ds . T he fa s ting r ule m a y need t o be a djus t ed if
the pr oc edur e is ur gent (eg c a r diova s c ula r c om pr om is e, lim b is c ha em ia ).

D R UG OPT I ONS:
E n t o n o x : Ca n c a us e na us e a , not fo r pr o lo nge d pe r io ds o f t im e

Mo r ph i n e:
Vi a l = 10m g/ 10m l
I V do s e = 0. 05-0. 01m g/ kg
Ons e t 5-10 m inut e s , D ur a t ion 2-4 ho ur s
SE : r e s pir a t o r y de pr e s s io n, na us e a , hypo t e ns ion, pr ur it us

Fen t a n yl :
Vi a l = 500m c g/ 10m l OR 10m c g/ 2m l - bot h 50m c g/ m l
D r a w u p 10m c g/ m l - 10m l s yr inge wit h 2m ls F e nt a yl + 8m ls N. Sa line
I V do s e = 0. 5-1m c g/ kg. G ive 0. 5m c g/ Kg bo lus a nd t he n a ddit iona l 25m c g bo lus e s
Ons e t a bo ut 1 m in, D ur a t io n 30-60 m ins
SE : R e s pir a t o r y de pr e s s ion, a pnoe a a nd pr ur it us

Mi da zo l a m:
Vi a l = 1m g/ m l o r 10m g/ 2m ls
D r a w u p 1m g/ m l - 10m g in 10m ls
I V do s e = 1-5m g. G ive 1-2m g bolus e s for a m ne s ia / a nxio lys is , 3-8m g fo r s e da t io n, t it r a t e in 1m g bo lus e s , give s lo wly
o ve r 2 m ins . R E D U CE DOSE IN E L D E R L Y
Ons e t 2-5 m ins , D ur a t io n 20-120 m ins
SE : Hypot e ns io n, r e s pir a t or y de pr e s s ion, pr o lo nge d e ffe c t a ft e r pr o c e dur e o ve r , c a t io n in e lde r ly

Pr o po f o l :
Vi a l = 10m g/ m l
D r a w u p 2 x 10m l s yr inge s o f 10m g/ m l
I V do s e St a r t wit h a 0. 5m g/ kg bolus a nd t o p up wit h 10m g (1m l) blous e s a s ne e de d
Ons e t 30 s e c s , D ur a t ion 3-8 m ins
SE : Hypo t e ns ion a nd r e s pir a t o r y de pr e s s io n

K et a mi n e:
Vi a l = 500m g/ 10m ls (50m l/ kg)
D r a w u p in a 10m l s yr inge , 2m l ke t a m ine + 8m ls N. Sa line t o give 10m g/ m l
I V do s e = 0. 5-1m g/ kg. G ive n 0. 5m g/ kg wit h a n a ddit iona l 10m g bo lus e ve r y 2 m ins up t o 1m g/ kg
Ca n c om bine wit h m ida zola m 1-2m g t o r e duc e e m e r ge nc e phe nom e no n.
Ons e t 30 s e c s , D ur a t ion 5-10 m ins ,
SE : Se c r e t io ns m a y c a us e la r yngo s pa s m , t a c hyc a r dia , hype r t e ns io n, a git a t io n/ e m e r ge nc e (a void in ps yc ho s is )

NB: Ca n us e ke t ofo l if t r a ine d in it s us e (ha lf do s e s of e a c h o f ke t a m ine a nd pr o po fo l in c om bina t io n)

C OMPLI C AT I ONS:
La r yngos pa s m : 02, BV M wit h PE E P, deepen s eda t ion/ pr oc eed t o R SI
Apnoea : 02, ja w t hr us t / BV M
Hypot ens ion: us ua lly tr a ns ient , IV fluid bolus , m et a r a m inol (0. 5-1m g bolus es )
Hypoxia : 02, s uppor t br ea t hing
Br a dyc a r dia : a tr opine 500-600m c g bolus
R E F:

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 66

 SEPSIS

D R UG D OSE S:
Ant ibiot ic s : Chec k m ic r oguide for a ppr opr ia t e c hoic e

R E F:
https://www.sccm.org/getattachment/SurvivingSepsisCampaign/Guidelines/Adult-Patients/Surviving-Sepsis-Campaign-Hour-1-
Bundle.pdf?lang=en-US
R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 67
 STATUS EPILEPTICUS

D ef i n i t i o n
Any s e izur e a c t ivit y t ha t is pr o lo nge d fo r m o r e t ha n 5-10 m inut e s o r >2
s e izur e s wit ho ut full r e c ove r y

Ma n a gemen t

0-5mi n s
Air wa y: R e c o ve r y po s it io n, s uc t io n e xt e r na lly (ne ve r ins e r t a nyt hing int o t he
m o ut h)
Br e a t hing: High flo w o 2
Cir c ula t io n: IV Ac c e s s , E CG t r a c ing, V BG : lo o k fo r r e ve r s ible c a us e s
(e le c t r o lyt e s , gluc o s e )
D is a bilit y: G L U COSE , c he c k pupils , c ons ide r CT he a d, pa br ine x if wit hdr a wa l
s e izur e s (a ft e r gluc o s e c o r r e c t e d if r e le va nt )

G ive do s e Be nzo dia ze pine s :

IV : L o r a ze pa m 2-4m g (o r D ia ze pa m 5-10m g o r Mida zo la m 2-4m g)
P R : D ia ze pa m 10-20m g
Buc c a l: D ia ze pa m 10m g
IM: Mida zo la m 10m g

If no e ffe c t give 2nd do s e be nzo ’s a ft e r 10 m ins

10-15 mi n s
St a r t a ddit iona l t r e a t m e nt :
L e ve t ir a c e t a m 20m g/ Kg IV o ve r 15 m inut e s (c a n give up t o 2-4g if r e quir e d)
Or
P he nyt o in 20m g/ kg IV , m a x 50m g/ m inut e

15-20 mi n s
If s t ill s e izing c o nt a c t ICU fo r c ons ide r a t io n/ pr e pa r a t io n int uba t io n
Co ns ide r int uba t ion e a r lie r if a ir wa y c o nc e r ns o r pr ofo und m e t a bo lic
a c ido s is

R E F:

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 STROKE

I f s i gn s / s ympt o ms s u gges t i ve o f an a c u t e s t r o k e a n d o n s et u n der 4h r s :

Blue light t o ne a r e s t s t r o ke unit (Na t iona l Ho s pit a l fo r Ne ur o lo gy a nd
Ne ur o s ur ge r y @ Que e ns Squa r e )
Onc e a m bula nc e bo o ke d c o n t a c t H ASU 07753 739286

I f o n s et 4-72 h r s :
Ar r a nge CT he a d a nd inve s t iga t ion in E D but d/ w HASU via r e fe r a pa t ie nt (m a y
a c c e pt pa t ie nt s wit hin 72hr s o f a s t r o ke fo r o ngo ing m a na ge m e nt a t s t r oke
unit ).

I f o n s et o ver 72h r s (o r pa t i en t n o t f o r t r a n s f er t o H ASU):

D / w ne ur o lo gy o r m e dic s a t t he R F H

I n i t i a l ma n a gemen t :
A-E a s s e s s m e nt
Che c k G luc o s e
Ma na ge hype r t e ns io n c a r e fully

I f s i gn s a n d s ympt o ms r es o l ve f o l l o w T I A pa t h wa y

R E F:

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 69

 THORACOTOMY - PAGE 1

R E F:
Taken from St Mungo's:https://stmungos-ed.com/surgical/thoracotomy

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 70

 THORACOTOMY - PAGE 2

R E F:
Taken from St Mungo's:https://stmungos-ed.com/surgical/thoracotomy

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 71

 TOXICOLOGY: PARACETAMOL OVERDOSE

R E F:
Author: Dr Ken Graham, ED

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 72

 TOXICOLOGY: SUMMARY EMERGENCY MANAGEMENT

R E F:
Author: Dr Ken Graham, ED

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 73

 TOXICOLOGY: TOXIDROMES

R E F:
Author: Dr Ken Graham, ED

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 74

 TRACHEOSTOMY: EMERGENCY MANAGEMENT

C ALL FOR H E LP E AR LY :
C a l l PAAR T (2525/ 2472) f o r a n y t r a c h eo s t o my emer gen c i es
C o n s i der emer gen c y c al l 2222

R E F:

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 75

 APPENDIX 1:

BURNS GUIDELINES FROM THE LONDON AND SOUTH

EAST ENGLAND BURNS NETWORK

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 76

 APPENDIX 2:

TRAUMA GUIDELINES FROM TACTIC GROUP

R E SUS PR OMPT C AR D S: T ALI A BAR R Y , VI C K I C OWLI NG V1. 1 88