By Graham Robert Nimmo
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Extra resources for Adult Medical Emergencies Handbook
5’C, give paracetamol 1g iv or orally. If not, send the unit back to the laboratory. Contact a consultant haematologist. Intensive care may be needed. Intensive Care may be needed. If you are unsure whether the diagnosis is Bacterial ContaminaFon or ABO incompaFbility, treat both, and contact a consultant haematologist for advice. 62 adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11 Table 1: Guidelines for Recognition and Management of Acute Transfusion Reactions CATEGORY SIGNS SYMPTOMS POSSIBLE CAUSE Category 1: Localised Pruritis Hypersensitvity Mild cutaneous Febrile non-haemolytic reactions: transfusion reactions: • Urticaria • Antibodies to white • Rash blood cells, platelets • Mild Fever • Antibodies to proteins, including IgA Category 2: • Flushing Anxiety Hypersensitivity Moderately • Urticaria Pruritis (moderate-severe) Severe • Rigors Palpitations Febrile non-haemolytic • Fever Mild dyspnoea transfusion reactions: • Restlessness Headache • Antibodies to white • Tachypnoea blood cells, platelets • Tachycardia • Antibodies to proteins, including IgA Possible contamination with pyrogens and/or bacteria Category 3: • Rigors Anxiety Life • Fever Chest pain Threatening • Restlessness Pain near • Hypotension infusion site (fall of >20% in Respiratory systolic BP) distress/ • Tachypnoea +++ shortness of • Tachycardia breath (rise of >20% in Loin/back pain heart rate) Headache • Haemoglobinuria • Unexplained bleeding (DIC) Acute intravascular haemolysis Bacterial contamination and septic shock Fluid overload Anaphylaxis Transfusion related acute lung injury (TRALI) Transfusion associated Graft versus Host Dyspnoea disease (TA-GvHD) Note: If an acute transfusion reaction occurs, as you are starting to treat the patient check the blood pack labels and the patient’s identity.
Urgent ventilation, immediate surgery. ii) Is senior help required immediately, and, if so, whom? iii) Where should the patient be looked after? This is a decision about nursing care, monitoring and treatment level. The choices include: - General wards. - Intermediate care facility (Coronary Care Unit: CCU or High Dependency Unit: HDU). - Theatre - Intensive Care Unit (ICU). i Placing the patient in a monitored HDU bed without increasing the level of appropriate medical input and definitive treatment will not improve outcome on it’s own.
If the patient is talking A is clear and B isn’t dire. g. drug administration. • If any patient with known or suspected chronic respiratory disease arrives in A&E, CAA or ARAU on high concentration oxygen check ABG immediately and adjust oxygen accordingly. • When assessing breathing think of it in the same way as you think of the pulse: rate, volume, rhythm, character (work of breathing), symmetry. Look for accessory muscle use, and the ominous sign of paradoxical chest/abdomen movement: “see-saw”.