Medical emergencies assessment

Acute stroke is considered to be an acute medical emergency. Identification of the time and manner of stroke onset is an important determinant in treatment. The time the patient was last without symptoms is used as the time of stroke onset. Since patients typically do not experience pain, determining the onset time can be difficult. It is also important to document risk factors and previous functional status of the patient to assess current disability due to the stroke. 

Performs basic cardiac life support, and assesses and participates in drug therapy management during medical emergencies. 

The phrase in near proximity to the workplace does not directly relate to any specific distance. In medical emergencies, response time is a more relevant measure. Sufficient response time for medical assistance is to be based on an assessment of workplace hazards and the possible outcomes that could occur. 

Take-home message Further reading Resources for families Chapter 6S Medical emergencies Preparation Assessment Management... 

If transferring someone to hospital, always write a cover letter ring ahead so the medics understand the problem and can contact you if required. Otherwise, the patient may return without appropriate assessment and management. See Ch.65 for management of medical emergencies on psychiatric wards. 

First aid is emergency care provided for injury or sudden illness before emergency medical treatment is available. The first aid provider in the workplace is someone who is trained in the delivery of initial medical emergency procedures, using a limited amount of equipment to perform a primary assessment and intervention while awaiting arrival of emergency medical service (EMS) personnel. 

Patients with incomplete responses should contact their health care provider immediately for instructions, while those with a poor response should proceed directly to the emergency department.1 In the emergency department, baseline PEF measurements and oxygen saturation should be monitored. PEF should be monitored before and 15 to 20 minutes after bronchodilator administration. Treatment should be initiated as soon as lung function is assessed (Fig. 11-3). Dosages for emergency department and hospital use of quick relief medications are shown in Table 11-5. 

With symptom-triggered therapy, medication is given only if symptoms emerge, resulting in shorter treatment duration, and avoidance of over sedation. A typical regimen would be lorazepam 2 mg administered every hour as needed when a structured assessment scale (e.g., Clinical Institute Withdrawal Assessment-Alcohol, Revised) indicates that symptoms are moderate to severe. Current guidelines recommend such individualized therapy over fixed-schedule therapy. 

The cocaine addict most often presents during withdrawal after a binge of cocaine use. Cocaine withdrawal is not life threatening and does not require medical intervention in the same sense as alcohol or opiate withdrawal. It is, however, associated with a profound depression that can render the addict suicidal for 24-48 hours. The crashing cocaine addict should be assessed for suicide risk and, if indicated, the patient should be monitored in an emergency psychiatric setting or may require a brief 1-2 day inpatient psychiatric admission until the withdrawal resolves and the suicide risk is relieved. 

Because of the risk of suicide, patients should be carefully assessed for suicidal ideation and risk from the beginning of treatment. Most suicide attempts occur within 2 months of beginning of treatment. This justifies the use of drags that carry a low risk in overdose, since most patients attempt suicide with their own medication in patients who are already suicidal. But some of these same drags may lead to the emergence of agitation and suici-dality in patients who at baseline appeared well. 

Ascertainment of treatment-emergent side effects requires a baseline symptom assessment before treatment is begun and at regular intervals thereafter. An ideal way to monitor side effects is to use medication-specific side effect scales that are designed for a particular drug class. These combine physical and behavioral symptoms with information obtained from the medical evaluation of the patient. Rating scales may help differentiate treatment-emergent side effects from an exacerbation of a symptom present at baseline, or from other causes of physical or behavioral symptoms. They may also help the family and the child accurately identify and label these side effects and then discuss them with the physician. 

Pelham, W.E. (1989). Behavior therapy, behavioral assessment, and psychostimulant medication in the treatment of attention deficit disorders an interactive approach. In Swanson, J. and Bloomingdale, L., eds. Attention Deficit Disorders (IV) Current Concepts and Emerging Trends in Emotional and Behavioral Disorders of Childhood. London Pergamon Press, pp. 169— 195. 

Medical assessment of the injured victims was headed by an experienced surgeon, Head of the Surgical Department of Emergency Surgery. Doctors of all specialties were involved with medical assessment. Every injured patient was personally supervised by an assigned doctor starting from the time when the patient was admitted to the operating theatre. 

Most of the studies that have been done with antidepressants are limited to TCAs and SSRIs, most likely reflecting the fact that these medications are widely used (511, 512). The good news is that these studies have not detected an obvious increased risk of major structural anomalies. The cautionary note is that most of these studies assess the child immediately after birth and thus are insensitive to detecting neurodevelopmental problems that may only emerge after longer periods of time (e.g., learning or behavioral problems). 

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