By Lisa Carroll
This ebook offers Nurse Practitioners operating within the box of Acute medication with an up-to-the-minute, useful, and accomplished advisor to the administration of acute scientific sufferers. It serves as a textual content from which the busy hugely expert nurse can receive details on overview, prognosis, and administration of acute health conditions. It identifies priorities for therapy and publications the reader during the administration of the sufferer. at any place attainable the most recent released directions were integrated. the ultimate bankruptcy of the booklet considers the felony, expert and moral concerns confronted through nurses operating at a sophisticated point. the problems of position improvement, the improvement of protocols and prescribing are thought of.
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Additional resources for Acute Medicine A Handbook for Nurse Practitioners
Note the different strengths of adrenaline that may be required for IV use. If adults are treated with an adrenaline auto-injector, the 300 micrograms will usually be sufficient. A second dose may be required. Half doses of adrenaline may be safer for patients on amitriptylline, imipramine or beta blocker. A crystalloid may be safer than a colloid. 1. Anaphylaxis treatment algorithm. Reproduced with kind permission of the Resuscitation Council UK. 31 r If the patient is unresponsive – open airway, using head tilt and chin lift.
The usual signs of tamponade are distended neck veins and hypotension. These are absent during cardiac arrest. A tamponade should be suspected if there is a history of chest trauma. Treatment is needle pericardiocentesis, which requires expert assistance. Toxic Substances History may lead you to suspect that toxic substances are a cause of cardiac arrest. If you know what the toxin is give the antidote. uk – see Chapter 3 for more information). Some common toxins and their antidotes are: r paracetamol – N-acetylcysteine r digoxin – digoxin specific FAB antibodies r benzodiazepines – flumazenil r opioids – naloxone r tricyclics – consider administering sodium bicarbonate intravenously r beta blockers – glucagon Thromboembolism The most common cause is pulmonary embolism.
The severity of toxicity cannot be assessed on the plasma salicylate level alone but aids assessment. r Salicylate toxicity is usually associated with plasma concentrations >350 mg/l (Toxbase 2005). r Most adult deaths occur in patients whose plasma concentration exceeds 700 mg/l (Toxbase 2005). Severe poisoning is indicated if the patient has: r confusion r impaired consciousness r metabolic acidosis r high salicylate plasma concentration Risk factors for death are: r patient over 70 years of age r central nervous system features r acidosis r hyperpyrexia r late presentation following ingestion r pulmonary oedema r plasma salicylate concentration >700 mg/L ASSESSMENT AND INVESTIGATION SPECIFIC TO ASPIRIN OVERDOSE r Obtain salicylate levels at least two hours after ingestion as peak plasma concenr r r r trations will not occur before this time.