By Graham Robert Nimmo
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Extra info for Adult Medical Emergencies Handbook
6. Collect urine for next 24 hours for evidence of haemolysis and send to laboratory. 7. If clinical improvement, restart transfusion slowly with new blood unit and observe carefully. 8. If no clinical improvement within 5-10 minutes or if signs and symptoms worsen, treat as Category 3 and ensure help is coming.
Treatment • The management of cardiogenic, hypovolaemic or septic shock unresponsive to the above measures can be very difficult. • Tracheal intubation and ventilation, vasoactive drug therapy, invasive haemodynamic monitoring or mechanical circulatory support may be required. • In acute coronary syndromes PCI, thrombolysis, or other interventions may be needed. • Persisting hypotension with impaired organ perfusion despite supplemental oxygen and correction of volume status may necessitate vaso-active drug support.
Monitoring is an integral part of the treatment/re-assessment/ treatment/re-assessment loop. • The place of urgent investigation is detailed previously. • In order to make a definitive diagnosis specific blood tests or imaging techniques may be required. g. to x-ray until stabilised, and then only with adequate support, vascular access, monitoring and appropriate escort. Assessment and re-assessment Assess response to treatment by continuous clinical observation, repeated assessment of airway, breathing, circulation and disability (conscious level) as above with uninterrupted monitoring of ECG and oxygen saturation.