[...]... body system affected (Table 1. 1) 3 ACUTE MEDICAL EMERGENCIES: THE PRACTICAL APPROACH Table 1. 1 Classification of medical emergencies Type % Cardiac Respiratory Neurological Gastrointestinal 29 26 21 13 This information may be broken down further to reveal the common reasons for admission: ● ● ● ● ● ● myocardial infarction stroke cardiac failure acute exacerbation of asthma acute exacerbation of chronic... junior doctors’ hours; and increase medical specialisation There is an annual increase of emergency admissions in excess of 5% and they account for over 40% of all acute National Health Service beds In the UK the mean hospital bed complement is 6 41, but only 18 6 are allocated for medical patients with an average 95% of these housing medical emergencies The common acute conditions can be broadly classified... Left Blank Reading: 15 minutes CHAPTER 1 Introduction INTRODUCTION After reading this chapter you will understand: ● the current problems in the assessment of acute medical emergencies ● the need for a structured approach to the medical patient THE PROBLEM A medical emergency can arise in any patient, under a variety of circumstances, for example: ● ● ● ● a previously fit individual acute on chronic illness... traditional fashion 5 ACUTE MEDICAL EMERGENCIES: THE PRACTICAL APPROACH The key principles of MedicALS are shown in the box Key principles of MedicALS ● ● ● ● Do no further harm Focused knowledge and basic skills are essential A structured approach will identify problems and prioritise management Prompt accurate assessment improves patient outcome SUMMARY The number and complexity of acute medical emergencies. .. components will be discussed in detail in Part II 11 This Page Intentionally Left Blank PART II STRUCTURED APPROACH This Page Intentionally Left Blank Reading: 30 minutes CHAPTER 3 A structured approach to medical emergencies OBJECTIVES After reading this chapter you will be able to describe the: ● correct sequence of priorities to be followed when assessing an acutely ill medical patient ● primary and secondary... Obeys commands Localises pain Withdraws from pain Abnormal flexion Abnormal extension Nil Verbal response Orientated Confused Inappropriate words Incomprehensible sounds Nil Score 4 3 2 1 6 5 4 3 2 1 5 4 3 2 1 19 ACUTE MEDICAL EMERGENCIES: THE PRACTICAL APPROACH In the presence of any neurological dysfunction, assessment of the serum glucose is necessary If the result is not immediately available then a... comprehensive neurological examination is rarely required in the acutely ill patient A screening examination of the nervous system can be accomplished as follows 1 Assess the conscious state using the Glasgow Coma Scale 2 A Mini Mental State Examination (See box below) 23 ACUTE MEDICAL EMERGENCIES: THE PRACTICAL APPROACH Abbreviated mental-status examination 1 Age 2 Time (to nearest hour) 3 Address for recall at... 3 .1 After reading the case history, answer the following question: A 54 year old man is admitted to hospital because of an acute onset of confusion Briefly describe your primary assessment of this patient SUMMARY ● The aim of the primary assessment is to identify and treat immediately life threatening conditions ● In most medical patients this can be done rapidly from the end of the bed 21 ACUTE MEDICAL. .. diagnosis of a lethal condition Most acutely ill medical patients (approximately 75%) do not have an immediately life threatening problem However, a rapid primary assessment is still required The primary assessment should be repeated following any deterioration in the patient’s condition so that appropriate resuscitative measures can be commenced immediately 15 ACUTE MEDICAL EMERGENCIES: THE PRACTICAL APPROACH... etc) 7 Date of birth (day and month sufficient) 8 Year of World War I 9 Name of present Monarch 10 Count backwards 20 1 Each correct answer scores one mark Healthy people score 8 10 Source: Qureshi KN, Hodkinson HM Evaluation of a ten-question mental test in the institutionalized elderly Age and Ageing 19 74; 3: 15 2–7 3 Examine the external ocular movements for diplopia, nystagmus or fatiguability Elicit . their on-going support and invaluable assistance in the production of this text. x 00-AcuteMed-Prelims-cpp 28/9/2000 3 :13 pm Page x PART I INTRODUCTION 0 1- AcuteMed -1 - cpp 28/9/2000 3:23 pm Page 1 This. system affected (Table 1. 1). Key point Inappropriate action costs lives 3 Reading: 15 minutes 0 1- AcuteMed -1 - cpp 28/9/2000 3:23 pm Page 3 Table 1. 1. Classification of medical emergencies This information. pain 13 7 Chapter 11 The patient with altered conscious level 14 7 Chapter 12 The collapsed patient 17 1 Chapter 13 The overdose patient 18 5 Chapter 14 The patient with a headache 19 3 Chapter 15 The