1st Edition

Care Bundles in Emergency Medicine

By Timothy Williamson, Bilal Salman Copyright 2014

    A care bundle is a group of specific, non-prescriptive, evidence-based components that, when performed collectively and reliably, have been established to improve patient outcomes. Emergency medicine care bundles support healthcare professionals in providing focused management plans for common presentations. They are explicitly focused on the initial intervention and are specific to the resuscitation and management that precedes in patient care. Care bundles are fundamental to enabling a quick, well-defined response from the emergency care team, whose actions can make a vital difference to a patient's long-term outcome from the first few steps of treatment. Invaluable to both trainees and consultants, Care Bundles in Emergency Medicine uses the specific approach propagated by the Institute for Healthcare Improvement. It is concise yet highly detailed, making use of bullets, ideal for rapid, everyday reference. Each presentation lists the specific care bundle, additional information and considerations if required, and a concluding overview to reinforce key concepts.

    Foreword vi Preface vii Abbreviations viii The universal care bundle 1 1 Trauma 3 o Head injury (GCS score <15) 4 o Concussion or minor head injury (GCS score = 15) 6 o Cervical spine injury 8 o Soft tissue neck injury (whiplash) 10 o Dislocation (overview) 11 o Shoulder dislocation 12 o Fractured pelvis 13 o Fractured neck of femur 15 o Fractured ankle 17 o Fractured scaphoid 19 o Fractured distal radius 20 o Sprain or strain 21 o Laceration 22 2 Medical emergencies 25 o ST elevation myocardial infarction (STEMI) 26 o Acute coronary syndrome 28 o Acute heart failure or pulmonary oedema 29 o Tachycardia 30 o Bradycardia 31 o Post.cardiac arrest care 33 o Asthma 34 o Community-a cquired pneumonia 36 o Pneumothorax 37 o Deep vein thrombosis 38 o Pulmonary embolus 40 o Chronic obstructive pulmonary disease 42 o Type 1 respiratory failure 44 o Type 2 respiratory failure 45 o Gastrointestinal haemorrhage (upper) 47 o Headache (general management) 49 o Seizure and status epilepticus 51 o Stroke 53 o Transient ischaemic attack 55 o Subarachnoid haemorrhage 57 o Meningitis 59 o Acute renal failure 61 o Urinary tract infection 63 o Diabetic ketoacidosis 65 o Hyperglycaemic hyperosmolar non-k etosis 66 o Hypoglycaemia 67 o Altered level of consciousness or coma 69 o Sepsis 71 o Disseminated intravascular coagulation 72 o Anaphylaxis 73 o Hypothermia 75 3 Surgical emergencies 79 o Septic joint 80 o Acute lower back pain (atraumatic) 81 o Spinal cord compression 82 o Testicular torsion 83 o Aortic dissection 84 o Limb ischaemia 85 o Appendicitis 86 o Acute pancreatitis 87 o Acute cholecystitis 89 o Renal colic 90 o Gastrointestinal haemorrhage (lower) 91 o Intestinal obstruction 92 o Acute urinary retention 93 o Shock 94 4 Women and children fs health 97 Women 98 o Ectopic pregnancy 98 o Vaginal bleeding in pregnancy 99 Children 101 o Croup 101 o Bronchiolitis 103 o Asthma: age 2.5 years 104 o Asthma: age >5 years 107 o Febrile child 110 o Apnoea 113 o Status epilepticus 114 o Pulled elbow (subluxation of the radial head) 116 5 Elderly care and bereavement 119 o Frail elderly discharge 120 o Bereavement care 121 6 Mental health emergencies 123 o Deliberate self- harm 124 o Poisoning 125 o Alcohol intoxication 127 o Alcohol withdrawal 129 o Substance misuse 131 o Panic or anxiety 132 o Acute psychosis 133 Index 135

    Biography

    Bilal Salman, Timothy Williamson