34 Critical Care Emergencies
CRITICAL-CARE AREAS DRUG INFUSION GUIDELINES11 Criteria for neurosurgical consultation:
Refer all the following patients to the neurosurgery team:
(i) Coma continues after resuscitation (GCS <9).
(ii) Deterioration in neurological status, e.g. worsening in conscious
state (2 points or more decrease in GCS), seizures, increasing
headache, focal neurological signs.
(iii) Skull fracture:
(a) compound depressed fracture
(b) basal skull fracture (see p. 397)
(c) any skull fracture with confusion, decreased level of
consciousness or focal neurological signs.
(iv) Penetrating head injury.
(v) Confusion or other neurological disturbance (GCS 9–13) for
more than 2 h with no defined skull fracture.
(vi) Radiological abnormality on CT head scan.
12 Stabilize the patient’s condition first and make sure any associated injuries
have been dea lt wit h before transferring t he patient, if transfer is necessar y.
(i) The transport team must be trained and suitably experienced and
carry appropriate monitoring equipment (see p. 456).
13 Refer all other patients for admission under the care of the surgical team.These infusion guidelines were developed for use in critical care areas only. Most
require close monitoring with titration to response, and are thus inappropriate
for general ward areas. All calculations assume an adult weight of 70–80 kg.
Paediatric resuscitation drug doses are available in Figure 11.1 (p. 338) and Table
11.4 (p. 345) in Section XI, Paediatric Emergencies.
Other paediatric doses are available in any paediatric formulary.
Readers are strongly advised to re-check all doses with another medical person
before commencing therapy.