Adult critical care nursing KB

va ua 411040 Surgeon Vice AdmiralManish Honwad, VSM Armed Forces Medical College Director & Commandant Pune - 411 040 24332 ASCON : 7040 (0) Mob. 9930621135 NIC Mail : honwad.ms@navy.gov.in Gmail : coladm88@gmail.com(0) MESSAGE 1. The quality of a healthcare institution is reflected not only in its clinical services but also in its commitment to learning, innovation, and the continuous development of its human resources. In an ever-evolving healthcare environment, nursing professionals must be equipped to translate scientific knowledge into sound clinical decisions and deliver care that is safe, timely, and responsive to the needs of every patient. 2: The development of this handbook on emergency protocols represents a constructive effort to strengthen the practical preparedness of nursing personnel. By bringing together clearly organized guidelines and decision-making algorithms, this resource Aims to support a systematic approach to emergencies, where timely assessment, appropriate action, and continuous evaluation are integral to patient management. 3. Medical emergencies often demand coordinated action within a limited time frame. A well-prepared nursing professional must be able to recognize warning signs, anticipate complications, communicate effectively with the multidisciplinary team, and maintain composure in challenging circumstances. These capabilities are strengthened through structured learning, simulation-based training, regular practice, and adherence to established clinical standard. 4. As an institution dedicated to medical education and professional development, AFMC recognizes the importance of resources that connect academic learning with clinical responsibilities. | appreciate the initiative undertaken by the team in developing this handbook and acknowledge their efforts in creating a resource that can support teaching, learning and clinical preparedness. 5. | hope this publication will encourage nursing professionals to pursue continuous improvement, strengthen their clinical reasoning, and approach emergency situations with confidence, discipline, and a strong sense of responsibility. May it also serve as a valuable aid for nursing students and educators in fostering a culture of patient safety, teamwork and professional excellence. 6. | extend my best wishes to the editorial team and all contributors for their dedication to this endeavor. | trust that this initiative will make a meaningful contribution to nursing education and the delivery of quality healthcare. Place : Pune (Manish Honwad) Date : Oct 2026 Surgeon Vice Admiral Director & Commandant 2 1

1hR ~~<M ~m, cit~~'iA~ '3t{ 'cliq1uiz /flen &'edJ Of/&'r;d( MD (Obs & Gyn), M Phil Dean & Deputy Commandant MESSEGE ft:liel ff.lfa\m, q81fatJ1H4 - 411040. Armed Forces Medical College Pune 411040. Tele. : Mil 7049 (0) 7315 (R) Mob. : 7791908624,8390433228 Email : docatulseth@yahoo.com 1. The advancement of healthcare depends on the integration of scientific knowledge, clinical expertise, and a sustained commitment to improving patient outcomes. Within this endeavor, nursing professionals occupy a vital position, translating clinical evidence into practice while ensuring that patients receive timely, compassionate, and competent care. 2. Emergency management is an essential component of professional nursing practice, requiring the ability to recognize clinical warning signs, interpret patient findings, establish priorities, and initiate appropriate measures without unnecessary delay. The development of a structured reference handbook dedicated to emergency protocols is therefore a valuable academic initiative that supports the application of knowledge in demanding clinical situations. 3. A well-designed clinical algorithm can assist ~ealthcare professionals in following a logical sequence of actions, reducing uncertainty during critical events and promoting consistency in patient management. However, effective implementation also depends on clinical reasoning, professional judgement,. familiarity with institutional protocols, and the ability to work collaboratively within a multidisciplinary team. 4. From an academic perspective, resource of this nature provide an opportunity to strengthen the connection between classroom instruction, skills laboratory training, and clinical experience. They can facilitate independent learning, support competency-based education, and encourage nursing students and practitioners to remain updated with evolving standards of healthcare practice.5. I congratulate the team involved in conceptualizing and preparing this handbook. The initiative reflects the importance of developing educational resources that are practical, ~ccessible and relevant to the responsibiliti~s of nursing professionals. I hope this work will inspire further academic engagement, promote reflective clinical practice, and contribute to the development of confident and competent healthcare practitioners. May this publication serve as a useful companion for nurse educators, students, and practicing professionals, reinforcing the principles of lifelong learning, patient-centered care, and professional accountability. 6. I extend my sincere wishes to all contributors for the successful dissemination and effective utilization of this resource in nursing education and clinical practice. Place : Pune Date :bt--Nov202 Jai Hind! (Atu Seth) Major General Dean & Dy Commandant 2

Var Maj Gen Rachel Thomas vat ADG MNS Ao. 331, Tele : 011-2141 1788 (Off) ASCON :33998 Integrated HQ of MoD (Army) 38479 (Res) Adjutant General's Branch Dte Gen Medical Services (Army) Quality.2015@nic.in DGMS-4, Defence Offices Complex No. 331, 'A' Block, 3rd Floor Kasturba Gandhi Marg, New Delhi-110001 MESSAGE 1: Military Nursing Service officers, through successive generations, have stood as an unwavering pillar of quality patient care within the Armed Forces Medical Services. The dynamic and high-acuity nature of clinical practice demands sound clinical judgment, prompt recognition of emergencies and timely intervention to ensure patient safety and optimal outcome. 2. This handbook is a valuable compilation of systematic approaches and clinical algorithms designed to support nursing professionals in the management of emergencies. The clear and practical presentation of protocols provides a useful framework for rapid decision-making while reinforcing the principles of patient safety, prioritization, teamwork and evidence-based practice. 3. | commend the efforts of the contributors, reviewers and Organising team for developing this practical and clinically relevant resource. Their commitment to professional excellence and continuous learning reflects the enduring value and commitment to delivering high-quality patient care. 4. | am confident that this handbook will serve as a useful reference for Nursing Officers, educators and healthcare professionals in strengthening their emergency nursing competencies and translating clinical knowledge into timely and effective patient care. 5. | extend my sincere appreciation to all those associated with this endeavour and wish the publication every success. Jai Hind! Place: New Delhi (Rachel Thomas) Maj Gen Dated: .2\ Oct 2026 ADGMNS 4 3

ar fort Bar GANG Brig Kjron Jeet Brg MNS (P&T) 7 318 ASCON : 35000 arf, Dte Gen of Medical Services (Army) Adjutant Branch Integrated HQ of MoD (Army) Defence Offices Complex Block, 3rd Floor, Room No. 318 KG Marg, New Dethi-110001 MESSAGE 1. The strength of the Military Nursing Service lies in its unwavering dedication to patient welfare, professional integrity and the highest standards of clinical practice. As healthcare continues to advance, nursing professionals must remain adaptable,vigilant and proficient in applying their knowledge to complex clinical situations, particularly when timely decisions are critical to patient survival and recovery. 2. The preparation of this handbook on emergency protocols is a purposeful initiative towards promoting a systematic and disciplined approach to emergency nursing care. By presenting clinical procedures and decision-making pathways in an organized manner, this resource can assist nursing officers in recognizing priorities, initiating appropriate interventions and coordinating care effectively during time sensitive situations. I appreciate the dedication of the responsibility of compiling this handbook. The to professional development and the of that can be applied across diverse clinical initiatives also reinforce the importance of standardization, accountability learning among nursing fraternity. 4. I encourage Nursing officers, educators and students to utilize this publication as a reference for strengthening their emergency management skills and refining their clinical judgement. May it motivate every reader to remain prepared for unforeseen challenges, uphold professional standards and place patient safety and the centre of every intervention. 5. I convey my sincere appreciation to all contributors and extend my best wishes for the successful use of this handbook in nursing education, clinical training and patient care. Jai Hind....! i (KironPlace: New Delhi Brig 2026 Brig MNS (P&T) 5 4

. Briy V qtr - 411 040. College of Nursing Principal Armed Forces Medical College Pune - 411 040. Mob.: 9699808069, 9435785254 E-mail : sugirtha_sudarsan@yahoo.co.in Nursing excellence is founded upon the integration of knowledge, skill, discipline and sound professional judgement. Equally important are effective teamwork, clear communication, adaptability and a commitment to lifelong learning. The ability to translate classroom learning into appropriate bedside interventions is what truly defines competent nursing practice. With the growing complexity of healthcare needs, the importance of structured emergency management and standardised clinical practices cannot be overstated. This handbook is a thoughtful academic initiative aimed at bringing together essential clinical information, practical guidelines and systematic approaches to emergency care. It is intended to provide nursing professionals with a reliable reference that can support their clinical responsibilities and strengthen their preparedness for unforeseen situations. As an institution committed to nurturing competent, conscientious and professionally equipped nursing officers, | acknowledge with appreciation the collective efforts, dedication and academic contribution of the editorial team and everyone associated with bringing this handbook to fruition. The development of such an educational resource reflects the continued emphasis on professional growth, knowledge sharing and the pursuit of higher standards in nursing education and patient care. | trust that this handbook will find meaningful application in clinical settings and academic environments alike. May it encourage its readers to continually update their knowledge, strengthen their practical abilities and approach every clinical challenge with confidence, compassion and a strong sense of responsibility. | extend my sincere compliments to the entire team and wish this publication every success in its endeavour to contribute towards better nursing practices and quality patient care. Jai Hind! Place: Pune of Nursing Date: 03 Nov 2026 AFMG, Pune 6 5

Adult Critical Care Nursing Manual Editorial Committee Chief Editor Brig V Sugirtha Editorial Board Col Shiji K Nair Maj Kamala Jimiwal ADULT CRITICAL CARE NURSING MANUAL LtCol Hemalatha LtCol Kumud Dogra 6

Adult Critical Care Nursing Manual CONTRIBUTORS Maj Nimmy Ouseph RESPIRATORY Maj Arya Aravind Tutor, College of Nursing AFMC Pune College of Nursing AFMC Pune ORTHOPAEDIC Maj Bhavya Tutor, College of Nursing AFMC Pune Maj Surabhi College of Nursing AFMC Pune NEURO Maj Brighty Tutor, College of Nursing AFMC Pune Maj Saranya College of Nursing AFMC Pune CARDIAC Lt Col Arpita Dan Asst Prof, College of Nursing AFMC Pune Maj Jibila College of Nursing AFMC Pune ONCOLOGY Lt Col P Hemalatha Assoc Prof, College of Nursing AFMC Pune Maj Anisha College of Nursing AFMC Pune Maj Ramya College of Nursing AFMC Pune COLLEGE OF NURSING • AFMC PUNE 1 / 2 Maj Nimmy Ouseph COLLEGE OF NURSING • AFMC PUNE 7

Adult Critical Care Nursing Manual CONTRIBUTORS OBSTETRIC Lt Col Kumud Dogra Assoc Prof, College of Nursing AFMC Pune Maj Poonguzhali V College of Nursing AFMC Pune GENERAL MEDICINE & SURGERY Lt Col Rituparna Guha Assoc Prof, College of Nursing AFMC Pune Lt Col Ranjana Bhandari College of Nursing AFMC Pune PSYCHIATRIC Lt Col Mercy Jacob Asst Prof, College of Nursing AFMC Pune Maj Babita College of Nursing AFMC Pune MISCELLANEOUS Lt Col P Hemalatha Assoc Prof, College of Nursing AFMC Pune Maj Hima K College of Nursing AFMC Pune COLLEGE OF NURSING • AFMC PUNE 2 / 2COLLEGE OF NURSING • AFMC PUNE 8

CONTENTS Each chapter opens with its own topic list and page numbers. C H A P T E R 0 1 Respiratory 10–16 C H A P T E R 0 2 Oncology 17–27 C H A P T E R 0 3 Orthopaedic 28–32 C H A P T E R 0 4 CTVS - Cardiothoracic and Vascular Surgery 33–45 C H A P T E R 0 5 Neurology 46–56 C H A P T E R 0 6 General Medicine & Surgery 57–70 C H A P T E R 0 7 Psychiatric 71–74 C H A P T E R 0 8 Obstetrics & Gynaecology 75–83 C H A P T E R 0 9 Miscellaneous 84–95 A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 9

C H A P T E R 0 1 RESPIRATORY M A N A G E M E N T A L G O R I T H M S TOPICS IN THIS SECTION P A G E 01 Acute asthma exacerbation 11 02 Acute exacerbation of COPD (AECOPD) & nursing management 12–13 03 Acute respiratory distress syndrome (ARDS) 14 04 Pulmonary oedema 15 05 Pneumothorax 16 A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 10

R E S P I R A T O R Y REFERENCES 1. Global Initiative for Asthma. Global strategy for asthma management and prevention. 2026 report. Fontana (WI): Global Initiative for Asthma; 2026. 2. American Thoracic Society. An official American Thoracic Society clinical practice guideline: noninvasive ventilation for acute respiratory failure. Am J Respir Crit Care Med. American Thoracic Society; 2021. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 11

R E S P I R A T O R Y REFERENCES 1. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the prevention, diagnosis, and management of COPD: 2025 report. GOLD; 2025. 2. European Respiratory Society. European Respiratory Society guideline on the management of COPD exacerbations. Lausanne: European Respiratory Society; 2023. 3. National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. NICE guideline NG115. London: NICE; updated 2023. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 12

R E S P I R A T O R Y REFERENCES 1. Matthay MA, Arabi Y, Arroliga AC, Bernard GR, Bersten AD, Brochard LJ, et al. A new global definition of acute respiratory distress syndrome. Am J Respir Crit Care Med. 2024;209:37-47. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 14

R E S P I R A T O R Y REFERENCES 1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2023 focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023;44(37):3627-39. doi:10.1093/eurheartj/ehad195. 2. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. Circulation. 2022;145(18):e895-e1032. doi:10.1161/CIR.0000000000001063. 3. American Thoracic Society. An official American Thoracic Society clinical practice guideline: noninvasive ventilation for acute respiratory failure. Am J Respir Crit Care Med. American Thoracic Society; 2021. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 15

R E S P I R A T O R Y REFERENCES 1. Roberts ME, Rahman NM, Maskell NA, Bibby AC, Blyth KG, Corcoran JP, et al. British Thoracic Society guideline for pleural disease. Thorax. 2023;78(11):1143-56. doi:10.1136/thorax-2023-220304. 2. American Thoracic Society. An official American Thoracic Society clinical practice guideline: noninvasive ventilation for acute respiratory failure. Am J Respir Crit Care Med. American Thoracic Society; 2021. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 16

C H A P T E R 0 2 ONCOLOGY M A N A G E M E N T A L G O R I T H M S TOPICS IN THIS SECTION P A G E 01 Febrile neutropenia in adults with cancer 18 02 Tumour lysis syndrome (TLS) 19 03 Disseminated intravascular coagulation (DIC) in cancer 20 04 Cardiac tamponade in cancer 21 05 Superior vena cava (SVC) obstruction 22 06 Extravasation of chemotherapy 23 07 Carotid blowout syndrome 24 08 Malignant spinal cord compression (MSCC) 25 09 SIADH 26 10 Hypercalcaemia in cancer 27 A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 17

O N C O L O G Y REFERENCES 1. ASCO. White Blood Cell Growth Factors: Guideline Update. J Clin Oncol. ASCO; 2025. 2. ESMO. Management of febrile neutropenia in patients with cancer. ESMO; 2023. 3. European Society for Medical Oncology. ESMO clinical practice guidelines: management of cancer-related emergencies. Lugano: ESMO; 2024. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 18

O N C O L O G Y REFERENCES 1. British Society for Haematology. Tumour lysis syndrome: prevention and management guidance. British Society for Haematology; 2023. 2. Coiffier B, et al. Evidence-based recommendations for tumour lysis syndrome: contemporary update. Coiffier B, et al; 2022. 3. European Society for Medical Oncology. ESMO clinical practice guidelines: management of cancer-related emergencies. Lugano: ESMO; 2024. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 19

O N C O L O G Y REFERENCES 1. Levi M, et al. Disseminated intravascular coagulation: current guidance and management. Levi M, et al; 2022. 2. ISTH. Guidance on diagnosis and management of disseminated intravascular coagulation. ISTH; 2024. 3. European Society for Medical Oncology. ESMO clinical practice guidelines: management of cancer-related emergencies. Lugano: ESMO; 2024. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 20

O N C O L O G Y REFERENCES 1. ESC. Guidelines for the management of pericardial diseases. ESC; 2025. 2. Klein AL, et al. Contemporary diagnosis and management of pericardial effusion and tamponade. Klein AL, et al; 2022. 3. European Society for Medical Oncology. ESMO clinical practice guidelines: management of cancer-related emergencies. Lugano: ESMO; 2024. 4. ESC. Guidelines for the diagnosis and management of pericardial diseases. Eur Heart J. 2015;36:2921. 5. Harrison’s Principles of Internal Medicine. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 21

O N C O L O G Y REFERENCES 1. National Institute for Health and Care Excellence. Spinal metastases and metastatic spinal cord compression. NICE guideline NG234. London: NICE; 2023. 2. ESMO. Management of oncological emergencies in cancer patients. ESMO; 2023. 3. European Society for Medical Oncology. ESMO clinical practice guidelines: management of cancer-related emergencies. Lugano: ESMO; 2024. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 22

O N C O L O G Y REFERENCES 1. ESMO-EONS. Management of chemotherapy extravasation: clinical practice recommendations. ESMO-EONS; 2024. 2. ONS. Safe handling and administration of antineoplastic therapies. ONS; 2024. 3. European Society for Medical Oncology. ESMO clinical practice guidelines: management of cancer-related emergencies. Lugano: ESMO; 2024. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 23

O N C O L O G Y REFERENCES 1. ESMO. Management of oncological emergencies in cancer patients. ESMO; 2023. 2. National Institute for Health and Care Excellence. Suspected cancer: recognition and referral. NICE guideline NG12. London: NICE; updated 2023. 3. European Society for Medical Oncology. ESMO clinical practice guidelines: management of cancer-related emergencies. Lugano: ESMO; 2024. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 24

O N C O L O G Y REFERENCES 1. National Institute for Health and Care Excellence. Spinal metastases and metastatic spinal cord compression. NICE guideline NG234. London: NICE; 2023. 2. National Institute for Health and Care Excellence. Brain tumours (primary) and brain metastases in over 16s. NICE guideline NG99. London: NICE; updated 2022. 3. European Society for Medical Oncology. ESMO clinical practice guidelines: management of cancer-related emergencies. Lugano: ESMO; 2024. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 25

O N C O L O G Y REFERENCES 1. Spasovski G, et al. Hyponatraemia treatment standard: contemporary recommendations. Spasovski G, et al; 2022. 2. European Society of Endocrinology. Clinical practice guidance on hyponatraemia. European Society of Endocrinology; 2023. 3. European Society for Medical Oncology. ESMO clinical practice guidelines: management of cancer-related emergencies. Lugano: ESMO; 2024. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 26

O N C O L O G Y REFERENCES 1. ESMO. Management of oncological emergencies in cancer patients. ESMO; 2023. 2. European Society for Medical Oncology. ESMO clinical practice guidelines: management of cancer-related emergencies. Lugano: ESMO; 2024. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 27

C H A P T E R 0 3 ORTHOPAEDIC M A N A G E M E N T A L G O R I T H M S TOPICS IN THIS SECTION P A G E 01 Acute compartment syndrome 29–30 02 Fat embolism syndrome 31–32 A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 28

O R T H O P A E D I C REFERENCES 1. American Academy of Orthopaedic Surgeons. Management of acute compartment syndrome: clinical practice guideline. Rosemont (IL): AAOS; 2021. 2. British Orthopaedic Association. BOAST: diagnosis and management of compartment syndrome. London: British Orthopaedic Association; 2024. 3. National Institute for Health and Care Excellence. Fractures (complex): assessment and management. NICE guideline NG37. London: NICE; updated 2022. 4. Lippincott Williams & Wilkins. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 29

O R T H O P A E D I C REFERENCES 1. American Academy of Orthopaedic Surgeons. Management of acute compartment syndrome: clinical practice guideline. Rosemont (IL): AAOS; 2021. 2. British Orthopaedic Association. BOAST: diagnosis and management of compartment syndrome. London: British Orthopaedic Association; 2024. 3. National Institute for Health and Care Excellence. Fractures (complex): assessment and management. NICE guideline NG37. London: NICE; updated 2022. 4. American Academy of Orthopaedic Surgeons (AAOS). Management of Acute Compartment Syndrome: Evidence-Based Clinical Practice Guideline. Published November 18, 2025. Available at: aaos.org/acs2025cpg. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 30

O R T H O P A E D I C REFERENCES 1. AABB. Clinical practice guidance for transfusion and trauma-associated coagulopathy. AABB; 2023. 2. Orthopaedic Trauma Association. Fat Embolism Syndrome: contemporary review and management. Orthopaedic Trauma Association; 2022. 3. National Institute for Health and Care Excellence. Fractures (complex): assessment and management. NICE guideline NG37. London: NICE; updated 2022. 4. American Academy of Orthopaedic Surgeons (AAOS). Management of Acute Compartment Syndrome: Evidence-Based Clinical Practice Guideline. Published November 18, 2025. Available at: aaos.org/acs2025cpg. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 31

C H A P T E R 0 4 CTVS M A N A G E M E N T A L G O R I T H M S TOPICS IN THIS SECTION P A G E 01 Acute coronary syndrome (ACS) 34–35 02 Tachyarrhythmia management (with pulse) 36–37 03 Acute heart failure: assessment and management 38–39 04 Cardiac tamponade management 40–41 05 Advanced cardiovascular life support (ACLS) 42–43 06 Atrioventricular (AV) block management 44–45 A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 33

C T V S REFERENCES 1. Rao SV, O'Donoghue ML, Ruel M, Rab T, Tamis-Holland JE, Alexander JH, et al. 2025 ACC/AHA guideline for the management of patients with acute coronary syndromes. Circulation. 2025;151(13):e771-e862. doi:10.1161/CIR.0000000000001309. 2. Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al. 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44(38):3720-826. doi:10.1093/eurheartj/ehad191. 3. American College of Cardiology; American Heart Association. Guideline for the evaluation and diagnosis of chest pain. J Am Coll Cardiol. American College of Cardiology; American Heart Association; 2021. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L REFERENCES 1. Braunwald E. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia: Elsevier; 2022. 2. Rao SV, O'Donoghue ML, Ruel M, Rab T, Tamis-Holland JE, Alexander JH, et al. 2025 ACC/AHA guideline for the management of patients with acute coronary syndromes. Circulation. 2025;151(13):e771-e862. doi:10.1161/CIR.0000000000001309. 3. Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al. 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44(38):3720-826. doi:10.1093/eurheartj/ehad191. 4. American College of Cardiology; American Heart Association. Guideline for the evaluation and diagnosis of chest pain. J Am Coll Cardiol. American College of Cardiology; American Heart Association; 2021. 34

C T V S REFERENCES 1. Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns HJGM, et al. 2024 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2024;45(36):3314-414. doi:10.1093/eurheartj/ehae176. 2. American College of Cardiology; American Heart Association. Guideline for the evaluation and diagnosis of chest pain. J Am Coll Cardiol. American College of Cardiology; American Heart Association; 2021. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L REFERENCES 1. Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay. J Am Coll Cardiol. 2019;74(7):e51-e156. 2. American Heart Association. 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(16_suppl_2):S366-S468. 3. Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Elsevier; 2022. 4. Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns HJGM, et al. 2024 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2024;45(36):3314-414. doi:10.1093/eurheartj/ehae176. 5. American College of Cardiology; American Heart Association. Guideline for the evaluation and diagnosis of chest pain. J Am Coll Cardiol. American College of Cardiology; American Heart Association; 2021. 36

C T V S REFERENCES 1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2023 focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023;44(37):3627-39. doi:10.1093/eurheartj/ehad195. 2. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. Circulation. 2022;145(18):e895-e1032. doi:10.1161/CIR.0000000000001063. 3. American College of Cardiology; American Heart Association. Guideline for the evaluation and diagnosis of chest pain. J Am Coll Cardiol. American College of Cardiology; American Heart Association; 2021. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L REFERENCES 1. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016;37(27):2129-2200. 2. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2023 focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023;44(37):3627-39. doi:10.1093/eurheartj/ehad195. 3. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. Circulation. 2022;145(18):e895-e1032. doi:10.1161/CIR.0000000000001063. 4. American College of Cardiology; American Heart Association. Guideline for the evaluation and diagnosis of chest pain. J Am Coll Cardiol. American College of Cardiology; American Heart Association; 2021. 38

C T V S REFERENCES 1. ESC. Guidelines for the management of pericardial diseases. ESC; 2025. 2. Klein AL, et al. Contemporary diagnosis and management of pericardial effusion and tamponade. Klein AL, et al; 2022. 3. American College of Cardiology; American Heart Association. Guideline for the evaluation and diagnosis of chest pain. J Am Coll Cardiol. American College of Cardiology; American Heart Association; 2021. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 40

C T V S REFERENCES 1. International Liaison Committee on Resuscitation. 2025 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation. 2025. 2. American College of Cardiology; American Heart Association. Guideline for the evaluation and diagnosis of chest pain. J Am Coll Cardiol. American College of Cardiology; American Heart Association; 2021. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L REFERENCES 1. American Heart Association. 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC). Dallas (TX): American Heart Association; 2025. 2. European Resuscitation Council. European Resuscitation Council Guidelines 2025: Adult Advanced Life Support. Resuscitation. 2025. 3. American Heart Association. Advanced Cardiovascular Life Support (ACLS) Provider Manual. 2025 Update. Dallas (TX): American Heart Association; 2025. 4. International Liaison Committee on Resuscitation. 2025 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation. 2025. 5. American College of Cardiology; American Heart Association. Guideline for the evaluation and diagnosis of chest pain. J Am Coll Cardiol. American College of Cardiology; American Heart Association; 2021. 43

C T V S REFERENCES 1. Kusumoto FM, et al. 2021 ACC/AHA Guideline for the Evaluation and Management of Bradycardia. Circulation. Kusumoto FM, et al; 2021. 2. American College of Cardiology; American Heart Association. Guideline for the evaluation and diagnosis of chest pain. J Am Coll Cardiol. American College of Cardiology; American Heart Association; 2021. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L REFERENCES 1. Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay. J Am Coll Cardiol. 2019;74(7):e51-e156. 2. Surawicz B, Knilans TK. Chou's Electrocardiography in Clinical Practice: A Simplified Approach. 7th ed. Elsevier; 2020. 3. Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Elsevier; 2022. 4. Kusumoto FM, et al. 2021 ACC/AHA Guideline for the Evaluation and Management of Bradycardia. Circulation. Kusumoto FM, et al; 2021. 5. American College of Cardiology; American Heart Association. Guideline for the evaluation and diagnosis of chest pain. J Am Coll Cardiol. American College of Cardiology; American Heart Association; 2021. 45

C H A P T E R 0 5 NEUROLOGY M A N A G E M E N T A L G O R I T H M S TOPICS IN THIS SECTION P A G E 01 Traumatic brain injury 47–48 02 NIH Stroke Scale (NIHSS) 49 03 Management of stroke 50 04 Status epilepticus 51–52 05 Acute meningitis 53–54 06 Sedation and medications for increased intracranial pressure 55 07 Management of increased intracranial pressure 56 08 Malignant spinal cord compression (MSCC): see Oncology 25 A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 46

N E U R O L O G Y REFERENCES 1. Carney N, et al. Guidelines for the Management of Severe Traumatic Brain Injury. Neurosurgery. 2023 update. 2. National Institute for Health and Care Excellence. Head injury: assessment and early management. NICE guideline NG232. London: NICE; 2023. 3. National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. NICE guideline NG128. London: NICE; updated 2022. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L REFERENCES 1. Brain Trauma Foundation. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2017;80(1):6-15. 2. Carney N, Totten AM, O'Reilly C, et al. Guidelines for the management of severe traumatic brain injury, fourth edition. J Neurotrauma. 2016;33(6):510-517. 3. Joseph B, Aziz H, Pandit V, et al. Diagnosis and management of traumatic brain injury: a review. BMJ. 2019;364:l152. 4. Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006;58(3 Suppl):S2-16. 5. Carney N, et al. Guidelines for the Management of Severe Traumatic Brain Injury. Neurosurgery. 2023 update. 6. National Institute for Health and Care Excellence. Head injury: assessment and early management. NICE guideline NG232. London: NICE; 2023. 7. National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. NICE guideline NG128. London: NICE; updated 2022. 47

N E U R O L O G Y REFERENCES 1. Powers WJ, et al. AHA/ASA Guidelines for the Early Management of Acute Ischemic Stroke. Stroke. Powers WJ, et al; 2021. 2. Greenberg SM, Ziai WC, Cordonnier C, Dowlatshahi D, Francis B, Goldstein JN, et al. 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage. Stroke. 2022;53(7):e282-e361. doi:10.1161/STR.0000000000000407. 3. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke. Stroke. 2021;52:e364-e467. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L REFERENCES 1. Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46-e110. 2. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2014;45(7):2160-2236. 3. Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870-947. 4. National Institute for Health and Care Excellence (NICE). Stroke and TIA in over 16s: diagnosis and initial management. NICE guideline [NG128]; 2020. 5. Greenberg SM, Ziai WC, Cordonnier C, Dowlatshahi D, Francis B, Goldstein JN, et al. 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage. Stroke. 2022;53(7):e282-e361. doi:10.1161/STR.0000000000000407. 6. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke. Stroke. 2021;52:e364-e467. 49

N E U R O L O G Y REFERENCES 1. World Health Organization. WHO guidelines on meningitis diagnosis, treatment and care. Geneva: World Health Organization; 2025. 2. Neurocritical Care Society. Status epilepticus management guidance. Neurocritical Care Society; 2023. 3. National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. NICE guideline NG128. London: NICE; updated 2022. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L REFERENCES 1. Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus - Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia. 2015;56(10):1515-1523. 2. Glauser T, Shinnar S, Gloss D, et al. Evidence-based guideline: Treatment of convulsive status epilepticus in children and adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016;16(1):48-61. 3. Brophy GM, Bell R, Claassen J, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17(1):3-23. 4. Zeiler FA, Teitelbaum J, Gillman LM, West M, Kaplan PW. Neurocritical care society pediatric status epilepticus guidelines. Neurocrit Care. 2020;32(1):175-203. 5. World Health Organization. WHO guidelines on meningitis diagnosis, treatment and care. Geneva: World Health Organization; 2025. 6. Neurocritical Care Society. Status epilepticus management guidance. Neurocritical Care Society; 2023. 7. National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. NICE guideline NG128. London: NICE; updated 2022. 51

N E U R O L O G Y REFERENCES 1. World Health Organization. WHO guidelines on meningitis diagnosis, treatment and care. Geneva: World Health Organization; 2025. 2. National Institute for Health and Care Excellence. Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management. London: NICE; 2024. 3. National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. NICE guideline NG128. London: NICE; updated 2022. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L REFERENCES 1. Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Scheld WM, et al. 2017 Infectious Diseases Society of America's clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin Infect Dis. 2017;64(6):e34-e65. 2. van de Beek D, Brouwer MC, Koedel U, van der Ende A, van de Beek D. Community-acquired bacterial meningitis. Nat Rev Dis Primers. 2021;7(1):23. 3. World Health Organization. WHO guidelines on meningitis diagnosis, treatment and care. Geneva: World Health Organization; 2025. 4. National Institute for Health and Care Excellence. Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management. London: NICE; 2024. 5. National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. NICE guideline NG128. London: NICE; updated 2022. 53

N E U R O L O G Y REFERENCES 1. Neurocritical Care Society. Guidelines for the Management of Severe Traumatic Brain Injury. Neurocritical Care Society; 2024. 2. National Institute for Health and Care Excellence. Head injury: assessment and early management. NICE guideline NG232. London: NICE; 2023. 3. National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. NICE guideline NG128. London: NICE; updated 2022. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L REFERENCES 1. Carney N, Totten AM, O'Reilly C, et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery. 2017;80(1):6-15. 2. Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons; et al. Guidelines for the Management of Severe Traumatic Brain Injury. J Neurotrauma. 2017;34(1):1-106. 3. Citerio G, Crippa IA, Bronco A, et al. Intensive Care Management of Patients with Acute Brain Injury: An Update. Minerva Anestesiol. 2020;86(9):972-988. 4. Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Guideline for Healthcare Professionals. Stroke. 2012;43(6):1711-1737. 5. Neurocritical Care Society. Guidelines for the Management of Severe Traumatic Brain Injury. Neurocritical Care Society; 2024. 6. National Institute for Health and Care Excellence. Head injury: assessment and early management. NICE guideline NG232. London: NICE; 2023. 7. National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. NICE guideline NG128. London: NICE; updated 2022. 55

C H A P T E R 0 6 GENERAL MEDICINE & SURGERY M A N A G E M E N T A L G O R I T H M S TOPICS IN THIS SECTION P A G E 01 Snakebite envenoming 58–60 02 Organophosphorus poisoning 61 03 Acute abdomen 62 04 Foreign body ingestion 63 05 Magnet ingestion 64 06 Sharp object ingestion 65 07 Oesophageal food impaction 66 08 Anaphylaxis 67 09 Septic shock 68 10 Management of sexual assault 69 11 SAFE kit: use and items required 70 A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 57

SNAKE BITE Snakebite Envenoming: The World Health Organization (WHO) defines snakebite envenoming as a potentially life- threatening disease caused by toxins injected from the bite of a venomous snake or through venom sprayed into the eyes Clinical syndromes of snakebite : Progressive weakness (neuroparalytic/neurotoxic), bleeding (vasculotoxic/haemotoxic), myotoxic and painful progressive Swelling Source: https://ncdc.mohfw.gov.in/uploads/pdf/Standard-Treatment-Guidelines-for-Management-of-Snake-Bite.pdf G E N E R A L M E D I C I N E & S U R G E R Y REFERENCES 1. WHO. Guidelines for the Management of Snakebites. 2nd ed. Regional Office for South-East Asia; 2023. 2. WHO. Snakebite envenoming: clinical management and prevention. WHO; 2024. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 58

Source: https://nirrch.res.in/wp-content/uploads/2023/10/Management-Flowchart.pdf G E N E R A L M E D I C I N E & S U R G E R Y REFERENCES 1. WHO. Guidelines for the Management of Snakebites. 2nd ed. Regional Office for South-East Asia; 2023. 2. WHO. Snakebite envenoming: clinical management and prevention. WHO; 2024. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 59

SNAKE BITE : KEY NOTES Anti Snake Venom Reaction Anaphylaxis can be of rapid onset and life-threatening, monitor closely after giving ASV Urticaria, itching, fever, chills, Nausea, vomiting, diarrhoea, abdominal cramps, Tachycardia, hypotension, bronchospasm and angio-oedema A second dose of 0.5 mg (0.01mg/kg) of adrenalin 1: 1000 iv is given. this can be repeated for a third and final occasion but in the vast majority of reactions, 2 doses of adrenaline will be sufficient If there is hypotension or hemodynamic instability, IV fluids should be given. Once the patient has recovered, the ASV can be restarted slowly for 10-15 minutes, keeping the patient under close observation. Then the normal drip rate should be resumed. At the first sign of any of these ASV to be discontinued give dose of 0.5 mg (0.01mg/kg) of adrenalin 1:1000 In case of Asthmatic symptoms, give Salbutamol bronchodilator.  After Adrenaline, give intravenous antihistamine anti-H1 blocker (e.g. Chlorphenamine maleate, adults 10 mg, children 0.2 mg/kg intravenously) and Hydrocortisone (adults 100 mg, children 2 mg/kg body weight).  Anaphylactic shock unresponsive to adrenaline is treated by laying patient supine, legs elevated, and giving intravenous volume replacement (0.9% saline, adults 1-2 litres rapidly).  Unresponsive Bronchospasm or Angioedema is treated with optimal nebulised/inhaled and/or parental bronchodilator and oxygen.  Late Serum sickness reactions occur after 5 to 7 days can be easily treated with an oral steroid such as prednisolone, adults 5 mg 6 hourly, paediatric dose 0.7 mg/kg/day. oral Antihistaminic provide additional symptomatic relief. G E N E R A L M E D I C I N E & S U R G E R Y REFERENCES 1. WHO. Guidelines for the Management of Snakebites. 2nd ed. Regional Office for South-East Asia; 2023. 2. WHO. Snakebite envenoming: clinical management and prevention. WHO; 2024. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 60

MANAGEMENT OF OP POISIONING: KEY NOTES Immediate Priorities (ABCDE Approach) • Ensure personal safety – wear gloves, mask, gown. • Remove patient from exposure. • Decontaminate skin by removing contaminated clothing and washing with soap and water. • Establish IV access with two large-bore cannulas. • Attach cardiac monitor and pulse oximeter. • Send blood samples as advised (ABG, electrolytes, glucose, cholinesterase if available. • Maintain Airway; suction excessive secretions. • Prepare for early intubation if airway is compromised. Signs of OP Poisoning Remember SLUDGE-M • S – Salivation • L – Lacrimation • U – Urination • D – Defecation/Diarrhea • G – Gastrointestinal cramps • E – Emesis (Vomiting) • M – Miosis (Pinpoint pupils) Other findings: • Bronchorrhea • Sweating • Bradycardia • Muscle fasciculations • Weakness/paralysis • Altered consciousness • Seizures MANAGEMENT Medico-Legal Case (MLC) :Every suspected OP poisoning should be treated as a Medico-Legal Case. Nursing Responsibilities ✓ Inform the treating doctor immediately. ✓ Ensure MLC registration as per hospital protocol. ✓ Inform the police through the hospital as per institutional policy. ✓ Preserve poison container/bottle, vomitus (if required),gastric lavage sample, Contaminated clothing (properly labeled) ✓ Maintain chain of custody for all medico-legal specimens. ✓ Maintain documents & records. Signs of Adequate Atropinization ✔ Chest clear on auscultation ✔ Secretions dry ✔ Oxygen saturation improving (>94%) ✔ Heart rate >80/min ✔ Systolic BP >90 mmHg ✔ No bronchospasm Do NOT use pupil size alone to judge atropinization. Atropine Therapy Initial Dose Adult: 2–3 mg IV bolus Repeat every 3–5 minutes Double the previous dose if no response 2 mg → 4 mg → 8 mg → 16 mg → 32 mg Pralidoxime (2-PAM) Loading Dose 2 g IV over 20–30 minute Maintenance dose 500 mg/hour IV infusion OR 1–2 g IV every 6–8 hours Diazepam Give if: Seizures, Agitation, Severe poisoning Typical adult dose: 5–10 mg IV slowly G E N E R A L M E D I C I N E & S U R G E R Y REFERENCES 1. NASPGHAN. Management of Ingested Foreign Bodies in Children: clinical report, reaffirmed/updated 2022. 2. ESGE/ASGE. Guideline on foreign body ingestion and food bolus impaction. ESGE/ASGE; 2021. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 61

MANAGEMENT OF ACUTE ABDOMEN: KEY NOTES Sub Acute Intestinal Obstruction Key Points • Assess and stabilize Airway, Breathing, Circulation (ABC). • Keep the patient Nil Per Oral (NPO). • Insert large-bore IV cannula and begin IV fluid resuscitation. • Correct dehydration and electrolyte imbalance. • Insert Nasogastric (NG/Ryle's) tube for gastric decompression. • Monitor NG tube drainage. • Administer oxygen if required. • Give prescribed analgesics and antiemetics. • Administer broad-spectrum antibiotics if strangulation or perforation is suspected. • Monitor for signs of bowel ischemia (severe pain, fever, tachycardia, guarding). • Prepare for emergency surgery if indicated (complete obstruction, strangulation, perforation, peritonitis). • Obtain informed consent and preoperative investigations. Acute Pancreatitis Key Points • ABC assessment and stabilization. • Keep patient NPO to rest the pancreas. • Aggressive IV fluid resuscitation (especially within first 24 hours). • Administer oxygen therapy if needed. • Provide adequate pain relief (opioids as prescribed). • Administer antiemetics. • Correct electrolyte imbalance. • Monitor blood glucose. • Nutritional support (enteral feeding preferred if prolonged NPO). • Treat underlying cause (e.g., gallstones, alcohol, hypertriglyceridemia). • Antibiotics only if infected pancreatic necrosis is suspected. • Surgical or endoscopic intervention when indicated. Intussception Key Points • ABC stabilization. • Keep patient NPO. • Establish IV access. • Correct dehydration and electrolyte imbalance. • Insert NG tube if persistent vomiting or abdominal distension. • Pain management. • Ultrasound confirmation. • Non-operative reduction with air or contrast enema (if no perforation/peritonitis). • Emergency surgery if: o Perforation o Peritonitis o Failed enema reduction o Hemodynamic instability G E N E R A L M E D I C I N E & S U R G E R Y REFERENCES 1. NASPGHAN. Management of Ingested Foreign Bodies in Children: clinical report, reaffirmed/updated 2022. 2. ESGE/ASGE. Guideline on foreign body ingestion and food bolus impaction. ESGE/ASGE; 2021. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 62

FOREIGN BODY INGESTION Foreign body ingestion occurs when a non-food item or problematic object is swallowed, requiring urgent medical attention if it involves button batteries, multiple magnets, or sharp objects. MANAGEMENT OF FOREIGN BODY INGESTION 1. Obtain history: Ensure no concern for button battery or magnet ingestion (refer to those algorithms if there is concern). 2. Obtain STAT X -rays: lateral neck (including nasal cavities and nasopharynx) and AP or PA chest, and AP abdomen/pelvis views. 3. Keep NPO. If symptomatic or esophageal FB, start IV and MIVF. 4. Consult: ENT for above the clavicles; Peds GI for esophagus, below clavicles, or as needed for stomach or intestinal FB. Any concern for perforation or obstruction or history of esophageal or abdominal surgery: Consult Pediatric Surgery ESOPHAGUS STOMACH SMALL BOWEL Symptomatic: Drooling, dysphagia, Asymptomatic Symptomatic Asymptomatic Symptomatic respiratory compromise, severe pain Timely endoscopic removal depending on symptom severity 1. Repeat X -ray to ensure coin is still present 2. Urgent endoscopic removal No endoscopy needed. Consider straining stools, laxatives. Repeat X-ray at 2 weeks to confirm passage, or sooner if symptoms develop. Depending on size of object, consider admission for observation (larger objects could get caught at ileocecal valve). Consider alternative etiologies and alternative foreign bodies. Surgical removal if indicated. Coin Sizes: Quarter: 24mm Nickel: 21mm Penny:19mm Dime: 18mm Endoscopic removal if not passed in 2-4 weeks. Repeat X-ray before removing to ensure coin is still present. COIN & OTHER BLUNT OBJECT Endoscopic Retrieval Tips • Removal should be performed under general anesthesia • Inspect mucosa for extent, location, and depth of damage Discharge Considerations • Bowel regimen • Reliable/competent caregiver • Regular diet • • G E N E R A L M E D I C I N E & S U R G E R Y REFERENCES 1. World Health Organization. Clinical practice guidance for emergency care. World Health Organization; 2024. 2. NASPGHAN. Management of Ingested Foreign Bodies in Children: clinical report, reaffirmed/updated 2022. 3. ESGE/ASGE. Guideline on foreign body ingestion and food bolus impaction. ESGE/ASGE; 2021. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 63

MAGNET INGESTION 1. Obtain history: known magnet ingestion? 2. Obtain STAT X -rays: lateral neck (including nasal cavities and nasopharynx) and AP or PA chest, and AP abdomen/pelvis views : Determine single versus multiple magnets. 3. Keep NPO. Start IV and MIVF. 4. Consult: ENT for above the clavicles; Peds GI for esophagus, stomach, intestine, or below clavicles. MULTIPLE MAGNETS Or single magnet + other metal object(s) Any concern for perforation or obstruction or history of esophageal or abdominal surgery: Consult Pediatric Surgery SINGLE MAGNET Assess risk factors for further ingestion All within stomach or esophagus Beyond stomach In stomach or esophagus Beyond stomach Symptomatic: EMERGENT endoscopic removal Successful Removal: Discharge home after feeding tolerance with appropriate follow-up and education Asymptomatic: URGENT endoscopic removal Unsuccessful removal: Notify Pediatric Surgery for removal Symptomatic: 1. Admit for further monitoring. 2. Consult Peds GI and Pediatric surgery for endoscopic, laparoscopic removal 3. Keep NPO, IVF. Asymptomatic AND no concerning radiographic findings: 1. Admit for further monitoring 2. Consult Pediatric GI & Pediatric Surgery 3. Clear liquid diet 4. Serial radiographs q4- 6hrs 5. Can use Golytely, Miralax, or another laxative Non-urgent endoscopic removal if patient at risk for further ingestion Outpatient management with bowel regimen, serial X-rays, parental education if no risk factors. Confirm passage with X- rays at 2-3 days in outpatient. No progression on serial X-rays in 24-48 hours: Attempt removal by colonoscopy or endoscopy Progression of magnets on serial X-rays: Option 1: Option 2: Continue bowel regimen and serial x-rays until magnets have passed Outpatient management with bowel regimen, serial X-rays, parental education See reverse for additional information Endoscopic Retrieval Tips • Removal should be performed under general anesthesia • Inspect mucosa for extent, location, and depth of damage Discharge Considerations- When Waiting for Single Magnet to Pass • Bowel regimen • Reliable/competent caregiver • Regular diet • Encourage activity • Educate on signs of GI bleed (blood-stained vomiting, melena, abdominal pain, change in eating pattern) or features of intestinal obstruction (persistent vomiting, abdominal distention) • Remove any magnetic objects nearby • • child’s • G E N E R A L M E D I C I N E & S U R G E R Y REFERENCES 1. NASPGHAN. Management of Ingested Foreign Bodies in Children: clinical report, reaffirmed/updated 2022. 2. ESGE/ASGE. Guideline on foreign body ingestion and food bolus impaction. ESGE/ASGE; 2021. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 64

SHARP OBJECT INGESTION 1. Obtain STAT X -rays: lateral neck (including nasal cavities and nasopharynx) and AP or PA chest, and AP abdomen/pelvis views. 2. Keep NPO. If esophageal or symptomatic, start IV and MIVF. 3. Consult: ENT for above the clavicles; Peds GI for esophagus, intestine, or below clavicles. RADIO-OPAQUE Any concern for perforation or obstruction or history of esophageal or abdominal surgery: Consult Pediatric Surgery RADIO-LUCENT For example: toothpick, fishbone, glass Endoscopic removal within 2hrs Symptomatic or Length ≥ 3cm Width ≥ 2cm Gastric or Duodenal Asymptomatic and Length < 3cm Width <2cm Small Bowel (distal to ligament of Treitz) Asymptomatic Timely surgical removal Symptomatic, self-reported, or witnessed ingestion Timely endoscopic evaluation & removal Consider CT, ultrasound, MRI, or esophagram for further assessment Timely endoscopic removal Consider observation with bowel regimen, serial X -rays, parental education. Confirm passage with X-ray at 2 -3 days if outpatient. Remove if symptoms develop. Object found: Follow guidelines for found radio- opaque objects No object found: Observe or discharge with return precautions Esophageal Asymptomatic Symptomatic Endoscopic Retrieval Tips • Removal should be performed under general anesthesia • Inspect mucosa for extent, location, and depth of damage • If sharp end is facing cephalad, consider pushing the object into the stomach and rotate the sharp end caudally before removal • Safety pin: polypectomy snare can be used to close it before withdrawal • Toothpick: polypectomy snare is a good option Discharge Considerations • Reliable/competent caregiver • Regular diet • Encourage activity • Educate on signs of GI bleed (blood-stained vomiting, melena, abdominal pain, change in eating pattern) or features of intestinal obstruction (persistent vomiting, abdominal distention) G E N E R A L M E D I C I N E & S U R G E R Y REFERENCES 1. NASPGHAN. Management of Ingested Foreign Bodies in Children: clinical report, reaffirmed/updated 2022. 2. ESGE/ASGE. Guideline on foreign body ingestion and food bolus impaction. ESGE/ASGE; 2021. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 65

ESOPHAGEAL FOOD IMPACTION 1. Obtain STAT X -rays: lateral neck (including nasal cavities and nasopharynx) and AP or PA chest, and AP abdomen/pelvis views. 2. Keep NPO. Start IV and MIVF. 3. Consult Peds GI. SEVERE SYMPTOMS Difficulty breathing, retching, severe pain, not tolerating secretions Any concern for perforation or obstruction or history of previous esophageal surgery: Consult Pediatric Surgery MILD/ MODERATE SYMPTOMS No difficulty breathing, mild pain, tolerating secretions Timely endoscopic removal depending on symptom severity Consider X-ray with water soluble contrast: 1. Obtain AP chest/ abdomen 2. Patient drinks 50mL water soluble contrast 3. AP chest/abdomen immediately afterwards Endoscopic removal at provider discretion Endoscopic Retrieval Tips • Removal should be performed under general anesthesia • Inspect mucosa for extent, location, and depth of damage • Obtain proximal and distal esophageal biopsies • Assess for stricture. Dilation is cautioned against if eosinophilic esophagitis is suspected, or food has been impacted for a long duration Discharge Considerations • Ensure patient has appropriate GI follow-up G E N E R A L M E D I C I N E & S U R G E R Y REFERENCES 1. World Health Organization. Clinical practice guidance for emergency care. World Health Organization; 2024. 2. NASPGHAN. Management of Ingested Foreign Bodies in Children: clinical report, reaffirmed/updated 2022. 3. ESGE/ASGE. Guideline on foreign body ingestion and food bolus impaction. ESGE/ASGE; 2021. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 66

G E N E R A L M E D I C I N E & S U R G E R Y REFERENCES 1. World Allergy Organization. Anaphylaxis Guidance 2020: update and implementation review. World Allergy Organization; 2022. 2. Resuscitation Council UK. Emergency treatment of anaphylaxis: guidelines for healthcare providers. London: Resuscitation Council UK; 2021. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 67

G E N E R A L M E D I C I N E & S U R G E R Y REFERENCES 1. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47:1181-247. doi:10.1007/s00134-021-06506-y. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 68

G E N E R A L M E D I C I N E & S U R G E R Y REFERENCES 1. WHO. Responding to intimate partner violence and sexual violence against women: clinical and policy guidelines. Updated resources. WHO; 2021. 2. WHO. Clinical management of rape and intimate partner violence survivors. WHO; 2024. 3. CEHAT. Manual for Medical Examination of Sexual Assault (adapted). 2010, reprint 2012. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 69

C H A P T E R 0 7 PSYCHIATRIC M A N A G E M E N T A L G O R I T H M S TOPICS IN THIS SECTION P A G E 01 Delirium tremens 72 02 Violent and aggressive patient 73 03 Suspected suicide attempt 74 A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 71

P S Y C H I A T R I C REFERENCES 1. NICE. Alcohol-use disorders: diagnosis and management of physical complications (CG100), updated 2022. 2. WHO. mhGAP guideline for mental, neurological and substance use disorders. WHO; 2023. 3. World Health Organization. mhGAP guideline for mental, neurological and substance use disorders. Geneva: World Health Organization; 2023. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L REFERENCES 1. Sadock BJ, Sadock VA (Editors). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (2 Volume Set). 7th ed. Lippincott Williams & Wilkins Publishers; 2000. 2. NICE. Alcohol-use disorders: diagnosis and management of physical complications (CG100), updated 2022. 3. World Health Organization. mhGAP guideline for mental, neurological and substance use disorders. Geneva: World Health Organization; 2023. 72

P S Y C H I A T R I C REFERENCES 1. NICE. Violence and aggression: short-term management in mental health, health and community settings (NG10). NICE; 2022. 2. WHO. Guidance on mental health crisis care and de-escalation. WHO; 2022. 3. World Health Organization. mhGAP guideline for mental, neurological and substance use disorders. Geneva: World Health Organization; 2023. 4. Ahuja N. A Short Textbook of Psychiatry. 7th ed. Jaypee Publications; 2011. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 73

P S Y C H I A T R I C REFERENCES 1. NICE. Self-harm: assessment, management and preventing recurrence (NG225). NICE; 2022. 2. WHO. LIVE LIFE: implementation guide for suicide prevention. WHO; 2021. 3. World Health Organization. mhGAP guideline for mental, neurological and substance use disorders. Geneva: World Health Organization; 2023. 4. Ahuja N. A Short Textbook of Psychiatry. 7th ed. Jaypee Publications; 2011. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 74

C H A P T E R 0 8 OBSTETRICS & GYNAECOLOGY M A N A G E M E N T A L G O R I T H M S TOPICS IN THIS SECTION P A G E 01 Magnesium sulphate (MgSO4) dilution chart 76 02 Ferric carboxymaltose (FCM) dilution chart 77 03 Management of sexual violence cases 78 04 HIV-positive mother during intrapartum period 79 05 Maternal collapse 80 06 Disseminated intravascular coagulation (DIC) 81 07 Amniotic fluid embolism (AFE) 82 08 Ovarian hyperstimulation syndrome (OHSS) 83 A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 75

MANAGEMENT ALGORITHM | MAGNESIUM SULPHATE DILUTION CHART O B S T E T R I C S & G Y N A E C O L O G Y REFERENCES 1. WHO. WHO recommendations on maternal health. 2nd ed. Geneva: WHO; 2025. 2. FIGO. Good practice recommendations on prevention and treatment of pre-eclampsia. FIGO; 2021. 3. Royal College of Obstetricians and Gynaecologists. Thromboembolic disease in pregnancy and the puerperium: acute management. Green-top guideline. London: RCOG; updated 2023. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L REFERENCES 1. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 222: Gestational Hypertension and Preeclampsia. 2020. 2. Royal College of Obstetricians and Gynaecologists. Green-top Guideline No. 10: Hypertension in Pregnancy. 2022. 3. WHO. Recommendations for Prevention and Treatment of Pre-eclampsia and Eclampsia. 2011, updated 2018. 4. MoHFW. Clinical Practice Guidelines on Hypertensive Disorders in Pregnancy (India). 5. WHO. WHO recommendations on maternal health. 2nd ed. Geneva: WHO; 2025. 6. FIGO. Good practice recommendations on prevention and treatment of pre-eclampsia. FIGO; 2021. 7. Royal College of Obstetricians and Gynaecologists. Thromboembolic disease in pregnancy and the puerperium: acute management. Green-top guideline. London: RCOG; updated 2023. 76

MANAGEMENT ALGORITHM | FERRIC CARBOXYMALTOSE DILUTION CHART O B S T E T R I C S & G Y N A E C O L O G Y REFERENCES 1. WHO. WHO recommendations on maternal health. 2nd ed. Geneva: WHO; 2025. 2. British Society for Haematology. Iron deficiency anaemia in pregnancy: guidance. British Society for Haematology; 2021. 3. Royal College of Obstetricians and Gynaecologists. Thromboembolic disease in pregnancy and the puerperium: acute management. Green-top guideline. London: RCOG; updated 2023. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L REFERENCES 1. World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. 2016. 2. FOGSI Clinical Practice Guidelines on Iron Deficiency Anemia in Pregnancy. 2021. 3. Royal College of Obstetricians and Gynaecologists (RCOG). Blood Transfusion in Obstetrics. Green-top Guideline No. 47, 2015 (updated). 4. Summary of Product Characteristics. Ferric Carboxymaltose Injection (Ferinject / Injectafer). 5. WHO. WHO recommendations on maternal health. 2nd ed. Geneva: WHO; 2025. 6. British Society for Haematology. Iron deficiency anaemia in pregnancy: guidance. British Society for Haematology; 2021. 7. Royal College of Obstetricians and Gynaecologists. Thromboembolic disease in pregnancy and the puerperium: acute management. Green-top guideline. London: RCOG; updated 2023. 77

MANAGEMENT ALGORITHM | MANAGEMENT OF SEXUAL VIOLENCE CASES O B S T E T R I C S & G Y N A E C O L O G Y REFERENCES 1. WHO. Clinical management of rape and intimate partner violence survivors. WHO; 2024. 2. WHO. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring. WHO; 2021. 3. Royal College of Obstetricians and Gynaecologists. Thromboembolic disease in pregnancy and the puerperium: acute management. Green-top guideline. London: RCOG; updated 2023. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L REFERENCES 1. Ministry of Health and Family Welfare, Government of India. Guidelines and Protocols: Medico-legal Care for Survivors/Victims of Sexual Violence. 2020. 2. National AIDS Control Organization (NACO). HIV Post Exposure Prophylaxis (PEP) Guidelines. 2021. 3. RCOG Green-top Guideline No. 36. The care of women and girls following sexual assault. 2015 (Updated). 4. UNFPA. Clinical Management of Rape Survivors: A Guide for Health Providers. 2010. 5. WHO. Clinical management of rape and intimate partner violence survivors. WHO; 2024. 6. WHO. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring. WHO; 2021. 7. Royal College of Obstetricians and Gynaecologists. Thromboembolic disease in pregnancy and the puerperium: acute management. Green-top guideline. London: RCOG; updated 2023. 78

MANAGEMENT ALGORITHM | HIV-POSITIVE MOTHER DURING INTRAPARTUM PERIOD O B S T E T R I C S & G Y N A E C O L O G Y REFERENCES 1. WHO. Clinical management of rape and intimate partner violence survivors. WHO; 2024. 2. WHO. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring. WHO; 2021. 3. Royal College of Obstetricians and Gynaecologists. Thromboembolic disease in pregnancy and the puerperium: acute management. Green-top guideline. London: RCOG; updated 2023. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L REFERENCES 1. National AIDS Control Organization (NACO), India. National Guidelines for HIV Care and Treatment. 2024 Update. 2. British HIV Association (BHIVA). Guidelines for the Management of HIV in Pregnancy and Postpartum. 2022. 3. American College of Obstetricians and Gynecologists (ACOG). Management of HIV in Pregnancy. ACOG Practice Bulletin No. 234. 2021. 4. WHO. Clinical management of rape and intimate partner violence survivors. WHO; 2024. 5. WHO. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring. WHO; 2021. 6. Royal College of Obstetricians and Gynaecologists. Thromboembolic disease in pregnancy and the puerperium: acute management. Green-top guideline. London: RCOG; updated 2023. 79

MANAGEMENT ALGORITHM | MATERNAL COLLAPSE O B S T E T R I C S & G Y N A E C O L O G Y REFERENCES 1. WHO. WHO recommendations on maternal health. 2nd ed. Geneva: WHO; 2025. 2. FIGO. Best practice advice for maternal collapse and obstetric emergencies. FIGO; 2022. 3. Royal College of Obstetricians and Gynaecologists. Thromboembolic disease in pregnancy and the puerperium: acute management. Green-top guideline. London: RCOG; updated 2023. 4. RCOG. Green-top Guideline No. 56: Management of Maternal Collapse in Pregnancy. 2023. 5. AHA. ACLS Guidelines, 2020 & 2023 update; AHA Scientific Statement: Cardiac Arrest in Pregnancy, 2020; SOAP Recommendations, 2021. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 80

MANAGEMENT ALGORITHM | DISSEMINATED INTRAVASCULAR COAGULATION (DIC) O B S T E T R I C S & G Y N A E C O L O G Y REFERENCES 1. WHO. WHO recommendations on maternal health. 2nd ed. Geneva: WHO; 2025. 2. ISTH. Guidance on diagnosis and management of disseminated intravascular coagulation. ISTH; 2024. 3. Royal College of Obstetricians and Gynaecologists. Thromboembolic disease in pregnancy and the puerperium: acute management. Green-top guideline. London: RCOG; updated 2023. 4. RCOG. Green-top Guideline No. 63: Management of Postpartum Haemorrhage. 5. WHO; ESHG Guidelines; Topcu HO (2016). Amniotic Fluid Embolism; National Maternal Health; SOMANZ Guidelines. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 81

MANAGEMENT ALGORITHM | AMNIOTIC FLUID EMBOLISM (AFE) O B S T E T R I C S & G Y N A E C O L O G Y REFERENCES 1. RCOG. Thromboembolic Disease in Pregnancy and the Puerperium: acute management. RCOG; 2023. 2. ESC. 2023 Guidelines for the Management of Cardiovascular Disease During Pregnancy. Eur Heart J. ESC; 2023. 3. Royal College of Obstetricians and Gynaecologists. Thromboembolic disease in pregnancy and the puerperium: acute management. Green-top guideline. London: RCOG; updated 2023. 4. RCOG. Green-top Guideline No. 63: Management of Postpartum Haemorrhage; ACOG Practice Bulletin No. 76; WHO recommendations; Topcu HO et al. Amniotic Fluid Embolism. 2016. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 82

MANAGEMENT ALGORITHM | OVARIAN HYPERSTIMULATION SYNDROME (OHSS) O B S T E T R I C S & G Y N A E C O L O G Y REFERENCES 1. ESHRE. Ovarian Stimulation for IVF/ICSI: guideline. ESHRE; 2025. 2. RCOG. The Management of Ovarian Hyperstimulation Syndrome. RCOG; 2023. 3. Royal College of Obstetricians and Gynaecologists. Thromboembolic disease in pregnancy and the puerperium: acute management. Green-top guideline. London: RCOG; updated 2023. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 83

C H A P T E R 0 9 MISCELLANEOUS M A N A G E M E N T A L G O R I T H M S TOPICS IN THIS SECTION P A G E 01 How to hold a laryngeal mask airway (LMA) 85 02 Accidental removal of ETT pilot tube 86 03 Amphotericin B administration 87 04 Ventilator alarms: priority and colour coding 88 05 Thiamine infusion with DNS 89 06 Accidental removal of intercostal drain (ICD) 90 07 Administration of photosensitive drugs 91 08 Safe potassium administration 92 09 Calcium gluconate administration 93 10 Glucose + insulin infusion for hyperkalaemia 94 11 Accidental displacement or removal of ET tube 95 A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 84

M I S C E L L A N E O U S REFERENCES 1. American Association for Respiratory Care. Clinical practice guideline: patient-ventilator assessment. Respir Care. American Association for Respiratory Care; 2024. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 85

M I S C E L L A N E O U S REFERENCES 1. AARC. Clinical Practice Guideline: Patient-Ventilator Assessment. Respir Care. AARC; 2024. 2. American Association for Respiratory Care. Clinical practice guideline: patient-ventilator assessment. Respir Care. American Association for Respiratory Care; 2024. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 86

M I S C E L L A N E O U S REFERENCES 1. IDSA. Clinical Practice Guideline for the Management of Candidiasis. IDSA; 2021. 2. Amphotericin B. prescribing information and institutional infusion safety guidance. Amphotericin B; 2024. 3. American Association for Respiratory Care. Clinical practice guideline: patient-ventilator assessment. Respir Care. American Association for Respiratory Care; 2024. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 87

M I S C E L L A N E O U S REFERENCES 1. WHO. Thiamine deficiency and Wernicke encephalopathy: clinical guidance. WHO; 2022. 2. WHO. mhGAP guideline for mental, neurological and substance use disorders. WHO; 2023. 3. American Association for Respiratory Care. Clinical practice guideline: patient-ventilator assessment. Respir Care. American Association for Respiratory Care; 2024. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 89

M I S C E L L A N E O U S REFERENCES 1. AARC. Enteral Nutrition Safety and Administration: clinical practice guidance. AARC; 2022. 2. ASPEN. Safe Practices for Enteral Nutrition Therapy. ASPEN; 2023. 3. American Association for Respiratory Care. Clinical practice guideline: patient-ventilator assessment. Respir Care. American Association for Respiratory Care; 2024. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 90

M I S C E L L A N E O U S REFERENCES 1. Gorski LA, Hadaway L, Hagle ME, Broadhurst D, Clare S, Kleidon T, et al. Infusion therapy standards of practice. 9th ed. J Infus Nurs. 2024;47(1 Suppl 1):S1-S285. 2. Centers for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections. Atlanta (GA): CDC; updated 2024. 3. Matthay MA, Arabi Y, Arroliga AC, Bernard GR, Bersten AD, Brochard LJ, et al. A new global definition of acute respiratory distress syndrome. Am J Respir Crit Care Med. 2024;209:37-47. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 91

M I S C E L L A N E O U S REFERENCES 1. ISMP. Guidelines for Safe Medication Administration in Acute Care. ISMP; 2022. 2. Gorski LA, Hadaway L, Hagle ME, Broadhurst D, Clare S, Kleidon T, et al. Infusion therapy standards of practice. 9th ed. J Infus Nurs. 2024;47(1 Suppl 1):S1-S285. 3. Matthay MA, Arabi Y, Arroliga AC, Bernard GR, Bersten AD, Brochard LJ, et al. A new global definition of acute respiratory distress syndrome. Am J Respir Crit Care Med. 2024;209:37-47. A D U L T C R I T I C A L C A R E N U R S I N G M A N U A L 94

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