General Management in the ED

In the ED remember the three Rs:

1. Recognise






Prompt recognition is essential. Look out for:

  •     Unexplained acidosis
  •     Confusion
  •     Shock
  •     Hypoglycaemia
  •     Coagulopathy
  •     Deranged LFTs

2. Resuscitate

A – Consider intubation if unable to protect or maintain airway or poor oxygenation or ventilation

B – Give oxygen to correct hypoxia

C – Give fluids for hypotension with evidence of poor end organ perfusion

D – Maintain normogylcaemia


  •     Urinary catheter
  •     ABG
  •     CXR

Other investigations and monitoring as required.

3. Refer


  •     Regional transplant teams
  •     Gastroenterology teams
  •     Intensive care teams

Goals of circulatory support in patients with ALF are a mean arterial pressure (MAP) ≥ 75 mmHg (replace>60 ) and add cerebral perfusion pressure (CPP) 60-80 mmHg.

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