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
Adjuncts
- Urinary catheter
- ABG
- CXR
Other investigations and monitoring as required.
3. Refer
Involve:
- 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.