Protocols 13–17
Emergency Department Protocol Commons
Consultation Edition, Version 0.9
Phase II addresses five high-risk emergency presentations in which delay, fragmented assessment or premature closure can rapidly lead to serious harm.
The protocols provide structured pathways for acute chest pain, respiratory distress, shock, severe infection and altered mental status—from immediate recognition and stabilization through investigation, cause-directed treatment, reassessment, admission, transfer, observation or safe discharge.
These protocols are intended for professional review and responsible local adaptation. They are not approved clinical policies and must not be implemented without verification against current guidance, local resources, professional scopes of practice, medication formularies, legislation, referral arrangements and institutional governance requirements.
Download Phase II
The complete phase may be downloaded in either of the following formats:
Download the complete Phase II package — PDF and editable Word copies
Download the Phase II editable Word package for local adaptation
Readers may also review the individual PDF consultation copies below.
How to Review This Phase
Reviewers are not expected to comment on all five protocols.
Please select the protocols most relevant to your experience and consider:
- Clinical safety and accuracy
- Medication and dosing safety
- Diagnostic and treatment feasibility
- Staffing and monitoring requirements
- Laboratory and imaging capacity
- Referral and transfer arrangements
- Paediatric, maternal and older-adult considerations
- Resource-variable and small-island realities
- Important omissions or unnecessary complexity
Please submit a separate feedback form for each protocol being reviewed.
Submit feedback on a Phase II protocol
Protocol 13 — Acute Chest Pain and Suspected Acute Coronary Syndrome
This protocol provides a time-sensitive pathway for patients with acute chest pain or possible anginal equivalents.
It covers immediate ECG acquisition, exclusion of other life-threatening causes, serial ECG and troponin assessment, recognition of STEMI and other coronary-occlusion patterns, reperfusion or transfer, risk stratification, observation, admission and safe low-risk discharge.
Read or download the PDF consultation copy
Protocol 14 — Acute Shortness of Breath and Respiratory Distress
This protocol addresses acute dyspnoea, hypoxaemia, hypercapnia, abnormal breathing and suspected respiratory failure in adults and children.
It covers immediate ABCDE assessment, targeted oxygen therapy, ventilatory support, rapid differentiation of dangerous causes, cause-directed treatment, monitoring, reassessment, escalation, admission, transfer and safe discharge.
Read or download the PDF consultation copy
Protocol 15 — Shock and Hypotension
This protocol establishes a mechanism-based approach to undifferentiated shock and tissue hypoperfusion.
It emphasizes recognition beyond blood pressure alone, repeated perfusion assessment, cautious and targeted fluid therapy, haemorrhage control, early vasoactive support, focused diagnostic differentiation, source-specific treatment and timely critical-care or interfacility transfer.
Read or download the PDF consultation copy
Protocol 16 — Suspected Sepsis and Severe Infection
This protocol governs the early recognition and emergency treatment of severe infection, sepsis and septic shock across adult, paediatric, maternal, immunocompromised and older populations.
It addresses cultures, time-critical antimicrobials, individualized haemodynamic resuscitation, source control, antimicrobial stewardship, repeated reassessment, admission, transfer and carefully selected discharge.
Read or download the PDF consultation copy
Protocol 17 — Altered Mental Status and Reduced Level of Consciousness
This protocol provides a structured pathway for acute confusion, delirium, abnormal behaviour, reduced responsiveness, stupor or coma.
It emphasizes airway and ventilatory safety, immediate glucose testing, treatment of reversible causes, neurological and toxic-metabolic differentiation, collateral history, appropriate imaging and lumbar-puncture decisions, restraint safeguards, reassessment and safe disposition.
Read or download the PDF consultation copy
Submit Feedback
Feedback from emergency clinicians, nurses, pharmacists, allied health professionals, administrators, patient-safety personnel and other relevant reviewers is welcomed.
Please identify:
- The protocol number
- The relevant section or page
- The concern or recommendation
- Suggested replacement wording where possible
- Supporting evidence or local experience
- Whether the issue may represent an urgent patient-safety concern
Submit feedback on the Emergency Department Protocol Commons
Complete Protocol Index
Browse all 59 protocols and download individual PDF or editable Word copies
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