Protocols 18–23
Emergency Department Protocol Commons
Consultation Edition, Version 0.9
Phase III addresses neurological and cardiovascular presentations in which early recognition, time-sensitive treatment, repeated reassessment and access to specialist or regional care can substantially alter outcomes.
The protocols cover suspected stroke and TIA, seizures and status epilepticus, dangerous headache and intracranial emergencies, syncope, cardiac rhythm disturbance and hypertensive emergencies.
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 III
The complete phase may be downloaded in either of the following formats:
Download the complete Phase III package — PDF and editable Word copies
Download the Phase III 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 six protocols.
Please select the protocols most relevant to your experience and consider:
- Clinical safety and accuracy
- Time-critical decision points
- Medication and dosing safety
- Availability of CT, MRI, ECG and laboratory testing
- Access to thrombolysis, cardioversion and pacing
- Critical-care and specialist availability
- Transport and regional-referral realities
- Paediatric, maternal and older-adult considerations
- Anticoagulated and other high-risk populations
- 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 III protocol
Protocol 18 — Acute Focal Neurological Deficit, Suspected Stroke, and TIA
This protocol provides a time-critical pathway for acute focal neurological deficit and suspected stroke or transient ischaemic attack.
It covers last-known-well time, stroke-mimic exclusion, urgent imaging, thrombolysis and thrombectomy eligibility, blood-pressure and glucose management, haemorrhagic stroke, post-treatment monitoring, transfer, admission and selected TIA disposition.
Read or download the PDF consultation copy
Protocol 19 — Seizures and Status Epilepticus
This protocol addresses active seizures, recurrent seizures, convulsive and non-convulsive status epilepticus and postictal emergencies.
It covers immediate stabilization, time-based antiseizure treatment, refractory status, investigation of provoking causes, pregnancy-related seizures, paediatric seizures, monitoring, consultation, admission, transfer and safe first-seizure discharge where appropriate.
Read or download the PDF consultation copy
Protocol 20 — Acute Severe Headache, Meningism, and Suspected Intracranial Emergency
This protocol establishes a structured pathway for sudden, severe, unusual or high-risk headache and meningism.
It addresses subarachnoid and other intracranial haemorrhage, meningitis and encephalitis, raised intracranial pressure, cerebral venous thrombosis, vascular emergencies, diagnostic imaging and lumbar-puncture decisions, empiric treatment, specialist consultation, transfer, admission and safe discharge.
Read or download the PDF consultation copy
Protocol 21 — Syncope, Collapse, and Transient Loss of Consciousness
This protocol guides the assessment of transient loss of consciousness, near-syncope, collapse and unexplained falls.
It emphasizes focused history, examination, ECG, risk stratification, identification of cardiac, haemorrhagic, neurological, metabolic, orthostatic and situational causes, observation, admission, specialist referral and safe low-risk discharge.
Read or download the PDF consultation copy
Protocol 22 — Palpitations and Acute Tachyarrhythmias or Bradyarrhythmias
This protocol provides a rhythm-based approach to palpitations and acute arrhythmias.
It covers immediate instability assessment, synchronized cardioversion, pacing, broad- and narrow-complex tachycardia, atrial fibrillation and flutter, bradyarrhythmia, electrolyte and toxicological causes, special populations, monitoring, consultation, admission, transfer and selected discharge.
Read or download the PDF consultation copy
Protocol 23 — Severe Hypertension and Hypertensive Emergency
This protocol distinguishes asymptomatic severe hypertension from hypertensive emergency with acute target-organ injury.
It covers accurate blood-pressure confirmation, focused assessment, condition-specific investigations and treatment targets, cautious intravenous therapy when indicated, avoidance of harmful rapid reduction, acute aortic, neurological, cardiac, renal, pregnancy-related and catecholamine emergencies, monitoring, admission, transfer and follow-up.
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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