Protocols 24–30
Emergency Department Protocol Commons
Consultation Edition, Version 0.9
Phase IV addresses acute abdominal and flank pain, gastrointestinal bleeding, vomiting and diarrhoea, dehydration, acute glycaemic crises, kidney injury, dangerous electrolyte disorders, poisoning, intoxication, withdrawal, and severe allergic reactions.
These presentations often require parallel stabilization, rapid exclusion of time-critical causes, careful medication and fluid management, repeated reassessment, and early consultation or transfer when definitive services are unavailable locally.
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 IV
The complete phase may be downloaded in either of the following formats:
Download the complete Phase IV package — PDF and editable Word copies
Download the Phase IV 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 seven protocols.
Please select the protocols most relevant to your experience and consider:
- Clinical safety and accuracy
- Medication, antidote, insulin, electrolyte, and fluid safety
- Diagnostic and treatment feasibility
- Laboratory and imaging capacity
- Surgical, renal, toxicology, allergy, and critical-care access
- Referral and transfer arrangements
- Paediatric, maternal, older-adult, and immunocompromised considerations
- Infection-control and public-health requirements
- 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 IV protocol
Protocol 24 — Acute Abdominal and Flank Pain
This protocol provides a structured pathway for acute abdominal, pelvic, groin, and flank pain.
It emphasizes early recognition of shock, peritonitis, vascular catastrophe, obstruction, pregnancy-related emergencies, torsion, infected urinary obstruction, and other time-critical diagnoses; appropriate analgesia; targeted laboratory and imaging decisions; serial examination; source control; consultation; transfer; and safe disposition.
Read or download the PDF consultation copy
Protocol 25 — Gastrointestinal Bleeding
This protocol addresses haematemesis, coffee-ground emesis, melaena, haematochezia, maroon stool, and suspected occult or ongoing gastrointestinal haemorrhage.
It covers haemodynamic stabilization, major-haemorrhage activation, blood-product stewardship, variceal and non-variceal treatment bundles, anticoagulant reversal, endoscopy and CT-angiography pathways, recurrent bleeding, observation, admission, transfer, and safe discharge.
Read or download the PDF consultation copy
Protocol 26 — Acute Vomiting, Diarrhoea, Dehydration, and Electrolyte Disturbance
This protocol covers acute vomiting and diarrhoea, dehydration, excessive gastrointestinal losses, infectious gastroenteritis, suspected cholera, C. difficile infection, and associated electrolyte or acid-base disturbance.
It emphasizes danger-sign screening, oral rehydration whenever safe, measured intravenous replacement, infection precautions, selective testing and antimicrobials, repeated fluid-balance reassessment, and age-appropriate admission or discharge decisions.
Read or download the PDF consultation copy
Protocol 27 — Diabetic and Acute Glycaemic Emergencies
This protocol provides pathways for hypoglycaemia, diabetic ketoacidosis, hyperosmolar hyperglycaemic state, mixed DKA/HHS, euglycaemic DKA, severe hyperglycaemia, and insulin-device problems.
It addresses immediate glucose rescue, fluid and insulin therapy, potassium and osmolality safety, treatment of precipitants, paediatric and pregnancy-specific safeguards, transition from intravenous insulin, recurrence prevention, and safe disposition.
Read or download the PDF consultation copy
Protocol 28 — Acute Kidney Injury, Oliguria, and Dangerous Electrolyte Disorders
This protocol addresses acute kidney injury, reduced urine output, urinary obstruction, fluid overload, severe acid-base disturbance, and dangerous potassium, sodium, calcium, magnesium, or phosphate abnormalities.
It emphasizes rapid identification of reversible causes, medication and nephrotoxin stewardship, ECG-directed electrolyte rescue, cautious fluid or decongestion strategies, urinary decompression, urgent dialysis indications, monitoring, transfer, and recovery planning.
Read or download the PDF consultation copy
Protocol 29 — Poisoning, Overdose, Intoxication, and Withdrawal
This protocol provides an all-hazards approach to poisoning, overdose, intoxication, medication error, hazardous exposure, and withdrawal.
It covers toxidrome recognition, decontamination, antidotes, enhanced elimination, poison-centre or toxicology consultation, opioid and acetaminophen poisoning, cardiotoxic and metabolic toxins, pesticides and chemical exposure, alcohol and sedative withdrawal, psychosocial assessment, safeguarding, observation, transfer, and safe discharge.
Read or download the PDF consultation copy
Protocol 30 — Anaphylaxis and Severe Allergic Reactions
This protocol establishes immediate recognition and intramuscular-adrenaline treatment of anaphylaxis and severe allergic reactions.
It covers airway and shock stabilization, repeat adrenaline, refractory-anaphylaxis escalation, adjunctive treatments, observation and biphasic-risk assessment, trigger-specific considerations, auto-injector education, recurrence prevention, referral, transfer, and safe discharge.
Read or download the PDF consultation copy
Submit Feedback
Feedback from emergency clinicians, nurses, pharmacists, allied health professionals, surgeons, gastroenterology, nephrology, endocrinology, toxicology, allergy and critical-care personnel, administrators, patient-safety teams, 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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