Assessment of the patient with ALF firstly involves determination of the need for urgent life-saving intervention and resuscitation. Such measures may include endotracheal intubation and mechanical ventilation, treatment of shock, and administration of glucose if hypoglycemia is present. The next concern is assessment of the need and urgency for transfer of the patient to a liver unit. This will depend upon the expertise and facilities available at the place of presentation, the grade of encephalopathy and severity of illness at presentation (see adverse prognostic indicators below), and assessment of the rate of progression from the clinical history and examination. Regardless of these factors, the patient should be discussed with a specialist from a liver unit. If transportation is necessary, the patient should be accompanied by an experienced medical escort, and full monitoring and equipment to initiate therapy should be available. Endotracheal intubation and mechanical ventilation are usually indicated for transportation.
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