Author: embeds

September 8, 2019

Decontamination – First Contact

REMOVE – REMOVE – REMOVE

Remove Them..

At reception ask them to go outside to designated area and staff will be with them shortly. Inform Nurse in Charge!

Remove Clothes..

Use the disrobing card to get the patient to safely remove and bag up clothes. Do your best to maintain privacy. CARD HERE

Remove Substance..

Burning/Irritant – WET-Decon HERE
Not Burning/Irritating – DRY-Decon HERE

If we have ample warning or the number of patients will be significant, it may be worth deploying the decontamination tent but remember setting this up is time consuming.

September 7, 2019

0-12yrs WETFLAG

Tips:

If particularly BiIG – go up 1-2 yrs
If particularly SMALL – go down 1-2 yr
Prepare ET Tubes 0.5mm bigger and smaller
Chid’s weight known – specific calculations can be found after tables.

Boys 0-14yrs

Age	Birth	1mth	3mth	6mth	12mth	18mth	2yr	3yr	4yr	5yr	6yr	7yr	8yr	9yr	10yr	11yr	12yr	14yr	Age
Weight	3.5kg	4.5kg	6.5kg	8kg	9.5kg	11kg	12kg	14kg	16kg	18kg	21kg	23kg	25kg	28kg	31kg	35kg	43kg	50kg	Weight
Energy	20J	20J	30J	30J	40J	40J	50J	60J	60J	80J	80J	100J	100J	120J	130J	140J	150J	150J	Energy
Tube	3.0/3.5mm	3.5mm	3.5mm	4mm	4.5mm	4.5mm	4.5mm	5mm	5mm	5.5mm	5.5mm	6mm	6mm	6.5mm	6.5mm	6.5mm	7.5mm	8mm	Tube
Fluid-Medical	70ml	90ml	130ml	160ml	200ml	220ml	240ml	280ml	320ml	360ml	420ml	460ml	500ml	500ml	500ml	500ml	500ml	500ml	Fluid-Medical
Fluid - Trauma	35ml	45ml	65ml	80ml	100ml	110ml	120ml	140ml	160ml	180ml	210ml	230ml	250ml	250ml	250ml	250ml	250ml	250ml	Fluid-Trauma
Lorazepam	0.4mg	0.5mg	0.7mg	0.8mg	1.0mg	1.1mg	1.2mg	1.4mg	1.6mg	1.8mg	2.1mg	2.3mg	2.5mg	2.8mg	3.1mg	3.5mg	4.0mg	4.0mg	Lorazepam
Adrenaline 1:10'000	0.4ml	0.5ml	0.7ml	0.8ml	1.0ml	1.1ml	1.2ml	1.4ml	1.6ml	1.8ml	2.1ml	2.3ml	2.5ml	2.8ml	3.1ml	3.5ml	4.3ml	5.0ml	Adrenaline 1:10'000
Glucose 10% (ml)	7ml	9ml	13ml	16ml	19ml	22ml	24ml	28ml	32ml	36ml	42ml	46ml	50ml	56ml	62ml	70ml	86ml	100ml	Glucose 10%

Girls 0-14yrs

Age	Birth	1mth	3mth	6mth	12mth	18mth	2yr	3yr	4yr	5yr	6yr	7yr	8yr	9yr	10yr	11yr	12yr	14yr	Age
Weight	3.5kg	4.5kg	6kg	7kg	9kg	10kg	12kg	14kg	16kg	18kg	20kg	22kg	25kg	28kg	32kg	35kg	43kg	50kg	Weight
Energy	20J	20J	30J	30J	40J	40J	50J	60J	60J	80J	80J	90J	100J	120J	130J	140J	150J	150J	Energy
Tube	3.0/3.5mm	3.5mm	3.5mm	4mm	4.5mm	4.5mm	4.5mm	5mm	5mm	5.5mm	5.5mm	6mm	6mm	6.5mm	6.5mm	6.5mm	7.5mm	8mm	Tube
Fluid-Medical	70ml	90ml	120ml	140ml	180ml	200ml	240ml	280ml	320ml	360ml	400ml	440ml	500ml	500ml	500ml	500ml	500ml	500ml	Fluid-Medical
Fluid - Trauma	35ml	45ml	60ml	70ml	90ml	100ml	120ml	140ml	160ml	180ml	200ml	220ml	250ml	250ml	250ml	250ml	250ml	250ml	Fluid-Trauma
Lorazepam	0.4mg	0.5mg	0.6mg	0.7mg	0.9mg	1.0mg	1.2mg	1.4mg	1.6mg	1.8mg	2.0mg	2.2mg	2.5mg	2.8mg	3.2mg	3.5mg	4.0mg	4.0mg	Lorazepam
Adrenaline 1:10'000	0.4ml	0.5ml	0.6ml	0.7ml	0.9ml	1.0ml	1.2ml	1.4ml	1.6ml	1.8ml	2.0ml	2.2ml	2.5ml	2.8ml	3.2ml	3.5ml	4.3ml	5.0ml	Adrenaline 1:10'000
Glucose 10% (ml)	7ml	9ml	12ml	14ml	18ml	20ml	24ml	28ml	32ml	36ml	40ml	44ml	50ml	56ml	64ml	70ml	86ml	100ml	Glucose 10%

Calculations

Energy (J) [max 150J] =4 x Weight(kg)
Fluid Medical (ml) = 20 x Weight(kg)
Fluid Trauma (ml) = 10 x Weight(kg)
Lorazepam (mg) [max 4mg] = 0.1 x Weight(kg)
Adrenaline 1:10’000 (ml) [max 10ml] = 0.1 x Weight(kg)
Glucose 10% (ml) = 2 x Weight(kg)

Information from APLS Aide-Memoire

July 26, 2019

Hyperemesis Gravidarum

Nausea and vomiting in pregnancy is common and at best an unpleasant experience for the patient, and at worst can be life threatening. It normal starts @ 4-7/40, peaks @ 9/40, and finishes @ 20/40.

We need to conduct a thorough history and examination looking for causes other than a high βHCG. these include:

Abdominal pathology
Urinary pathology
Infections
Drug History
Chronic H.Pylori

July 19, 2019

Pulmonary Embolism in Pregnancy

Unfortunately the the normal pathway for investigation of PE performs poorly in pregnancy RCOG have the following pathway

1. Investigation – of suspected PE

Clinical assessment – its all on the history and exam scoring doesn’t work
Perform the following tests:
- CXR – sheilding can protect the baby and may avoid further radiation
- ECG
- Bloods: FBC, U&E, LFTs
Commence Dalteparin (unless treatment is contraindicated) – BNF
Arrange admission to AAU/AMU (>20/40 AMU @CRH and inform Obstetrics)

July 1, 2019

Be #urosceptical

Ditch the Dipstick – for patients >65Yrs or Catheterised!

Approx. 50% of over 65’s and most of those with catheters have asymptomatic bacteriuria. The patient will not benefit from treatment and often gives us premature closure (i.e. we blame a fictitious UTI for the patients symptoms and stop thinking). Read more

June 27, 2019

Ottawa SAH Rule

Headache is a common presentation to ED and Subarachnoid is the diagnosis we never want to miss. However, working out who needs a scan can be difficult as 50% of patients presenting with a subarachnoid have no neurological deficit.

The Ottawa SAH Rule is a validated tool for deciding who needs as CT scan. The Ottawa team have also done further work to decide which of the patients you do scan need a follow-up LP/CTA and who we could discharge. Read more

June 17, 2019

Epistaxis – ACP/MG Teaching

Slide set – HERE

Main topics

Anatomy
Cautery
Packing – Don’t force it call for ENT help (septal deviation or spurs)
Remember – Elderly patients can have devastating posterior bleeds call ENT early

Kindly presented by Mr Habib

June 10, 2019

Paediatric Sepsis Podcast (RCPCH)

RCPCH have released a GREAT series of podcasts on paediatric sepsis. It is from a paediatric slant, but is applicable to the ED and well worth a listen [For Docs and Nurses]

June 7, 2019

Sickle Cell Crisis

Painful Crisis

Severe pain is the most common reason that patients with sickle cell, will attend the ED. The pain can be agonising (and often underestimated by us), we need to act fast to help ease the symptoms Read more

May 28, 2019

Injuries in Non-Mobile Children

Unfortunately under 1 year olds are at a higher risk of NAI and this needs to be considered in ALL presentations. But remember if the child can’t Crawl/Stand/Cruise/Walk they shouldn’t injure themselves.