Since we need to keep socially distanced, teaching may need to be a bit different. so this is our first effort to provide you with some local teaching resources.
if you could fill out the form so we can improve the teaching and prepare for your questions in the Q&A.
we will send out invites to a teams meeting so wehw210 af e can discuss pointss around the teaching – and if we have time any other issues
Transfer of a patient for life, limb or organ saving treatment when the time taken to provide this treatment is a critical factor in outcome.
AKI is a common issue for patients presenting to the ED and not only has a significant mortality associated with it but also a massive cost to the NHS. Early recognition and treatment can improve outcomes. Read more
Since we need to keep socially distanced, teaching may need to be a bit different. so this is our first effort to provide you with some local teaching resources.
if you could fill out the form so we can improve the teaching and prepare for your questions in the Q&A.
we will send out invites to a teams meeting so we can discuss pointss around the teaching – and if we have time any other issues
RCEM 2012 Safe sedation in the ED and RCEM Ketamine for paediatric procedural sedation guideline. Please read these documents in full or participate in RCEM learning for further information.
This guideline is a brief summary of the RCEM 2012 Safe sedation in the ED and RCEM – Pharmacological Agents for Procedural Sedation and Analgesia in the Emergency Department – March 2019. Please read these documents in full or participate in RCEM learning elearning for further information.
| DRUG | ROLE | ROUTE | INITIAL DOSE (elderly) | REPEAT DOSE (elderly) | INITIAL DOSE (adult) | REPEAT DOSE (adult) | ONSET (min) | PEAK EFFECT (min) |
|---|---|---|---|---|---|---|---|---|
| Propofol | Sedation/Amnesia | IV | 10-20mg (slowly) | 10-20mg (slowly) | 0.5-1mg/kg | 0.5mg/kg every 3-5min | 0.5-1 | 1-2 |
| Midazolam | Sedation/Amnesia | IV (over 1-2 min) | 0.5mg | 0.5mg | 1-2mg (max 2.5mg as single dose) | After 2-5min | 1-2 | 3-4 |
| Ketamine | Sedation/Amnesia/Analgesia | IV (give over 30-60sec) | 10-30mg | 1mg/kg | 0.25-0.5mg/kg every 5-10 min | 0.5-1 | 1-2 | |
| Ketamine | Sedation/Amnesia/Analgesia | IM | 4-5mg/kg | 2-2.5mg/kg every 5-10min | 0.5-1 | 1-2 | ||
| Ketamine | Analgesia (sub-dissociative) | IV | 0.3mg/kg | 0.5-1 | 1-2 | |||
| Fentanyl | Analgesia (with other sedation) | IV | up to 0.5µg/kg | up to 0.5µg/kg (every 2min) | 1-2 | 3-5 | ||
| Fentanyl | Sedation/Amnesia | IV | up to 0.5-1.0µg/kg | up to 0.5-1.0µg/kg (every 2min) | 1-2 | 3-5 | ||
| Ketofol | Sedation/Amnesia/Analgesia | IV | 0.5-0.75mg/kg (of both agents) | 0.5-1 | 1-2 |
RCEM – Pharmacological Agents for Procedural Sedation and Analgesia in the Emergency Department – March 2019 – see this document for the references numbered in the table. Only use medications that you are familiar with unless supervised by an experienced colleague.
Occasionally patients with Tracheostomy or Laryngectomy present with difficulty breathing due to problem. As this is rare for us in ED, this situation can be very difficult for all of us. However the protocols below can help.
Tracheostomy is simply a passage from the neck into the trachea. In most cases the trachea will still be connected to the nose and mouth (so can breath though their mouth too).
AKA: Paediatric Inflammatory Multi-system Syndrome – Temporally associated with SARS-CoV 2
Although COVID-19 seems a benign disease in almost all children there are increasing evidence (however rare) of a “Paediatric multisystem inflammatory syndrome”. This is a RARE and newly emerging condition and there are many questions still e.g. It is currently unclear if it is directly related to the COVID-19 pandemic.
During the Covid-19 pandemic alternatives to LMWH have been agreed – [For those who can’t inject themselves]
As you are aware during the Covid-19 pandemic our use of oxygen has increased. However, supply is limited and most hospitals can only generate 3000-5000l/min of oxygen (i.e. enough to treat 300-500 patients on 10l/min). If you exceed this capacity the oxygen valves can freeze and the whole oxygen supply can fail (e.g Watford General closing)
In an effort to optimise our use of oxygen, so as many patients as possible can be treated, trust oxygen targets have been updated.
