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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..

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.

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

AgeBirth1mth3mth6mth12mth18mth2yr3yr4yr5yr6yr7yr8yr9yr10yr11yr12yr14yrAge
Weight3.5kg4.5kg6.5kg8kg9.5kg11kg12kg14kg16kg18kg21kg23kg25kg28kg31kg35kg43kg50kgWeight
Energy20J20J30J30J40J40J50J60J60J80J80J100J100J120J130J140J150J150JEnergy
Tube 3.0/3.5mm3.5mm3.5mm4mm4.5mm4.5mm4.5mm5mm5mm5.5mm5.5mm6mm6mm6.5mm6.5mm6.5mm7.5mm8mmTube
Fluid-Medical70ml90ml130ml160ml200ml220ml240ml280ml320ml360ml420ml460ml500ml500ml500ml500ml500ml500mlFluid-Medical
Fluid - Trauma 35ml45ml65ml80ml100ml110ml120ml140ml160ml180ml210ml230ml250ml250ml250ml250ml250ml250mlFluid-Trauma
Lorazepam 0.4mg0.5mg0.7mg0.8mg1.0mg1.1mg1.2mg1.4mg1.6mg1.8mg2.1mg2.3mg2.5mg2.8mg3.1mg3.5mg4.0mg4.0mgLorazepam
Adrenaline 1:10'0000.4ml0.5ml0.7ml0.8ml1.0ml1.1ml1.2ml1.4ml1.6ml1.8ml2.1ml2.3ml2.5ml2.8ml3.1ml3.5ml4.3ml5.0mlAdrenaline 1:10'000
Glucose 10% (ml)7ml9ml13ml16ml19ml22ml24ml28ml32ml36ml42ml46ml50ml56ml62ml70ml86ml100mlGlucose 10%

Girls 0-14yrs

AgeBirth1mth3mth6mth12mth18mth2yr3yr4yr5yr6yr7yr8yr9yr10yr11yr12yr14yrAge
Weight3.5kg4.5kg6kg7kg9kg10kg12kg14kg16kg18kg20kg22kg25kg28kg32kg35kg43kg50kgWeight
Energy20J20J30J30J40J40J50J60J60J80J80J90J100J120J130J140J150J150JEnergy
Tube 3.0/3.5mm3.5mm3.5mm4mm4.5mm4.5mm4.5mm5mm5mm5.5mm5.5mm6mm6mm6.5mm6.5mm6.5mm7.5mm8mmTube
Fluid-Medical70ml90ml120ml140ml180ml200ml240ml280ml320ml360ml400ml440ml500ml500ml500ml500ml500ml500mlFluid-Medical
Fluid - Trauma 35ml45ml60ml70ml90ml100ml120ml140ml160ml180ml200ml220ml250ml250ml250ml250ml250ml250mlFluid-Trauma
Lorazepam 0.4mg0.5mg0.6mg0.7mg0.9mg1.0mg1.2mg1.4mg1.6mg1.8mg2.0mg2.2mg2.5mg2.8mg3.2mg3.5mg4.0mg4.0mgLorazepam
Adrenaline 1:10'0000.4ml0.5ml0.6ml0.7ml0.9ml1.0ml1.2ml1.4ml1.6ml1.8ml2.0ml2.2ml2.5ml2.8ml3.2ml3.5ml4.3ml5.0mlAdrenaline 1:10'000
Glucose 10% (ml)7ml9ml12ml14ml18ml20ml24ml28ml32ml36ml40ml44ml50ml56ml64ml70ml86ml100mlGlucose 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

 

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

Read more

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)

Read more

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