It is vital that patients returning to police custody as discharged as safely as possible. Part of that is ensuring the custody team has adequate information about the patient. So so complete the Return to custody form, documenting…. Read more
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Hair Apposition Technique – HAT
Really useful method to close linear head wounds that you wouldn’t normally use glue for within the hair (esp. in children)
- Reduced pain
- Reduced follow up
- increased patient satisfaction (less pain and no need to see again)
- Faster and increased staff satisfaction
Emergency PEG/PEJ/RIG replacement
When a patients with a PEG/PEJ/RIG that has come out attends the ED its important that we can either replace it or insert an EN-Plug OR NG tube into the tract to maintain patentcy while being admitted (how to guide is below)
NG/Foley catheters must not be used to administer fluid or feed nor should the patient be sent home with it in-situ.
Retrobulbar haemorrhage
What is retrobulbar haemorrhage?
- Rapidly progressing haemorrhage into the retrobulbar space which is rare but potentially sight threatening.
- Retrobulbar haemorrhage causes a rapid rise in intraorbital volume and pressure.
- If not treated it can quickly lead to retinal ischaemia and infarction resulting in permanent visual impairment or complete visual loss.
Snake Bites
In the UK approximately 100 people are envenomated by a snake each year.
So what do you need to do if your patient has received a venomous bite from a snake? (not the classic UK cocktail).
- Don’t Cut & Suck!
- Treat what you see
- Call Toxbase
Measles
Suspected/Confirmed patients should be ISOLATED & wear PPE
Treating Staff – (should not be; non-immunised, pregnant or immunocompromised)
- single-use, disposable gloves
- single-use, disposable apron (or gown if extensive splashing or spraying, or performing an aerosol generating procedure (AGP))
- FFP3 – respiratory protective equipment (RPE)
- eye/face protection (goggles or visor)
Patient
- Surgical face mask
Background
- Measles is highly infectious – (4 day prior to and after rash appears) suspected patients should be isolated within the ED
- Measles Immunisation – 1 dose 90% effective, 2 doses 95% effective
- Measles is a notifiable disease
Bilary Disease
Gallstones are common, with a prevalence of approximately 10–15% of adults in Europe and the U.S. Most of the time patients are asymptomatic. but there are several ways gallstone disease can present.
Meningitis – Adults
- Keep your suspicions high – early signs it may not be clear
- Sepsis Kills – give antibiotics & fluid early
- Consider Acyclovir
- Give Dexamethasone with Antibiotics – it can reduce neurological sequelae
- Consider indications for CT before LP
- Get SENIOR support early
Rhabdomyolysis
We often worry about patients developing rhabdomyolysis and consequently developing AKI. However, there is much debate and little consistency in the published data, over how to diagnose and who needs admission to treat. So its important to consider both clinical context along with laboratory values
Rape & Sexual Assault
Don’t
Preform intimate examinations on Sexual assault/Rape patients
- Unless life-threatening injuries are suspected e.g Haemorrhage.
- As our examination will inevitably destroy evidence that may aid this patient’s case
Do’s
- Consider contamination injury (HIV, HepB, HepC) – Guide
- Consider emergency contraception
- Children must have police referral for safeguarding
- Refer to The Sexual Assault Referral Centre, either via Police or Self referral
