Vertigo is not always labyrinthitis!! There are some potentially serious conditions to think about. Your main question should be is it peripheral [good] or central [bad]?
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Anti-D immunoglobulin
Rhesus (Rh)-D negative women, pregnant with Rh-D positive foetus are at risk of developing antibodies against future pregnancies if/when they suffer a sensitising event. (Remember, this should be considered a standard treatment for all Rh-D negative women, as we are never certain of the fathers Rh-D status) Read more
Radial Buckle Fractures
Some Radial Buckle #’s in children can be managed with:
- Well fitting splint
- Advice sheet
This decision tree must be followed to identify suitable patients
If you are concerned about Non-Accidental injury – you must escalate your concern.
Pulmonary Embolism – PE
PE is somehow both the most over and under diagnosed condition. with severity ranging from the questionable sub-segmental PE to the Massive PE (an indication for thrombolysis). So think:
- Does this presentation sound like a PE? – If not STOP here
- Pregnant? – Click Here
- Do you think this is likely a PE? (if so you can’t use PERC)
- Does D-Dimer answer your question? (whats the Wells)
- High-Risk (Wells >4) – Treat before CT
- Massive PE – think Thrombolysis
- Sub-Massive PE – there is lots of debate (involve seniors), locally needs 2 consultant sign off and not considered time critical.
Giant Cell Arteritis – GCA
GCA is a is a vasculitis generally seen in the over 50’s and associated with polymyalgia rheumatic (PMR). However, unlike a lot of rheumatology, GCA is far from a benign condition that can be passed back to the GP’s, it can lead to some significant problems
- Sudden irreversible visual loss
- Development of thoracic aortic aneurysm
Methaemoglobinaemia
Q: Why are Smurf’s Blue?
A: Methaemoglobin (MetHb) of course!
– MetHb is produced by oxidisation of the Iron in Haemoglobin (Hb) from Fe2+ to Fe3+
– Fe3+ prevents Hb carrying oxygen (thus produces symptoms of hypoxia)
– Often due to chemical ingestion, but may also be genetic
– Treated with Methyl Blue & supportive measures
Get-There-Itis (Plan Continuation Bias)
The Federal Aviation Authority (FAA) are well-aware of the dangers of Plan Continuation Bias:
“The continuation of an original plan even with the availability of new information that suggests that the plan should be abandoned or at least updated.” AKA Get-There-Itis.
Get-There-Itis has been the cause of multiple fatal air-accidents, where pilots have allowed stressors to bias their decision making, and fatally stick to a failing plan. But… these stressors effect everyone and clinicians are not immune!
Hypernatraemia
Hypernatraemia is a not a common presentation in ED, as intense thirst often prevents significant hypernatraemia in neurologically intact individuals. So… Mortality rates are high (20-70%) and the severity of hypernatraemia has been shown be an independent predictor of mortality.
However, there is little good data on hypernatremia to base guidance on, and definitions vary within the literature
Return to Police Custody
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
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
