Mind the Gap is a handbook of clinical signs in black and brown skins
Author: embeds
Diabetic Hyperglycaemia (Kids)
Diabetic children sometimes attend ED with hyperglycaemia, but not in DKA (what should we do?)
Paeds have produced some advice to follow:
- Ketones over 0.6?
- <0.6: Encourage fluids & food, may need an insulin correction
- >0.6: ask Question 2
- Are there clinical features of DKA?
- NO: Encourage fluids & food, decide Insulin correction, will need to be monitored
- YES: Will need Paeds admission
COPD – exacerbations
COPD patients vary widely, due to their comorbidities, social circumstances, and wishes. So choosing the best treatment pathway for the patient can be complex. Involve senior decision makers.
Questions
- Is hospital the best place for them?
- Do they need NIV?
- Are they dying? – would you want to die surrounded by strangers or with your family?
Asthma – Adult
Severity – Severe or Life threatening – think RESUS
- Treatment within 30 min – bronchodilators and steroids should bee given within 30min
- 1hrs Observation after Neb – better after a neb don’t just send home they may deteriorate when it wears off.
- PEFR – must be >75% expected prior to discharge (at least 1hr after treatment finished)
- Discharge advice sheet – can print off from this guide, remember to check inhaler technique and consider a spacer
1. HAZMAT – 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
- Patient Disrobing instruction Card
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.
Tick-Bourne Diseases
The prevalence of diseases transmitted by tick bite have increased in recent years, within the UK. And it is now recognised that there are 3 main infections
- Lyme Disease
- Tick-Bourne Encephalitis
- Babesia
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, Clotting
- Commence Tinzaparin (unless treatment is contraindicated – use booking weight to calculate dose) –[BNF]
VTE prophylaxis in lower limb Immobilisation (ED – 2023)
In the Emergency Department (ED) lower leg immobilisation after injury is a necessary treatment but is also a known risk factor for the development of venous thromboembolism (VTE). This accounts for approximately 2% of all VTE cases which are potentially preventable with early pharmacological thromboprophylaxis.
Neonatal Resus
Paediatric – Time Critical Transfers (non-trauma)
Definition of a time critical transfer
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.
Principles
- Acceptance by the regional centre is NOT dependent on bed availability.
- Time critical transfer should normally be provided by the referring hospital team NOT Embrace.