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).
Like tension pneumothorax the biggest step is deciding to do it – Remember it it sight saving and they heal well
Retrobulbar Haematoma secondary to blunt eye injury is a a rare but potentially sight threatening injury.
However, this may only be recognised on CT if there is significant facial injury and altered conscious level.
Call Ophthalmology immediately to attend. If there is going to be any significant delay, it may be necessary for ED to preform a Lateral Canthotomy, to allow the eye to move forward, reduce the orbital pressure & preserve the patients sight.
NIV should be considered for use in patients with a persisting Acute Hypercapnic Respiratory Failures after a maximum of one hour of standard medical therapy.
Prevent the spread of infections by ensuring: routine immunisation, high standards of personal hygiene and practice, particularly hand-washing, and maintaining a clean environment. However, Public Health England recommend exclusion in some conditions.
Upper Extremity DVT (UEDVT) is far less common than Lower Extremity DVT, and posses a diagnostic challenge. We can use the Constant score in combination with D-Dimer.
Our OPAT service can provide IV antibiotics for cellulitis for those patients that can be managed as out patients but either require IV antibiotics or have failed oral therapy.
Hypocalcaemia can life threatening, due to arrhythmias and seizures.
Severity – Adjusted Calcium (Ca)
Hyponatraema is a common finding, especially within our elderly population. However, its significance is is not a simple numbers game, and needs senior input. Prior to treatment the following need to be considered and balanced.
