Hypokalaemia (low potassium), is a common problem. It is found in 14% of outpatients and 20% of inpatients, however only 4-5% of those are of clinical significance.
Severity
Severe: <2.5 mEq/l OR Symptomatic – Look for Hypomagnesaemia
Severe pain is the most common reason that patients with sickle cell, will attend the ED. The pain can be agonising (and often underestimated by us), we need to act fast to help ease the symptoms Read more
Unfortunately under 1 year olds are at a higher risk of NAI and this needs to be considered in ALL presentations. But remember if the child can’t Crawl/Stand/Cruise/Walk they shouldn’t injure themselves.
the iNFANT is truly a design enigma, it is simple yet complicated, amazing yet frustrating, beautiful yet disgusting. And due to a unique production method, each iNFANT has its own variations and special features. Read more
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
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.
Blood collects in the retrobulbar space
Pushing the eye forward to accommodate the extra volume.
The Orbital Septum (made up of the eyelids and ligaments that attach them to the orbital rim) restricts this forward movement, creating a compartment syndrome for the eye. Thus threatening the patients sight if not treated quickly.
Recognition
From Royal College Ophthalmologists
Severe pain
Red/Congested conjunctiva
Exophthalmos with proptosis – eye pushed forward
Internal ophthalmoplegia – impairment or loss of the pupillary reflex.
Visual flashes
Loss of vision – initially colour vision (esp. red), progressing to local visual loss.
However, this may only be recognised on CT if there is significant facial injury and altered conscious level.
Treatment
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.
Complete the Ad-hoc form
Increase pressures from Initial 12/5 cmH2O to 20/5cmH2O – as tolerated over 1st hour
However, ICU should be contacted early if the patient has one of the following:
Asthma – Intubation the option of choice in Life threatening
Pneumonia– NIV should only be considered as a bridge to intubation
No pre-exisiting respiratory issue – NIV not likely helpful
pH <7.25 (low threshold for ICU input)
pCO2 >6.5kPa (low threshold for ICU input)
Type 1 Respiratory Failure (low threshold for ICU input)
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.