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Atrial Fibrillation/Flutter (AF)

Before you start 

  • Whats the cause? – treating the precipitant often sorts the AF (adding B-Blockers to Sepsis can make things worse)
  • Stable or Unstable?  – Electricity vs. Drugs
  • CHADS-VASC vs. ORBIT– Anticoagulation (previously HAS-BLED)
  • Rhythm vs. Rate control??
  • NEW Symptomatic Arrhythmia Clinic [6-8weeks] – referral form attached tho the PDF

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Urinary Catheterisation in ED

Pre-catheterisation

  • Confirm appropriate indication
    • Relief of acute or chronic urinary retention
    • Need for accurate measurements of urinary output in critically ill patients
    • Patient requires prolonged immobilisation (e.g potentially unstable traumatic injury)
    • To improve comfort for end of life care
  • Bladder scan & document result
  • Appropriate consent from patient

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Hyponatraemia

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.

  1. Symptoms Severity – these are not exclusive to hyponatraemia and may be due to other disease processes (esp. if the low sodium is long-term)
  2. Sodium Level – the sodium concentration doesn’t always correlate to the clinical picture, and is dependant on speed of change, and co-morbidities
  3. Rate of Drop – the faster sodium levels drop the more symptomatic the patient often is (i.e. with long term hyponatraema the patient may be profoundly hyponatraemic but asymptomatic)
  4. Co-morbidities – Increasing sodium too quickly risks osmotic demyelination. How well will the patient cope with treatment?

Emergency treatment (hypertonic saline) is generally indicated in those with Severe Symptoms ONLY

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Brief Resolved Unexplained Event (BRUE)

Brief Resolved Unexplained Event (BRUE) is now the recommended term for ALTE (Apparent Life Threatening Event).

Definition:

BRUE is defined as an episode in an infant less than 12 months old characterized by: 

  • < 1 minute duration (typically 20-30s)
  • Followed by return to baseline state
  • Not explained by identifiable medical conditions

Includes one or more of the following:  

  • Central cyanosis/pallor
  • Absent, decreased or irregular breathing
  • Marked change in tone (hyper or hypotonia)
  • Altered level of consciousness

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QIP@CHT

Quality improvement (QI) is important in the Emergency Department. For our trainees it is an essential part of training, but we can and should all be involved.

Below you can see what QI-projects( QIP)are either ongoing (active) or proposed. – if you would like to get involved either approach the team of active projects, OR if proposed chat to any of the consultants. Let Dr Huw Masson (Audit lead) know who will update the status and is more than happy to help

If you have started a QIP OR just have a good idea complete the registration form – you can find others willing to help or inspire someone to take your idea forward if you don’t feel able.

RCEM QIP guidance – Click HERE (it doesn’t need to be original, it doesn’t have to succeed to pass)

Active and Proposed QIP’s

Register/Propose a QIP

Penthrox (Methoxyflurane)

Penthrox is an inhaled, patient controlled analgesic for use with moderate to severe acute pain associated with trauma.  Not to be used in atraumatic pain, chronic pain, children or pregnancy.

Rapid onset of analgesia lasting 25-60 minutes depending on rate and depth of inhalation.  Wears off 10 minutes after last inhalation.

Contraindications (CHECK ALLL):

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Paeds Liaison Form – EPR

The Paediatric Liaison Form (PLF is now part of EPR – how to guide)

This form alerts the Paediatric Liaison Team to your concerns so that they can investigate and provide appropriate support to the child & family.

You SHOULD inform the family that you are completing the form as the Paeds Liaison Team or other agencies (e.g. social services or school nurse)may contact them.

You SHOULD NOT use this form for patients who have either suffered or at risk of significant harm. In this case you should discuss directly with the paediatric consultant on-call.

PDF: Paediatric Liaison Form

PDF: Safeguarding Guide