Hyperammonaemia is a TIME CRITICAL medical emergency with the risk of death and serious neurological damage.
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Massive Transfusion Pathway
In the case of patient with Massive Haemorrhage weather that be from Trauma, Surgical, O&G, UGIB, you can activate the MTP
Remember:
- Do the Basics – don’t forget ABCD
- Inform Transfusion and get someone to run a G&S sample down
- FFP can take up to 45min and platelets come from Leeds
- If you no longer need the MTP – inform transfusion and return products ASAP
DKA in Kids
Diabetic Ketoacidosis – remember in paediatrics this may be the 1st presentation of diabetes.
- Fluid – are more considered that adults due to the risk of cerebral oedema
- Insulin – WAIT – need 1hr of fluid first
- Paeds – involve them early
DKA Management Calculator (recommended by paediatrics)- HERE
Teaching – Palliative Care
As we know everybody dies, but recognition and palliation of the dying patient can be difficult. One of our palliative care consultants Mary Keily has produced a video on “End of life care medicines”.
- We also have the Palliative care bundles in our quick orders on EPR, to make prescribing easier.
2. HAZMAT – Suspected Contamination Incident
So a patient comes to ED after white powder thrown is at them what do you do? Your initial response can help them and everyone in the department!
- Ask them to leave the department
- Going to garage was useful
- Inform Nurse in Charge and Consultant
- Dynamic risk assessment
- Performed by nursing/medical staff while outside
- Decontaminate
- Non-caustic chemicals: Dry decontamination
- Caustic, Biological, Radiological: Wet decontamination
- Retain clothing and wipes, double bagged as evidence/disposal
- Patient Disrobing Instruction Card
- Return to ED
If you haven’t seen the Initial Operational Response (IOR) training video please watch it.
The patient can then be thoroughly assesses, to identify the substance involved (this may involve witnesses, police info and symptomatology), and treated appropriately.
- Public Health England are a useful source of advice.
- Organophophate/Nerve agent – PHE
Police should be informed of the incident for several reasons: 1. Public safety, 2. To collect the evidence and possible find out what it was for you. (if this is not a criminal act Public health England can advise on return/disposal of personal effects)
Inform Manager On-Call of incident as it may disrupt the functioning of ED and can provide support.
Patient symptom-free and substance unknown
In our recent case Public Health England advised
- 4-6hr observation
- Discharge with advice:
- “if developing symptoms to return to the ED via ambulance but the patient must be aware that they must inform 999 of the original exposure.”
Resourses
- Public Health England (PHE) Advice – Lines
- PDF: PHE – Organophosphate – Inc. signs/symps and management of organophosphate poisoning & chain of evidence form
- Action Card – mobile patients
- NHS England (HAZMAT/CBRN) – inc. national stocks
- Home Offices (2015)
- Disrobing – pg 20
- DRY decontamination – pg 21
- WET decontamination – pg 22
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

Insitu SIM Instructions

SIMNews – Issue 1- Massive PE
Click here to download the poster
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Running insitu SIM at CHT means we to learn and share our learning
@cazandal, @chftedsim
EMbeds guide on how to manage PE’s here

SIMNews- Issue 2- Acute Pulmonary Oedema
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Running insitu SIM at CHT means we to learn and share our learning
@cazandal, @chftedsim
EMbeds pulmonary oedema guidelines

SIMNews – Issue 3- Anaphylaxis
Click here to download the poster
Click here to view on another tab
Running insitu SIM at CHT means we to learn and share our learning
@cazandal, @chftedsim