Author: embeds

COVID-19 (DKA/HHS)

Experience is showing that those with diabetic patients with COVID-19 are more likely to develop DKA/HSS. However, treating them with the traditional large amount of fluid is detrimental to their chest, if they have Covid-19

Hence the following has been developed from the Guy & Thomas’ guidance – CLICK HERE

High Clinical Suspicion of Covid-19

  • Clinical: Fever ≥37.8°C plus any of; cough, short of breath, myalgia, headache, sore throat
  • CXR: consistent with Covid-19

Read more

COVID-19 (40 Step Desaturation Test)

NHS England has introduced the use of a “40 step desaturation test” into discharge planning from the ED. You will have heard Covid -19 patients complaining of increasing SOB on exercise, and it’s important that we test this prior to discharge.

Method:

  • Is this appropriate? – Could the patient walk 40 steps before they were ill?
  • Patient remains in cubical – with mask on
  • Attach Sats probe – ensure good trace
  • Walk on spot 40 steps 
  • Monitor SaO2

 

 

COVID-19 (Talking to Relatives)

During the current Covid-19 pandemic relatives are not attending the hospital with patients, which means we are increasingly having to have difficult conversations over the phone. Chelsea and Westminster have published this helpful guide.

Remember:

  • Keep your language simple 
  • Avoid jargon/euphemism
  • Be honest
  • Pauses can be helpful
  • Don’t rush
  • Talk to your colleagues (these conversations will be difficult)

 

COVID-19 (Awake Self-Proning)

There is increasing evidence that Awake Self-Proning of our Covid-19 patients can improve oxygenation. Proning the patient can has several effects which can dramatically improve their SaO2

  • Improves Ventilation to back of the lung (the back of the lung contains more alveoli than the anterior lung)
  • Improves Perfusion – as blood supply to the back of the lung is always better than the front
  • Improves Clearance of secretions

Contraindications (all seem obvious)

Absolute contraindications:

  • Respiratory distress (RR ≥ 35, PaCO2 ≥ 6.5, accessory muscle use) 
  • Immediate need for intubation 
  • Haemodynamic instability (SBP < 90mmHg) or arrhythmia 
  • Agitation or altered mental status 
  • Unstable spine/thoracic injury/recent abdominal surgery 

Relative Contraindications: 

  • Facial injury 
  • Neurological issues (e.g. frequent seizures) 
  • Morbid obesity 
  • Pregnancy (2/3rd trimesters) 
  • Pressure sores / ulcers 

 

COVID-19 (Death Certification)

The rules have changed since 25th march 2020 on death certification, below is a brief summary of how this might affect us. We are aiming to keep a death certification box in both ED’s so that these can be completed in a timely fashion.

MCCD

Any doctor can complete a death certificate (MCCD) even if they haven’t seen the patient providing: Read more

COVID-19 (Respiratory Flow Chart)

As we know COVID-19 is putting an incredible burden on resources, especially for higher level respiratory support. It is important to target those resourses in the most effect way, hence the development of the “Respiratory Flow Chart”

 

 HRICRH
CPAP/NIVAcute FloorRespiratory Floor
Oxygen ONLY (FOR Escalation)Acute FloorRespiratory/Acute Floor
Oxygen ONLY (NOT FOR Escalation)Acute Floor/Ward 17Respiratory/Acute Floor/Ward 6CD
PalliativeWard 6Ward 6AB

Read more

COVID-19 (Escalation-Ophthalmology Referral)

Any patient presenting to ED with ONLY Ophthalmic symptoms should be referred directly by the ED triage team to Ophthalmology:

Referral

  • 08:30 – 17:30 Mon-Fri, and 09:00 – 12:00 Sat all referrals are to be made directly to dedicated phone
  • Out is these times refers to Ophthalmology on-call

Minimum dataset:

    1. Referrer name + grade + location.
    2. Patient details – 3 points of ID (name + D.O.B. + NHS / hospital number).
    3. Best contact number for patient.
    4. COVID-19 status of patient.
      • Asymptomatic, COVID-19 NOT suspected.
      • Symptomatic, COVID-19 SUSPECTED.
      • Symptomatic, COVID-19 CONFIRMED.
    5. Ophthalmic symptoms / signs on presentation.

Any patient presenting to ED with Ophthalmic symptoms/signs IN ADDITION TO other systemic issues should continue to be assessed and managed by ED as normal:

  • Refer as above once deemed stable 
  • If admitted under another team (e.g medics) – ensure admitting team area aware that the referral is still to be made (Document clearly in notes and verbally hand over)

Full Guide – HERE