Due to the increased prevalence of Group A Strep (GAS) during winter 2022-23 national guidance on how we treat sore throats was updated (National advice to lower the threshold for antibiotics was rescinded 15ht Feb 2023)
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Lower Back Pain: Red & Yellow Flags
Each year 1:15 of the adult population will seek medical help for Lower Back Pain, that is 2.6 million patients in the UK. Most Lower Back Pain is not serious and will revolve within 8 weeks, with analgesia and self physio.
However, this is not the case for some. This may be due to serious underlying pathology ‘RED Flags‘, or psychological factors that indicate chronicity ‘Yellow Flags‘.
Read moreAnaphylaxis 2021
Not all Allergies are Anaphylaxis!
Anaphylaxis is defined as:
- Severe life-threatening systemic hypersensitivity reaction
- Where BOTH of the following criteria are met:
- Sudden onset & rapid progression
- Life-threatening compromise of ONE or MORE of: Airway/Breathing/Circulation
Posterior Shoulder Dislocation
Posterior shoulder dislocation is far less common than anterior dislocation. But it is commonly missed with some sources stating 50% of posterior dislocations are missed in the ED. Read more
Hyperkalaemia
Remember: is it a haemolysed blood sample? (you can do an iSTAT)
Severity
- Mild: 5.5-5.9mmol/l – No urgent action required (Dietary & Medication modification & GP F/U)
- Moderate: 6.0-6.4mmol/l – Follow treatment guide (maybe suitable for discharge)
- Severe: ≥6.5mmol/l OR ECG changes – Follow treatment guide, must admit
Consenting for Blood Transfusion
We frequently consent for Blood Transfusion, but what risks do we tell the patients about and how common are those risks?
Dislocated Shoulder (Teaching Video)
Great review of shoulder reduction, techniques and sedation.
Learning points:
- Most techniques will work 80% of the time (Best results tailor the technique to the patient)
- Kocker’s shouldn’t be used in # greater tuberosity
- Cunningham technique looks interesting (I’m going to give this a go)
- Traction is the what causes the most pain. Reduce the traction & Reduce the sedation required
Necrotising Fasciitis
Necrotising fasciitis (NF) is a rare but serious bacterial infection that affects the soft tissue and fascia (Fournier gangrene, is NF affecting the perineum). In many cases NF progresses rapidly and early recognition and treatment is vital to halt progress. The mainstay of treatment is IV antibiotics and aggressive surgical debridement. Any delay increased the amount of tissue loss as well as the mortality. Read more
DVLA – Driving & Medical Conditions
For many conditions the patient should be informed to stop driving and inform the DVLA of their condition. It is the patients responsibility to inform the DVLA, and we should encourage them to do so.
[There is a £1000 fine AND the risk of prosecution] Read more
SAH – NICE 2022
Headache is a common presentation to ED and Subarachnoid Haemorrhage (SAH) is the diagnosis we never want to miss. However, working out who needs a scan can be difficult as 50% of patients presenting with a subarachnoid have no neurological deficit.
- ‘Thunder Clap’ headache peak of pain within 5min is a RED-FLAG
- Although, most patients with ‘Thunder Clap’ don’t have SAH, this should not deter emergent investigation
- Patients may present more subtlety the following should make you consider the diagnosis:
- neck pain or stiffness (limited or painful neck flexion on examination)
- photophobia
- nausea and vomiting
- new symptoms or signs of altered brain function (such as reduced consciousness, seizure or focal neurological deficit)
- Always be suspicious if the patient has communication difficulties.
