As we know “TIME is BRAIN” so early recognition of stroke is vital so BE FAST! Read more
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DKA in Kids
Diabetic Ketoacidosis – remember in paediatrics this may be the 1st presentation of diabetes.
- Fluid – are more considered than adults due to the risk of cerebral oedema
- Insulin – WAIT – need 1hr of fluid first
- Paeds – involve them early
- USE the BSPED DKA Management flow charts, calculators and full guidelines for when electrolytes won’t play ball which are all linked below.
DKA Management Calculator (recommended by paediatrics)- HERE
DKA Management Flow Chart – HERE
Full CHT DKA Guideline – HERE
Diabetic Hyperglycaemia (Kids)
Diabetic children sometimes attend ED with hyperglycaemia, but not in DKA (what should we do?)
Paeds have produced some advice to follow:
- Ketones over 0.6?
- <0.6: Encourage fluids & food, may need an insulin correction
- >0.6: ask Question 2
- Are there clinical features of DKA?
- NO: Encourage fluids & food, decide Insulin correction, will need to be monitored
- YES: Will need Paeds admission
Pneumothorax – BTS 2023
To drain or not to drain? – that is the question (Follow the BTS algorithm).This is not for Tension!
(All treatment options should be discussed with the patient to determine their main priority, with consideration for the least invasive option)
Stroke – BE FAST
Are You CO Aware?
With the onset of colder weather, many households in the UK are turning on their heating for the first time in months. Heating appliances need chimneys and flues to work safely – and these can block up over the summer months. So autumn is traditionally the period when people get poisoned by carbon monoxide (although it can happen any time of the year!)
Carbon monoxide (CO) is produced when anything containing carbon burns or smoulders. For practical purposes, this means the burning of any kind of fuel, commonly:
- Gas
- Coal
- Wood/Paper/Card
- Oil/Petrol/Diesel – (All UK cars have a ‘catalytic converter’ in the exhaust system, which converts carbon monoxide (CO) to carbon Dioxide (CO2), which is less poisonous. However, these converters need to warmed up – a cold car produces fatal amounts of CO in the exhaust)
CO is very poisonous. Exposure to as little as 300 parts per million (that’s just 0.03%) can prove fatal.
Immobilisation Protocol for Trauma Patients
Purpose of pathway
To clarify the immobilisation strategy for patients requiring Poly-Trauma CT Scans (anything more than an isolated CT Head)
Paediatric Surgical Pathway
As there are now no longer a paediatric clinical team at HRI, the paediatric surgical pathway is up-dating, this is the current provisional pathway, to ensure care falls inline with GIRFT report.
Upper GI Bleed (UGIB)
Not normally difficult to spot, but look for it in unexplained anaemia, or collapse.
Questions
- Is it VARICEAL? Mortality 35%, so is an emergency whatever the GBS is.
- Non-Variceal what’s the GBS? will help guide treatment
Anyone being admitted should be brought to HRI
Emergency Endoscopy is arranged by Med Reg
Status Epilepticus – APLS 2021
APLS 2021 Status Epilepticus Guide
