Getting some of the rarer antidotes has recently been clarified across Yorkshire – LEEDS Guide Read more
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#NoF – Unsuspected NoF
We have seen multiple incidence where clinicians of ALL grades have assessed patients with falls and examined hips and even mobilised patients
Evidence shows (and reflected in the incidents) this predominantly effects patients with:
- Communication difficulties: inc. Delirium, dementia, learning difficulties
- Live in Supported accommodation
- Normally require help mobilising
If a patient presents with ANY of these and a fall – X-ray Pelvis
Myocardial Infarction (MI) – PPCI/Thrombolysis
PPCI (Leeds PPCI Pathway)
- Target: Door to balloon 90min
- Criteria:
- Time: Chest pain within 12hrs (or worsened within 12hrs)
- ECG: ST elevation MI (1mm Limb or 2mm Chest leads) OR New LBBB. (Posterior MI do posterior leads and discuss with LGI)
- Actions:
- Resuscitate
- Contact PPCI team @ LGI (Mobile No. up in Resus)
- Arrange blue light (P1) ambulance to LGI
- Prasagrel 60mg if no previous CVA or Ticagrelor 180mg if previous CVA and Aspirin 300mg (if anti-coagulated Discuss with PCI team)
- Problems:
- Intubated patient: Often LGI would accept but need to arrange Cardiac ICU. If no bed patient could go for PCI to return locally immediately after PCI to our ICU’S?
- LGI Full: Occasionally the cath lab is full and can’t accept your patient
- Calling Manchester and Sheffield: It’s worth a go but they don’t have agreements with us so having your patient accepted can be difficult
- Don’t Forget Thrombolyisis: We need to open up the patients artery, if there is no quick decision to go for PPCI – Consider Thrombolysis
Acute Cystitis and Pyelonephritis Pathway
A joint Medical-Urology pathway has been agreed for Pyelonephritis
Study Running – Send Urine Sample prior to Antibiotics
(if this does not interfere with treatment of Red-Flag Sepsis)
Imaging in ED is only required if ED suspects:
- Ureteric Obstruction – Renal colic symptoms/Hx of stone
- Acute Surgical Abdomen
- Emphysematous pyelonephritis – Rare necrotising infection of the renal tract, presenting with flank pain and fever, 90% in uncontrolled diabetes mellitus (but immunocompromise and stones also increase chances)
- Renal Abscess – Presents with flank pain and fever, risk factors include; diabetes mellitus, Renal stones, obstruction
Tick-Bourne Diseases
The prevalence of diseases transmitted by tick bite have increased in recent years, within the UK. And it is now recognised that there are 3 main infections
- Lyme Disease
- Tick-Bourne Encephalitis
- Babesia
#NoF – Beware Occult Hip Fractures
Studies suggest around 1% of hip fractures are missed on plain X-ray. So as usual you must combine clinical and radiological findings. Read more
Hyperemesis Gravidarum
Nausea and vomiting in pregnancy is common and at best an unpleasant experience for the patient, and at worst can be life threatening. It normal starts @ 4-7/40, peaks @ 9/40, and finishes @ 20/40.
We need to conduct a thorough history and examination looking for causes other than a high βHCG. these include:
- Abdominal pathology
- Urinary pathology
- Infections
- Drug History
- Chronic H.Pylori
SNAP (paracetamol toxicity)
In Aug 2021 the treatment of paracetamol toxicity within the trust is due to change, for both adults and children. We will start using the SNAP N-acetyl cysteine (NAC) regime 12hrs, and 2 bags, (instead of the traditional 21hr & 3 bag regime)
Legionnaires Disease
There has been a resent increase in cases of Legionnaires Disease in the North West. So remember to request Urine Legionella Antigen test, if you have suspicions.
Post ROSC CT Protocol
Within ED we often have little information about the patient we are resuscitating. Post-ROSC (return of spontaneous circulation )we commonly perform CT head, but evidence and Resus Council Guidance suggests extending this scan can pick up important pathology that can otherwise be missed (13%).
