Author: embeds

February 18, 2024

Get-There-Itis (Plan Continuation Bias)

The Federal Aviation Authority (FAA) are well-aware of the dangers of Plan Continuation Bias:

“The continuation of an original plan even with the availability of new information that suggests that the plan should be abandoned or at least updated.” AKA Get-There-Itis.

Get-There-Itis has been the cause of multiple fatal air-accidents, where pilots have allowed stressors to bias their decision making, and fatally stick to a failing plan. But… these stressors effect everyone and clinicians are not immune!

February 14, 2024

Hypernatraemia

Hypernatraemia is a not a common presentation in ED, as intense thirst often prevents significant hypernatraemia in neurologically intact individuals. So… Mortality rates are high (20-70%) and the severity of hypernatraemia has been shown be an independent predictor of mortality.

However, there is little good data on hypernatremia to base guidance on, and definitions vary within the literature

February 12, 2024

Return to Police Custody

It is vital that patients returning to police custody as discharged as safely as possible. Part of that is ensuring the custody team has adequate information about the patient. So so complete the Return to custody form, documenting…. Read more

February 10, 2024

Hair Apposition Technique – HAT

Really useful method to close linear head wounds that you wouldn’t normally use glue for within the hair (esp. in children)

Reduced pain
Reduced follow up
increased patient satisfaction (less pain and no need to see again)
Faster and increased staff satisfaction

February 9, 2024

Emergency PEG/PEJ/RIG replacement

When a patients with a PEG/PEJ/RIG that has come out attends the ED its important that we can either replace it or insert an EN-Plug OR NG tube into the tract to maintain patentcy while being admitted (how to guide is below)

NG/Foley catheters must not be used to administer fluid or feed nor should the patient be sent home with it in-situ.

February 2, 2024

Retrobulbar haemorrhage

What is retrobulbar haemorrhage?

Rapidly progressing haemorrhage into the retrobulbar space which is rare but potentially sight threatening.
Retrobulbar haemorrhage causes a rapid rise in intraorbital volume and pressure.
If not treated it can quickly lead to retinal ischaemia and infarction resulting in permanent visual impairment or complete visual loss.

January 29, 2024

Snake Bites

In the UK approximately 100 people are envenomated by a snake each year.

So what do you need to do if your patient has received a venomous bite from a snake? (not the classic UK cocktail).

Don’t Cut & Suck!
Treat what you see
Call Toxbase

January 23, 2024

Measles

Suspected/Confirmed patients should be ISOLATED & wear PPE

Treating Staff – (should not be; non-immunised, pregnant or immunocompromised)

single-use, disposable gloves
single-use, disposable apron (or gown if extensive splashing or spraying, or performing an aerosol generating procedure (AGP))
FFP3 – respiratory protective equipment (RPE)
eye/face protection (goggles or visor)

Patient

Surgical face mask

Background

Measles is highly infectious – (4 day prior to and after rash appears) suspected patients should be isolated within the ED
Measles Immunisation – 1 dose 90% effective, 2 doses 95% effective
Measles is a notifiable disease

January 21, 2024

Bilary Disease

Gallstones are common, with a prevalence of approximately 10–15% of adults in Europe and the U.S. Most of the time patients are asymptomatic. but there are several ways gallstone disease can present.

January 15, 2024

Meningitis – Adults

Keep your suspicions high – early signs it may not be clear
Sepsis Kills – give antibiotics & fluid early
Consider Acyclovir
Give Dexamethasone with Antibiotics – it can reduce neurological sequelae
Consider indications for CT before LP
Get SENIOR support early