Vertigo is not always labyrinthitis!! There are some potentially serious conditions to think about. Your main question should be is it peripheral [good] or central [bad]?
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Anti-D immunoglobulin
Rhesus (Rh)-D negative women, pregnant with Rh-D positive foetus are at risk of developing antibodies against future pregnancies if/when they suffer a sensitising event. (Remember, this should be considered a standard treatment for all Rh-D negative women, as we are never certain of the fathers Rh-D status) Read more
Radial Buckle Fractures
Some Radial Buckle #’s in children can be managed with:
- Well fitting splint
- Advice sheet
This decision tree must be followed to identify suitable patients
If you are concerned about Non-Accidental injury – you must escalate your concern.
0-12yrs WETFLAG
Tips:
- If particularly BIG – go up 1-2 yrs
- If particularly SMALL – go down 1-2 yr
- Prepare ET Tubes 0.5mm bigger and smaller
APLS 7e
APLS 7e Trauma
Information from APLS Aide-Memoire
Pulmonary Embolism – PE
PE is somehow both the most over and under diagnosed condition. with severity ranging from the questionable sub-segmental PE to the Massive PE (an indication for thrombolysis). So think:
- Does this presentation sound like a PE? – If not STOP here
- Pregnant? – Click Here
- Do you think this is likely a PE? (if so you can’t use PERC)
- Does D-Dimer answer your question? (whats the Wells)
- Massive PE – think Thrombolysis
- Sub-Massive PE – there is lots of debate (involve seniors), locally needs 2 consultant sign off and not considered time critical.
Neonatal Seizures
Seizures are a common neurological emergency in the neonatal period, occurring in 1–5 per 1000 live births.1 The majority of neonatal seizures are provoked by an acute illness or brain insult with an underlying aetiology either documented or suspected, that is, these are acute provoked seizures (as opposed to epilepsy). They are also invariably focal in nature.
Clinical diagnosis of neonatal seizures is difficult. This is in part because there may be no, or very subtle, clinical features, and also because neonates frequently exhibit non-epileptic movements that can be mistaken for epileptic seizures.
Methaemoglobinaemia
Q: Why are Smurf’s Blue?
A: Methaemoglobin (MetHb) of course!
– MetHb is produced by oxidisation of the Iron in Haemoglobin (Hb) from Fe2+ to Fe3+
– Fe3+ prevents Hb carrying oxygen (thus produces symptoms of hypoxia)
– Often due to chemical ingestion, but may also be genetic
– Treated with Methyl Blue & supportive measures
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!
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
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
