Author: huw masson

Underage Sexual Activity

This applies to all children/young people under 16 years old and those 16-18 years who are considered vulnerable, engaging in sexual activity. Getting this right is immensely challenging, as it is impossible to cover all variables influencing decision making within this guidance, further more you need to carefully weight the often conlicting needs of the child. (Involve seniors early if you have any doubts) Read more

Tetanus – Wounds

Tetanus prone and High Risk definitions

Immunisation schedule

  • Primary: 2, 3 & 4 months old
  • Boosters: 3½ – 5yrs and 13-15yrs

Warning:

  • Immunisation only started nationwide in the UK in 1961 (people born before 1961 are unlikely to have completed a primary course)
  • Immunocompromised patients are unlikely to produce adequate antibodies

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Headache

There are numerous causes of headache, however, the pressing question in the ED is,

Is this a primary or SECONDARY headache?

  • Primary headaches [e.g. tension & migraine}, maybe painful and need analgesia but don’t require emergency investigation.
  • Secondary headaches, often but not always have serious underlying causes [e.g. SAH, central venous thrombosis] requiring emergent investigation and treatment

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Covid-19 (dexamethasone)

You may have seen in the news early results from the RECOVERY trial.

In Covid-19 patients requiring either Oxygen or Intubation, dexamethasone has been shown to reduce mortality.

  • Oxygen – 20% reduction in mortality
  • Intubation – 35% reduction in mortality
  • No respiratory support required – No benefit found

Inclusion: Covid-19 patient requiring oxygen or intubation

Medication: (RECOVERY study protocol)

  • Dexamethasone administered as an oral (liquid or tablets) or intravenous preparation 6 mg once daily for 10 days.
  • In pregnancy or breastfeeding women, prednisolone 40 mg administered by mouth (or intravenous hydrocortisone 80 mg twice daily) should be used instead of dexamethasone.

Post Dex Glucose monitoring:

  • Glucose should be checked every 6hrs (ideally fasted i.e. before meal)
  • If Glucose ≥12, follow the chart below either guided by their normal Total Daily Dose (TDD) of insulin, or weight if insulin nave, or unknown.
  • Full protocol – HERE

Alcohol Withdrawl

Generally we DON’T admit patients acutely solely for “Detox”

However the following groups should be admitted [taken from trust guide]

  • Patients requiring admission for another reason – refer to appropriate specialty (e.g.  Head injury going to CDU, or Upper GI bleed going to medicine)
  • ALL patients with symptoms / signs of Wernicke’s – medicine
  • ALL patients with Delirium Tremens – medicine
  • ALL alcohol withdrawal fits if patient to remain abstinent – medicine
  • ALL alcohol related seizures with possible other trigger – medicnie
  • ALL decompensated alcoholic liver disease – medicine

If admitted to CDU – complete the PAT tool

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Hyperosmolar Hyperglycaemic State (HHS)

HHS (A.K.A. HONK) is a diabetic emergency, but unlike DKA we don’t always think about it.

Patients with HHS are often elderly with multiple co-morbidities, and they are always very sick.

Definition

  • Hypovolaemia
  • Hyperglycaemia – generally ≥30mmol/l
  • High Osmolality – generally ≥320mosmol/kg (Calculation= 2[Na] + [Glucose] + [Urea])
  • & NOT:
    • Acidotic – pH >7.3, HCO3 >15mmol/l
    • Ketotic – blood <3mmol/l, Urine <2+

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