Author: huw masson

Tetanus – Wounds

Changes in: Tetanus prone and High Risk definitions

Immunisation schedule

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


  • 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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To maintain or restore patency of the ductus arteriosus

Only to be used in infants who are ventilated or where ventilation is immediately available

DO NOT DELAY IN STARTING Alprostadil if: there is clinical
suspicion of duct dependent CHD while waiting for paediatric cardiology opinion OR echocardiogram, even when in-house echo facilities are present.

PDF: Alprostidil


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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Ordering X-Rays from Triage

Be specific

  • Subtle fractures are hard to pick up – especially if the wrong X-Ray is requested. Ordering the right X-Ray helps patients.
  • Finger injury – request X-Ray Finger(specific), NOT a hand (they are different views and often of little use)
  • Wrist injury – request X-Ray Wrist NOT Radius & Ulna
    • You can request they include the distal half of radius and ulna if the pain covers that area but still request a wrist

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