Author: huw masson

EMBRACE & Paediatric Critical Care

In our trust we don’t have paediatric critical care beds. However, in our region we use EMBRACE (a paediatric critical care transport team), who can transfer critically  ill children to specialist centers (in or out of region).

EMBRACE

Y&H Paed Critical Care

Drugs:

  • Trust guide
  • Remember: Midazolam 10mg/2ml is used(not the 5mg/5ml we have  in ED)

 

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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Alprostadil

To maintain or restore patency of the ductus arteriosus

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

Guideline-for-use-of-Dinoprostone-in-duct-dependent-CHD-1-8-3

 

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

 

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 (Osmolality Calculation= 2[Na] + [Glucose] + [Urea])
  • & NOT:
    • Acidotic – pH >7.3, HCO3 >15mmol/l
    • Ketotic – blood <3mmol/l, Urine <2+

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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
  • Immediate reinforcing dose of vaccine – these patients are expected to have a rapid response to vaccine dose conferring protection

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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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