ACS – Acute Coronary Syndrome

December 22, 2017

This pathway is ONLY for single episodes of cardiac chest pain lasting over 15 min. Multiple episodes (¿unstable angina?), continuing chest pain, or non-cardiac chest pain need to be treated and investigated differently! Low Risk HEART 0-3 08-18:00 – can have their 2nd troponin and review on AAU 18-08:00 –… Read more

Acute Heart Failure (AHF) – ESC 2016

October 9, 2018

  AHF Triggers there are many triggers for AHF, which if recognized and treated with help improve outcomes Cardiac: ACS, Arrhythmia, Aortic Dissection, Acute Valve Incompetence, VSD, Malignant Hypertension Respiratory: PE, COPD Infection: Pneumonia, Sepsis, Infective endocarditis Toxins/Drugs: Alcohol, Recreational drugs, NSAIDs, Steroids, Cardiotoxic meds Increased Sympathetic Drive: Stress Metabolic:… Read more

Aortic Dissection

June 16, 2018

Aortic Dissection (AD), is uncommon (1 AD:200 ACS) but is…Rapidly FATAL!  Unfortunately recognising aortic dissection is difficult with a clinician pickup rate of 15-43%. Read more

Bradycardia

August 12, 2018

ALS Bradycardia Algorithm – Adult

Causes

Cardiac: Heart Block, Myocardial infarction, Myocarditis
Metabolic: Hypothermia, Hyperkalaemia, Hypokalaemia, Hypothyroid, Hypoxia
Toxin: digoxin, B-blocker

Treatment
For ALL conditions leading to bradycardia treating the underlying condition is the most appropriate treatment and for some the only thing that will work (i.e. severe hypothermia) Read more

Digital ECG

January 2, 2019

Digital ECG has now gone live on both sites. We now have no excuse for loosing ECGs and not sending them to the wards with patients! Please ensure you put an operator ID in as well as all the patient information to ensure the ECG transmits to EPR – if… Read more

DVLA – Driving & Medical Conditions

May 8, 2018

For many conditions the patient should be informed to stop driving and inform the DVLA of their condition. It is the patients responsibility to inform the DVLA, and we should encourage them to do so.
[There is a £1000 fine AND the risk of prosecution] Read more

Myocardial Infarction (MI) – PPCI/Thrombolysis

June 22, 2018

PPCI

Target: Door to balloon 90min
Criteria:

Time: Chest pain within 12hrs (or worsened within 12hrs)
ECG:  ST elevation MI (1mm Limb or 2mm Chest leads) OR New LBBB. (Posterior MI do posterior leads and discuss with LGI)

Actions:

Resuscitate
Contact PPCI team @ LGI (Mobile No. up in Resus)
Arrange blue light (P1) ambulance to LGI
Ticagrelor 180mg and Aspirin 300mg (if anti-coagulated Discuss with PCI team)

Problems: 

Intubated patient: Often LGI would accept but need to arrange Cardiac ICU. If no bed patient could go for PCI to return locally immediately after PCI to our ICU’S?
LGI Full: Occasionally the cath lab is full and can’t accept your patient

Calling Manchester and Sheffield: It’s worth a go but they don’t have agreements with us  so having your patient accepted can be difficult
Don’t Forget Thrombolyisis: We need to open up the patients artery, if there is no quick decision to go for PPCI – Consider Thrombolysis

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Primary Atrial Fibrillation (AF)

December 23, 2017

Before you start treating make sure you ask a few question Questions Whats the cause? – treating the precipitant often sorts the AF (adding B-Blockers to Sepsis can make things worse) Stable or Unstable?  – Electricity vs. Drugs less than 48hrs? – Rhythm vs. Rate control CHADS-VASC vs. HASBLED – Anticoagulation… Read more

Syncope – ESC 2018

September 25, 2018

Defintion:Transient Loss of Consciousness (TLOC) due to cerebral hypoperfusion, characterised by a rapid onset, short duration, and spontaneous complete recovery.
Common ED Complaint: 1.7% of all attendances
Difficult Diagnosis: less than 50% get a diagnosis in ED
Mortality & Serious Outcome: 0.8% mortality & 10.3% serious outcome @ 30 days

Ask 3 Questions!

Is this Syncope?
What is the underlying cause?
What is the best Follow-Up for this patient?

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Syncope – NOT collapse ? cause

December 20, 2017

Syncope can be a bit of a heart sink. However, if you ask 3  simple(ish) questions, you can improve the outcome for patients. (Remember universal hospital admission is not “SAFE”) Questions Was it Syncope? What is the cause? NO cause found – risk stratify (whats the risk?) Remember DVLA must… Read more

Tachycardia

February 28, 2018

Background

Cardiac arrhythmias are relatively common presentations to ED.
There are many causes, some more sinister than others.
If your patient is not acutely unwell then expert advice may be required.

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