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
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 (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
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 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
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
On the 8th of May we are changing our current troponin test to a HS-Trop (high sensitivity troponin). This will allow us to exclude ACS earlier in the patient journey, however it does mean getting used to new numbers and a new protocol. Read more
PPCI (Leeds PPCI Pathway)
Target: Door to balloon 90min
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)
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)
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
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
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?
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
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.