Category: Dept. Docs.

Death in ED

Do you need to Refer? 

  • A qualified medical practitioner certifies death is due to natural causes and
  • The family or other party do not raise any concerns
  • The full guidance is available – Guide to Reporting Deaths April19

Referred to the Coroner immediately (24 hrs/day)

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Massive Transfusion Pathway

In the case of patient with Massive Haemorrhage weather that be from Trauma, Surgical, O&G, UGIB, you can activate the MTP

Remember:

  • Do the Basics – don’t forget ABCD
  • Inform Transfusion and get someone to run a G&S sample down
  • FFP can take up to 45min and platelets come from Leeds
  • If you no longer need the MTP – inform transfusion and return products ASAP
major haemorrage

PDF:MTP

 

Concealed Illicit Drugs

Background

Those suspected of concealing illicit drugs often present near ports and borders however they can present to any ED or be brought in by the police.

Body Packers – Swallow large quantities of well packaged drugs to smuggle them into countries or institutions.  These are often well manufactured with a low risk of rupture but the potential for serious toxicity if rupture occurs.

Body Stuffers – Swallow small quantities of poorly packaged illicit substances often at the point of arrest to conceal them. These have a much high risk of package rupture but involve smaller quantities of substances.

 

Investigations

Authorisation for an intimate search or radiological investigation must come from an inspector or higher with written consent from the patient.

Intimate searches must be carried out by a police surgeon but require immediately available resuscitation facilities therefore may be conducted in the ED. ED physicians should not handle the drugs at any time.

AXR or low dose CT scanning can be used to detect concealed packages in Body Packers.

 

General Management

Try to obtain a history of what and how much has been concealed

Look for toxidromes suggestive of package leak –

  • Cocaine: Tachycardia, hypertension, agitation, diaphoresis, dilated pupils, hyperpyrexia, seizures, chest pain, arrhythmias and paranoia.
  • Heroin: pinpoint pupils, respiratory depression, decreased mental state, decreased bowel sounds
  • Amphetamines : – Nausea, Vomiting, Dilated Pupils, Tachycardia, Hypertensions, Sweating, Convulsions and the development of non-cardiogenic pulmonary oedema

ECG

Body Stuffers should be observed for signs of toxicity for a minimum 6 hours, consider activated Charcoal

Body Packers with positive imaging who are asymptomatic can be discharged back to police custody for monitoring. Bowel preparation such as Cleanprep or movicol can be used.

Toxidromes should be treated as per toxbase guidelines Toxbase

Body Packers with signs of cocaine or amphetamine toxicity or signs of obstruction/ileus require urgent surgical intervention.

Body packers with signs of Heroin toxicity should be treated with Naloxone infusion as per toxbase guidelines

 

Algorithms

 

 

Full RCEM Guide

COVID-19 (Which Covid Test)

Once the “Decision to Admit” has been made, an appropriate Covid-19 Test will need to be performed

  1. Select the appropriate patient group below
  2. Perform Test
  3. Clearly document which test was performed

Suspected Covid-19 Positive Patient

Patients with Covid-19 symptoms should have 2 swabs taken immediately

  1. PCR Testing – sent to lab
  2. Lateral Flow Devices – in ED for result after 30mins.

Record result on EPR as “Covid-19 Antigen Lateral Flow – POCT”

Patients Admitted To: Stroke (HASU), Paeds (HDU) OR Requires “URGENT” Result

Any patients identified by site commander as needing urgent result for flow reasons

(This also includes direct ward admissions to gastro and oncology)

  • Test swabs on ROCHE LIAT machine (performed by)
    • Site Commander
    • Night Matron
    • Stroke nurses
  • In ED prior to transfer – Results are in 90mins.

Record result on EPR as “Covid-19 RNA PCR – POCT”

NO Covid-19 Symptoms Present

A swab MUST be taken and sent to the lab for PCR testing.

Patient does not wait in ED for result.