An elderly patient attends the ED with difficulty mobilising, Nursing staff tell you that the patient needs a CT head for STROKE? – “They are really unsteady if they try to stand and they can’t lift their arms up”. Read more
Diabetic Ketoacidosis – remember in paediatrics this may be the 1st presentation of diabetes.
Adrenal crisis or insufficiency is a life threatening emergency due to the lack of glucocorticoid. Adrenal crisis can be primary due to destruction of the adrenal cortex (Addison’s), or secondary due to down regulation (chronic steroid use) Read more
Hypernatraemia is a not a common presentation in ED, as intense thirst often prevents significant hypernatraemia in neurologically intact individuals. So… Mortality rates are high (20-70%) and the severity of hypernatraemia has been shown be an independent predictor of mortality.
However, there is little good data on hypernatremia to base guidance on, and definitions vary within the literature
We often worry about patients developing rhabdomyolysis and consequently developing AKI. However, there is much debate and little consistency in the published data, over how to diagnose and who needs admission to treat. So its important to consider both clinical context along with laboratory values
Remember: is it a haemolysed blood sample? (you can do an iSTAT)
Severity
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
Paediatric Hypoglycaemia (BM <2.6) is a relatively common presentation in the Emergency Department. However, if we don’t do the BM it’s easy to miss.
Hypoglycaemia is generally caused by disruption in one of the following:
Both COVID-19 infection and treatment with dexamethasone impair glycemic control. So its important to monitor blood sugars and consider DKA & HHS in COVID-19 patients. Latest guidance from DIABETES-UK
