Painful Crisis
Severe pain is the most common reason that patients with sickle cell, will attend the ED. The pain can be agonising (and often underestimated by us), we need to act fast to help ease the symptoms Read more
Category: Haem/Onc
Pre-Arrival Blood (O-ve)
On rare occasions you may receive a pre-alert, where you want blood available for the patient when they arrive (for example in major haemorrhage). This process has been agreed with transfusion so this can be done safely and responsibly. Read more
Metastatic Spinal Cord Compression (MSCC)
You need to be a bit more suspicious and have a lower threshold for investigation than in patients without Known, Suspected OR Previous Malignancy Read more
Transfusion Care Pathway
When giving blood products you need to use the transfusion care pathway.
- Octaplex
- Blood/Plt’s/FFP
It can be found on intranet > Policies & Documents Library >Other Systems [green button] > Clinical records repository > Search [title And transfusion] – its only 9 clicks away (and some writing)
DVLA – Driving & Medical Conditions
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
High INR
Patients sometimes present to ED or are send to ED due to over anticoagulation with warfarin
1. Is there Major/Significant bleeding?
Yes
- Resuscitate (ABCD)
- Give 5mg Vitamin K IV
- Octaplex Guide
- Treat bleeding and admit to appropriate speciality
Sepsis
Background
Sepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs. Sepsis can lead to shock, multiple organ failure and death especially if not recognized early and treated promptly.’ (GSA, 2010) Read more
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
- If you no longer need the MTP – inform transfusion and return products ASAP
Deep Vein Thrombosis (DVT)
Our protocol is initiated by ED and GP’s
Do the Wells Score and the D-Dimer – even if the wells score is high risk we still need a D-Dimer as will guide what happens in the event of a negative initial scan.
Ambulatory Vs MAU – is Rivaroxaban contraindicated, or patient won’t mange ambulatory care.
Ambulatory Patients – order U/S on EPR and prescribe 3 weeks of Rivaroxaban (3 x weekly scripts). Ultrasound will tell them to stop if scan negative and refer to DVT clinic or back to GP.
PDF:dvt
VTE prophylaxis in Lower Limb Injury
Our pathway has recently changed to reduce time and inconvenience, for both you and our patients.
- Consider in ALL over 16’s with lower limb immobilisation.
- Bloods not required for everyone.
- Prescribe for 2 weeks (to cover any delay to # clinic)
- Shapes Bin is collected from ED
PDF:vte
Search tags: lower limb fracture vte, lower limb # vte
