To drain or not to drain? – that is the question (Follow the BTS algorithm).This is not for Tension!
(All treatment options should be discussed with the patient to determine their main priority, with consideration for the least invasive option)
To drain or not to drain? – that is the question (Follow the BTS algorithm).This is not for Tension!
(All treatment options should be discussed with the patient to determine their main priority, with consideration for the least invasive option)
Warning:
The ACS pathway is for patients where coronary ischemia is in your differential. It is not a blanket pathway for chest pain of unknown cause.
If an initial trop is taken >8 hours post chest pain, and patients have no new ECG ischaemia, and no history of unstable angina, there is no compulsion to repeat a second troponin.
Anticoagulated with a NOAC, or with Warfarin (with a therapeutic INR),
Patients with ST Elevation (if not accepted for primary PCI) or those with CP + new ST Depression should be discussed with a local Cardiologist and come directly to CCU.
As it is difficult to be prescriptive for every other circumstance, a discussion with a senior / cardiologist may be worthwhile in order to best place your patient within the hospital. Factors that should make you think about a senior discussion are included on the pathway.
If patients do exit the pathway (no new symptoms, no new ECG ischemia and troponins that meet the exit criteria to exclude an MI), two other important possibilities still require consideration:
Patients on Warfarin/DOAC : Use Asprin and Clopidogrel
In the Emergency Department (ED) lower leg immobilisation after injury is a necessary treatment but is also a known risk factor for the development of venous thromboembolism (VTE). This accounts for approximately 2% of all VTE cases which are potentially preventable with early pharmacological thromboprophylaxis.
There have been >100 patients identified as having MPox in the UK during the current outbreak. Most of these cases have been amongst men who have sex with men.
Reports have suggested that although lesions occur any where including palms and soles. Genital lessons and lymphadenopathy are very common
The Paediatric Liaison Form (PLF is now part of EPR – how to guide)
This form alerts the Paediatric Liaison Team to your concerns so that they can investigate and provide appropriate support to the child & family.
You SHOULD inform the family that you are completing the form as the Paeds Liaison Team or other agencies (e.g. social services or school nurse)may contact them.
You SHOULD NOT use this form for patients who have either suffered or at risk of significant harm. In this case you should discuss directly with the paediatric consultant on-call.
PDF: Safeguarding Guide
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