First Aid (ALL)
- Encourage bleeding
- Wash with copious amounts of water or saline
- Don’t Suck
- Don’t use Caustic agents
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
March 2024 – UKHSA warn there is increasing cases in DRC (Democratic Republic of Congo), so stay vigilant in travellers from central Africa.
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
Nausea and vomiting in pregnancy is common and at best an unpleasant experience for the patient, and at worst can be life threatening. It normal starts @ 4-7/40, peaks @ 9/40, and finishes @ 20/40.
We need to conduct a thorough history and examination looking for causes other than a high βHCG. these include:
Generally we DON’T admit patients acutely solely for “Detox”
However the following groups should be admitted [taken from trust guide]
If admitted to CDU – complete the PAT tool
Measuring for and advising patients on the use of elbow crutches is an important skill for ED staff.