Primary Eyecare Acute Referral Scheme
Category: Learning
Meningitis – Adults
- Keep your suspicions high – early signs it may not be clear
- Sepsis Kills – give antibiotics & fluid early
- Consider Acyclovir
- Give Dexamethasone with Antibiotics – it can reduce neurological sequelae
- Consider indications for CT before LP
- Get SENIOR support early
Rhabdomyolysis
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
Early Pregnancy Bleed <16/40
Bleeding in early pregnancy is a relatively common problem and in the many cases (esp. with spotting) the pregnancy remains viable. However, bleeding in early pregnancy should never be thought of as normal, and it is vital that we investigate this appropriately.
Communication is also vital at a very stressful time
- Who you are discussing this pregnancy in front of? – Does the patient want them to know
- Manage expectations – There is nothing we or mum can do to change the out come of the pregnancy apart from ensuring mum is well
- Ensure the patient has all the details they need – Return advice, clinic time, where to go, what is happening
- Be sensitive to the patients feelings – Patients respond very differently, be careful not to impose your emotions/assumptions on the situation
Think Anti-D!
Anti-D immunoglobulin guide
Search: ectopic pregnancy, Ectopic Pregancy, pv bleed, MISCARRIAGE, vaginal bleed, EPAU
Headache
There are numerous causes of headache, however, the pressing question in the ED is,
Is this a primary or SECONDARY headache?
- Primary headaches [e.g. tension & migraine}, maybe painful and need analgesia but don’t require emergency investigation.
- Secondary headaches, often but not always have serious underlying causes [e.g. SAH, central venous thrombosis] requiring emergent investigation and treatment
Delirium in the ED
Delirium is one of a number of geriatric syndromes and has significant associated morbidity and mortality.
3 subtypes of delirium
- Hyperactive – easies to spot, one we are most familiar with. Characterised by agitation/aggression/hallucinations “the non cooperative patient”
- Hypoactive – harder to spot. Characterised by drowsiness, less responsive, vacant, sleeping more at home
- Mixed
Remember there is NO SUCH THING AS A “POOR HISTORIAN” !! – Just a poor clinician! If your patient is not cooperating and can’t tell you very much then you need to find out why!!! Read more
Hypothermia
Remove COLD, Add WARM, Don’t SHAKE
- 32-35ºC [Mild] – Shivering, Tachycardia, Tachypnoeic, Vasoconstriction
- 30-32ºC [Moderate] – Shivering stops, Pale/Cyanosed, Hypotensive, Confused, Lethargic
- <30ºC [Severe] – Low GCS, Bradycardia/pnoeic, Hypotensive, Arrhythmias, Cardiac Arrest
Assessing Functional Leg Weakness
When patients present with functional symptoms. It can be difficult to discern whether if it is an actual or functional weakness. And it can be even more difficult to convince the patient. However these tests can not only help you workout what is happening, but also demonstrate function to the patient. Read more
Epistaxis – Management
Nose bleeds are a bloody common problem (bad pun intended) – most originating at the front to the nose where there is a cluster of blood vessels – Little’s Area.
In the young the bleeding often starts after trauma (e.g. picking or punching noses). In the elderly however, it is commonly a manifestation of underlying vascular disease. Read more
Pneumonia (Community Acquired)
Severe Pneumonia: Please Request/Send – Samples Sputum/Blood/Urine
BTS Definition of CAP
Signs of acute Lower Respiratory Tract illness (LRTI) [Cough] &:
- ≥1 other LRTI Symptom [Pleuritic pain, Tachypnea, Dyspnea, etc]
- New Focal Chest Signs [Creps, Bronchial breathing, Red. A/E]
- ≥1 Systemic sign [Fever, Sweats, Chills, Rigors, >38oC]
- New CXR changes [if hospitalized]
