Category: Medical

Emergency PEG/PEJ/RIG replacement

When a patients with a PEG/PEJ/RIG that has come out attends the ED its important that we can either replace it or insert an EN-Plug OR NG tube into the tract to maintain patentcy while being admitted (how to guide is below)

NG/Foley catheters must not be used to administer fluid or feed nor should the patient be sent home with it in-situ.

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Acute Cystitis and Pyelonephritis Pathway

A joint Medical-Urology pathway has been agreed for Pyelonephritis

Remember- Imaging in ED is only required if ED suspects:

  • Ureteric Obstruction – Renal colic symptoms/Hx of stone
  • Acute Surgical Abdomen
  • Emphysematous pyelonephritis – Rare necrotising infection of the renal tract, presenting with flank pain and fever, 90% in uncontrolled diabetes mellitus (but immunocompromise and stones also increase chances)
  • Renal Abscess – Presents with flank pain and fever, risk factors include; diabetes mellitus, Renal stones, obstruction

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DVT pathway 2021

Signs and Symps

No single feature is diagnostic:

  • Single limb oedema – Most specific
  • Leg pain – 50% but is nonspecific
  • Calf pain on dorsiflexion of the foot (Homan’s sign)
  • Tenderness of deep veins – 75% of patients
  • Warmth AND/OR erythema (although blanching is possible)
  • A palpable, indurated, cordlike, tender subcutaneous venous segment

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NIV (Non Invasive Ventilation)

NIV should be considered for use in patients with a  persisting Acute Hypercapnic Respiratory Failures after a maximum of one hour of standard medical therapy.

  • Complete the Ad-hoc form
  • Increase pressures from Initial 12/5 cmH2O to 20/5cmH2O – as tolerated over 1st hour

However, ICU should be contacted early if the patient has one of the following:

  • Asthma – Intubation the option of choice in Life threatening
  • Pneumonia – NIV should only be considered as a bridge to intubation
  • No pre-exisiting respiratory issue – NIV not likely helpful
  • pH <7.25 (low threshold for ICU input)
  • pCO2 >6.5kPa (low threshold for ICU input)
  • Type 1 Respiratory Failure (low threshold for ICU input)

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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
  • FFP can take up to 45min and platelets come from Leeds
  • If you no longer need the MTP – inform transfusion and return products ASAP
major haemorrage

PDF:MTP