Experience is showing that those with diabetic patients with COVID-19 are more likely to develop DKA/HSS. However, treating them with the traditional large amount of fluid is detrimental to their chest, if they have Covid-19
Hence the following has been developed from the Guy & Thomas’ guidance – CLICK HERE
High Clinical Suspicion of Covid-19
Clinical: Fever ≥37.8°C plus any of; cough, short of breath, myalgia, headache, sore throat
British Society of Thoracic Imaging (BSTI) have released a free learning resource containing CXR and CT of confirmed Covid-19 cases, will short history including time image was taken from onset of symptoms.
From the China experience CXR/CT doesn’t seem to be a rule out strategy in ED at the moment – However, its a useful resource to help recognition of Covid-19 CXR’s
Hyponatraema is a common finding, especially within our elderly population. However, its significance is is not a simple numbers game, and needs senior input. Prior to treatment the following need to be considered and balanced.
Symptoms Severity – these are not exclusive to hyponatraemia and may be due to other disease processes (esp. if the low sodium is long-term)
Sodium Level – the sodium concentration doesn’t always correlate to the clinical picture, and is dependant on speed of change, and co-morbidities
Rate of Drop – the faster sodium levels drop the more symptomatic the patient often is (i.e. with long term hyponatraema the patient may be profoundly hyponatraemic but asymptomatic)
Co-morbidities – Increasing sodium too quickly risks osmotic demyelination. How well will the patient cope with treatment?
Emergency treatment (hypertonic saline) is generally indicated in those with Severe Symptoms ONLY
Each year 1:15 of the adult population will seek medical help for Lower Back Pain, that is 2.6 million patients in the UK. Most Lower Back Pain is not serious and will revolve within 8 weeks, with analgesia and self physio.
However, this is not the case for some. This may be due to serious underlying pathology ‘RED Flags‘, or psychological factors that indicate chronicity ‘Yellow Flags‘.
We all recognise the importance of ensuring patients with Parkinson’s disease (PD) get their medication, but..
What do you do if the patient can’t swallow?
We will need to work out what alternative routes we could use, for example dispensable via NG or patches, and what dose. For an ED clinical it is most likely beyond us and we need help! However, that may be extremely difficult to get especially Out of Hours
Excellent website that can give you options – select the patients normal regime (initially just one line but you can add as many as needed) and press calculate. It gives you a dispensable and patch dose, which can help the discussion with pharmacy about where we can get it