Category: Medical

Medical Emergencies in Eating Disorders

Eating disorders* are relatively common and unfortunately patients who “look well” can have a significant mortality risk. MEED.org.uk have national risk tools to recognise those that would benefit from admission, which fit with our local mental health teams, and agreed by both acute medicine and paediatrics

(*anorexia nervosa, bulimia nervosa, binge eating or avoidant restrictive food intake disorder)

Risk Assessment

RED indicators

Anyone with one or more RED’s is high risk and should be considered for admission MEED

  • BMI <13/<70% mBMI
  • Recent weight loss >1 kg/week for 2 weeks in an underweight patient
  • HR (awake) <40
  • Recurrent syncope with standing BP <90 systolic (<0.4th percentile for age) and postural drop >20 mmHg (or increase HR >30 [>35 if <16])
  • Fluid refusal or signs of dehydration
  • Temperature <35.5°C tympanic/35°C axillary
  • Long Qt or other ECG abnormalities
  • Low Glu/Na/K/Ca/PO4/Alb
  • Low WCC, Hb <10
  • Acute food refusal/very low calorie intake per day
  • Physical struggles with carers over nutrition
  • High levels of uncontrolled exercise (>2 hours/day)
  • Daily purging behaviours
  • Self-harm
  • Moderate–high risk suicidal ideas.
MEED Check list

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

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Delirium in the ED

Delirium is one of a number of geriatric syndromes and has significant associated morbidity and mortality.

3 subtypes of delirium

  1. Hyperactive – easies to spot, one we are most familiar with. Characterised by agitation/aggression/hallucinations “the non cooperative patient”
  2. Hypoactive – harder to spot. Characterised by drowsiness, less responsive, vacant, sleeping more at home
  3. 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

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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]

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