- Activate EARLY in head injury patients on warfarin.
- Order on EPR & Paper [see below]
- Infuse over no more than 30 min
- Recheck INR at 30 min after finished infusion
Indications
- EMERGENCY reversal of Warfain
- Factor II or X deficiency
Category: Medical
Vertigo in ED
Vertigo is not always labyrinthitis!! There are some potentially serious conditions to think about. Your main question should be is it peripheral [good] or central [bad]?
Pulmonary Embolism – PE
PE is somehow both the most over and under diagnosed condition. with severity ranging from the questionable sub-segmental PE to the Massive PE (an indication for thrombolysis). So think:
- Does this presentation sound like a PE? – If not STOP here
- Pregnant? – Click Here
- Do you think this is likely a PE? (if so you can’t use PERC)
- Does D-Dimer answer your question? (whats the Wells)
- Massive PE – think Thrombolysis
- Sub-Massive PE – there is lots of debate (involve seniors), locally needs 2 consultant sign off and not considered time critical.
Methaemoglobinaemia
Q: Why are Smurf’s Blue?
A: Methaemoglobin (MetHb) of course!
– MetHb is produced by oxidisation of the Iron in Haemoglobin (Hb) from Fe2+ to Fe3+
– Fe3+ prevents Hb carrying oxygen (thus produces symptoms of hypoxia)
– Often due to chemical ingestion, but may also be genetic
– Treated with Methyl Blue & supportive measures
Hypernatraemia
Hypernatraemia is a not a common presentation in ED, as intense thirst often prevents significant hypernatraemia in neurologically intact individuals. So… Mortality rates are high (20-70%) and the severity of hypernatraemia has been shown be an independent predictor of mortality.
However, there is little good data on hypernatremia to base guidance on, and definitions vary within the literature
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.
Snake Bites
In the UK approximately 100 people are envenomated by a snake each year.
So what do you need to do if your patient has received a venomous bite from a snake? (not the classic UK cocktail).
- Don’t Cut & Suck!
- Treat what you see
- Call Toxbase
Measles
Suspected/Confirmed patients should be ISOLATED & wear PPE
Treating Staff – (should not be; non-immunised, pregnant or immunocompromised)
- single-use, disposable gloves
- single-use, disposable apron (or gown if extensive splashing or spraying, or performing an aerosol generating procedure (AGP))
- FFP3 – respiratory protective equipment (RPE)
- eye/face protection (goggles or visor)
Patient
- Surgical face mask
Background
- Measles is highly infectious – (4 day prior to and after rash appears) suspected patients should be isolated within the ED
- Measles Immunisation – 1 dose 90% effective, 2 doses 95% effective
- Measles is a notifiable disease
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
