As we know “TIME is BRAIN” so early recognition of stroke is vital so BE FAST! Read more
Category: Medical
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
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]
Pneumothorax – BTS 2023
To drain or not to drain? – that is the question (Follow the BTS algorithm).This is not for Tension!
(All treatment options should be discussed with the patient to determine their main priority, with consideration for the least invasive option)
Are You CO Aware?
With the onset of colder weather, many households in the UK are turning on their heating for the first time in months. Heating appliances need chimneys and flues to work safely – and these can block up over the summer months. So autumn is traditionally the period when people get poisoned by carbon monoxide (although it can happen any time of the year!)
Carbon monoxide (CO) is produced when anything containing carbon burns or smoulders. For practical purposes, this means the burning of any kind of fuel, commonly:
- Gas
- Coal
- Wood/Paper/Card
- Oil/Petrol/Diesel – (All UK cars have a ‘catalytic converter’ in the exhaust system, which converts carbon monoxide (CO) to carbon Dioxide (CO2), which is less poisonous. However, these converters need to warmed up – a cold car produces fatal amounts of CO in the exhaust)
CO is very poisonous. Exposure to as little as 300 parts per million (that’s just 0.03%) can prove fatal.
Upper GI Bleed (UGIB)
Not normally difficult to spot, but look for it in unexplained anaemia, or collapse.
Questions
- Is it VARICEAL? Mortality 35%, so is an emergency whatever the GBS is.
- Non-Variceal what’s the GBS? will help guide treatment
Anyone being admitted should be brought to HRI
Emergency Endoscopy is arranged by Med Reg
Medical SDEC
Note: If the referrer feels the presentation of a patient is not within the inclusion/exclusion criteria they can still contact the SDEC co-ordinator and check for acceptance into SDEC.
- ED referrals ONLY 08-18:00
- Check Capacity prior to sending
- Investigations: FBC/U&E/Clotting/ECG
