Category: Neurology

Parkinson’s disease guidance

Trust guidance – 2026 (July) – Parkinsons Disease Guideline (COMBINED) (Review July 2029).pdf

For those admitted with known Parkinson’s disease:

1. Ensure to prescribe their regular PD medications, ensuring CORRECT:

    • Drug
    • Dose
    • Timings
    • Formulation (standard VS modified release)

(review patient medications, GP record or last clinic letter for up to date list of medications)

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 may need help! Speak to pharmacy if support required.

CHFT Guideline

Calculate patch dose using trust guideline (hyperlinked above). Combine doses for patient on frequency not available. For example on five times day dosing combine BD an TDS dosing. If you need any assistance calculating the dose, please speak to pharmacy for advice.

NOTE: Most Parkinson’s medications now stocked in ED – Emergency PD medications also available on ward 5 if struggling for supply out of hours.

 

2. Do not routinely refer for admissions unrelated to their PD

For those with undiagnosed but suspected Parkinsonism:

  1. Review any medication causes and stop/wean if clinically able
  2. Refer for outpatient clinic

Inpatient referrals: – – – – – –
May be necessary if admitted due to a complication directly related to their PD
May be necessary if due to side effects of PD medications
May be necessary if their PD/mobility is limiting discharge
May be necessary due to complex issues relating to their PD
If < 70, refer to neurology via MS teams (consultant-to-consultant)
If > 70, refer to a geriatrician (Dr F Bell at Huddersfield, Dr Z Beckett at Calderdale – via communicate ‘referral elderly medicine pool OR EPR request ‘referral to elderly medicine’ )

Outpatient referrals: – – – –
May be necessary if suspecting PD with no formal diagnosis
May be necessary if known PD requiring follow-up or outpatient review
If under neurology, via MS teams
If under geriatrics, EPR referral (Parkinson’s post wd dis)

 

ASPEN Collar fitting

Fitting ASPEN collars is import – for both the comfort and function of the collar. The DENS study has been looking at the effectiveness on collars in peg fractures. Preliminary results suggest limited benefit, which made be due to the fact the many patients remove the collar early as not comfortable.

 

APSEN Training Video

 

ASPEN VISTA (adjustable) – Coming Soon

Primary Intracerebral Haemorrhage

In anybody who there is suspicion of a non-traumatic haemorrhage arrange an urgent CT Head.

All patients need IV access and  U&E, FBC, Coag

If CT confirms PICH (not traumatic, not SAH): –

Anticoagulation

If anticoagulated with warfarin or NOAC discuss with stroke consultant and Haematologist regarding reversal

If not anticoagulated give Tranexamic acid – 1g in 100mls Saline/Glucose over 10 mins followed by 1g in 250mls Saline over 6 hours.

Blood Pressure

BP needs to be <150/80 – use labetalol (max 400mg – until BP <160 or HR <50) and GTN infusion

Neurosurgical Referral

Not all patients with intracerebral bleeds need referral to neurosurgery – you could save yourself and your patient a lot of time and effort!

Those to refer:

  • GCS 9-12/15 with lobar haemorrhage
  • Isolated intraventricual haemorrhage
  • Hydrocephalus on presentation
  • Rapid deterioration following arrival (gcs drop by 2 points or more in the motor component)
  • Cerebellar bleed

Admit those not going to Neurosurgery to HASU at CRH after discussion with Stroke team

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

Read more

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