This is guide to the investigation of Metastatic Spinal Cord Compression (MSCC) in Oncology/Haematology patients. – (Trust link)
You need to be a bit more suspicious and have a lower threshold for investigation than in patients without Known, Suspected OR Previous Malignancy Read more
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.
Time Critical Medication (TCM) is scheduled medication that the patient is already on when they present to the Emergency Department (ED).
The medications are “time critical” because a
delayed or missed dose can result in harm with exacerbation of symptoms and the development of complications leading to an increased mortality.
Movement disorders – Parkinson’s / Myasthenia medication
Immunomodulators including HIV medication
Sugar (Insulin)
Steroids – Addison’s and adrenal insufficiency
Epilepsy – anticonvulsants
DOACs and warfarin
Its really important for our patients that these medications are prescribed and given while in ED/uSDEC/fSDEC.
If you are withholding these medication (which may be necessary) -please document the reason for this clearly in the notes.
In hours speak to pharmacy if you require any support with these patients.
We all recognise the importance of ensuring patients with Parkinson’s disease (PD) get their medication, but..
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.
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
Some patients present to ED with symptoms or investigations suspicious an undiagnosed cancer, but don’t require emergency admission. To reduce the barriers to care the trust has implemented a referral route for ED.
Ensure you include a valid e-mail address on the referral form. The Patient Pathway team will acknowledge receipt of your referral via e-mail within 2 working days. If you do not receive this e-mail, please escalate to the EPIC
Once completed the PPC team will review the request and feed them into either “Fast-Track Clinics” if further workup required or MDT’s if fits those pathways.
This should allow our patients quick access to appropriate clinics, without the inherent delays and wasted clinical time of asking the patient to attend their GP. BMA/NHSe
For many conditions the patient should be informed to stop driving and inform the DVLA of their condition. It is the patients responsibility to inform the DVLA, and we should encourage them to do so.
[There is a £1000 fine AND the risk of prosecution] Read more
Headache is a common presentation to ED and Subarachnoid Haemorrhage (SAH) is the diagnosis we never want to miss. However, working out who needs a scan can be difficult as 50% of patients presenting with a subarachnoid have no neurological deficit.
