If anybody is symptomatic after button battery ingestion they need referral to the Surgical team for urgent endoscopic removal. Liase immediately with our local surgical/ENT teams but be aware this may end up as a time critical transfer to Leeds especially if child <2years. Read more
The provision of out of hours mental health services for Children and young people (under the age of 18) and in hours services are different.
In-Hours (9am – 8pm) – contact CAMHS via switchboard
OOH (8pm – 9am) – contact the Mental Health Liason team (RAID) via switchboard (they will see/telephone review these patients initally and help with the mental health aspects including levels of risk and follow up plans with further mental health services)
Most, if not all, primary presentations to the ED with mental health concerns will meet the threshold for discussion with these services even if they decide same day review isn’t appropriate/they direct you elsewhere.
All self-harm and any overdose must be discussed!
Acute behavioural disturbance in children and young people has no nationally approved guideline and should be discussed with senior ED (ST4+), paediatric and mental health colleagues.
In young people for whom a HEADSSS assessment has been performed and you have low level concerns but for whom formal mental health/safeguarding thresholds have not been reached there are local resources which it may be useful to direct young people towards.
BLOSM colleagues are also a great resource repository even if children don’t meet formal referral criteria
Night OWLS – confidential emotional support line open between 8pm and 8am
Openminds Calderdale – repository of multiple sources of well-being support for children in Calderdale
Kirklees Keep in Mind – repository of multiple sources of well-being support for children in Kirklees
Night OWLS is a confidential support line for children, young people, their parents and carers who live in Bradford, Leeds, Calderdale, Kirklees and Wakefield.
Read more
Most of us will have seen patients like this – agitated, aggressive and often with police or security pinning them down.
Refusing treatment = Mental Capacity Assessment [LINK]
| Order | Drug | Route | Typical Dose (mg) | Onset (min) | Duration (hr) | Warning |
|---|---|---|---|---|---|---|
| First Line | Lorazepam - Adult | IV | 1mg IM/IV (max dose 4mg/24hrs) | 2-5 | 1-2 | Respiratory depression, IM unpredictable onset |
| IM | 15-30 | |||||
| Lorazepam-Elderly | IV | 0.5mg IM/IV (max dose 2mg/24hrs) | 2-5 | |||
| IM | 15-30 | |||||
| Second Line - Adult | Olanzapine (not within 1hr of IM Lorazepam) | IM | 5mg (max dose 20mg/24hr) | 15-45 | >10 | Arrhythmia Risk: Only if previously used OR ECG |
| Second Line - Elderly | Promethazine | IM | 10mg | 15-30 | >10 | |
| Sedation ST4+ involvement required | Ketamine | IV | 1-2mg/kg | 1 | 20-30 | Theoretical risk of worsening cardiovascular instability |
| IM | 2-4mg/kg | 3-5 | 60-90 |
It is vital that patients returning to police custody as discharged as safely as possible. Part of that is ensuring the custody team has adequate information about the patient. So so complete the Return to custody form, documenting…. Read more
Delirium is one of a number of geriatric syndromes and has significant associated morbidity and mortality.
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
Remember to complete ReACT or CAMHS assessment tools on EPR Read more
A selection of patient, relative, and general resources designed to assist those presenting with self injury, and those who care for them.
Domestic abuse can affect anyone and often its not readily disclosed on an ED admission. We must be alert to the fact some of our patients may be attending with domestic abuse. Please explore concerns and escalate if you’re unsure. Our colleagues in the Pennine Domestic Violence Group have kindly drawn this a guidance up for us.
