NIPPV 3 machines are used throughout the trust to deliver NIV and CPAP – and should be commenced in ED if transfer to ward/ICU is adding significant delay
NIV/CPAP is an Aerosol Generating Proceedure (AGP)
Since we need to keep socially distanced, teaching may need to be a bit different. so this is our first effort to provide you with some local teaching resources.
Watch the video
Teams Q&A
we will send out invites to a teams meeting so wehw210af e can discuss pointss around the teaching – and if we have time any other issues
Since we need to keep socially distanced, teaching may need to be a bit different. so this is our first effort to provide you with some local teaching resources.
Watch the video
Teams Q&A
we will send out invites to a teams meeting so we can discuss pointss around the teaching – and if we have time any other issues
Adrenaline vs Placebo in out of hospital cardiac arrest
Headline Results:
Survival to hospital admission: adrenaline 23.8% vs placebo 8% (Significant)
Survival @ 3 months: adrenaline 3% vs placebo 2.2% (Significant)
Survival @ 3 months with good neurological outcome (MRS 0-3): adrenaline 2.1% vs placebo 1.6% (Non-Significant)
Interesting Result:
What did the public thing was the important outcome? In the restudy survey 95% of public reported that survival with good neurological outcome was more important than surviving to hospital.
Extrapolation of Adrenaline use: to all UK adult cardiac arrests in a year, adrenaline would increase:
Significant reduction in anaphylactoid reactions 2% vs 11%
Significant reduction in gastric symptoms (if either ondasetron or 12hr regime used)
Significant reduction in treatment pauses
What next?
10 centres using (inc Edinburgh, Newcastle, Guys St Thomas’)
We can’t implement the 12hr regime just yet (however, discussions are going on with Acute Med and Hepatology)
Pre-NAC ondasetron does seem like a good idea
Frailty
Comprehensive Frailty Assessments
NNT to prevent a death 17
NNT to prevent NH admission @ 6months 20
Frailty Score @ Triage
Initially 50% accuracy (esp. around 4/5)
Addition of props significantly improved triage accuracy
Do you find walking more difficult or do you need mobility aid? Yes > 4+
Do you do your own shopping & housework? No > 5
Do you need help washing & dressing? Yes > 6
Do you live in a care home or have carers?
If carers > 5+
If needs assistance with personal care > 6-7
Are they confused or have a diagnosis of dementia? Yes > 5
Delerium
PINCHME – for all frail patients they may not have delirium now but soon…
Parkinson’s Disease and can’t swallow
Find the right dispensable regime or patch – use pdmedcalc
Other ways of doing things
TRAWL
South Tees frailty team call all discharged frail patients to ensure things are going well and arrange further input as needed
Falls Rapid Response Team
Newcastle and Gateshead, paramedic and OT in a car reduce, conveyance to ED from 75%(with Ambos) to 45%
Dying
We all do it and we all want the best death possible – But we often do it badly
1:3 patients admitted on acute adult take are in their last year of life
80% of NH patients are in the last year of life
But we don’t always know which patient or recognise how quickly this will happen – think about the following:
Parallel planning: we can be both treating the patient, and making plans how we can allow them the best death if they are dying.
Sedating For Scan: PAUSE – this might be the last time they are conscious, consider them and their family and do they need time
Use the word Dying: find out what is important to them, and their family, what are their fears and what they want to know, allow silence.
Society is unfamiliar with death: Narrating whats happening for the family can help, e.g “that rattley noise you can hear is only a small amount of fluid in their throat, it can sound horrid but its not bothering them at all” Remember we are used to these stages but to families they are scared and they often assume that the patient is suffering.