Category: Respiratory

MERS

Middle East respiratory syndrome coronavirus (MERS-CoV)

MERS is classified as a High Consequence Infectious Disease (HCID), and although unlikely is serious and could be imported into the UK at ANY time. Risks are higher when there is increased travel to endemic areas such as Hajj.

Symptoms include fever and cough that progress to a severe pneumonia causing shortness of breath and breathing difficulties. In some cases, a diarrheal illness has been the first symptom to appear.

UK Health Security Agency:

Suspected = Isolate & Full PPE

  • Trust Guidance
  • PPE Notes:
    • FFP3 (can’t use hoods)
    • Buddy System vital
  • Senior Review needed
    • Collect relevant information
    • Contact Microbiologist immediately (as may de-escalate without tests)

SITE Specifics

HRI:

  • Primary site for Pre-alerts
  • 1 Patient – goes to Isolation. room
  • 2 Patients  – second patient goes to Minors 5
    • end of corridor and lounge closed off
  • 3+ Patients – ALL MERS patients moved to Minors Corridor
    • Minors corridor closed
    • Minors/UCH moved to uSDEC
    • Internal Trust Majax

CRH:

  • 1 Patient – goes to “Old Relatives”
    • Corridor closed from treatment room to door to ambulance corridor
    • Patients moving from majors wait to department will need to go outside to ambulance entrance
  • 2 Patients  – second patient goes to treatment room to left of reps room
    • Corridor closed sure extended to reception
    • Patient 1 MUST move out of ED and cubicle cleaned 

Useful Videos

Donning:

Doffing:

Taking Bloods:

Think -TB

The prevalence of Tuberculosis in our region is increasing and has significant issues for both the patient and public health if we miss it.

Symptoms

  • Cough
  • Fever
  • Night Sweats
  • Lymphadenopathy
  • Weight loss

High-Risk factors to consider

Characteristics

  • Previous/Latent TB
  • TB Contact
  • Immunocompromised
  • Substance Misuse
  • Homeless/Prision
  • Pubs – esp. Vulcan Hudds

Travel/Ethnicity

  • Eastern Europe
  • India/Pakistan
  • East Asia
  • Africa

CXR Changes

  • Upper Lobe Consolidation
  • Hilar Lymphadenopathy
  • Cavities

Actions

  • Provide 3 AFB samples – Ideally performed in ED/Ward (but if patient fit for discharge and unable provide samples in ED give patient pots and request which they return to their GP.
  • Don’t Commence TB treatment – unless instructed by respiratory team
  • If admitted isolation requested
  • If discharged Patient told to isolate and if must go into public wear face mask
  • Contact TB team:
    • Huddersfield/Halifax – Based on GP postcode
    • In-Hours: either through Switch board or as EPR referral
    • Out of Hours: Though EPR referral
    • They will ensure appropriate notification of Public Health

Huddersfield

  • Dr Anneka Biswas
  • Chantelle Lashington
  • Deborah Howgate

Halifax

  • Dr Nicholas Scriven
  • Mary Hardcastle
  • Manjinder Kaur

2WW – Suspected Cancer

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.

Emergency Department MDT referral request – HERE

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

Pulmonary Embolism – PE

PE is somehow both the most over and under diagnosed condition. with severity ranging from the questionable sub-segmental PE to the Massive PE (an indication for thrombolysis). So think:

  • Does this presentation sound like a PE? – If not STOP here
  • Pregnant?  – Click Here
  • Do you think this is likely a PE? (if so you can’t use PERC)
  • Does D-Dimer answer  your question? (whats the Wells)
  • Massive PE  – think Thrombolysis
  • Sub-Massive PE – there is lots of debate (involve seniors), locally needs 2 consultant sign off and not considered time critical.

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Methaemoglobinaemia

Q: Why are Smurf’s Blue? 

A: Methaemoglobin (MetHb) of course!

– MetHb is produced by oxidisation of the Iron in Haemoglobin (Hb) from Fe2+ to Fe3+

– Fe3+ prevents Hb carrying oxygen (thus produces symptoms of hypoxia)

– Often due to chemical ingestion, but may also be genetic

– Treated with Methyl Blue & supportive measures

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