Category: Respiratory

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

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

Anaphylaxis 2021

Not all Allergies are Anaphylaxis!

Anaphylaxis is defined as:

  • Severe life-threatening systemic hypersensitivity reaction
  • Where BOTH of the following criteria are met:
    1. Sudden onset & rapid progression
    2. Life-threatening compromise of ONE or MORE of: Airway/Breathing/Circulation

Read more

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)
  • High-Risk (Wells >4) – Treat before CT
  • 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.

Read more

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

Read more