Flu season 2018-9 is here and we need to think about Influenza PCR testing
POCT role-out has been delayed, however, please consider need for Tamiflu/Oseltamivir in discharged patients [yellow box]
Category: Respiratory
Are You CO Aware?
With the onset of colder weather, many households in the UK are turning on their heating for the first time in months. Heating appliances need chimneys and flues to work safely – and these can block up over the summer months. So autumn is traditionally the period when people get poisoned by carbon monoxide (although it can happen any time of the year!)
Carbon monoxide (CO) is produced when anything containing carbon burns or smoulders. For practical purposes, this means the burning of any kind of fuel, commonly:
- Gas
- Coal
- Wood/Paper/Card
- Oil/Petrol/Diesel – (All UK cars have a ‘catalytic converter’ in the exhaust system, which converts carbon monoxide (CO) to carbon Dioxide (CO2), which is less poisonous. However, these converters need to warmed up – a cold car produces fatal amounts of CO in the exhaust)
CO is very poisonous. Exposure to as little as 300 parts per million (that’s just 0.03%) can prove fatal.
Scombroid Poisoning- NOT another fishy allergy
Scombroid poisoning (AKA – Histamine fish poisoning) is apparently more common than we think and accounts for 40% of seafood related illness in the USA according to the CDC. But Scombriod poisoning is missed as its put down to allergy. Read more
A-a gradient
A-a gradient = Alveolar Oxygen – arterial Oxygen
This is “relatively” simple way of working out if the paO2 on a ABG is normal, and demonstrates V/Q mismatch well. V/Q mismatch is simple terms is either an area of the lung either under ventilated(pneumonia) or under perfused (PE). Read more
Pneumonia (Community Acquired)
BTS Definition of CAP
Signs of acute Lower Respiratory Tract illness (LRTI) [Cough] &:
- ≥1 other LRTI Symptom [Pleuritic pain, Tachypnea, Dyspnea, etc]
- New Focal Chest Signs [Creps, Bronchial breathing, Red. A/E]
- ≥1 Systemic sign [Fever, Sweats, Chills, Rigors, >38oC]
- New CXR changes [if hospitalized]
COPD think VBG
We have recently introduced the use of VBG in COPD.
Why Change?
- Pain – we all know and warn our patients ABG’s are painful. Patients know it to and delay presentation.
- Number of bloods taken – patients attending with COPD will generally have venous bloods taken at triage. Would you want stabbing again if it could be avoided?
Asthma – Adult
Asthma is common and potentially fatal.
- Severity – Severe or Life threatening – think RESUS
- Treatment within 30 min – bronchodilators and steroids should bee given within 30min
- 2hrs Observation after Neb – better after a neb don’t just send home they may deteriorate when it wears off.
- Discharge advice sheet – can print off from this guide, remember to check inhaler technique and consider a spacer
PDF:asthma adult
Pneumonia – Paeds
CAP is far less common than URTI’s, however, it needs to be considered within your differentials. Depending on severity there is a guide to investigation and treatment.
PDF:cap pead
COPD – exacerbations
COPD patients vary widely, due to their comorbidities, social circumstances, and wishes. So choosing the best treatment pathway for the patient can be complex. Involve senior decision makers.
Questions
- Is hospital the best place for them?
- Do they need NIV?
- Are they dying? – do you want to die surrounded by strangers or with your family?
PDF:copd
Pneumothorax – Medical ones
To drain or not to drain – that is the question (Follow the BTS algorithm).This is not for Tension!
Suggestion: Large pneumothorax consider placing a Seldinger drain instead of needle aspiration.
- Its small and no more painful
- Measure volume removed (counting 50ml syringes)
- Turn off while awaiting CXR
- Drained enough – can remove
- Not enough – can then connect to seal and open
(second stabbing removed)
PDF:pneumo