Chest injury as part of major trauma, can range from painful to life threatening so prompt treatment and recognition is vital. Esp. in ‘Silver Trauma’ when ‘minor’ injuries may have devastating consequences – the full guidance can be found @WYMTN – HERE
Category: Respiratory
Pneumonia (Community Acquired)
Severe Pneumonia: Please Request/Send – Samples Sputum/Blood/Urine
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]
Pneumothorax – BTS 2023
To drain or not to drain? – that is the question (Follow the BTS algorithm).This is not for Tension!
(All treatment options should be discussed with the patient to determine their main priority, with consideration for the least invasive option)
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.
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? – would you want to die surrounded by strangers or with your family?
Asthma – Adult
Severity – Severe or Life threatening – think RESUS- Treatment within 30 min – bronchodilators and steroids should bee given within 30min
- 1hrs Observation after Neb – better after a neb don’t just send home they may deteriorate when it wears off.
- PEFR – must be >75% expected prior to discharge (at least 1hr after treatment finished)
- Discharge advice sheet – can print off from this guide, remember to check inhaler technique and consider a spacer
Pulmonary Embolism in Pregnancy
Unfortunately the the normal pathway for investigation of PE performs poorly in pregnancy RCOG have the following pathway
1. Investigation – of suspected PE
- Clinical assessment – its all on the history and exam scoring doesn’t work
- Perform the following tests:
- CXR – sheilding can protect the baby and may avoid further radiation
- ECG
- Bloods: FBC, U&E, LFTs, Clotting
- Commence Tinzaparin (unless treatment is contraindicated – use booking weight to calculate dose) –[BNF]
Emergency Tracheostomy/Laryngectomy Management
Occasionally patients with Tracheostomy or Laryngectomy present with difficulty breathing due to problem. As this is rare for us in ED, this situation can be very difficult for all of us. However the protocols below can help.
Tracheostomy
Tracheostomy is simply a passage from the neck into the trachea. In most cases the trachea will still be connected to the nose and mouth (so can breath though their mouth too).
NIV (Non Invasive Ventilation)
NIV should be considered for use in patients with a persisting Acute Hypercapnic Respiratory Failures after a maximum of one hour of standard medical therapy.
- Complete the Ad-hoc form
- Increase pressures from Initial 12/5 cmH2O to 20/5cmH2O – as tolerated over 1st hour
However, ICU should be contacted early if the patient has one of the following:
- Asthma – Intubation the option of choice in Life threatening
- Pneumonia – NIV should only be considered as a bridge to intubation
- No pre-exisiting respiratory issue – NIV not likely helpful
- pH <7.25 (low threshold for ICU input)
- pCO2 >6.5kPa (low threshold for ICU input)
- Type 1 Respiratory Failure (low threshold for ICU input)
Avian Flu – 2022
Avian flu is droplet spread and can sometimes effect humans as well as birds. Severity varies in human cases varies widely from mild to severe and deaths have been reported.
