2 video links to PHE how to Don and Doff your PPE
Category: Resus
3. HAZMAT – CBRNe (Chemical, Biological, Radiological and Nuclear) incidents
NHS England, Public Health England and the Health Protection Agency have produced several very useful resources for us to use – BUT First.
Remove – Remove – Remove
Basics
Contacts
- Health Protection Agency Teams – HERE
- West Yorkshire
- In hours: 0113 386 0300
- Out of hours: 114 304 9843
- West Yorkshire
-
ECOSA (Emergency Coordinated Scientific Advice System) – 0300 3033 493
- UK NPIS – 0344 892 0111
Guides
- PHE: CBRNe Guide – covers from initial contact to specific threats
- HPA: New Disease New Threats – images and info to aid identification
- PHE: Suspected Novichock in ED – guide to management
- NHS England: Guide to Major Incident and Mass Casualty – covers most MAJAX issues inc. ballistics, explosive, chemical
- Local: Ram-Gene – External Radioactive Contamination
- PHE: Radiation (internal only) – we have Rotem Ram-Gene
CT Abdo/Pelvis & Pregnancy Testing
Radiology are now requesting blood pregnancy testing reproductive females from 10-35days from last period. But what is wrong with urine pregnancy testing?
Read moreTXA – Tranexamic Acid
TXA a bleeding wonder drug!
Crash 2 Study (2010)
- Multi-Centre RCT of the use of TXA in trauma
- Inclusion – Adult trauma patients with ≥1 of
- Suspicion of significant haemorrhage
- HR ≥110bpm
- sBP ≤90mmHg
- Treatment – 1g TXA IV over 10min then a second 1g TXA IV over 8hrs
- Outcome – Significant reduction in Death, bleeding with NO increase in clots(thrombotic disease)
- Most benefit seen if given early (<3hr – NNT 53)
Acidosis & VBG’s
We are frequently asked to check the lactate on Venous Blood Gases (VBG’s), by the nursing staff. However, remember to look at the first result (pH) it is the most important.
Acidosis: Unless you have a good reason (e.g. you know its due to DKA) you should be investigating and performing an Arterial Blood Gas (ABG)
Dabigatran Reversal
Bleeding on Dabigatran?
- <C>ABCD – as usual trying to stop bleed
- Bloods: FBC, Clotting, U&E, G&S
- Discuss with Haematologist (esp. if taken within 12-24hr)
- Idarucizumab (PRAXBIND) 5g IV
- Found in Emergency Drug cupboard
- We experienced delay finding as spelt wrong in the catalogue!
Domestic Abuse
Domestic abuse can affect anyone and often its not readily disclosed on an ED admission. We must be alert to the fact some of our patients may be attending with domestic abuse. Please explore concerns and escalate if you’re unsure. Our colleagues in the Pennine Domestic Violence Group have kindly drawn this a guidance up for us.
Rare Antidotes – how to get
Getting some of the rarer antidotes has recently been clarified across Yorkshire (Accessing rarely used antidotes-SOP)
EMBRACE & Paediatric Critical Care
In our trust we don’t have paediatric critical care beds. However, in our region we use EMBRACE (a paediatric critical care transport team), who can transfer critically ill children to specialist centers (in or out of region).
EMBRACE
- 0114 268 8180
- Guidance
Y&H Paed Critical Care
Drugs:
- Trust guide
- Remember: Midazolam 10mg/2ml is used(not the 5mg/5ml we have in ED)
- Found in theatres control drug cupboard (see trust guide)
AAGBI – Intubation Check List
Simple pre-intubation checklist for the whole team to be aware of so we can make intubation in ED as safe as possible.
PDF: Full Version (included tracheostomy displacement algorithm)
