Category: speciality

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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Hypernatraemia

Hypernatraemia is a not a common presentation in ED, as intense thirst often prevents significant hypernatraemia in neurologically intact individuals. So… Mortality rates are high (20-70%) and the severity of hypernatraemia has been shown be an independent predictor of mortality.

However, there is little good data on hypernatremia to base guidance on, and definitions vary within the literature

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Rash/Derm Guide

Guide Taken from the Primary Care Dermatology Society(PCDS) other good sourse is DermnetNZ.

A relatively easy way to find out what you’re looking at!

Rash – Apearance
Rash – Site
Lesions
Skin Conditions (DermnetNZ – a bit clunckier)

Trust Dalteparin dosing

Trust Guidance varies slightly from BNF for those patients over 100kg

Non-Pregnant PE/DVT treatment

Dalteparin Cr Clearance >29ml/minDalteparin Cr Clearance 20-29ml/min
Weight (kg)DoseWeight (kg)Dose
<45kg7,500 units OD<63kg5,000 units am
2,500 units pm
45-56kg10,000 units OD63-80kg5,000 units BD
57-68kg12,500 units OD81-98kg7,500 units am
5,000 units pm
69-82kg15,000 units OD99-116kg7,500 units BD
83-100kg18,000 units OD117-134kg10,000 units am
7,500 units pm
101-115kg10,000 units BD135-152kg10,000 units BD
116-140kg12,500 units BD
>140kg15,000 units BD

Pregnant PE/DVT treatment

Weight (kg)Dose
<50kg10,000 units OD
50-69kg12,500 units OD
70-79kg15,000 units OD
80-89kg18,000 units OD
90-109kg20,000 units OD
110-124kg22,500 units OD
125-139kg12,500 units BD
140-154kg15,000 units am
12,500 units pm
155-169kg15,000 units BD

COVID-19 (DKA/HHS)

Experience is showing that those with diabetic patients with COVID-19 are more likely to develop DKA/HSS. However, treating them with the traditional large amount of fluid is detrimental to their chest, if they have Covid-19

Hence the following has been developed from the Guy & Thomas’ guidance – CLICK HERE

High Clinical Suspicion of Covid-19

  • Clinical: Fever ≥37.8°C plus any of; cough, short of breath, myalgia, headache, sore throat
  • CXR: consistent with Covid-19

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Hyponatraemia

Hyponatraema is a common finding, especially within our elderly population. However, its significance is is not a simple numbers game, and needs senior input. Prior to treatment the following need to be considered and balanced.

  1. Symptoms Severity – these are not exclusive to hyponatraemia and may be due to other disease processes (esp. if the low sodium is long-term)
  2. Sodium Level – the sodium concentration doesn’t always correlate to the clinical picture, and is dependant on speed of change, and co-morbidities
  3. Rate of Drop – the faster sodium levels drop the more symptomatic the patient often is (i.e. with long term hyponatraema the patient may be profoundly hyponatraemic but asymptomatic)
  4. Co-morbidities – Increasing sodium too quickly risks osmotic demyelination. How well will the patient cope with treatment?

Emergency treatment (hypertonic saline) is generally indicated in those with Severe Symptoms ONLY

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