Category: speciality

Hypomagnesaemia

Classification

  • Normal: 1.1-0.7
  • Mild: 0.69-0.5 – No symptoms or non-specific symptoms, such as lethargy, muscle cramps, or muscle weakness
  • Severe: <0.5 – Severe neurologic symptoms such as nystagmus, tetany, seizures, and cardiac arrhythmias

Signs/Symps (normally <0.5)

  • MSK: Muscle Twitch, Tremor, Tetany, Cramps
  • CNS: Apathy, Depression, Hallucination, Agitation, Confusion, Seizure
  • CVS: Tachycardia, Hypertension, Arrhythmia, Digoxin Toxicity
  • BioChem: Hypokalaemia, Hypocalcaemia, Hypophosphataemia, Hyponatraemia

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Hyperosmolar Hyperglycaemic State (HHS)

HHS (A.K.A. HONK) is a diabetic emergency, but unlike DKA we don’t always think about it.

Patients with HHS are often elderly with multiple co-morbidities, and they are always very sick.

Definition

  • Hypovolaemia
  • Hyperglycaemia – generally ≥30mmol/l
  • High Osmolality – generally ≥320mosmol/kg (Osmolality Calculation= 2[Na] + [Glucose] + [Urea])
  • & NOT:
    • Acidotic – pH >7.3, HCO3 >15mmol/l
    • Ketotic – blood <3mmol/l, Urine <2+

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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

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

Hyperkalaemia

Remember: is it a haemolysed blood sample? (you can do an iSTAT)

Severity

  • Mild: 5.5-5.9mmol/l – No urgent action required (Dietary & Medication modification & GP F/U)
  • Moderate: 6.0-6.4mmol/l – Follow treatment guide (maybe suitable for discharge)
  • Severe: ≥6.5mmol/l OR ECG changes – Follow treatment guide, must admit

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Mpox (Formerly: Monkeypox)

Wear Gloves & Wash Your Hands!!!

There have been >100 patients identified as having Mpox in the UK during the current outbreak. Most of these cases have been amongst men who have sex with men.

Reports have suggested that although lesions occur any where including palms and soles. Genital lessons and lymphadenopathy are very common

March 2024 – UKHSA warn there is increasing cases in DRC (Democratic Republic of Congo), so stay vigilant in travellers from central Africa.

 

Trust SOP -HERE

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DKA – Adult

Things to remember

  • Give 0.9%NaCl
  • Actrapid “Fixed Rate” 0.1unit/kg/hr
  • Basal Insulin e.g. Levemir, Lantus, Semglee, Abasaglar, Toujeo, Tresiba,
    please continue this at usual dose and times
  • Potassium – if below 5.5 will need KCl infusion (see guide)
  • BM <14 – Start 10% Dextrose 125ml/hr
  • BEWARE SGLT-2 inhibitors chance of Euglycaemic DKA

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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

Brown/Black/Blue

Red/Pink/Purple/Skin Colour

White

Yellow

Orange

Skin Conditions (DermnetNZ – a bit clunckier)

Lower Limb DVT

Signs and Symps

No single feature is diagnostic:

  • Single limb oedema – Most specific
  • Leg pain – 50% but is nonspecific
  • Calf pain on dorsiflexion of the foot (Homan’s sign)
  • Tenderness of deep veins – 75% of patients
  • Warmth AND/OR erythema (although blanching is possible)
  • A palpable, indurated, cordlike, tender subcutaneous venous segment

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