Painful Crisis
Severe pain is the most common reason that patients with sickle cell, will attend the ED. The pain can be agonising (and often underestimated by us), we need to act fast to help ease the symptoms
Read moreSickle Cell
Category: Haem/Onc
Metastatic Spinal Cord Compression (MSCC)
This is guide to the investigation of Metastatic Spinal Cord Compression (MSCC) in Oncology/Haematology patients. – (Trust link)
You need to be a bit more suspicious and have a lower threshold for investigation than in patients without Known, Suspected OR Previous Malignancy Read more
Consenting for Blood Transfusion
We frequently consent for Blood Transfusion, but what risks do we tell the patients about and how common are those risks?
DVLA – Driving & Medical Conditions
For many conditions the patient should be informed to stop driving and inform the DVLA of their condition. It is the patients responsibility to inform the DVLA, and we should encourage them to do so.
[There is a £1000 fine AND the risk of prosecution] Read more
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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High INR
Patients sometimes present to ED or are send to ED due to over anticoagulation with warfarin
1. Is there Major/Significant bleeding?
Yes
- Resuscitate (ABCD)
- Give 5mg Vitamin K IV
- Octaplex Guide
- Treat bleeding and admit to appropriate speciality
Octaplex – work fast its an EMERGENCY!
- Activate EARLY in head injury patients on warfarin.
- Order on EPR & Paper [see below]
- Infuse over no more than 30 min
- Recheck INR at 30 min after finished infusion
Indications
- EMERGENCY reversal of Warfain
- Factor II or X deficiency
Read more
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
Primary Intracerebral Haemorrhage
In anybody who there is suspicion of a non-traumatic haemorrhage arrange an urgent CT Head.
All patients need IV access and U&E, FBC, Coag
If CT confirms PICH (not traumatic, not SAH): –
Anticoagulation
If anticoagulated with warfarin or NOAC discuss with stroke consultant and Haematologist regarding reversal
If not anticoagulated give Tranexamic acid – 1g in 100mls Saline/Glucose over 10 mins followed by 1g in 250mls Saline over 6 hours.
Blood Pressure
BP needs to be <150/80 – use labetalol (max 400mg – until BP <160 or HR <50) and GTN infusion
Neurosurgical Referral
Not all patients with intracerebral bleeds need referral to neurosurgery – you could save yourself and your patient a lot of time and effort!
Those to refer:
- GCS 9-12/15 with lobar haemorrhage
- Isolated intraventricual haemorrhage
- Hydrocephalus on presentation
- Rapid deterioration following arrival (gcs drop by 2 points or more in the motor component)
- Cerebellar bleed
Admit those not going to Neurosurgery to HASU at CRH after discussion with Stroke team
VTE prophylaxis in lower limb Immobilisation (ED – 2023)
In the Emergency Department (ED) lower leg immobilisation after injury is a necessary treatment but is also a known risk factor for the development of venous thromboembolism (VTE). This accounts for approximately 2% of all VTE cases which are potentially preventable with early pharmacological thromboprophylaxis.
