Three large scale multi-centre trials into Severe Sepsis and Septic Shock: ProCESS (USA), ARISE(Aus), ProMISe(UK), all showed the same thing. What works is good early resuscitation (Not the fancy stuff from ICU – however, that does have its place later on).
Category: Surgical
Urinary Retention
A common problem which affects 1 in 10 men between 70-79yrs and 1 in 3 men 80-89yrs (10M:F)
Signs/Symptoms
- Unable to pass urine (may be passing small amounts overflow)
- Desire to pass urine (reduced in neurological causes e.g. cauda equine)
- Suprapubic & loin pain (may not be present in chronic or neurological causes)
- Palpable bladder on examination

Ingested Magnets
Ingestion of Strong Magnets is a TIME CRITICAL EMERGENCY
(Multiple Magnets OR a single Magnet and Metallic Objects)
Strong magnets (such as Neodymium)
- Now common place around the house
- From; fridge magnets to toys and peicings
Ingested:
- Intestinal injury can occur within 8-24 hours
- However, symptoms may take weeks to develop
- Symptomatic patients are a SURGICAL emergency
Detection:
- 2 views – to determine number of magnets (if in doubt assume multiple)
RCEM recommendation (best practice)
Aortic Dissection
Aortic Dissection (AD), is uncommon (1 AD:200 ACS) but is…Rapidly FATAL! Unfortunately recognising aortic dissection is difficult with a clinician pickup rate of 15-43%. Read more
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
#NoF – Fractured Neck of Femur
BOAST Guidance
- #NoF patients (or other fragility fracture) who requiring CT Head (for head injury) also be performed a CT Neck
- Fragility fractures indicate the patient is at high risk of also sustain C-Spine injury.
- Also the pain is likely distracting and the patient is often over 65yrs old so Canadian C-Spine rules will not apply.
Hx/Exam
- Why did They Fall? – was this a collapse?
- Are they sick? – Co-morbidity/illness is common in this group and must be recognised
- Anticoagulants? – This affects treatment
- On Warfarin – If INR >1.5 (or unavailable) Vit-K 5mg
- Other injuries? – >65’s the most common mechanism of TARN major trauma is fall <2m
- Typically – Pain hip/buttock, shortened, externally rotated
- Atypical – Few signs (can they lift their leg & is rotation at the hip painful)
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?
Necrotising Fasciitis
Necrotising fasciitis (NF) is a rare but serious bacterial infection that affects the soft tissue and fascia (Fournier gangrene, is NF affecting the perineum). In many cases NF progresses rapidly and early recognition and treatment is vital to halt progress. The mainstay of treatment is IV antibiotics and aggressive surgical debridement. Any delay increased the amount of tissue loss as well as the mortality. Read more
Hyperemesis Gravidarum
Nausea and vomiting in pregnancy is common and at best an unpleasant experience for the patient, and at worst can be life threatening. It normal starts @ 4-7/40, peaks @ 9/40, and finishes @ 20/40.
We need to conduct a thorough history and examination looking for causes other than a high βHCG. these include:
- Abdominal pathology
- Urinary pathology
- Infections
- Drug History
- Chronic H.Pylori
Major Trauma: STOP>SORT>GO
YAS crews may on occasions (rarely) bring us a Major Trauma patient that meets the criteria for bypass to the MTC because they have a problem that the crew cannot manage, or they won’t survive to LGI e.g. an unmanageable airway/ incompressible haemorrhage. In these instances we will get a pre-alert either from the crew or more likely the Major Trauma Triage Co-ordinator in EOC with some information but primarily the reason the patient is coming to us.