Category: Surgical

Urology Referral Pathways

Referral

The first point of contact for urology advice and referral is the general surgical SHO. This is the on-call surgical SHO carrying the on-call bleep. Some of the on call general surgical SHO have a urology background.

If a time critical emergency such as torsion is presenting, then the first point of contact should be the urology registrar.

Urologist are happy to operate on patients over the age of 3 years old. Under the age of 3 if this on a urological emergency such as a torsion then this patient should be referred to Leeds paediatric urology services.

Streaming

Any patent with a post op complication for up to 7 days form urological procedure – should be streamed directly to the urology team via the surgical SHO. If the patient is unwell and needs resuscitation and immediate management for example sepsis, then ED team needs to be involved in resuscitation measures and the urological registrar needs to be involved as well

Pyelonephritis

Currently ALL Pyelonephritis should be admitted under the urology team. There is a conversation between urology and medical teams happening currently to see if that requires further rationalisation. However currently the position is all pyelonephritis patients who need admitting are done so under the urology team.

  • Uncomplicated pyelonephritis – does not require CT scanning or ultrasound scanning from the emergency department.
  • Suspicion of an obstructive uropathy –  CT KUB needs to be arranged from the ED

Investigations including:

  • FBC
  • U&E, CRP
  • Blood Cultures
  • Urine cultures

Appropriate Antibiotics should be prescribed using the current antibiotic guidelines.

Renal Colic

CTKUB are now available 24/7.

Patient presenting >50 years old  with a renal colic story, should have a ultrasound scan done at the bedside to ensure that there is no aortic aneurysm before being sent for a CT KUB.

Uncomplicated renal colic needs a non contrast CT scan. This should be organised by the ED

Uncomplicated renal colic patients can wait CT KUB for  results on SDEC. (The case must be to be discussed with the surgical SHO on-call and accepted by them before transfer of the patient. SDEC closes at 6 pm)

Haematuria

All frank hematuria needs investigation

  • Admit + 3-way catheter – those at risk of clot retention and shock 
    • Hb <100
    • Post void bladder scan>250 ml 
  • All those discharged: will need a OPD cystoscopy arranged as well as a USS (the request for flexible cystoscopy on EPR is Urol Cystoscopy  post Wd Dis)
Catheters

New catheters and catheter complications – follow current guidelines. Community nurses follow up for TWOC or other catheter care (HOUDINI team in Kirklees)

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:

  • Use X-Ray (NOT metal detectors)
  • May require AP and lateral images to see how many

RCEM recommendation (best practice)

Read more

Massive Transfusion Pathway

In the case of patient with Massive Haemorrhage weather that be from Trauma, Surgical, O&G, UGIB, you can activate the MTP

Remember:

  • Do the Basics – don’t forget ABCD
  • Inform Transfusion and get someone to run a G&S sample down
  • FFP can take up to 45min and platelets come from Leeds
  • If you no longer need the MTP – inform transfusion and return products ASAP
major haemorrage

PDF:MTP

 

Vascular Emergencies (Regional Pathways)

Intro

Vascular surgery has been reconfigured across etc region. The vascular oncall will be based at BRI 24/7.

Multiple pathways have been developed below to help guide appropriate use – full guide HERE

AAA (Symptomatic)
 
AAA (Incidental)
 
Ischaemic Limb (Acute)

Ischaemic Limb (Critical)

Ischaemic Limb (Intermittent Claudication)
 
Uncontrolled Haemorrhage (Interventional Radiology)

Some patients benefit from control of bleeding using embolization techniques, which is a procedure performed by an Interventional Radiologist.

Patients should be treated in their receiving hospital to the maximum of that hospital’s capability, where at all possible. When all local treatment options have been exhausted, the patient should be discussed with one of the Arterial Centres (BRI) with a view to transfer for ongoing management by IR techniques.

Isolated Vascular Trauma

Diabetic Foot

Emergency Transfer

Urgent Vascular Clinic

Access is very limited to this clinic. It is envisioned by WYVas that access to UVAC for ED patients will be arranged through direct (telephone) referral to either:

  • IN hours: Local (HRI) or ON-Call (BRI)Vascular Consultant
  • OUT of hours: ON-Call (BRI) Vascular Consultant