
In the UK approximately 100 people are envenomated by a snake each year.
So what do you need to do if your patient has received a venomous bite from a snake? (not the classic UK cocktail).
- Don’t Cut & Suck!
- Treat what you see
- Call Toxbase

In the UK approximately 100 people are envenomated by a snake each year.
So what do you need to do if your patient has received a venomous bite from a snake? (not the classic UK cocktail).
We often worry about patients developing rhabdomyolysis and consequently developing AKI. However, there is much debate and little consistency in the published data, over how to diagnose and who needs admission to treat. So its important to consider both clinical context along with laboratory values
Preform intimate examinations on Sexual assault/Rape patients
How to apply the FERNO traction splint for our in-hospital patients
The depth and type of sedation required in children depends on the procedure to be carried out.
Sedation is described as:
Minimal – Drug induced calm, the patient is awake and responds to verbal commands but may have impairment of cognition and coordination.
Moderate – Drug induced depression of consciousness but patients respond purposefully to verbal commands or tactile stimulation.
Deep – Drug induced depression of consciousness during which patients are asleep and cannot be easily roused, respond to painful stimuli.
Dissociative – Ketamine Sedation produces a trance like state.
Painful procedures preformed for children in the ED are usually done with Ketamine Sedation for which there is a separate pathway – Ketamine Sedation
Painless procedures such a diagnostic imaging do not require Ketamine or Opioids therefore drugs such as oral Chloral Hydrate or Buccal Midazolam should be considered, neither of these require cannulation.
Any of the following comorbidities / contraindications require discussion with an anaesthetist / senior paediatrician:
Oral – give 45-60 minutes before procedure, it has an unpleasant taste but can be mixed with blackcurrant squash
Dose: –
Minimal Sedation: 30-50 mg/kg Maximum 1g
Moderate Sedation: 100mg/kg Maximum 2g
Side Effects
Gastric irritation including nausea and vomiting reported.
Beware cardiac arrhythmias and respiratory depression with loss of airway reflexes at high doses.
There is NO reversal agent available
Buccal: Give 15 minutes pre-procedure and give half the dose into each side of the mouth
Dose: –
1-9 years: 0.2mg – 0.3mg/kg; Maximum 5mg
10-18 years: 6mg – 7mg; Maximum 8mg if 70kg or over
Side Effects
Short acting benzodiazepine causing sedation, hypnosis, anxiolysis, anterograde amnesia
Beware respiratory depression / hypotension / loss of airway reflexes at high doses.
Can lead to a distressing paradoxical excitement in children
Reversal agent: Flumazenil
Flumazenil dose: 10 microgram/kg [Max 200 microgram], repeat at 1 minute intervals up to 5 times.
Full trust policy is available on intranet here
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.
This is a relatively common presentation within the ED that has a myriad of possible diagnoses ranging from sprain to malignancy. One thing to remember is that patients and relatives will look for a traumatic reason for limb pain, and may link it to minor injuries that would not have caused it. Read more
There is currently a national shortage of Intranasal Diamorphine therefore we are using Intranasal Fentanyl as a replacement.
Dose is 1.5micrograms/Kg for the initial dose and 0.75micrograms/kg 10 minutes later if required.

Draw up the appropriate dose plus 0.1ml to allow for the dead space in the Mucosal Atomizer Device
Attach the MAD to the syringe
Sit the child at 45 degrees insert MAD loosely into the nostril and press the plunger
Doses greater than 0.5ml should be split between 2 nostrils