There are approximately 20'000 strangulation victims each year in the UK
1:11 sexual assault victims
Strangulation/Hanging/Suffocation are the most common suicide method in Wales and England
There are approximately 20'000 strangulation victims each year in the UK
1:11 sexual assault victims
Strangulation/Hanging/Suffocation are the most common suicide method in Wales and England
Time Critical Medication (TCM) is scheduled medication that the patient is already on when they present to the Emergency Department (ED).
The medications are “time critical” because a
delayed or missed dose can result in harm with exacerbation of symptoms and the development of complications leading to an increased mortality.
Movement disorders – Parkinson’s / Myasthenia medication
Immunomodulators including HIV medication
Sugar (Insulin)
Steroids – Addison’s and adrenal insufficiency
Epilepsy – anticonvulsants
DOACs and warfarin
Its really important for our patients that these medications are prescribed and given while in ED/uSDEC/fSDEC.
If you are withholding these medication (which may be necessary) -please the reason for this clearly in the notes.
Average life expectancies are often longer than you imagine and after 100yrs life expectancy increases!
However, Clinical frailty score is often more predictive.
Study shows that the rate of change in frailty has a significant impact on life expectancy. People with “Stable” growth in frailty score remaining at their base line but the faster the CFS changes more impact that has.
So its worth asking how things have changed over the last year.
Frailty has a significant influence on recovery and mortality in relation to both “MINOR” and “MAJOR” trauma.
Rib injury is probably more important than most of us realise – suggesting 15% increase in mortality for every rib a frail person fractures. JRCALC have since updated guidance to recommend “rib spring” rather than “gentle palpation” in examination.
Mater hospital Dublin have introduced a review clinic for patients following significant traumas.
Mater hospital – Adult only ED
Silver Trauma Review Clinic
A really common presentation elderly patients that can be tricky with a higher baseline probability of cardiac causes.
Get up and Go test
We often over test look for the simple things first they are the most common.
Most patients would prioritise time with love ones rather than fruitless time with us.
Emergency Laparotomy: CFS is more predictive than age
Covid:
In-hospital CPR: frailty can predict outcome in UK trial
Ombudsman states: End of Life
But our communication needs to be clear to patients and families, not just saying “they are sick” but how sick. And not just what we are not going to do but what we are going to do for the patient.
The prevalence of Tuberculosis in our region is increasing and has significant issues for both the patient and public health if we miss it.
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
Remember: is it a haemolysed blood sample? (you can do an iSTAT)
Severity
And either
Or
Onset is usually after 20 weeks of gestation, but it can also occur up to a few weeks postpartum.
Eclampsia- This is pre-eclampsia that has progressed to seizures
Clinical features of pre-eclampsia:
HELLP syndrome is a variant of severe pre-eclampsia characterised by haemolysis, elevated liver enzymes and low platelets.4
Symptoms and signs are similar to those of pre-eclampsia but also include jaundice and bleeding.
Management of Pre-eclampsia:
Definitive management:
Definitive management of pre-eclampsia is ultimately delivery of the fetus. Timing of delivery will be decided by senior members of the obstetric team according to the severity of pre-eclampsia, the current gestation and in consultation with the patient. Following diagnosis of pre-eclampsia, the majority of women are managed as inpatients until delivery.
ED Management of Eclampsia:
Full NICE guidance is available here
Opioid Toxicity causes:
Other Symptoms may include (but are not diagnostic or opioid toxicity):
Naloxone is the antidote to Opioids however as these are commonly co-ingested with other depressants. full reversal of symptoms may not occur with treatment.
In acute opioid toxicity, the aim of naloxone administration should be reversal of respiratory depression and maintenance of airway protective reflexes, not full reversal of unconsciousness.
Naloxone infusion if required is based on the total dose given to obtain Respiratory rate of 10
Link to the full guidance is here
Head injury is witnessed, reported, suspected, or cannot be excluded.
Post fall Neurological Observations must be completed for at least 12 hours and at the above intervals as a minimum:
During this time If there is any deterioration in the patient’s condition including level of consciousness, pupil reaction, limb power, cardiovascular observation you must revert to ½ hourly neurological observation and seek URGENT medical review.
Patients should be reviewed if no change in condition at 12 hours to ascertain if neurological observations are still indicated – this decision must be documented in the medical notes.
Under no circumstances should Neurological observations be omitted because the patient is asleep
Admitted with Head Injury
During this time If there is any deterioration in the patient’s condition, including level of consciousness, pupil reaction, limb power or cardiovascular observation you must revert to ½ hourly neurological observations and seek URGENT medical review. Patients should be reviewed if no change in condition at 12 hours to ascertain if neurological observations are still indicated – this decision must be documented in the medical notes.
Under no circumstances should Neurological observations be omitted because the patient is asleep.
During this time If there is any deterioration in the patient’s condition, including level of consciousness, pupil reaction, limb power or cardiovascular observation you must seek URGENT medical review and revert to ½ hourly neurological observations as a minimum, or ¼ hourly, if still within the first 2 hours post thrombolysis.
Under no circumstances should Neurological observations be omitted because the patient is asleep.