Category: Uncategorized

Non-Major Trauma Pelvic Fractures in Older Adults

The vast majority of non-major trauma pelvic fractures presenting to Calderdale & Huddersfield A&E will be fragility fractures in elderly patients — almost exclusively:

  • Isolated pubic rami fractures (anterior ring, FFP-I)
  • Pubic rami fractures with concurrent non-displaced sacral fracture (FFP-II)

These represent 84% of all elderly pelvic fractures nationally, and virtually all are non-operative injuries by definition. The remaining cases are a small minority and are addressed in the referral criteria below.

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Major Haemorrhage Protocol

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

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
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Medical Emergencies in Eating Disorders

Eating disorders* are relatively common and unfortunately patients who “look well” can have a significant mortality risk. MEED.org.uk have national risk tools to recognise those that would benefit from admission, which fit with our local mental health teams, and agreed by both acute medicine and paediatrics

(*anorexia nervosa, bulimia nervosa, binge eating or avoidant restrictive food intake disorder)

Risk Assessment

RED indicators

Anyone with one or more RED’s is high risk and should be considered for admission MEED

  • BMI <13/<70% mBMI
  • Recent weight loss >1 kg/week for 2 weeks in an underweight patient
  • HR (awake) <40
  • Recurrent syncope with standing BP <90 systolic (<0.4th percentile for age) and postural drop >20 mmHg (or increase HR >30 [>35 if <16])
  • Fluid refusal or signs of dehydration
  • Temperature <35.5°C tympanic/35°C axillary
  • Long Qt or other ECG abnormalities
  • Low Glu/Na/K/Ca/PO4/Alb
  • Low WCC, Hb <10
  • Acute food refusal/very low calorie intake per day
  • Physical struggles with carers over nutrition
  • High levels of uncontrolled exercise (>2 hours/day)
  • Daily purging behaviours
  • Self-harm
  • Moderate–high risk suicidal ideas.
MEED Check list

Paediatric Sickle Cell Disease

Most children with sickle have direct access to the paediatric ward and team and will not present to ED.

On the rare occassions children and young people do present we need to get it right. The Paediatric Team use the Leeds Hospital Guideline to guide this. Our primary role in PED is to manage pain while we ask for help.

An adapted version of the LTHT Painful Crisis Flowchart follows but the key is to involve the paediatric team for support early. If patients attend with a personalised analgesia plan from a recognised NHS organisation please ensure this is followed where possible.

Quick access to the Fentanyl guideline and SORTT tool mentioned below.

Pain Crisis Sickle LTHT (1)

 

 

 

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

Epistaxis – Management

Nose bleeds are a bloody common problem (bad pun intended) – most originating at the front to the nose where there is a cluster of blood vessels – Little’s Area.

In the young the bleeding often starts after trauma (e.g. picking or punching noses). In the elderly however, it is commonly a manifestation of underlying vascular disease. Read more