Category: Uncategorized

Insect bites and stings

Advise people with an insect bite or sting that:

  • a community pharmacist can advise about self-care treatments
  • skin redness and itching are common and may last for up to 10 days
  • it is unlikely that the skin will become infected
  • avoiding scratching may reduce inflammation and the risk of infection
  • they should seek medical help if symptoms worsen rapidly or significantly at any time, or they become systemically unwell.

Be aware that:

  • a rapid-onset skin reaction from an insect bite or sting is likely to be an inflammatory or allergic reaction, rather than an infection
  • most insect bites or stings will not need antibiotics.

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LVAD – Resus & Troubleshooting

LVADs (Left Ventricular Assist Device) are becoming more common and there are patients in our region with them as a bridge to transplant or recovery and in some cases a destination therapy.

The patient and their family will likely know more about this device than you and should have brought spare parts. Our local LVAD centre is Wythenshaw however, there are other units around the country the patient may direct you to.

The patient may not have a palpable pulse, the blood pressure will be low and the heart pump sounds like a buzz when you listen.

If patient is unresponsive or has a history of collapse its important to troubleshoot the device and resusitation may be required

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Non-Site Specific Referrals

This is the pathway for patients in whom there is a significant concern about malignancy or other serious pathology but who do not meet the pathway for a site specific referral e.g lung cancer pathway etc.

Patients must be haemodynamically stable and suitable for discharge from the ED to have their investigations as an  urgent outpatient.

Exclusion Criteria:
• Patient has specific alarming symptoms warranting referral onto a site-specific two week
wait pathway
• Patient is too unwell or unable to attend as an outpatient or needs acute admission
• Patient is likely to have a non-cancer diagnosis suitable for another specialist pathway
• Patient is currently being investigated for the same problem by another specialist team
• Please consider whether a referral to frailty might be more appropriate

How to complete the referral via EPR

Once referral is completed the team will pick it up and arrange further investigations.

Ensure the patient contact details on EPR are up to date and they know the team will be contacting them.

Need For Recovery

The Need for Recovery (NfR) score is a well validated tool to measure your need for recovery after the physical/mental strains of work. Originally designed for bus drivers, it has since been successfully used across may careers including recent studies in ED doctors and ACP’s.


  • We would like to see how you’re doing (anonymously) – so please answer honestly
  • If over time your score has increased or you think your score is high – please talk to any of the senior team

Previous studies

JobWhole populationBus DriversMerchant SailorsMinersNursesNursesParamedicsED DrsED ACP
CountryNetherlands Netherland UK IsraelBrazilNetherlandsNetherlandsUK 2020UK 2021
NFR score3827.236.455.236.439.443.670TBC

Suspected Cauda Equina Syndrome CES

1. Red Flags: Has the patient developed any of the following?

  • Difficulty initiating micturition or impaired sensation of urinary flow
  • Altered perianal, perineal or genital sensation S2-S5 dermatomes – area may be small or as big as a horses’ saddle (subjectively reports or objectively tested)
  • Severe or progressive neurological deficit of both legs, such as major motor weakness with knee extension, ankle eversion, or foot dorsiflexion
  • Loss of sensation of rectal fullness
  • Sexual dysfunction (achievement of erection or ability to ejaculate, loss of genital sensation)

If Yes to ANY proceed to 2.

If NO to ALL consider other diagnosis and possibility of GP follow-up

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