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)

 

 

 

Alprostadil

To maintain or restore patency of the ductus arteriosus

Only to be used in infants who are ventilated or where ventilation is immediately available

Guideline-for-use-of-Dinoprostone-in-duct-dependent-CHD-1-8-3

 

DO NOT DELAY IN STARTING Alprostadil if: there is clinical
suspicion of duct dependent CHD while waiting for paediatric cardiology opinion OR echocardiogram, even when in-house echo facilities are present.

PDF: Alprostidil

 

Faltering Growth

Failure to Thrive | Obgyn Key

Faltering growth and poor weight gain in neonates are handled very differently.

Fortunately for us our paediatric colleagues have developed a very robust (read long) guideline to help us understand what we may need to do for these children.

They also appreciated we aren’t so good in PED at reading long guidelines so please refer to the bottom of the linked document for the appendices – one for babies and one for children.

Enjoy