Remember: is it a haemolysed blood sample? (you can do an iSTAT)
Severity
Aortic Dissection (AD), is uncommon (1:980 non-traumatic chest pain) but is…Rapidly FATAL! However, is testable for 80% if recognised early, unfortunately recognising aortic dissection is difficult with a clinician pickup rate of 15-43%.
Read more
It’s essential any Modifiable causes are treated, these include:
“Early cardioversion is not recommended without appropriate anticoagulation or transoesophageal echocardiography if AF duration is longer than 24 h, or there is scope to wait for spontaneous cardioversion.”
In reality risks increase beyond 12hrs from onset, and those reverted in ED will often return to AF by the time they get to AF clinic follow up.
Arrhythmia clinic is for patients with newly diagnosed and symptomatic AF/SVT (if the patient is not symptomatic they should be followed up through their GP).
It should be remembered that patients will be seen after at least 6 weeks so anticoagulation decisions should not be delayed for clinic.
Based primarily on:
EMbeds clinical quick guide
Last evidence review: October 2026
Suggested next review: October 2026
This is a clinical support guide and does not replace clinical judgement, current CHFT medicines guidance or specialist advice.
Link to ALL Trust protocols – HERE
Read moreThe vast majority of non-major trauma pelvic fractures presenting to Calderdale & Huddersfield A&E will be fragility fractures in elderly patients — almost exclusively:
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.
Read moreIn the case of patient with Massive Haemorrhage weather that be from Trauma, Surgical, O&G, UGIB, you can activate the MHP
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)
Anyone with one or more RED’s is high risk and should be considered for admission MEED
Gastric volvulus is fortunately a rare pathology where the stomach rotates 180°. This causes a foregut obstruction but also strangulation of the stomach wall. This rapidly leads to necrosis, perforation and sepsis, and a mortality rate 42-56%.
Making Gastric Volvulus a surgical emergency! However it is easy to misdiagnosed especially as an upper GI bleed (UGIB).
If anybody is symptomatic after button battery ingestion they need referral to the Surgical team for urgent endoscopic removal. Liase immediately with our local surgical/ENT teams but be aware this may end up as a time critical transfer to Leeds especially if child <2years. Read more
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.
