NHS England has introduced the use of a “40 step desaturation test” into discharge planning from the ED. You will have heard Covid -19 patients complaining of increasing SOB on exercise, and it’s important that we test this prior to discharge. Method: Is this appropriate? – Could the patient walk… Read more
There is increasing evidence that Awake Self-Proning of our Covid-19 patients can improve oxygenation. Proning the patient can has several effects which can dramatically improve their SaO2 Improves Ventilation to back of the lung (the back of the lung contains more alveoli than the anterior lung) Improves Perfusion – as blood supply… Read more
Early senior decision making around DNACPR, is vital for both staff, patients, and families.
Document decsion making and communications clearly
There will be regular updates in “handover” about ICU admission criteria – as these may change over time
The rules have changed since 25th march 2020 on death certification, below is a brief summary of how this might affect us. We are aiming to keep a death certification box in both ED’s so that these can be completed in a timely fashion.
Any doctor can complete a death certificate (MCCD) even if they haven’t seen the patient providing: Read more
You may have seen in the news early results from the RECOVERY trial. In Covid-19 patients requiring either Oxygen or Intubation, dexamethasone has been shown to reduce mortality. Oxygen – 20% reduction in mortality Intubation – 35% reduction in mortality No respiratory support required – No benefit found Inclusion: Covid-19… Read more
Experience is showing that those with diabetic patients with COVID-19 are more likely to develop DKA/HSS. However, treating them with the traditional large amount of fluid is detrimental to their chest, if they have Covid-19
Hence the following has been developed from the Guy & Thomas’ guidance – CLICK HERE
High Clinical Suspicion of Covid-19
Clinical: Fever ≥37.8°C plus any of; cough, short of breath, myalgia, headache, sore throat
CXR: consistent with Covid-19
2 video links to PHE how to Don and Doff your PPE Read more
Local instructional videos for donning/doffing Non-Aerosol Generating Procedures Aerosol Generating Procedures Disponible FFP3 (Leeds) Read more
Due to the limited capacity when referring patients to the “New Arrhythmia Clinic” we MUST Send a BNP We don’t need to wait for the result in ED prior to referral and discharge BNP Result (clinic will review) >400, we will arrange an urgent echo and face-to-face clinic. <400, we will book a remote… Read more
Any patient presenting to ED with ONLY Ophthalmic symptoms should be referred directly by the ED triage team to Ophthalmology: Referral 08:30 – 17:30 Mon-Fri, and 09:00 – 12:00 Sat all referrals are to be made directly to dedicated phone Out is these times refers to Ophthalmology on-call Minimum dataset:… Read more
Symptoms suggestive of Acute Myocardial Infarction
Chest Pain within 12 hours
ECG showing acute myocardial infarction
ST elevation >1mm in limb leads
ST elevation >2mm in precordial leads
New LBBB with appropriate clinical history
As you are aware during the Covid-19 pandemic our use of oxygen has increased. However, supply is limited and most hospitals can only generate 3000-5000l/min of oxygen (i.e. enough to treat 300-500 patients on 10l/min). If you exceed this capacity the oxygen valves can freeze and the whole oxygen supply… Read more
AKA: Paediatric Inflammatory Multi-system Syndrome – Temporally associated with SARS-CoV 2
Although COVID-19 seems a benign disease in almost all children there are increasing evidence (however rare) of a “Paediatric multisystem inflammatory syndrome”. This is a RARE and newly emerging condition and there are many questions still e.g. It is currently unclear if it is directly related to the COVID-19 pandemic.
Case definition (RCPCH)
A child presenting with persistent fever, inflammation (neutrophilia, elevated CRP and lymphopaenia) and evidence of single or multi-organ dysfunction (shock, cardiac, respiratory, renal, gastrointestinal or neurological disorder). This may include children fulfilling full or partial criteria for Kawasaki disease.
Exclusion of any other microbial cause, including bacterial sepsis, staphylococcal or streptococcal shock syndromes, infections associated with myocarditis such as enterovirus (waiting for results of these investigations should not delay seeking expert advice).
SARS-CoV-2 PCR testing may be positive or negative
Some patients who present with COVID-19 infection will be not suitable for escalation and actively dying when they attend the ED, for these patients the best management may be palliative care. The primary symptom that causes distress is breathlessness. Palliative Care of COVID-19 patients will ideally be provided with a… Read more
To improve management and maintain protection for staff and patients we have created a RespED at both sites, much of the flow chart is based on information from the Italian society of emergency medicine As time more information becomes avalible this will inevitably change Read more
As we know COVID-19 is putting an incredible burden on resources, especially for higher level respiratory support. It is important to target those resourses in the most effect way, hence the development of the “Respiratory Flow Chart”
During the current Covid-19 pandemic relatives are not attending the hospital with patients, which means we are increasingly having to have difficult conversations over the phone. Chelsea and Westminster have published this helpful guide. Remember: Keep your language simple Avoid jargon/euphemism Be honest Pauses can be helpful Don’t rush Talk… Read more
During the Covid-19 pandemic alternatives to LMWH have been agreed – [For those who can’t inject themselves]
British Society of Thoracic Imaging (BSTI) have released a free learning resource containing CXR and CT of confirmed Covid-19 cases, will short history including time image was taken from onset of symptoms. From the China experience CXR/CT doesn’t seem to be a rule out strategy in ED at the moment… Read more