1. Why we get things wrong – “A tale of two systems”
November 3, 2018Very few of us come to work intent on doing harm. However, despite that we all keep making mistakes. Most of them pass unnoticed and… Read more
A-a gradient
March 25, 2018A-a gradient = Alveolar Oxygen – arterial Oxygen This is “relatively” simple way of working out if the paO2 on a ABG is normal, and demonstrates… Read more
Acidosis & VBG’s
October 4, 2019We are frequently asked to check the lactate on Venous Blood Gases (VBG’s), by the nursing staff. However, remember to look at the first result… Read more
ACS (HS-Trop) Pathway
April 16, 2019On the 8th of May we are changing our current troponin test to a HS-Trop (high sensitivity troponin). This will allow us to exclude ACS… Read more
Acute Behavioural Disturbance / Excited Delirium
December 24, 2017Most of us will have seen patients like this – agitated, aggressive and often with police or security pinning them down. High risk of Cardiovascular… Read more
Acute Heart Failure (AHF) – ESC 2016
October 9, 2018AHF Triggers there are many triggers for AHF, which if recognized and treated with help improve outcomes Cardiac: ACS, Arrhythmia, Aortic Dissection, Acute Valve… Read more
Adrenal Crisis
February 11, 2018Adrenal crisis or insufficiency is a life threatening emergency due to the lack of glucocorticoid. Adrenal crisis can be primary due to destruction of the… Read more
Alcohol Withdrawl
June 20, 2018Generally we DON’T admit patients acutely solely for “Detox” However the following groups should be admitted [taken from trust guide] Patients requiring admission for another… Read more
Anion Gap & Metabolic Acidosis
March 26, 2018The anion gap (AG) represents the amount of unmeasured anions in the plasma. AG =([Na]+[K]) – ([HCO3]+[Cl]) The main contributor to the AG is albumin… Read more
Aortic Dissection
June 16, 2018Aortic Dissection (AD), is uncommon (1 AD:200 ACS) but is…Rapidly FATAL! Unfortunately recognising aortic dissection is difficult with a clinician pickup rate of 15-43%. Read more
Are You CO Aware?
October 24, 2018With the onset of colder weather, many households in the UK are turning on their heating for the first time in months. Heating appliances need… Read more
Asthma – Adult
December 24, 2017Asthma is common and potentially fatal. Severity – Severe or Life threatening – think RESUS Treatment within 30 min – bronchodilators and steroids should bee… Read more
Be #urosceptical
July 1, 2019Ditch the Dipstick – for patients >65Yrs or Catheterised! Approx. 50% of over 65’s and most of those with catheters have asymptomatic bacteriuria. The patient… Read more
Bell’s Palsy
May 2, 2018Bell’s Plays is a lower motor neurone (LMN) lesion of the facial nerve (CN VII), which causes one side of the face to “droop” [1%… Read more
Bradycardia
August 12, 2018ALS Bradycardia Algorithm – Adult Causes Cardiac: Heart Block, Myocardial infarction, Myocarditis Metabolic: Hypothermia, Hyperkalaemia, Hypokalaemia, Hypothyroid, Hypoxia Toxin: digoxin, B-blocker Treatment For ALL conditions… Read more
Button Battery Ingestion
July 9, 2018A button battery lodged in the Oesophagus is a medical emergency as it can cause necrosis and significant GI bleed – Refer immediately If anybody… Read more
Cervical (Carotid OR Vertebral) Artery Dissection
November 24, 2018Cervical artery dissection is a rare but significant cause of stroke and headache/neckache, which is easy to overlook. Leading to a typically delay in diagnosis… Read more
COPD – exacerbations
December 22, 2017COPD patients vary widely, due to their comorbidities, social circumstances, and wishes. So choosing the best treatment pathway for the patient can be complex. Involve… Read more
COPD think VBG
February 18, 2018We have recently introduced the use of VBG in COPD. Why Change? Pain – we all know and warn our patients ABG’s are painful. Patients… Read more
Dabigatran Reversal
September 16, 2019Bleeding on Dabigatran? <C>ABCD – as usual trying to stop bleedBloods: FBC, Clotting, U&E, G&SDiscuss with Haematologist (esp. if taken within 12-24hr)Idarucizumab (PRAXBIND) 5g IVFound… Read more
Deep Vein Thrombosis (DVT)
December 22, 2017It is worth remembering that HRI and CRH have different processes for the management of DVT see Management section. Signs and Symps No single feature… Read more
Delirium in the ED
March 11, 2019Delirium is one of a number of geriatric syndromes and has significant associated morbidity and mortality. 3 subtypes of delirium Hyperactive – easies to spot,… Read more
DKA – Adult
February 6, 2018Things to remember Give 0.9%NaCl Actrapid “Fixed Rate” 0.1unit/kg/hr Basal Insulin (lantus/levemir) give this too – usual time and dose Potassium – if below 5.5 will… Read more
DVLA – Driving & Medical Conditions
May 8, 2018For many conditions the patient should be informed to stop driving and inform the DVLA of their condition. It is the patients responsibility to inform the… Read more
Giant Cell Arteritis – GCA
March 13, 2018GCA is a is a vasculitis generally seen in the over 50’s and associated with polymyalgia rheumatic (PMR). However, unlike a lot of rheumatology, GCA… Read more
Headache
February 27, 2018There are numerous causes of headache, however, the pressing question in the ED is, Is this a primary or SECONDARY headache? Primary headaches [e.g. tension… Read more
High INR
March 17, 2018Patients sometimes present to ED or are send to ED due to over anticoagulation with warfarin 1. Is there Major/Significant bleeding? Yes Resuscitate (ABCD) Give… Read more
Hypercalcaemia
February 11, 201890% of hypercalcaemia is due to either malignancy or hyperparathyroid. Severity: Adjusted Calcium (Ca) Severe: >3.5mmol/l – URGENT treatment (risk of dysrhythmia) Moderate: 3.0-3.5mmol/l – PROMPT treatment (maybe well tolerated if… Read more
Hyperkalaemia
February 11, 2018Remember: is it a haemolysed blood sample? (you can do an iSTAT) Severity Mild: 5.5-5.9mmol/l – No urgent action required (Dietary & Medication modification &… Read more
Hyperosmolar Hyperglycaemic State (HHS)
May 23, 2018HHS (A.K.A. HONK) is a diabetic emergency, but unlike DKA we don’t always think about it. Patients with HHS are often elderly with multiple co-morbidities,… Read more
Hypocalcaemia
February 11, 2018Hypocalcaemia can life threatening, due to arrhythmias and seizures. Severity – Adjusted Calcium (Ca) Mild: >1.9mmol/l Severe: ≤1.9mmol/l OR Symptomatic Read more
Hypoglycaemia – Adult
July 8, 2018Hypoglycaemia (Blood glucose under 4.0 mmol/l) is potentially fatal and should be treated. it may be defined as “mild” self-treated, or “severe” treated by a… Read more
Hypokalaemia
June 2, 2018Hypokalaemia (low potassium), is a common problem. It is found in 14% of outpatients and 20% of inpatients, however only 4-5% of those are of… Read more
Hypomagnesaemia
December 11, 2019Classification Normal: 1.1-0.7 Mild: 0.69-0.5 Mod-Severe: <0.5 Signs/Symps (normally <0.5) MSK: Muscle Twitch, Tremor, Tetany, Cramps CNS: Apathy, Depression, Hallucination, Agitation, Confusion, Seizure CVS: Tachycardia,… Read more
Hypothermia
December 22, 2017Remove COLD, Add WARM, Don’t SHAKE 32-35ºC [Mild] – Shivering, Tachycardia, Tachypnoeic, Vasoconstriction 30-32ºC [Moderate] – Shivering stops, Pale/Cyanosed, Hypotensive, Confused, Lethargic <30ºC [Severe] –… Read more
Influenza POCT (Adult)
December 20, 2018Flu season 2018-9 is here and we need to think about Influenza PCR testing POCT role-out has been delayed, however, please consider need for Tamiflu/Oseltamivir in… Read more
LA – Toxicity
December 22, 2017We are regularly doing femoral blocks next to major vessels. So warn the patient of the symptoms, & keep them monitored(at least 15 min). Symptoms… Read more
Massive Transfusion Pathway
February 6, 2018In the case of patient with Massive Haemorrhage weather that be from Trauma, Surgical, O&G, UGIB, you can activate the MTP Remember: Do the Basics… Read more
Meningitis – Adults
December 16, 2017This advice is based on Becky’s CTR, as well as NICE and the joint consensus statement. Keep your suspicions high – early signs it may not be… Read more
Metastatic Spinal Cord Compression (MSCC)
October 3, 2018This is guide to the investigation of Metastatic Spinal Cord Compression (MSCC) in Oncology/Haematology patients. You need to be a bit more suspicious and have a… Read more
Monkeypox
September 18, 2018Wear Gloves & Wash Your Hands!!! In September 2018 there have been 2 cases of Monkey pox in the UK (Hence the PHE advice) Monkeypox… Read more
Myocardial Infarction (MI) – PPCI/Thrombolysis
June 22, 2018PPCI (Leeds PPCI Pathway) Target: Door to balloon 90min Criteria: Time: Chest pain within 12hrs (or worsened within 12hrs) ECG: ST elevation MI (1mm Limb… Read more
New: MERS Standard Operating Procedure
August 22, 2019Please see the updated SOP for Middle East respiratory syndrome coronavirus. Make sure you are familiar with this protocol and for anymore information please contact… Read more
Notifiable Diseases
May 10, 2019Registered Medical Practitioners in England and Wales have a statutory duty to notify Public Health about the following diseases. To facilitate rapid treatment and control… Read more
Octaplex – work fast its an EMERGENCY!
December 16, 2017In recent incidents we have had significant delays in giving OCTAPLEX, So ….. Activate EARLY in head injury patients on warfarin. Order on EPR &… Read more
OPAT-Cellulitis
May 12, 2018Often patients with cellulitis, need more than oral antibiotic management. However, they are not so sick to require hospital admission. OPAT allows suitable patients to… Read more
Ottawa SAH Rule
June 27, 2019Headache is a common presentation to ED and Subarachnoid is the diagnosis we never want to miss. However, working out who needs a scan can… Read more
Parkinson’s Disease & can’t swallow
October 2, 2019We all recognise the importance of ensuring patients with Parkinson’s disease (PD) get their medication, but.. What do you do if the patient can’t swallow?… Read more
Pneumonia (Community Acquired)
March 9, 2018BTS Definition of CAP Signs of acute Lower Respiratory Tract illness (LRTI) [Cough] &: ≥1 other LRTI Symptom [Pleuritic pain, Tachypnea, Dyspnea, etc] New Focal Chest… Read more
Pneumothorax – Medical ones
December 20, 2017To drain or not to drain? – that is the question (Follow the BTS algorithm).This is not for Tension! Read more
Pre-Arrival Blood (O-ve)
March 13, 2019On rare occasions you may receive a pre-alert, where you want blood available for the patient when they arrive (for example in major haemorrhage). This… Read more
Primary Atrial Fibrillation (AF)
December 23, 2017Before you start treating make sure you ask a few question Whats the cause? – treating the precipitant often sorts the AF (adding B-Blockers to… Read more
Proximal Myopathy/Muscle Weakness
May 1, 2018The Case An elderly patient attends the ED with difficulty mobilising, Nursing staff tell you that the patient needs a CT head for STROKE? –… Read more
Pulmonary Embolism – PE
December 20, 2017PE is somehow both the most over and under diagnosed condition. with severity ranging from the questionable sub-segmental PE to the Massive PE (an indication… Read more
Pulmonary Embolism in Pregnancy
July 19, 2019Unfortunately the the normal pathway for investigation of PE performs poorly in pregnancy RCOG have the following pathway 1. Investigation – of suspected PE Clinical… Read more
Purple Glove Syndrome – Case
September 23, 2018Is a rare complication of I.V. Phenytoin, which presents with a triad of: Pain, Oedema & Discolouration, typically in the hand. In our case a… Read more
Rabies [notifiable disease]
July 17, 2018Recent Incident: Bat contact was not recognized (effectively touching a bat without gloves means treatment is recommended) Rabies is an acute viral encephalomyelitis caused by members of… Read more
Rare Antidotes – how to get
August 30, 2018Getting some of the rarer antidotes has recently been clarified across Yorkshire (Accessing rarely used antidotes-SOP) Read more
RCEM CPD 2019 Day 1
April 2, 2019HEAD AND NECK Tracheostomy Emergency Care – Dr Brendan McGarth www.Tracheostomy.org.uk Needs to distinguish Tracheostomy from laryngectomy as a laryngectomy has no connection to the… Read more
Rhabdomyolysis
January 15, 2019We often worry about patients developing rhabdomyolysis and consequently developing AKI. However, there is much debate and little consistency in the published data, over how… Read more
Scombroid Poisoning- NOT another fishy allergy
April 19, 2018Scombroid poisoning (AKA – Histamine fish poisoning) is apparently more common than we think and accounts for 40% of seafood related illness in the USA… Read more
Sepsis
March 13, 2018Background Sepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs. Sepsis can lead to… Read more
SEPSIS
November 23, 2018Our video maybe light hearted but… SEPSIS is a Killer (1:4 Die) and time matters Recognise, Resuscitate, Review Read more
Sex, Bites, and Needle Sticks
February 28, 2018First Aid (ALL) Encourage bleeding Wash with copious amounts of water or saline Don’t Suck Don’t use Caustic agents Read more
Sickle Cell Crisis
June 7, 2019Painful Crisis Severe pain is the most common reason that patients with sickle cell, will attend the ED. The pain can be agonising (and often… Read more
Sore Throat
March 17, 2018Background Acute sore throats are often caused by a virus, last about a week and get better without antibiotics. withholding antibiotics rarely causes complications. Antibiotic… Read more
Syncope – ESC 2018
September 25, 2018Defintion:Transient Loss of Consciousness (TLOC) due to cerebral hypoperfusion, characterised by a rapid onset, short duration, and spontaneous complete recovery. Common ED Complaint: 1.7% of all attendances Difficult… Read more
Tachycardia
February 28, 2018Background Cardiac arrhythmias are relatively common presentations to ED. There are many causes, some more sinister than others. If your patient is not acutely unwell… Read more
Transfusion Care Pathway
July 13, 2018PDF: Transfusion Care Pathway When giving blood products you need to use the transfusion care pathway. Octaplex Blood/Plt’s/FFP It can be found on intranet >… Read more
Upper GI Bleed (UGIB)
December 22, 2017Not normally difficult to spot, but look for it in unexplained anaemia, or collapse. Questions Is it VARICEAL? Mortality 35%, so is an emergency whatever… Read more
Vertigo in ED
December 20, 2017Vertigo is not always labyrinthitis!! There are some potentially serious conditions to think about. Your main question should be is it peripheral [good] or central… Read more