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Very 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 = Alveolar Oxygen – arterial Oxygen This is “relatively” simple way of working out if the paO2 on a ABG is normal, and demonstrates… Read more

On 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

Most 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

Adrenal 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

Generally 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

Aortic 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

With 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

Ditch 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 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

A 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 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

We 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

Bleeding 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

Delirium 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

Things 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

GCA 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

There 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

90% 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

Remember: 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

Hypocalcaemia 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 (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

Classification 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

Remove 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

We 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

In 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

This 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

Wear 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

Please 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

Registered 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

Often 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

Headache 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

BTS 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

To drain or not to drain? – that is the question (Follow the BTS algorithm).This is not for Tension! Read more

Before 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

The 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

Unfortunately 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

Is 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

Getting some of the rarer antidotes has recently been clarified across Yorkshire (Accessing rarely used antidotes-SOP) Read more

 HEAD 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

Scombroid 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

Background 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

First Aid (ALL) Encourage bleeding Wash with copious amounts of water or saline Don’t Suck Don’t use Caustic agents   Read more

Painful 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

Defintion: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

Background 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

Not 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 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