1. Why we get things wrong – “A tale of two systems”

November 3, 2018

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

March 25, 2018

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

ACS – Acute Coronary Syndrome

December 22, 2017

This pathway is ONLY for single episodes of cardiac chest pain lasting over 15 min. Multiple episodes (¿unstable angina?), continuing chest pain, or non-cardiac chest… Read more

Acute Behavioural Disturbance / Excited Delirium

December 24, 2017

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

Acute Heart Failure (AHF) – ESC 2016

October 9, 2018

  AHF 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, 2018

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

Alcohol Withdrawl

June 20, 2018

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

June 16, 2018

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

Are You CO Aware?

October 24, 2018

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

Asthma – Adult

December 24, 2017

Asthma is common and potentially fatal. Severity – Severe or Life threatening – think RESUS Treatment within 30 min – bronchodilators and steroids should bee… Read more

Bell’s Palsy

May 2, 2018

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

Bradycardia

August 12, 2018

ALS 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

Cervical (Carotid OR Vertebral) Artery Dissection

November 24, 2018

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

COPD – exacerbations

December 22, 2017

COPD 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

Deep Vein Thrombosis (DVT)

December 22, 2017

Our protocol is initiated by ED and GP’s Do the Wells Score and the D-Dimer – even if the wells score is high risk we… Read more

DKA – Adult

February 6, 2018

Things to remember Give NaCl 0.9% Actrapid “Fixed Rate” 0.1unit/kg/hr Basal Insulin (lantus/levemir) give this too – usual time and dose Potassium – if below… Read more

DVLA – Driving & Medical Conditions

May 8, 2018

For 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, 2018

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

Headache

February 27, 2018

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

High INR

March 17, 2018

Patients 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, 2018

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

Hyperkalaemia

February 11, 2018

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

Hyperosmolar Hyperglycaemic State (HHS)

May 23, 2018

HHS (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, 2018

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 – Adult

July 8, 2018

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

Hypokalaemia

June 2, 2018

Hypokalaemia (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

Hypothermia

December 22, 2017

Remove COLD, Add WARM, Don’t SHAKE Use common sense, and do basics <32’C CORE temperature  probe (skin temp inaccurate) Active renaming (warm fluids etc) Don’t… Read more

Massive Transfusion Pathway

February 6, 2018

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

Metastatic Spinal Cord Compression (MSCC)

October 3, 2018

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

Monkeypox

September 18, 2018

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

Myocardial Infarction (MI) – PPCI/Thrombolysis

June 22, 2018

PPCI Target: Door to balloon 90min Criteria: Time: Chest pain within 12hrs (or worsened within 12hrs) ECG:  ST elevation MI (1mm Limb or 2mm Chest… Read more

OPAT-Cellulitis

May 12, 2018

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

Pneumonia (Community Acquired)

March 9, 2018

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

Pneumothorax – Medical ones

December 20, 2017

To drain or not to drain – that is the question (Follow the BTS algorithm).This is not for Tension! Suggestion: Large pneumothorax consider placing a Seldinger drain… Read more

Primary Atrial Fibrillation (AF)

December 23, 2017

Before you start treating make sure you ask a few question Questions Whats the cause? – treating the precipitant often sorts the AF (adding B-Blockers… Read more

Proximal Myopathy/Muscle Weakness

May 1, 2018

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

Purple Glove Syndrome – Case

September 23, 2018

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

Rabies [notifiable disease]

July 17, 2018

Recent 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

Scombroid Poisoning- NOT another fishy allergy

April 19, 2018

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

Sepsis

March 13, 2018

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

SEPSIS

November 23, 2018

Our 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, 2018

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

Sore Throat

March 17, 2018

Background 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, 2018

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

Syncope – NOT collapse ? cause

December 20, 2017

Syncope can be a bit of a heart sink. However, if you ask 3  simple(ish) questions, you can improve the outcome for patients. (Remember universal… Read more

Tachycardia

February 28, 2018

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

Upper GI Bleed (UGIB)

December 22, 2017

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 in ED

December 20, 2017

Vertigo is not always labyrinthitis!! There are some potentially serious conditions to think about. Your main question should be  is it peripheral or central [badness].… Read more