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

Acidosis & VBG’s

October 4, 2019

We 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

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

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

COPD think VBG

February 18, 2018

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

COVID-19 (40 Step Desaturation Test)

April 12, 2020

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… Read more

Covid-19 (4C Mortality Score)

September 28, 2020

The 4C mortality score has been developed by ISARIC[BMJ], based on 35.463 UK Covid-19 patients. If cases climb prognostication may become more important and this… Read more

COVID-19 (Awake Self-Proning)

April 8, 2020

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… Read more


March 19, 2020

NIV/CPAP  is an Aerosol Generating Proceedure (AGP) Staff must wear full APG PPE In Side room with a door Door Marked with APG sign –HERE… Read more


March 19, 2020

Deteriorating Patients Early senior decision making around DNACPR, is vital for both staff, patients, and families. Document decsion making and communications clearly There will be… Read more

COVID-19 (Death Certification)

April 4, 2020

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… Read more

Covid-19 (dexamethasone)

June 16, 2020

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… Read more


April 15, 2020

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… Read more

COVID-19 (Doning/Doffing Video)

March 10, 2020

2 video links to PHE how to Don and Doff your PPE Read more

COVID-19 (Donning/Doffing-LOCAL)

March 25, 2020

Local instructional videos for donning/doffing Non-Aerosol Generating Procedures Aerosol Generating Procedures Disponible FFP3 (Leeds) Read more

COVID-19 (Escalation-Arrhythmia Clinic)

March 26, 2020

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… Read more

COVID-19 (Escalation-Ophthalmology Referral)

March 27, 2020

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,… Read more

COVID-19 (Escalation-Primary PCI)

April 10, 2020

Eligibility Symptoms suggestive of Acute Myocardial Infarction Chest Pain within 12 hours ECG showing acute myocardial infarction ST elevation >1mm in limb leads ST elevation… Read more

Covid-19 (Hyperglycaemia)

July 17, 2020

Both COVID-19 infection and treatment with dexamethasone impair glycemic control. So its important to monitor blood sugars and consider DKA & HHS in COVID-19 patients.… Read more

COVID-19 (optimal use of oxygen)

April 16, 2020

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… Read more

COVID-19 (Paediatric multisystem inflammatory syndrome)

May 13, 2020

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… Read more

COVID-19 (Palliative Care)

April 8, 2020

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… Read more

COVID-19 (Respiratory Flow Chart)

March 27, 2020

As we know COVID-19 is putan incredible burden on resources, especially for higher level respiratory support. It is important to target those resources in the… Read more

COVID-19 (Talking to Relatives)

April 12, 2020

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… Read more

COVID-19 (VTE prophylaxis in Lower Limb Injury)

April 20, 2020

During the Covid-19 pandemic alternatives to LMWH have been agreed – [For those who can’t inject themselves] Read more

COVID-19 (Which Covid Test)

January 14, 2021

Once the “Decision to Admit” has been made, an appropriate Covid-19 Test will need to be performed Select the appropriate patient group below Perform Test… Read more

COVID-19 (X-Ray learning resource)

March 15, 2020

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… Read more


November 4, 2020

NIPPV 3 machines are used throughout the trust to deliver NIV and CPAP – and should be commenced in ED if transfer to ward/ICU is… Read more

Emergency Tracheostomy/Laryngectomy Management

May 13, 2020

Occasionally patients with Tracheostomy or Laryngectomy present with difficulty breathing due to problem. As this is rare for us in ED, this situation can be… Read more

Influenza POCT (Adult)

December 17, 2019

The 2019-20 Flu season has arrived, and we need to be thinking about who to test and who to treat. Full guide HERE But don’t forget… Read more

New: MERS Standard Operating Procedure

August 22, 2019

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

NIV (Non Invasive Ventilation)

February 6, 2020

NIV should be considered for use in patients with a  persisting Acute Hypercapnic Respiratory Failures after a maximum of one hour of standard medical therapy. However, ICU… Read more

Pneumonia – Paeds

December 24, 2017

CAP is far less common than URTI’s, however, it needs to be considered within your differentials. Depending on severity there is a guide to investigation… Read more

Pneumonia (Community Acquired)

March 9, 2018

Severe Pneumonia: Please Request/Send – Samples Sputum/Blood/Urine BTS Definition of CAP Signs of acute Lower Respiratory Tract illness (LRTI) [Cough] &:  ≥1 other LRTI Symptom… 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! Read more

Pulmonary Embolism – PE

December 20, 2017

PE 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, 2019

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

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

Trust Dalteparin dosing

July 12, 2020

Trust Guidance varies slightly from BNF for those patients over 100kg Non-Pregnant PE/DVT treatment CrCl Calculator – HERE CrCl <20ml/min contact haematologist Pregnant PE/DVT treatment… Read more