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Tips:  If particularly BiIG – go up 1-2 yrs If particularly SMALL – go down 1-2 yr Prepare ET Tubes 0.5mm bigger and smaller Chid’s… 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

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

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

The 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 (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

Causes Cardiac: Heart Block, Myocardial infarction, Myocarditis Metabolic: Hypothermia, Hyperkalaemia, Hypokalaemia, Hypothyroid, Hypoxia Toxin: digoxin, B-blocker Treatment For ALL conditions leading to bradycardia treating the… Read more

A new burns referral pathway has been developed with Mid Yorks to securely send images of the patients burn. Allowing the burns team to arrange… Read more

We frequently consent for Blood Transfusion, but what risks do we tell the patients about and how common are those risks? 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

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

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

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

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

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

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

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

REMOVE – REMOVE – REMOVE Remove Them.. At reception ask them to go outside to designated area and staff will be with them shortly. Inform… Read more

Domestic abuse can affect anyone and often its not readily disclosed on an ED admission. We must be alert to the fact some of our… Read more

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

In our trust we don’t have paediatric critical care beds. However, in our region we use EMBRACE (a paediatric critical care transport team), who can… Read more

PREPARE or prepare to fail Read more

Background Defined as any traumatic injury to the head other than superficial facial injuries. The commonest cause of death and disability in people age 1-40… Read more

Hyponatraema is a common finding, especially within our elderly population. However, its significance is is not a simple numbers game, and needs senior input. Prior… 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

Like tension pneumothorax the biggest step is deciding to do it – Remember it it sight saving and they heal well Retrobulbar Haematoma secondary to… Read more

We are part of the West Yorkshire Major Trauma Network with our MTC at LGI WYMTN: Guides We know that from time-time patient are brought to… 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

PPCI (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

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

Definition of a time critical transfer  Transfer of a patient for life, limb or organ saving treatment when the time taken to provide this treatment… Read more

RCEM 2012 Safe sedation in the ED and RCEM Ketamine for paediatric procedural sedation guideline. Please read these documents in full or participate in RCEM… Read more

Before you start  Whats the cause? – treating the precipitant often sorts the AF (adding B-Blockers to Sepsis can make things worse) Stable or Unstable? … Read more

In anybody who there is suspicion of a non-traumatic haemorrhage arrange an urgent CT Head. All patients need IV access and  U&E, FBC, Coag If… 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

Don’t Preform intimate examinations on Sexual assault/Rape patients Unless life-threatening injuries are suspected e.g Haemorrhage. As our examination will inevitably destroy evidence that may aid… Read more

REALISTIC EMERGENCY MEDICINE  Read more

What is retrobulbar haemorrhage? Rapidly progressing haemorrhage into the retrobulbar space which is rare but potentially sight threatening. Retrobulbar haemorrhage causes a rapid rise in… 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

Occasionally children (<18 yrs) unfortunately will either die in ED or be brought in dead, this is obviously a terrible time for the child’s family… Read more

So a patient comes to ED after white powder thrown is at them what do you do? Your initial response can help them and everyone… Read more

TXA a bleeding wonder drug! Crash 2 Study (2010) Multi-Centre RCT of the use of TXA in trauma Inclusion – Adult trauma patients with ≥1… Read more