0-12yrs WETFLAG

September 7, 2019

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

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

AAGBI – Intubation Check List

April 2, 2019

Simple pre-intubation checklist for the whole team to be aware of so we can make intubation in ED as safe as possible. PDF: Full Version… 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

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

Adult Sedation

June 4, 2020

This guideline is a brief summary of the RCEM 2012 Safe sedation in the ED and RCEM – Pharmacological Agents for Procedural Sedation and Analgesia… Read more

Anion Gap & Metabolic Acidosis

March 26, 2018

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

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


August 12, 2018

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

Burns Referral Pathway

May 8, 2019

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

C-Spine Injury

September 4, 2018

C-spine injury ranges from the obvious fracture-dislocation to the less obvious ligamentous injury, affecting about 2.5% of blunt trauma patients. However, ALL of them are… Read more

Consenting for Blood Transfusion

December 2, 2020

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

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 (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-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 (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 (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 (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

CT Abdo/Pelvis & Pregnancy Testing

December 11, 2019

Radiology are now requesting blood pregnancy testing reproductive females from 10-35days from last period. But what is wrong with urine pregnancy testing? Read more

Dabigatran Reversal

September 16, 2019

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

Decontamination – First Contact

September 8, 2019

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

Devastating Brain Injury?

February 15, 2018

Scenario (Not uncommon) A patient either post arrest or head injury has a CT demonstrating significant brain injury and Leeds says “No” What do we… Read more

Domestic Abuse

August 27, 2018

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

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

ECG placement & mis-LEADing ECG’s

July 24, 2020

V1: 4th intercostal space (ICS), RIGHT margin of the sternum V2: 4th ICS along the LEFT margin of the sternum V4: 5th ICS, mid-clavicular line… Read more

EMBRACE & Paediatric Critical Care

July 18, 2019

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

Emergency General Anaesthetic Checklist

February 13, 2018

PREPARE or prepare to fail 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

Head Injury

February 27, 2018

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


January 13, 2020

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


December 22, 2017

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

LA – Toxicity

December 22, 2017

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

Lateral Canthotomy

May 7, 2019

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

Major Incident/MAJAX Guide

January 23, 2019

NHS England have published this fantastic resource [Click here] covering Major Incidents including; gunshot, crush, nerve agents and much more. This is not to replace… Read more

Major Trauma Network

February 16, 2018

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

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

Meningitis – Adults

December 16, 2017

  Keep your suspicions high – early signs it may not be clear Sepsis Kills – give antibiotics & fluid early Consider Acyclovir Give Dexamethasone with… Read more

Myocardial Infarction (MI) – PPCI/Thrombolysis

June 22, 2018

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 (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

Octaplex – work fast its an EMERGENCY!

December 16, 2017

In recent incidents we have had significant delays in giving OCTAPLEX, So ….. Activate EARLY in head injury patients on warfarin. Order on EPR &… Read more

Paediatric – Time Critical Transfers (non-trauma)

June 14, 2020

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

Paediatric Ketamine Sedation

June 4, 2020

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

Pre-Arrival Blood (O-ve)

March 13, 2019

On 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/Flutter (AF)

December 23, 2017

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

Primary Intracerebral Haemorrhage

December 1, 2020

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

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

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

Rape & Sexual Assault

March 6, 2018

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

Rare Antidotes – how to get

August 30, 2018

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

RCEM CPD Conference Day 3

April 4, 2019


Retrobulbar haemorrhage

February 2, 2020

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


January 15, 2019

We 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, 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


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

Silver Trauma

October 21, 2019

The population is ageing and thus our ‘typical’ trauma patient is also changing. In 2017 the TARN report “Major injury in older people” highlighted the… Read more

SUDIC – Sudden Unexpected Death In Child

March 13, 2018

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

Suspected Contamination Incident – HAZMAT

July 20, 2018

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

Transfusion Care Pathway

July 13, 2018

PDF: 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

TXA – Tranexamic Acid

October 16, 2019

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