#NoF – Fractured Neck of Femur
15-Dec-2024BOAST Guidance #NoF patients (or other fragility fracture) who requiring CT Head (for head injury) also be performed a CT Neck Fragility fractures indicate the patient is at high… Read more
1. Why we get things wrong – “A tale of two systems”
03-Nov-2018Very 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
2WW – Suspected Cancer
01-Jan-2025Some patients present to ED with symptoms or investigations suspicious an undiagnosed cancer, but don’t require emergency admission. To reduce the barriers to care the… Read more
Aortic Dissection
15-Oct-2026Aortic 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
Bell’s Palsy
10-Jun-2025Bell’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
Bilary Disease
21-Jan-2024Gallstones are common, with a prevalence of approximately 10–15% of adults in Europe and the U.S. Most of the time patients are asymptomatic. but there are several ways… Read more
Button Battery Ingestion
31-Dec-2025Oesophageal Button Battery = Emergency Refer Immediately If anybody is symptomatic after button battery ingestion they need referral to the Surgical team for urgent endoscopic… Read more
Chest Trauma – WYMTN
06-Jan-2024Chest injury as part of major trauma, can range from painful to life threatening so prompt treatment and recognition is vital. Esp. in ‘Silver Trauma’… Read more
Chronic Pancreatitis
07-Nov-2025Chronic pancreatitis is a low grade inflammatory disease of the pancreas. It can occur after an attack of acute pancreatitis or can present on its… Read more
Consenting for Blood Transfusion
02-Dec-2024We frequently consent for Blood Transfusion, but what risks do we tell the patients about and how common are those risks? Read more
Dabigatran Reversal
16-Sep-2019Bleeding 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
Dental Abscess
29-Sep-2026Dental Abscess requires a Dentist for Definitive Treatment Symptoms: Dental Pain Unpleasant taste Fever and Malaise Trismus Dysphagia Facial Swelling Regional Lymphadenopathy Tooth Decay Gum… Read more
Diverticulosis, diverticular disease and diverticulitis
30-Dec-2025The prevalence of diverticula Is unknown as most are asymptomatic. However, it is rare before the age of 40 and increases with age. Diverticulosis occurs… Read more
End of life care in the Emergency Department
09-Oct-2026Why recognising dying matters Recognising that someone may be approaching the end of their life can be difficult, particularly in the busy and sometimes unpredictable… Read more
Epistaxis – Management
13-Nov-2025Nose bleeds are a bloody common problem (bad pun intended) – most originating at the front to the nose where there is a cluster of… Read more
Eye Clinic Referral Criteria
08-Jan-2019What should you send to Eye Clinic and how soon? Read more
FERNO Traction Splint
25-Nov-2023How to apply the FERNO traction splint for our in-hospital patients Read more
Hyperemesis Gravidarum
26-Jul-2024Nausea and vomiting in pregnancy is common and at best an unpleasant experience for the patient, and at worst can be life threatening. It normal… Read more
Ingested Magnets
20-Apr-2025Ingestion of Strong Magnets is a TIME CRITICAL EMERGENCY (Multiple Magnets OR a single Magnet and Metallic Objects) If unsure if magnet classes as a… Read more
Lateral Canthotomy
07-May-2023Like 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
Lisfranc Injuries
16-Sep-2025A Lisfranc injury describes an injury of the foot between the metatarsal and tarsal spaces. Around 20-40% of Lisfranc injuries are initially missed, so a… Read more
Major Trauma: STOP>SORT>GO
04-Jul-2024YAS crews may on occasions (rarely) bring us a Major Trauma patient that meets the criteria for bypass to the MTC because they have a… Read more
Necrotising Fasciitis
28-Nov-2024Necrotising fasciitis (NF) is a rare but serious bacterial infection that affects the soft tissue and fascia (Fournier gangrene, is NF affecting the perineum). In… Read more
Octaplex – work fast its an EMERGENCY!
03-Apr-2024Activate EARLY in head injury patients on warfarin. Order on EPR & Paper [see below] Infuse over no more than 30 min Recheck INR at 30… Read more
Paediatric Surgical Pathway
21-Oct-2025As there are now no longer a paediatric clinical team at HRI, the paediatric surgical pathway is up-dating, this is the current provisional pathway, to… Read more
PEARS
19-Jan-2024Primary Eyecare Acute Referral Scheme Read more
Referral criteria for ENT clinics (CAS)
08-Dec-2024The following conditions can be referred through the ENT CAS clinic. If same day referral required talk directly with ENT on-call If suitable for CAS… Read more
Retrobulbar haemorrhage
02-Feb-2024What 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
SEPSIS
13-Jun-2025Three large scale multi-centre trials into Severe Sepsis and Septic Shock: ProCESS (USA), ARISE(Aus), ProMISe(UK), all showed the same thing. What works is good early… Read more
Snake Bites
29-Jan-2024In the UK approximately 100 people are envenomated by a snake each year. So what do you need to do if your patient has received… Read more
Surgery Referral Pathway
09-Nov-2020Introduction The Surgical and ED teams have worked closely to provide an agreed process, to aid patient flow through the ED and help to maintain… Read more
Thomas Spint – how to apply
03-Feb-2019Invented by a Welshman ‘Hugh Owen Thomas’, the introduction of this simple device in World War 1 went on to reduce the mortality of #femurs… Read more
Upper GI Bleed (UGIB)
20-Oct-2025Not 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
Urinary Retention
25-Apr-2025A common problem which affects 1 in 10 men between 70-79yrs and 1 in 3 men 80-89yrs (10M:F) Signs/Symptoms Unable to pass urine (may be… Read more
Urology Referral Pathways
01-Jul-2021Referral The first point of contact for urology advice and referral is the general surgical SHO. This is the on-call surgical SHO carrying the on-call… Read more
Vascular Emergencies (Regional Pathways)
27-Dec-2025Intro Vascular surgery has been reconfigured across etc region. The vascular oncall will be based at BRI 24/7. Multiple pathways have been developed below to… Read more
