Posterior shoulder dislocation is far less common than anterior dislocation. But it is commonly missed with some sources stating 50% of posterior dislocations are missed in the ED. Read more
Month: December 2020
Hyperkalaemia
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 & GP F/U)
- Moderate: 6.0-6.4mmol/l – Follow treatment guide (maybe suitable for discharge)
- Severe: ≥6.5mmol/l OR ECG changes – Follow treatment guide, must admit
Consenting for Blood Transfusion
We frequently consent for Blood Transfusion, but what risks do we tell the patients about and how common are those risks?
Primary Intracerebral Haemorrhage
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 CT confirms PICH (not traumatic, not SAH): –
Anticoagulation
If anticoagulated with warfarin or NOAC discuss with stroke consultant and Haematologist regarding reversal
If not anticoagulated give Tranexamic acid – 1g in 100mls Saline/Glucose over 10 mins followed by 1g in 250mls Saline over 6 hours.
Blood Pressure
BP needs to be <150/80 – use labetalol (max 400mg – until BP <160 or HR <50) and GTN infusion
Neurosurgical Referral
Not all patients with intracerebral bleeds need referral to neurosurgery – you could save yourself and your patient a lot of time and effort!
Those to refer:
- GCS 9-12/15 with lobar haemorrhage
- Isolated intraventricual haemorrhage
- Hydrocephalus on presentation
- Rapid deterioration following arrival (gcs drop by 2 points or more in the motor component)
- Cerebellar bleed
Admit those not going to Neurosurgery to HASU at CRH after discussion with Stroke team
