The Case
An elderly patient attends the ED with difficulty mobilising, Nursing staff tell you that the patient needs a CT head for STROKE? – “They are really unsteady if they try to stand and they can’t lift their arms up”. Read more
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High INR
Patients sometimes present to ED or are send to ED due to over anticoagulation with warfarin
1. Is there Major/Significant bleeding?
Yes
- Resuscitate (ABCD)
- Give 5mg Vitamin K IV
- Octaplex Guide
- Treat bleeding and admit to appropriate speciality
Cervical (Carotid OR Vertebral) Artery Dissection
Cervical artery dissection is a rare but significant cause of stroke and headache/neckache, which is easy to overlook. Leading to a typically delay in diagnosis of 7 days. Unfortunately imaging the cervical arteries is not simple, with MRA being the method of choice. Hence these patients must be referred to the “Stroke Consultant”.
Major Incident/MAJAX Guide
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 our trusts “Major Incident Plan”, however its a great learning resource and worth going through Read more
Adrenal Crisis
Adrenal crisis or insufficiency is a life threatening emergency due to the lack of glucocorticoid. Adrenal crisis can be primary due to destruction of the adrenal cortex (Addison’s), or secondary due to down regulation (chronic steroid use) Read more
Bradycardia
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 underlying condition is the most appropriate treatment and for some the only thing that will work (i.e. severe hypothermia) Read more
Octaplex – work fast its an EMERGENCY!
- Activate EARLY in head injury patients on warfarin.
- Order on EPR & Paper [see below]
- Infuse over no more than 30 min
- Recheck INR at 30 min after finished infusion
Indications
- EMERGENCY reversal of Warfain
- Factor II or X deficiency
Read more
Vertigo in ED
Vertigo is not always labyrinthitis!! There are some potentially serious conditions to think about. Your main question should be is it peripheral [good] or central [bad]?
Anti-D immunoglobulin
Rhesus (Rh)-D negative women, pregnant with Rh-D positive foetus are at risk of developing antibodies against future pregnancies if/when they suffer a sensitising event. (Remember, this should be considered a standard treatment for all Rh-D negative women, as we are never certain of the fathers Rh-D status) Read more
Radial Buckle Fractures
Some Radial Buckle #’s in children can be managed with:
- Well fitting splint
- Advice sheet
This decision tree must be followed to identify suitable patients
If you are concerned about Non-Accidental injury – you must escalate your concern.
