Severity – Severe or Life threatening – think RESUS- Treatment within 30 min – bronchodilators and steroids should bee given within 30min
- 1hrs Observation after Neb – better after a neb don’t just send home they may deteriorate when it wears off.
- PEFR – must be >75% expected prior to discharge (at least 1hr after treatment finished)
- Discharge advice sheet – can print off from this guide, remember to check inhaler technique and consider a spacer
Author: embeds
1. HAZMAT – First Contact
REMOVE – REMOVE – REMOVE
Remove Them..
At reception ask them to go outside to designated area and staff will be with them shortly. Inform Nurse in Charge!
Remove Clothes..
Use the disrobing card to get the patient to safely remove and bag up clothes. Do your best to maintain privacy. CARD HERE
Remove Substance..
- Burning/Irritant – WET-Decon HERE
- Not Burning/Irritating – DRY-Decon HERE
- Patient Disrobing instruction Card
If we have ample warning or the number of patients will be significant, it may be worth deploying the decontamination tent but remember setting this up is time consuming.
Tick-Bourne Diseases
The prevalence of diseases transmitted by tick bite have increased in recent years, within the UK. And it is now recognised that there are 3 main infections
- Lyme Disease
- Tick-Bourne Encephalitis
- Babesia
Pulmonary Embolism in Pregnancy
Unfortunately the the normal pathway for investigation of PE performs poorly in pregnancy RCOG have the following pathway
1. Investigation – of suspected PE
- Clinical assessment – its all on the history and exam scoring doesn’t work
- Perform the following tests:
- CXR – sheilding can protect the baby and may avoid further radiation
- ECG
- Bloods: FBC, U&E, LFTs, Clotting
- Commence Tinzaparin (unless treatment is contraindicated – use booking weight to calculate dose) –[BNF]
VTE prophylaxis in lower limb Immobilisation (ED – 2023)
In the Emergency Department (ED) lower leg immobilisation after injury is a necessary treatment but is also a known risk factor for the development of venous thromboembolism (VTE). This accounts for approximately 2% of all VTE cases which are potentially preventable with early pharmacological thromboprophylaxis.
Neonatal Resus
NEONATAL CRASH CALL – IF NEEDED
CALL NEONATAL CONSULTANT (MAY ONLY GIVE ADVICE AS AT CRH)
CONSIDER CALLING THE ED CONSULTANT
***Remember Grab Box***
Paediatric – Time Critical Transfers (non-trauma)
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 is a critical factor in outcome.
Principles
- Acceptance by the regional centre is NOT dependent on bed availability.
- Time critical transfer should normally be provided by the referring hospital team NOT Embrace.
Limping Child
This is a relatively common presentation within the ED that has a myriad of possible diagnoses ranging from sprain to malignancy. One thing to remember is that patients and relatives will look for a traumatic reason for limb pain, and may link it to minor injuries that would not have caused it. Read more
Hypercalcaemia
90% of hypercalcaemia is due to either malignancy or hyperparathyroid.
Severity: Adjusted Calcium (Ca)
- Severe: >3.5mmol/l – URGENT treatment (risk of dysrhythmia)
- Moderate: 3.0-3.5mmol/l – PROMPT treatment (maybe well tolerated if chromic)
- Mild: <3.0mmol/l – doesn’t require urgent treatment and often asymptomatic
Bell’s Palsy
Bell’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% of cases are bilateral], and patients are often concerned that it is a stroke.
However, unlike in stroke the whole face is affected, in stroke and other upper motor neurone (UMN) lesions the upper portion of the face is unaffected due to input from both sides of the brain. Read more
