Author: embeds

Urinary Catheterisation in ED

Pre-catheterisation

  • Confirm appropriate indication
    • Relief of acute or chronic urinary retention
    • Need for accurate measurements of urinary output in critically ill patients
    • Patient requires prolonged immobilisation (e.g potentially unstable traumatic injury)
    • To improve comfort for end of life care
  • Bladder scan & document result
  • Appropriate consent from patient

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MHRA: Ondansetron small increased risk of oral clefts following use in the first 12 weeks of pregnancy

MHRA (Medicines & Healthcare products Regulatory Agency)  has recently published a warning regarding the use of ondasetron in early pregnancy.leading to a small but significant risk of cleft lip. – LINK HERE

“Recent epidemiological studies report a small increased risk of orofacial malformations in babies born to women who used ondansetron in early pregnancy.1 4 Key evidence was an observational study of 1.8 million pregnancies in the USA of which 88,467 (4.9%) were exposed to oral ondansetron during the first trimester of pregnancy. The study reported that ondansetron use was associated with an additional 3 oral clefts per 10,000 births (14 cases per 10,000 births versus 11 cases per 10,000 births in the unexposed population).1 These data were recently reviewed within Europe and considered to be robust.”

Patients with vomiting in early pregnancy requiring antiemetics you can review the guidance on “Hyperemesis Gravidarum”

3. HAZMAT – CBRNe (Chemical, Biological, Radiological and Nuclear) incidents

NHS England, Public Health England and the Health Protection Agency have produced several very useful resources for us to use – BUT First.

Remove – Remove – Remove

Basics

Contacts

  • Health Protection Agency Teams – HERE
    • West Yorkshire
      • In hours: 0113 386 0300
      • Out of hours: 114 304 9843

  • ECOSA (Emergency Coordinated Scientific Advice System) – 0300 3033 493

  • UK NPIS – 0344 892 0111

Guides

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Hyponatraemia

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 to treatment the following need to be considered and balanced.

  1. Symptoms Severity – these are not exclusive to hyponatraemia and may be due to other disease processes (esp. if the low sodium is long-term)
  2. Sodium Level – the sodium concentration doesn’t always correlate to the clinical picture, and is dependant on speed of change, and co-morbidities
  3. Rate of Drop – the faster sodium levels drop the more symptomatic the patient often is (i.e. with long term hyponatraema the patient may be profoundly hyponatraemic but asymptomatic)
  4. Co-morbidities – Increasing sodium too quickly risks osmotic demyelination. How well will the patient cope with treatment?

Emergency treatment (hypertonic saline) is generally indicated in those with Severe Symptoms ONLY

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Influenza POCT (Adult)

Flu season has arrived, and we need to be thinking about who to test and who to treat. Full guide HERE But don’t forget MERS!!

Q1. Do you suspect Flu?

  • Fever
  • Coryza
  • Arthralgia and/or Myalgia
  • Malaise
  • GI symptoms – with or without signs of respiratory/other involvement e.g. CN

Yes! – Respiratory precautions

  • Isolated in a side room
  • Surgical face mask worn on entry to room + gloves and apron
  • FFP3 mask or hood worn for aerosol generating procedures
  • Bare below the elbow / good quality hand hygiene
  • Proceed to Q2

 

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#NoF – Fractured Neck of Femur

BOAST 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 risk of also sustain C-Spine injury.
    • Also the pain is likely distracting and the patient is often over 65yrs old so Canadian C-Spine rules will not apply.

Hx/Exam

  • Why did They Fall? – was this a collapse?
  • Are they sick? – Co-morbidity/illness is common in this group and must be recognised
  • Anticoagulants? – This affects treatment
    • On Warfarin – If INR >1.5 (or unavailable) Vit-K 5mg
  • Other injuries? – >65’s the most common mechanism of TARN major trauma is fall <2m
  • Typically – Pain hip/buttock, shortened, externally rotated
  • Atypical – Few signs (can they lift their leg & is rotation at the hip painful)

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Lower Back Pain: Red & Yellow Flags

Each year 1:15 of the adult population will seek medical help for Lower Back Pain, that is 2.6 million patients in the UK. Most Lower Back Pain is not serious and will revolve within 8 weeks, with analgesia and self physio.

However, this is not the case for some. This may be due to serious underlying pathology ‘RED Flags‘, or psychological factors that indicate chronicity ‘Yellow Flags‘.

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