RCPCH What0-18.nhs.uk – have released a comprehensive set of guides for children and young people. (Which our Paeds. team are now using)
- Professional Hospital Guides – HERE
- Patental Guides – HERE
Author: embeds
Ingested Magnets
Ingestion of Strong Magnets is a TIME CRITICAL EMERGENCY
(Multiple Magnets OR a single Magnet and Metallic Objects)
Strong magnets (such as Neodymium)
- Now common place around the house
- From; fridge magnets to toys and peicings
Ingested:
- Intestinal injury can occur within 8-24 hours
- However, symptoms may take weeks to develop
- Symptomatic patients are a SURGICAL emergency
Detection:
- Use X-Ray (NOT metal detectors)
- May require AP and lateral images to see how many
RCEM recommendation (best practice)
NIV (Non Invasive Ventilation)
NIV should be considered for use in patients with a persisting Acute Hypercapnic Respiratory Failures after a maximum of one hour of standard medical therapy.
- Complete the Ad-hoc form
- Increase pressures from Initial 12/5 cmH2O to 20/5cmH2O – as tolerated over 1st hour
However, ICU should be contacted early if the patient has one of the following:
- Asthma – Intubation the option of choice in Life threatening
- Pneumonia – NIV should only be considered as a bridge to intubation
- No pre-exisiting respiratory issue – NIV not likely helpful
- pH <7.25 (low threshold for ICU input)
- pCO2 >6.5kPa (low threshold for ICU input)
- Type 1 Respiratory Failure (low threshold for ICU input)
Proximal Myopathy/Muscle Weakness
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
Massive Transfusion Pathway
In the case of patient with Massive Haemorrhage weather that be from Trauma, Surgical, O&G, UGIB, you can activate the MTP
Remember:
- Do the Basics – don’t forget ABCD
- Inform Transfusion and get someone to run a G&S sample down
- FFP can take up to 45min and platelets come from Leeds
- If you no longer need the MTP – inform transfusion and return products ASAP
DKA in Kids
Diabetic Ketoacidosis – remember in paediatrics this may be the 1st presentation of diabetes.
- Fluid – are more considered that adults due to the risk of cerebral oedema
- Insulin – WAIT – need 1hr of fluid first
- Paeds – involve them early
DKA Management Calculator (recommended by paediatrics)- HERE
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
Mental Capacity Act (2005)
Applies to all over 16’s
Principles
- Everyone is presumed to have capacity – until a lack of capacity has been established
- All practical efforts have been made to help patient make a decision
- Explain decision and options as clearly and concisely as possible (be flexible)
- Make every effort to help the person understand (language line, writing, etc.)
- Are there others who might help them understand? (nursing, medical, family, freinds)
- People are free to make an unwise decision
- Anything done under the act MUST be in the patients best interest
- Carefully consider what is the least restrictive option
Return to Custody
If patients are being discharged to the care of the police, we need to:
- Complete the Police discharge paperwork
- Document it in the notes Read more
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”.
