Category: Learning

Domestic Abuse

Domestic abuse can affect anyone and often its not readily disclosed on an ED admission. We must be alert to the fact some of our patients may be attending with domestic abuse. Please explore concerns and escalate if you’re unsure. Our colleagues in the Pennine Domestic Violence Group have kindly drawn this a guidance up for us.

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Hyperemesis Gravidarum

Nausea and vomiting in pregnancy is common and at best an unpleasant experience for the patient, and at worst can be life threatening. It normal starts @ 4-7/40, peaks @ 9/40, and finishes @ 20/40.

We need to conduct a thorough history and examination looking for causes other than a high βHCG. these include:

  • Abdominal pathology
  • Urinary pathology
  • Infections
  • Drug History
  • Chronic H.Pylori

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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]

 

EMBRACE & Paediatric Critical Care

In our trust we don’t have paediatric critical care beds. However, in our region we use EMBRACE (a paediatric critical care transport team), who can transfer critically  ill children to specialist centers (in or out of region).

EMBRACE

Y&H Paed Critical Care

Drugs:

  • Trust guide
  • Remember: Midazolam 10mg/2ml is used(not the 5mg/5ml we have  in ED)