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
Category: Learning
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
Scombroid Poisoning- NOT another fishy allergy
Scombroid poisoning (AKA – Histamine fish poisoning) is apparently more common than we think and accounts for 40% of seafood related illness in the USA according to the CDC. But Scombriod poisoning is missed as its put down to allergy. 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
Underage Sexual Activity
This applies to all children/young people under 16 years old and those 16-18 years who are considered vulnerable, engaging in sexual activity. Getting this right is immensely challenging, as it is impossible to cover all variables influencing decision making within this guidance, further more you need to carefully weight the often conlicting needs of the child. (Involve seniors early if you have any doubts) Read more
Rabies [notifiable disease]
Recent Incident: Bat contact was not recognized (effectively touching a bat without gloves means treatment is recommended)
Rabies is an acute viral encephalomyelitis caused by members of the lyssavirus genus. The UK has been declared “Rabies-Free”. However, it is known that even in “Rabies-Free” counties the bat population posse a risk.
In the UK the only bat to carry rabies is the Daubenton’s Bat [Picture on the Left] and this is not a common bat in the UK. The UK and Ireland are Classified as “low-risk” for bat exposure. Despite our “low-risk” status in 2002 a man died from rabies caught in the UK from bat exposure.
Although rabies is rare it is fatal so we must treat appropriately, Public Health England – Green book details this.
Risk Assessment
To establish patients risk and thus treatment you need to establish the Exposure Category and Country Risk [Link to Country Risk]
Exposure Category
Combined Country/Animal & Exposure Risk
Treatment
Obviously patients with wounds will need appropriate wound care and cleaning, specifics for rabies are below.
If in ANY doubt, or you feel you need advice about treatment contact: On-Call Microbiologist (who will contact PHE or Virology advice)
You will likely need to liaise with the duty pharmacist to obtain vaccine or HRIG – which may need to be sent from a different hospital. [it is probably worth trying to obtain the 1st weeks treatment if possible, to avoid treatment delays]
Rabies and Immunoglobulin Service (RIgS), National Infection Service, Public Health England, Colindale (PHE Colindale Duty Doctor out of hours): 0208 327 6204 or 0208 200 4400
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]?
