You need to be a bit more suspicious and have a lower threshold for investigation than in patients without Known, Suspected OR Previous Malignancy Read more
Category: Learning
Diabetic Hyperglycaemia (Kids)
Diabetic children sometimes attend ED with hyperglycaemia, but not in DKA (what should we do?)
Paeds have produced some advice to follow:
- Ketones over 0.6?
- <0.6: Encourage fluids & food, may need an insulin correction
- >0.6: ask Question 2
- Are there clinical features of DKA?
- NO: Encourage fluids & food, decide Insulin correction, will need to be monitored
- YES: Will need Paeds admission
COPD – exacerbations
COPD patients vary widely, due to their comorbidities, social circumstances, and wishes. So choosing the best treatment pathway for the patient can be complex. Involve senior decision makers.
Questions
- Is hospital the best place for them?
- Do they need NIV?
- Are they dying? – would you want to die surrounded by strangers or with your family?
Asthma – Adult
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
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.
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
