Category: Medical

Pseudo-Hyperkalaemia Pathway

When patients sent in by GP “” – how much do you do?

Pseudo-Hyperkalaemia Pathway

* Examples of High Risk Patients: Dialysis, Renal Transplant, CKD under renal team. Previous Hyperkalaemia.

  ** All patients being discharged need to be discussed/seen by a Tier 3+ level Dr who will assign themselves to the patient. Put the Diagnoses as ‘No abnormality Detected’ AND ‘Potassium Level.’

 

Streaming Pathway:

Patients POC results, ECG and PMH reviewed.

Make sure the patients contact number is correct. Inform them if their lab result comes back high then we will contact them. If they do not hear from us then their result is normal.

 Move the patient to the ‘Streaming’ Tab and record the time they left in the bubble. Once the lab result is back, if it is raised then recall the patient for treatment. If it is normal then discharge from the system ensuring to put the discharge time as when they left the department.

If the lab sample haemolyses – The decision to recall is at the discretion of the Tier 3+ doctor.

Notes:

This pathway has been created as a guide to help reduce the investigation burden and length of stay of patients with pseudo-hyperkalaemia. The purpose of having an Tier 3+ level doctor responsible for these patients is they can make a quick global assessment of the patient and decide whether the patient is high risk and if the streaming pathway is appropriate, rather than relying on a regimented list of conditions or parameters.

In hours this should be done by the front door doctor. Out of hours Tier 1/2 doctors can still see these patients but they should then be discussed with a Tier 3+ Doctor.

 

Thanks to Dr Stuart Mitchell

2WW – Suspected Cancer

Some patients present to ED with symptoms or investigations suspicious an undiagnosed cancer, but don’t require emergency admission. To reduce the barriers to care the trust has implemented a referral route for ED.

Emergency Department MDT referral request – HERE

Once completed the PPC team will review the request and feed them into either “Fast-Track Clinics” if further workup required or MDT’s if fits those pathways.

This should allow our patients quick access to appropriate clinics, without the inherent delays and wasted clinical time of asking the patient to attend their GP. BMA/NHSe

Parkinson’s Disease & can’t swallow

We all recognise the importance of ensuring patients with Parkinson’s disease (PD) get their medication, but..

What do you do if the patient can’t swallow?

We will need to work out what alternative routes we could use, for example dispensable via NG or patches, and what dose. For an ED clinical it is most likely beyond us and we need help! However, that may be extremely difficult to get especially Out of Hours

https://www.parkinsonscalculator.com/calculator2-withoutNG.htmlpdmedcalc

Excellent website that can give you options – select the patients normal regime (initially just one line but you can add as many as needed) and press calculate.  It gives you a dispensable and patch dose, which can help the discussion with pharmacy about where we can get it

Mpox (Formerly: Monkeypox)

Wear Gloves & Wash Your Hands!!!

There have been >100 patients identified as having Mpox in the UK during the current outbreak. Most of these cases have been amongst men who have sex with men.

Reports have suggested that although lesions occur any where including palms and soles. Genital lessons and lymphadenopathy are very common

March 2024 – UKHSA warn there is increasing cases in DRC (Democratic Republic of Congo), so stay vigilant in travellers from central Africa.

 

Trust SOP -HERE

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DKA – Adult

Things to remember

  • Give 0.9%NaCl
  • Actrapid “Fixed Rate” 0.1unit/kg/hr
  • Basal Insulin e.g. Levemir, Lantus, Semglee, Abasaglar, Toujeo, Tresiba,
    please continue this at usual dose and times
  • Potassium – if below 5.5 will need KCl infusion (see guide)
  • BM <14 – Start 10% Dextrose 125ml/hr
  • BEWARE SGLT-2 inhibitors chance of Euglycaemic DKA

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Unsuspected NoF

We have seen multiple incidence where clinicians of ALL grades have assessed patients with falls and examined hips and even mobilised patients

Evidence shows (and reflected in the incidents) this predominantly effects patients with:

  • Communication difficulties: inc. Delirium, dementia, learning difficulties
  • Live in Supported accommodation
  • Normally require help mobilising

If a patient presents with ANY of these and a fall – X-ray Pelvis

 

Measles

Suspected/Confirmed patients should be ISOLATED & wear PPE 

Treating Staff – (should not be; non-immunised, pregnant or immunocompromised)

  • single-use, disposable gloves
  • single-use, disposable apron (or gown if extensive splashing or spraying, or performing an aerosol generating procedure (AGP))
  • FFP3 – respiratory protective equipment (RPE)
  • eye/face protection (goggles or visor)

Patient

  • Surgical face mask

Background

  • Measles is highly infectious – (4 day prior to and after rash appears) suspected patients should be isolated within the ED
  • Measles Immunisation – 1 dose 90% effective, 2 doses 95% effective
  • Measles is a notifiable disease
EM3

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