If anybody is symptomatic after button battery ingestion they need referral to the Surgical team for urgent endoscopic removal. Liase immediately with our local surgical/ENT teams but be aware this may end up as a time critical transfer to Leeds especially if child <2years. Read more
Mind the Gap is a handbook of clinical signs in black and brown skins
Another excellent resource, especially for childhood rashes is the website SKINDEEP.
When patients present with functional symptoms. It can be difficult to discern whether if it is an actual or functional weakness. And it can be even more difficult to convince the patient. However these tests can not only help you workout what is happening, but also demonstrate function to the patient. Read more
Not normally difficult to spot, but look for it in unexplained anaemia, or collapse.
Questions
Anyone being admitted should be brought to HRI
Emergency Endoscopy is arranged by Med Reg
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
Time Critical Medication (TCM) is scheduled medication that the patient is already on when they present to the Emergency Department (ED).
The medications are “time critical” because a
delayed or missed dose can result in harm with exacerbation of symptoms and the development of complications leading to an increased mortality.
Movement disorders – Parkinson’s / Myasthenia medication
Immunomodulators including HIV medication
Sugar (Insulin)
Steroids – Addison’s and adrenal insufficiency
Epilepsy – anticonvulsants
DOACs and warfarin
Its really important for our patients that these medications are prescribed and given while in ED/uSDEC/fSDEC.
If you are withholding these medication (which may be necessary) -please document the reason for this clearly in the notes.
In hours speak to pharmacy if you require any support with these patients.
Any of:
Emergency DC Cardioversion (DCC) is the mainstay of treatment. Obviously DCC is uncomfortable experience and sedation is preferable, however, if unstable sedation may not be an option.
It’s essential any Modifiable causes are treated, these include:
“Early cardioversion is not recommended without appropriate anticoagulation or transoesophageal echocardiography if AF duration is longer than 24 h, or there is scope to wait for spontaneous cardioversion.”
In reality risks increase beyond 12hrs from onset, and those reverted in ED will often return to AF by the time they get to AF clinic follow up.
AF increases the chance of Stroke by 5x (and those recently diagnosed are least likely be on any form of protection)
