Category: Medical

Anaphylaxis 2021

Not all Allergies are Anaphylaxis!

Anaphylaxis is defined as:

  • Severe life-threatening systemic hypersensitivity reaction
  • Where BOTH of the following criteria are met:
    1. Sudden onset & rapid progression
    2. Life-threatening compromise of ONE or MORE of: Airway/Breathing/Circulation

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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

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Medical Emergencies in Eating Disorders

Eating disorders* are relatively common and unfortunately patients who “look well” can have a significant mortality risk. MEED.org.uk have national risk tools to recognise those that would benefit from admission, which fit with our local mental health teams, and agreed by both acute medicine and paediatrics

(*anorexia nervosa, bulimia nervosa, binge eating or avoidant restrictive food intake disorder)

Risk Assessment

RED indicators

Anyone with one or more RED’s is high risk and should be considered for admission MEED

  • BMI <13/<70% mBMI
  • Recent weight loss >1 kg/week for 2 weeks in an underweight patient
  • HR (awake) <40
  • Recurrent syncope with standing BP <90 systolic (<0.4th percentile for age) and postural drop >20 mmHg (or increase HR >30 [>35 if <16])
  • Fluid refusal or signs of dehydration
  • Temperature <35.5°C tympanic/35°C axillary
  • Long Qt or other ECG abnormalities
  • Low Glu/Na/K/Ca/PO4/Alb
  • Low WCC, Hb <10
  • Acute food refusal/very low calorie intake per day
  • Physical struggles with carers over nutrition
  • High levels of uncontrolled exercise (>2 hours/day)
  • Daily purging behaviours
  • Self-harm
  • Moderate–high risk suicidal ideas.
MEED Check list