We frequently consent for Blood Transfusion, but what risks do we tell the patients about and how common are those risks?
Category: Medical
DVLA – Driving & Medical Conditions
For many conditions the patient should be informed to stop driving and inform the DVLA of their condition. It is the patients responsibility to inform the DVLA, and we should encourage them to do so.
[There is a £1000 fine AND the risk of prosecution] Read more
Headache
There are numerous causes of headache, however, the pressing question in the ED is,
Is this a primary or SECONDARY headache?
- Primary headaches [e.g. tension & migraine}, maybe painful and need analgesia but don’t require emergency investigation.
- Secondary headaches, often but not always have serious underlying causes [e.g. SAH, central venous thrombosis] requiring emergent investigation and treatment
Delirium in the ED
Delirium is one of a number of geriatric syndromes and has significant associated morbidity and mortality.
3 subtypes of delirium
- Hyperactive – easies to spot, one we are most familiar with. Characterised by agitation/aggression/hallucinations “the non cooperative patient”
- Hypoactive – harder to spot. Characterised by drowsiness, less responsive, vacant, sleeping more at home
- Mixed
Remember there is NO SUCH THING AS A “POOR HISTORIAN” !! – Just a poor clinician! If your patient is not cooperating and can’t tell you very much then you need to find out why!!! Read more
Assessing Functional Leg Weakness
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
Sore Throat
Background
Acute sore throats are often caused by a virus, last about a week and get better without antibiotics. withholding antibiotics rarely causes complications. Antibiotic stewardship is everyone’s responsibility to prevent resistance developing.
Assessment
Are there any concerns regarding airway compromise? – If yes – transfer to resus, give high flow Oxygen, IV steroids, IV antibiotics, Nebulised adrenaline 1:1000, IV fluids, take bloods and refer to both anaesthetics and ENT registrar.
Otherwise:
Assess all under 5s with a temperature as per the NICE fever guidelines
Assess the patient for signs of severe sepsis – if present use the severe sepsis guidelines
If no signs of sepsis assess patient, exclude Quinsey (unilateral swelling, paina nd trismus) and calculate the FeverPAIN score and Centor score
FeverPAIN = 1 point for each of –
- Fever
- Purulent tonsillar exudate
- Attendance within 3 days of onset
- severely Inflamed tonsils
- No cough/coryza
Centor = 1 point for each of –
- Tonsillar exudate
- Tender anterior cervical lymphadenopathy or lymphadenititis
- History of fever >38
- No cough
Treatment
Can the aptient swallow fluids and medication – if not give a stat dose of IV Dexametasone, IV antibiotics, IV fluids and analgesia – review in 2 hours. If they can swallow at this time then you can consider discharge with a patient information leaflet.
- FeverPAIN = 0 or 1/ Centor = 0,1 or 2 – no antibiotics, self care advice
- FeverPAIN = 2 or3 – no antibiotics or a script for 3-5 days time if no better, self care advice
- FeverPAIN = 4 or 5 / Centor 3 or 4 = give Antibiotics immediately, self care advice
Patients to seek medical advice if become more unwell or not improving after 1 week
Self care advice – Paracetamol, Ibuporfen, Adequate fluids, Medicated lozenges
Antibiotics –
Phenoxymethylpenicillin 5-10 days
If Penicillin allergy – Clarithromycin or Erythromycin 5 days
Tonsillitis Patient Information Leaflet
Search: tonsillitis
Pneumonia (Community Acquired)
Severe Pneumonia: Please Request/Send – Samples Sputum/Blood/Urine
BTS Definition of CAP
Signs of acute Lower Respiratory Tract illness (LRTI) [Cough] &:
- ≥1 other LRTI Symptom [Pleuritic pain, Tachypnea, Dyspnea, etc]
- New Focal Chest Signs [Creps, Bronchial breathing, Red. A/E]
- ≥1 Systemic sign [Fever, Sweats, Chills, Rigors, >38oC]
- New CXR changes [if hospitalized]
Upper GI Bleed (UGIB)
Not normally difficult to spot, but look for it in unexplained anaemia, or collapse.
Questions
- Is it VARICEAL? Mortality 35%, so is an emergency whatever the GBS is.
- Non-Variceal what’s the GBS? will help guide treatment
Anyone being admitted should be brought to HRI
Emergency Endoscopy is arranged by Med Reg
Syncope – ESC 2018
- Defintion:Transient Loss of Consciousness (TLOC) due to cerebral hypoperfusion, characterised by a rapid onset, short duration, and spontaneous complete recovery.
- Common ED Complaint: 1.7% of all attendances
- Difficult Diagnosis: less than 50% get a diagnosis in ED
- Mortality & Serious Outcome: 0.8% mortality & 10.3% serious outcome @ 30 days
Ask 3 Questions!
- Is this Syncope?
- What is the underlying cause?
- What is the best Follow-Up for this patient?
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?
