To drain or not to drain? – that is the question (Follow the BTS algorithm).This is not for Tension!
(All treatment options should be discussed with the patient to determine their main priority, with consideration for the least invasive option)
Category: Respiratory
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
Avian Flu – 2022
Avian flu is droplet spread and can sometimes effect humans as well as birds. Severity varies in human cases varies widely from mild to severe and deaths have been reported.
Case Definition = Clinical Criteria + Exposure Criteria
Acute Flaccid Paralysis (AFP)/ Acute flaccid myelitis (AFM)
AFP/AFM is rare rare but serious neurological condition, which is associated with POLIO infection but has also been linked with other infections (and in the USA they have spikes every 2 yrs last 2020). AFP leads to weakness and paralysis affecting face and limbs but also the respiratory muscles and may lead to respiratory failure.
Covid-19: Oximetry @home pathway
In 2022 we can now refer Covid-19 patients who are being discharged into the “Oximetry @home” pathway.
CHFT staff need to complete the attached referral form and email it to the LCD email address on the form. LCD will then make contact with the patient within 24 hours and onboard them (as it’s an 8am-6pm service).
Chest Trauma – WYMTN
Chest injury as part of major trauma, can range from painful to life threatening so prompt treatment and recognition is vital. Esp. in ‘Silver Trauma’ when ‘minor’ injuries may have devastating consequences – the full guidance can be found @WYMTN – HERE
Covid-19 Trust Isolation (Dec 2021)
The trust isolation policies have been updated inline with national guidance.
- Scenario 1 – Staff member Symptomatic
- Scenario 2 – Staff member asymptomatic, with a positive contact (inc. within household)
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:
- Sudden onset & rapid progression
- Life-threatening compromise of ONE or MORE of: Airway/Breathing/Circulation
Legionnaires Disease
There has been a resent increase in cases of Legionnaires Disease in the North West. So remember to request Urine Legionella Antigen test, if you have suspicions.
NIV (Non Invasive Ventilation)
NIV should be considered for use in patients with a persisting Acute Hypercapnic Respiratory Failures after a maximum of one hour of standard medical therapy.
- Complete the Ad-hoc form
- Increase pressures from Initial 12/5 cmH2O to 20/5cmH2O – as tolerated over 1st hour
However, ICU should be contacted early if the patient has one of the following:
- Asthma – Intubation the option of choice in Life threatening
- Pneumonia – NIV should only be considered as a bridge to intubation
- No pre-exisiting respiratory issue – NIV not likely helpful
- pH <7.25 (low threshold for ICU input)
- pCO2 >6.5kPa (low threshold for ICU input)
- Type 1 Respiratory Failure (low threshold for ICU input)
