2 video links to PHE how to Don and Doff your PPE
Category: Respiratory
Influenza POCT (Adult)
Flu season has arrived, and we need to be thinking about who to test and who to treat. Full guide HERE But don’t forget MERS!!
Q1. Do you suspect Flu?
- Fever
- Coryza
- Arthralgia and/or Myalgia
- Malaise
- GI symptoms – with or without signs of respiratory/other involvement e.g. CN
Yes! – Respiratory precautions
- Isolated in a side room
- Surgical face mask worn on entry to room + gloves and apron
- FFP3 mask or hood worn for aerosol generating procedures
- Bare below the elbow / good quality hand hygiene
- Proceed to Q2
Pneumonia – Paeds
CAP is far less common than URTI’s, however, it needs to be considered within your differentials. Depending on severity there is a guide to investigation and treatment.
Clinical Features Typically
- Cough
- Fever
- Breathing difficulties
- Tachypnoea Read more
Acidosis & VBG’s
We are frequently asked to check the lactate on Venous Blood Gases (VBG’s), by the nursing staff. However, remember to look at the first result (pH) it is the most important.
Acidosis: Unless you have a good reason (e.g. you know its due to DKA) you should be investigating and performing an Arterial Blood Gas (ABG)
MERS Standard Operating Procedure
Please see the updated SOP for Middle East respiratory syndrome coronavirus. Make sure you are familiar with this protocol and for anymore information please contact the Infection Control Team.
MERS SOP – Click Here
Pulmonary Embolism in Pregnancy
Unfortunately the the normal pathway for investigation of PE performs poorly in pregnancy RCOG have the following pathway
1. Investigation – of suspected PE
- Clinical assessment – its all on the history and exam scoring doesn’t work
- Perform the following tests:
- CXR – sheilding can protect the baby and may avoid further radiation
- ECG
- Bloods: FBC, U&E, LFTs, Clotting
- Commence Tinzaparin (unless treatment is contraindicated – use booking weight to calculate dose) –[BNF]
Are You CO Aware?
With the onset of colder weather, many households in the UK are turning on their heating for the first time in months. Heating appliances need chimneys and flues to work safely – and these can block up over the summer months. So autumn is traditionally the period when people get poisoned by carbon monoxide (although it can happen any time of the year!)
Carbon monoxide (CO) is produced when anything containing carbon burns or smoulders. For practical purposes, this means the burning of any kind of fuel, commonly:
- Gas
- Coal
- Wood/Paper/Card
- Oil/Petrol/Diesel – (All UK cars have a ‘catalytic converter’ in the exhaust system, which converts carbon monoxide (CO) to carbon Dioxide (CO2), which is less poisonous. However, these converters need to warmed up – a cold car produces fatal amounts of CO in the exhaust)
CO is very poisonous. Exposure to as little as 300 parts per million (that’s just 0.03%) can prove fatal.
A-a gradient
A-a gradient = Alveolar Oxygen – arterial Oxygen
This is “relatively” simple way of working out if the paO2 on a ABG is normal, and demonstrates V/Q mismatch well. V/Q mismatch is simple terms is either an area of the lung either under ventilated(pneumonia) or under perfused (PE). Read more
COPD think VBG
Why VBG instead of ABG?
- Pain – we all know and warn our patients ABG’s are painful. Patients know it to and delay presentation.
- Number of bloods taken – patients attending with COPD will generally have venous bloods taken at triage. Would you want stabbing again if it could be avoided?
