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.
Category: Resus
Paediatric Blast Injury
Save the Children, have published a used full guide on management on blast injuries in children. Taking you through pre-hospital, ED and inpatient care.
Although blast injury is rare in the UK it’s worth a read as an adjunct to APLS/ATLS training.
- Recognising “Blast Lung” – which may be subtle initially and develop over hours (p51)
- Prophylactic antibiotics
- Compartment syndrome and fasciotomy (p105)
- Burns Fluids and escharotomies (p112)
Paediatric Ketamine Sedation
RCEM 2022 Safe sedation in the ED and RCEM Ketamine for paediatric procedural sedation guideline. Please read these documents in full or participate in RCEM learning for further information.
Adult Sedation
This guideline is a brief summary of the RCEM 2022 Safe sedation in the ED and RCEM – Pharmacological Agents for Procedural Sedation and Analgesia in the Emergency Department – March 2020. Please read these documents in full or participate in RCEM learning elearning for further information. Read more
Burns Referral Pathway
A new burns referral pathway has been developed with Mid Yorks to securely send images of the patients burn. Allowing the burns team to arrange the most appropriate follow-up for your patient.
This requires BOTH online referral & phone call
The Process
- GoTo – Burns Homepage (NHS computers ONLY)
- Select – New Referral (NO login required)
- Complete – the following sections (* means required field)
- Referrers Details – you will need an NHS email address
- Patient Details
- Injury Details – Answering “Yes” to airway burns or fluid resuscitation will open further boxes
- Additional Details – Patient’s phone number and address (only appears if NO airway or resuscitation issues)
- Checklist – Ensure ALL completed and submit
- Sending an Image – After submission a QR code will appear to send an image you will need to us the SID App
- Launch the SID App on mobile device – Yours or ED Co-Ordanator (apple/android)
- Scan the QR code
- Consent the patient – Patient Information Leaflet
- Take Photo of Injury – this will not be saved on the device
- Phone Burns team – They can review the details and images and better advise you on management.
Resources
Major Incident/MAJAX Guide
NHS England have published this fantastic resource [Click here] covering Major Incidents including; gunshot, crush, nerve agents and much more.
This is not to replace our trusts “Major Incident Plan”, however its a great learning resource and worth going through Read more
Scombroid Poisoning- NOT another fishy allergy
Scombroid poisoning (AKA – Histamine fish poisoning) is apparently more common than we think and accounts for 40% of seafood related illness in the USA according to the CDC. But Scombriod poisoning is missed as its put down to allergy. Read more
Bradycardia
Causes
- Cardiac: Heart Block, Myocardial infarction, Myocarditis
- Metabolic: Hypothermia, Hyperkalaemia, Hypokalaemia, Hypothyroid, Hypoxia
- Toxin: digoxin, B-blocker
Treatment
For ALL conditions leading to bradycardia treating the underlying condition is the most appropriate treatment and for some the only thing that will work (i.e. severe hypothermia) Read more
Octaplex – work fast its an EMERGENCY!
- Activate EARLY in head injury patients on warfarin.
- Order on EPR & Paper [see below]
- Infuse over no more than 30 min
- Recheck INR at 30 min after finished infusion
Indications
- EMERGENCY reversal of Warfain
- Factor II or X deficiency
Read more
Pulmonary Embolism – PE
PE is somehow both the most over and under diagnosed condition. with severity ranging from the questionable sub-segmental PE to the Massive PE (an indication for thrombolysis). So think:
- Does this presentation sound like a PE? – If not STOP here
- Pregnant? – Click Here
- Do you think this is likely a PE? (if so you can’t use PERC)
- Does D-Dimer answer your question? (whats the Wells)
- Massive PE – think Thrombolysis
- Sub-Massive PE – there is lots of debate (involve seniors), locally needs 2 consultant sign off and not considered time critical.
