NIPPV 3 machines are used throughout the trust to deliver NIV and CPAP – and should be commenced in ED if transfer to ward/ICU is adding significant delay
This video demonstrates how to set up CPAP on the NIPPV 3
Most of us will have seen patients like this – agitated, aggressive and often with police or security pinning them down.
Refusing treatment = Mental Capacity Assessment [LINK]
| Drug | Route | Typical Dose (mg) | Onset (min) | Duration (min) | Warning |
|---|---|---|---|---|---|
| Midazolam | IV | 2-5 | 1-5 | 30-60 | Respiratory depression, IM unpredictable onset |
| IM | 5 | 10-15 | 120-360 | ||
| Lorazepam | IV | 2-4 | 2-5 | 60-120 | |
| IM | 4 | 15-30 | 60-120 | ||
| Haloperidol | IV | 5-10 | 10 | 180-360 | Arrhythmia Risk: Only if previously used OR ECG |
| IM | 10-20 | 15-30 | 180-360 | ||
| Ketamine | IV | 1-2mg/kg | 1 | 20-30 | Theoretical risk of worsening cardiovascular instability |
| IM | 2-4mg/kg | 3-5 | 60-90 |
PDF:abd
Transfer of a patient for life, limb or organ saving treatment when the time taken to provide this treatment is a critical factor in outcome.
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.
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 2019. Please read these documents in full or participate in RCEM learning elearning for further information. Read more
Occasionally patients with Tracheostomy or Laryngectomy present with difficulty breathing due to problem. As this is rare for us in ED, this situation can be very difficult for all of us. However the protocols below can help.
Tracheostomy is simply a passage from the neck into the trachea. In most cases the trachea will still be connected to the nose and mouth (so can breath though their mouth too).
AKA: Paediatric Inflammatory Multi-system Syndrome – Temporally associated with SARS-CoV 2
Although COVID-19 seems a benign disease in almost all children there are increasing evidence (however rare) of a “Paediatric multisystem inflammatory syndrome”. This is a RARE and newly emerging condition and there are many questions still e.g. It is currently unclear if it is directly related to the COVID-19 pandemic.
There is increasing evidence that Awake Self-Proning of our Covid-19 patients can improve oxygenation. Proning the patient can has several effects which can dramatically improve their SaO2
Absolute contraindications:
Relative Contraindications:
