Category: Resus

COVID-19 (X-Ray learning resource)

British Society of Thoracic Imaging (BSTI) have released a free learning resource containing CXR and CT of confirmed Covid-19 cases, will short history including time image was taken from onset of symptoms.

From the China experience CXR/CT doesn’t seem to be a rule out strategy in ED at the moment – However, its a useful resource to help recognition of Covid-19 CXR’s

BSTI Covid-19 image bank

 

3. HAZMAT – CBRNe (Chemical, Biological, Radiological and Nuclear) incidents

NHS England, Public Health England and the Health Protection Agency have produced several very useful resources for us to use – BUT First.

Remove – Remove – Remove

Basics

Contacts

  • Health Protection Agency Teams – HERE
    • West Yorkshire
      • In hours: 0113 386 0300
      • Out of hours: 114 304 9843

  • ECOSA (Emergency Coordinated Scientific Advice System) – 0300 3033 493

  • UK NPIS – 0344 892 0111

Guides

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Hyponatraemia

Hyponatraema is a common finding, especially within our elderly population. However, its significance is is not a simple numbers game, and needs senior input. Prior to treatment the following need to be considered and balanced.

  1. Symptoms Severity – these are not exclusive to hyponatraemia and may be due to other disease processes (esp. if the low sodium is long-term)
  2. Sodium Level – the sodium concentration doesn’t always correlate to the clinical picture, and is dependant on speed of change, and co-morbidities
  3. Rate of Drop – the faster sodium levels drop the more symptomatic the patient often is (i.e. with long term hyponatraema the patient may be profoundly hyponatraemic but asymptomatic)
  4. Co-morbidities – Increasing sodium too quickly risks osmotic demyelination. How well will the patient cope with treatment?

Emergency treatment (hypertonic saline) is generally indicated in those with Severe Symptoms ONLY

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Hypothermia

Remove COLD, Add WARM, Don’t SHAKE

  • 32-35ºC [Mild] – Shivering, Tachycardia, Tachypnoeic, Vasoconstriction
  • 30-32ºC [Moderate] – Shivering stops, Pale/Cyanosed, Hypotensive, Confused, Lethargic
  • <30ºC [Severe] – Low GCS, Bradycardia/pnoeic, Hypotensive, Arrhythmias, Cardiac Arrest

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Silver Trauma

The population is ageing and thus our ‘typical’ trauma patient is also changing. In 2017 the TARN report “Major injury in older people” highlighted the following issues:

  • The typical major trauma patient: has changed from a young and male to being an older patient.
  • Older Major Trauma Patients (ISS>15): A fall of <2m is the commonest mechanism of injury
  • Triage/Recognition of ‘Silver Trauma’ is POOR
    • Pre-hospital: Not identified hence taken to TU’s (Here) not MTC’s (Leeds).
    • The ED: Often seen by Junior Staff and endure significant treatment delays.
    • Hospital: Much less likely to be transferred to specialist care.
    • Outcomes: More likely to die, but those who survive have similar levels of disability to younger people.

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Head Injury

Background

  • Defined as any traumatic injury to the head other than superficial facial injuries.
  • The commonest cause of death and disability in people age 1-40 in the UK.
  • Account for 1.4 million ED attendances each year, 95% of these are minor head injuries that can be managed in the ED.

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