Category: Surgical

Necrotising Fasciitis

Necrotising fasciitis (NF) is a rare but serious bacterial infection that affects the soft tissue and fascia (Fournier gangrene, is NF affecting the perineum). In many cases NF progresses rapidly and early recognition and treatment is vital to halt progress. The mainstay of treatment is IV antibiotics and aggressive surgical debridement. Any delay increased the amount of tissue loss as well as the mortality. Read more

Early Pregnancy Bleed <16/40

Bleeding in early pregnancy is a relatively common problem and in the many cases (esp. with spotting) the pregnancy remains viable. However, bleeding in early pregnancy should never be thought of as normal, and it is vital that we investigate this appropriately.

 

Communication is also vital at a very stressful time

  • Who you are discussing this pregnancy in front of? – Does the patient want them to know
  • Manage expectations – There is nothing we or mum can do to change the out come of the pregnancy apart from ensuring mum is well
  • Ensure the patient has all the details they need – Return advice, clinic time, where to go, what is happening
  • Be sensitive to the patients feelings – Patients respond very differently, be careful not to impose your emotions/assumptions on the situation

Think Anti-D!

Anti-D immunoglobulin guide

 

Search: ectopic pregnancy, Ectopic Pregancy, pv bleed, MISCARRIAGE, vaginal bleed, EPAU

Sore Throat

Background

Acute sore throats are often caused by a virus, last about a week and get better without antibiotics. withholding antibiotics rarely causes complications. Antibiotic stewardship is everyone’s responsibility to prevent resistance developing.

Assessment

Are there any concerns regarding airway compromise?  – If yes – transfer to resus, give high flow Oxygen, IV steroids, IV antibiotics, Nebulised adrenaline 1:1000, IV fluids, take bloods and refer to both anaesthetics and ENT registrar.

Otherwise:

Assess all under 5s  with a temperature as per the NICE fever guidelines

Assess the patient for signs of severe sepsis – if present use the severe sepsis guidelines

If no signs of sepsis assess patient, exclude Quinsey (unilateral swelling, paina nd trismus) and calculate the FeverPAIN score and Centor score

FeverPAIN = 1 point for each of –

  • Fever
  • Purulent tonsillar exudate
  • Attendance within 3 days of onset
  • severely Inflamed tonsils
  • No cough/coryza

Centor = 1 point for each of –

  • Tonsillar exudate
  • Tender anterior cervical lymphadenopathy or lymphadenititis
  • History of fever >38
  • No cough

Treatment

Can the aptient swallow fluids and medication – if not give a stat dose of IV Dexametasone, IV antibiotics, IV fluids and analgesia – review in 2 hours. If they can swallow at this time then you can consider discharge with a patient information leaflet.

  • FeverPAIN = 0 or 1/ Centor = 0,1 or 2 – no antibiotics, self care advice
  • FeverPAIN = 2 or3 – no antibiotics or a script for 3-5 days time if no better, self care advice
  • FeverPAIN = 4 or 5 / Centor 3 or 4 = give Antibiotics immediately, self care advice

Patients to seek medical advice if become more unwell or not improving after 1 week

Self care advice – Paracetamol, Ibuporfen, Adequate fluids, Medicated lozenges

 

Antibiotics –

Phenoxymethylpenicillin 5-10 days

If Penicillin allergy – Clarithromycin or Erythromycin 5 days

Tonsillitis Patient Information Leaflet

Full NICE Guidance

 

Search: tonsillitis

Epistaxis – Management

Nose bleeds are a bloody common problem (bad pun intended) – most originating at the front to the nose where there is a cluster of blood vessels – Little’s Area.

In the young the bleeding often starts after trauma (e.g. picking or punching noses). In the elderly however, it is commonly a manifestation of underlying vascular disease. Read more

Upper GI Bleed (UGIB)

Not normally difficult to spot, but look for it in unexplained anaemia, or collapse.

Questions

  • Is it VARICEAL? Mortality 35%, so is an emergency whatever the GBS is.
  • Non-Variceal what’s the GBS? will help guide treatment

Anyone being admitted should be brought to HRI

Emergency Endoscopy is arranged by Med Reg

Read more

Bell’s Palsy

Bell’s Plays is a lower motor neurone (LMN) lesion of the facial nerve (CN VII), which causes one side of the face to “droop” [1% of cases are bilateral], and patients are often concerned that it is a stroke.

However, unlike in stroke the whole face is affected, in stroke and other upper motor neurone (UMN) lesions the upper portion of the face is unaffected due to input from both sides of the brain. Read more

#NoF – Fractured Neck of Femur

BOAST Guidance

  • #NoF patients (or other fragility fracture) who requiring CT Head (for head injury) also be performed a CT Neck
    • Fragility fractures indicate the patient is at high risk of also sustain C-Spine injury.
    • Also the pain is likely distracting and the patient is often over 65yrs old so Canadian C-Spine rules will not apply.

Hx/Exam

  • Why did They Fall? – was this a collapse?
  • Are they sick? – Co-morbidity/illness is common in this group and must be recognised
  • Anticoagulants? – This affects treatment
    • On Warfarin – If INR >1.5 (or unavailable) Vit-K 5mg
  • Other injuries? – >65’s the most common mechanism of TARN major trauma is fall <2m
  • Typically – Pain hip/buttock, shortened, externally rotated
  • Atypical – Few signs (can they lift their leg & is rotation at the hip painful)

Read more