Check out the new video page in the education section of the website.....useful media explaining common difficult procedures.......
You may have noticed some Red Cross "First aid" leaflets have appeared in the minor injuries area?!... We are lucky to be part of a join project with Public Health Oldham and the Red Cross, to try and raise awareness of first aid in the community and attempt to reduce the number of patients presenting to us, with minor injuries that could be easily treated at home or elsewhere.
The idea is this - we offer the leaflet to any minor injury patient that attends and ask them to drop the form off at reception after they have been discharged. They can either fill the form in (if they are interested) or tick the box saying "not interested" if that's how they feel. The Red Cross do the rest.
The patient is contacted at home and can go on a FREE first aid course... this teaches some basic medical stuff but also importantly lets the patients know where they can get advise/help that is NOT in the Emergency Department......
A good idea and worth trying I think?!..... But what are your thoughts? I'd be interested to hear/read your ideas.
I am sure most of you are aware, but the updated NICE guidance for the Management of Head Injury Patients was published this month. The highlights include
- All patients with a head injury who are taking warfarin require a CT brain regardless of symptoms.
- The paediatric guidance has changed slightly, have a close look, but ultimately we do not need to be scanning kids JUST because they are vomiting.
A 64 year old patient with a stage 4 squamous cell lung cancer attends the A&E department at 22.00 hrs with a history of an increase in SOB over the last 2 days, some left sided pleuritic type chest pain and a pyrexia of 38.3 degrees for which he has taken some Paracetamol while he was at home. He received his first cycle of intravenous chemotherapy 10 days ago. The drugs he received were Gemcitibine and Carboplatin.
Obs on arrival - temp 36.1 degrees, pulse 98 bpm and BP 110/60, 02 sats 91% on air
PMH – nil to note other than lung cancer
Medications – metoclopramide 10mgs prn, Zomorph 10mg bd and Oromorph 5mg prn.
Examination- Crackles on left side with some reduced air entry, pulse regular, able to speak in full sentences. Does not look distressed.
- What are the differential diagnoses?
- What does your initial assessment consist of (include all investigations you would include in your plan)?
- What does your initial management plan consist of within the first hour of arrival into the department (please be specific regarding any drugs that you would prescribe to be administered)
- What might be included in your subsequent plan of care?
- If you were not sure regarding patient management especially relating to any oncology aspects who would you contact for support considering that this was an out of hours situation?
A 64 year old man presents with sudden severe left sided headache and immediately vomited twice. He felt dizzy but there was no aura or visual disturbances. He has a previous history of migraine for which he takes Migraleve. The current headache is much more severe and he has never vomited with his usual attacks of migraine. He has a 2 year history of hypertension for which he is prescribed Ramipril by his GP.
Pyrexial 37.8, pulse 80 reg, BP 170/100 mmHg
Irritable and felt dizzy on movement of head
Fundi normal, no neck stiffness, no focal neurological signs
Symmetrical reflexes, plantars down going
Rest of physical examination was normal
What are the possible diagnosis?
What is your management?
Further Educational Activity
Now complete this doctors.net module on Acute Headache:
A 50 year old business man was brought into the Emergency Department by ambulance. A work colleague had accompanied him and had called the ambulance. Apparently they had been celebrating a business deal by spending the afternoon in a pub. The patient had gone outside for a smoke and when he had not returned 15 minutes later, the colleague found him outside at the back of the Pub, at the bottom of 4 steps. The patient was incoherent and covered in vomit. The Paramedics thought the patient was drunk and had managed to walk him into the ambulance and have him lie down. Vital signs performed by the Paramedics were within the normal range but the patient just wanted to curl up and go to sleep. On arrival to the Emergency Department, he was allocated a "Major's cubicle". You examine the patient and find:
Airway - Open and Clear
Breathing - Spontaneously, 12 breaths/min, Chest Clear, Sat 96% on air,
Circulation - well perfused, Pulse 70/min, BP 140/100 mmHg
Disability - Eye open to Painful stimuli, Groans to Painful Stimuli, Feeble attempt to withdraw painful stimuli by both hands
Further findings on Examination:
Occipital Haematoma with Scalp Laceration - bleeding on to the trolley
No other evidence of Trauma.
Pupils equal and reactive to light
Ears - Normal
No needle marks
BM Stix 7 mmol/l
- What's the GCS
- What's your working diagnosis
- What's your management
After you have posted your comments, do the following Module on Doctor's.net.
A 4 year child falls off a swing and sustains the following injury. The photographs show a deformed left wrist with pinching of the skin. What are your priorities in managing this child? What type of analgesia will you provide?
Now complete the doctors.net module on "Paediatric Fractures - Upper Limb" -http://www.doctors.net.uk/ecme/wfrmNewIntro.aspx?moduleid=1239 and upload your certificate onto your eportfolio.
After advice from the Coroners Narrative verdict today, there is been a slight alteration to the Pathway. Under refer to Medics,
"CT brain before anticoagulant treatment if any evidence of head injury"
Which obviously goes for any anticoagulation administration even beyond transient loss of consciousness patients (who may rarely need ACS treatment) .
Check out the new department pics on the website via 'learn more' on the home page or via general info : new department
As you have discovered the new site is now up and live. Comments and feedback please in the comments below! This evening I have added a page on Lectures. Have you seen it. If not go check it out. Should keep you out of mischief for a few hours!
Please note that now all the subheadings of Guidelines and Proformas have their very own pages. This should speed up looking for stuff (hover over the menu heading to get get sub-headings to pop up). It also should also aid development of more material. Go check it out!
All ready and raring to go
Almost there folks, nearly ready for prime time. Watch this space...
We are in the process of migrating the site to a new look, new hosted space.
Tell us what you think and if you have any suggestions or requests.