MyCpdZw - Protocols Details

EPISTAXIS

Epistaxis also called acute hemorrhage or nose bleed is a medical condition in which bleeding occurs from the nasal cavity of the nostril. Nose bleed can occur due to a trauma to the nose, due to accident, or injury to the interior of the nose from pricking.

Diagnosis

Generally occur further posteriorly with increasing age.

Suspect posterior bleed if anterior source not identified, bleeding bilaterally, bleeding continues into

pharynx when nares pinched.

Can be life threatening. NEVER UNDERSETIMATE A NOSEBLEED.

Protect yourself from the inevitable mess!

Management

1. ABC’s resuscitation & monitoring as indicated,

2. IV access,

3. FBC, U&E’s, Coagulation profile if significant bleeding,

4. Try local pressure 10-20 minutes,

5. Need good lightining, suction & assistance to view bleeding site,

6. Clear the nares- with sucker or get patient to blow nose,

7. Anaesthetize with Co-phenylcaine spray,

8. If a slow bleeding spot is seen anteriorly Silver Nitrate cautery sticks can be used but

there is a tendency to rebleed,

9. Insert expanding foam pack (Merocel) or balloon catheter (Epistat),

10. For posterior bleeds that continue after appropriate packing try bilateral packing

followed by packing with Foley catheters & gauze,

11. If you successfully stop the bleeding observe in the ED for hour. If no further bleeding,

observation stable & path if patient tests are normal then discharge,

12. LMO F/U for removal of packs in 1-2 days,

13. Advise avoidance of strenuous activity, dry/cold environments, caffeine, alcohole, nose

blowing/picking, bending over & straining for the next week,

14. Admission advisable if:

· Elderly,

· Coagulopathy present,

· Posterior Foley packs,

· Desaturating on room air,

· Cardiovascular compromise.

Recent Protocols

COVID 19

COVID 19 is a disease caused by the most recently discovered coronavirus which is a large family of corona viruses causing illnesses. In humans it causes Respiratory infections for example Severe Acute Respiratory Disease (SARs) PRESENTATION Fever 77-98% Cough 46-82% Myalgia/Fatigue 11-52% Shortness of breath 3-31% Incubation period 14 days, most people develop symptoms between 5-6ays from exposure Stage1 (Early infection). Stage 2. Stage 3(Hyperinflation phase) Viral response---------------------------Pulmonary Phase----------------------Host Response *Anyone presenting with flu like symptoms should be assumed to be a COVID 19 case until proven otherwise*

WARFARIN OVERDOSE/ TOXICITY

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SUICIDAL IDEATION

Suicidal ideation, also known as suicidal thoughts, is thinking about or having an unusual preoccupation with suicide.

SPINAL CORD INJURY

Emergency signs and symptoms of a spinal cord injury after an accident may include: Extreme back pain or pressure in your neck, head or back. Weakness, incoordination or paralysis in any part of your body. Numbness, tingling or loss of sensation in your hands, fingers, feet or toes. Loss of bladder or bowel control.