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Summary of 175 pages for the course Medicine at Medicine (File)
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Medicinea
Department of
Emergency Medicine
–
Guidelines
,Revision history
1.1 - Obstetrics / gynaecology guideline updated to reflect service changes. Limping child
/ Salter Harris classification added.
1.2 - Phone directory updated. New bleep system included. PEPSE guidance updated
following meeting with GUM. Ventilator settings for NIPPV added. IR1 triggers added.
Contact details for SPoA. ENT hearing loss guideline added.
2.0 - Updated clinical triggers for incident reporting. Updated antimicrobial guidelines to
reflect 2009 antimicrobial formulary. Paediatric gastroenteritis guideline added (based on
work by Alison Robinson). General care of the pregnant woman (OB Guideline 25)
added. NICE violence / rapid tranquilisation guidance and NICE ‘When to suspect child
maltreatment’ added. Open fracture antibiotic guidance updated. Tinzaparin dosage
schedule added. CAP guidance updated to reflect new antibiotic guidance. ACS algorithm
updated to 2009 version. New TIA and acute stroke guidance added. Neutropenic sepsis
pathway updated to reflect current regional guidance. Noradrenaline infusion table from
CEM added. Corrected nasal diamorphine for use with 5mg vials. Housing advice
contacts added. Local anaesthetic toxicity guidance added.
2.01 - Bloods for paediatric hypoglycaemia screen added. PEWS chart added. Guidance
for statement writing added. Stroke thrombolysis procedures added. NIHSS stroke score
added. Organ donation / coroner added.
2.1 - NICE petechial rash guidance added. Pneumothorax guidance updated as per BTS
2010. DKA guideline for adults added as per Diabetes UK. Insulin chart and
hypoglycaemia guide- line also from Diabetes UK. 5th MT base fractures adapted from
Foot and Ankle hyperbook.
2.5 - Updated to 2010 ALS guidance. PPCI guidance added. Some modifications to AF
risk stratification to bring into line with NICE. Brugada information added. Aortic
dissection algorithm added. NICE URTI guidance reformatted for legibility. Migraine
criteria added. Vertigo updated (Hallpike and Epley included). Paracetamol nomogram
updated for 2012 changes. PE/DVT flowcharts updated to bring into line with two-level
guidance recommended by NICE 2012.
Nov 2014
Anaesthetics chapter by Dr Helen Turner – pain charts changed to reflect MHRA
guidance. Sedation policy inserted. Lipid emulsion storage areas updated.
June 2015
Medicine Chapter by Dr Helen Turner – Multiple changes to reflect new national
Guidance.
Revision 2.5 February 2013.
,Introduction
This book represents the guidelines for the Department of Emergency Medicine at East
Lancashire Hospitals NHS trust. It should be considered an ongoing project, and it is intended
that the book be updated on a regular basis to ensure continuity with current practice and new
research.
It should be noted that it is a book of guidelines and not protocols, and clinicians should remember
that each patient is unique, and that clinical judgement is required. Every effort has been made to
ensure drug doses are correct, but where doubt exists, they should be checked with the BNF or
manufacturers’ guidance.
If errors in the text are identified, or if there are suggestions for improvements or additions in
subsequent editions, please notify the author.
Charles Thomson November 2008
, Acknowledgements
ALS protocols from guidelines of Resuscitation Council UK with permission. Many of the
guidelines in the acute medicine pages are from the East Lancashire NHS Trust Acute Medicine
Handbook. AF rhythm/rate flowchart from NICE. ST elevation diagram from ECGpedia. org.
Bundle branch block diagrams from Wikimedia by A.Rad. ACS algorithm from Lancashire
Cardiac. Asthma flowchart from BTS / SIGN. Antibiotic prescribing in URTI - NICE.
Meningococcal disease from British Infection Society, publicised by Meningitis Research
Foundation (www.meningitis.org). Acid-base nomogram from internet. Toxicology guide to
observations - copyright HPA, prepared by NPIS. Blood transfusion reactions and monitoring
from Transfusion Handbook. Sepsis pathway based on w..survivingsepsis.org by Lancs and
South Cumbria Critical Care Network. Hepatitis B exposure table from ‘Green book’
immunisation guidelines.
Acute pain flowcharts and noradrenaline table from College of Emergency Medicine. Local
anaesthetic toxicity guidance from AAGBI.
Slitlamp picture from Orbis. Eyelid eversion from Tearfund. Stye photograph by A. Riemann.
Fundus photographs from www.dundee.ac.uk, Dr R S Mac Walter, Consultant Physician,
Dundee Teaching Hospitals NHS Trust.
Medicolegal advice based on material from Newcastle Teaching Hospitals A&E handbook.
DVLA regulations from ‘At-a-glance’ guide www.dvla.gov.uk.
Obstetric guidelines based on trust women’s health guidelines and on guidelines prepared by
K. Bhatia.
Orthopaedic minor injury guidelines based on material from Newcastle Hospitals. Head injury
and cervical spine guidance from NICE. Dermatome chart from American Spinal Injury
Association. Spinal cord diagram from ‘The Human Brain’ by John Nolte. Limping child guide-
line based on that of Central Manchester and Manchester Children’s Hospitals. Salter-Harris
pictures from Smart Draw Healthcare Edition. Ankle rule diagram from www.gp-training.net.
Shoulder and wrist radiographs are from uwmsk.org, and Michael L. Richardson MD.
Management of the burns patient diagram from Initial Managment of a Major Burn , BMJ
vol.328, reprinted by permission of BMJ Publishing Group Ltd.. Tetanus immunisation guidance
from
‘Green Book’.
Paediatric guidelines from APLS (ALSG, Manchester) or NHS North West. Asthma guideline
from SIGN. Feverish child guidance from NICE. Recognition of child treatment from NICE.
Gastroenteritis in children based on NICE guidance.
Specific reprint permission has not been sought for the use of national guidance, since this is a
non-commercial project, and it has been assumed that those bodies publishing the guidance
would wish it publicised as widely as possible.
If any author or other body has copyright concerns or feels that their work has not been
adequately acknowledged please contact the author and corrections can be made in future
editions.
No original part of this work may be commercially distributed without prior agreement. Non-
commercial reproduction is permitted, with the requirement that the original source is
acknowledged.
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