19/04/2017

Last minute arrangements had to be made as the speaker cancelled at the last minute, but we managed well!

1. Propanolol Update
Talked about what to do if you had a patient with propanolol OD. Reminded everyone that these patients can often appear well, and deteriorate really really quickly.

Remember, propanolol has beta blocker effects and sodium channel blocking effects. This is why it is so dangerous - and can cause hypotension and seizures.
Treatment should be as per toxbase. There is a toxbase app.
ECMO may be a useful bridging tool.
**AVOID PHENYTOIN for seizures - Na blocking **

Article on LITFL.

2. Brief Human Factors Discussion 
It is easier to de-escalate than escalate.
Be careful with locums - not all are familiar with the department.

3. QUIP
RCEM has lots of QUIP resources.
There is always a balance between access, quality and finance.


HAP25

25th January 2017: Simulation

Simulation Session
LA, AL, LG, CD, LH, SR

1. Hyperkalaemia and Arrest  
Guidelines on hyperkalaemia and reminder of what each treatment does from here, together with clear guidelines for hyperkalaemic arrest.
Look for our guidelines on the intranet - we now don't give insulin and dextrose mixed, but insulin in saline, and dextrose separately if BM low.

Hyperkalaemia 
http://www.aliem.com/2013/mythbuster-calcium-gluconate-raises-serum-calcium-as-calcium-chloride/
http://first10em.com/2016/01/21/hyperkalemia/
http://www.rcemfoamed.co.uk/portfolio/hyperkalaemia/ 
http://adultemergencymedicine.blogspot.co.uk/2016/03/hyperkalaemia.html?m=1 

http://learning.bmj.com/learning/module-intro/hyperkalaemia-diagnosis-management.html?moduleId=6055258&searchTerm=%E2%80%9Chyperkalaemia%E2%80%9D&page=1&locale=en_GB
http://learning.bmj.com/learning/module-intro/hyperkalaemia.html?moduleId=10047565&searchTerm=%E2%80%9Chyperkalaemia%E2%80%9D&page=1&locale=en_GB
http://lifeinthefastlane.com/hyperkalemia/

CPR and ROSC
There's links to loads of other CPR websites at the bottom of my blog post here (too many to copy and paste!).
There are Post ROSC guidelines - and a departmental / local policy
IResus app is available for android and iphone.
I wrote a summary for Foundation Docs a while ago - might be out of date.

Human Factors
There's always time to prescribe - and check medications. Look at this great blog here.
You can look up guidelines like you would in real life - cognitively unload 

Don't be afraid to be a leader. 

That’s Not My Job

 This is a story about four people named Everybody, Somebody, Anybody and Nobody.  There was an important job to be done and Everybody was sure that Somebody would do it.  Anybody could have done it, but Nobody did it.  Somebody got angry about that, because it was Everybody’s job.  Everybody thought Anybody could do it, but Nobody realized that Everybody wouldn’t do it.  It ended up that Everybody blamed Somebody when Nobody did what Anybody could have. 

Remember - if you don't direct your requests, nobody will do them, when anybody and everybody could have. 

2. Overdose and Serotonin Syndrome 

Toxbase app is available to everyone with an athens password - available from the library. 

Remember to do a proper neurological examination in overdose ?what - pyrexia and rigidity should make you think of serotonin syndrome. This needs treatment - you might need to speak to NPIS for cyproheptidine. 

For more information, if you go to googlefoam.com and search, you get loads of handy links. 

Serotonin syndrome vs neuroleptic malignant - I love these flashcards. 

Dantrolene can be given but might make the serotonin syndrome worse - so I'd stay away. Toxbase suggests it for serotonin - but not for serotonin syndrome. Cyproheptidine is recommended on toxbase.