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NICE Guidance...

NICE Guidance. April 2012. ... the Government handbook of everything Medical, ever. A few general points. CG (TA, IP etc) Change in format Need for IT No Quick Reference guides Key priorities Mention of protocols. In the ED. Breadth of work in EM 11 in 2010, 10 in 2011

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NICE Guidance...

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  1. NICE Guidance... • April 2012

  2. ... the Government handbook of everything Medical, ever

  3. A few general points • CG (TA, IP etc) • Change in format • Need for IT • No Quick Reference guides • Key priorities • Mention of protocols

  4. In the ED • Breadth of work in EM • 11 in 2010, 10 in 2011 • Confidential Enquiries etc • Who sits on the committee? • How do we keep up with these? • What do we do already? • Can we use these for pressure?

  5. Sentinel Guidance • Chest Pain / NSTEMI • Alcohol • Anaphylaxis • VTE • Meningococcal disease • Transient Loss of Consciousness • Epilepsy • Sedating children • Delirium • COPD

  6. Chest Pain & NSTEMI* CG94 / 95 • Risk assessment • M vs F • >3 risk factors • Risk • >10% offer CT Calcium score • >30% functional imaging • >61% angio • Do not use ETT for stable angina • ?What factors make angina unlikely? (4)

  7. AlcoholCG 100/115 • Withdrawal • Assessment with symptom-triggered score (CIWA) • Benzodiazepine (carbemazepine) • Early hepatology review • Alcohol support services • Wernicke’s - high dose thiamine iv • ?What AUDIT score triggers intervention? (1)

  8. AnaphylaxisCG 134 • Mast Cell Triptase • <16 yo - test if due to drugs, venom or unknown cause • Observe for 6-12 hrs • Offer Adrenaline sc TTO • Referral to allergy services • Education / patient information • ?What is the timing of Mast Cell Triptase? (1)

  9. VTECG 92 • WRT ED: • Should be giving prophylaxis if • Decreased mobility for >3/7 • Decreased mobility and risk factors • Avoid dehydration & mobilise early • ?What are the risk factors for VTE? (4)

  10. Meningococcal DiseaseCG 102 • Shock / non-specifically unwell • Rash • CT? - decreased GCS or focal signs • ?What antibiotics are recommended in hospital? (1)

  11. TLOCCG 109 • How to do Emergency Medicine • Red flags • ECG abnormality (all ages) • Failure • Exertional history • Family history of SCD <40 • SoB • Murmur • Advice - driving, work • ?What indicates vasovagal syncope? (4)

  12. EpilepsyCG 137 • First fit • Protocols to ensure proper assessment • Developmental assessment in children • ?What are pseudosezures called? (1)

  13. Sedation in ChildrenCG 112 • Training / competencies • Levels of sedation • Deep sedation • Fasting - 2 4 6 • CO2, BP, ECG

  14. DeliriumCG 103 • Confusion Assessment Method • Hypo- vs hyperactive delirium • Cognition, Perception, Physical & social • Interventions • Drugs - research needed • ?What are the risk factors for delirium? (4)

  15. COPDCG 101 • Admit or discharge? • pH <7.35 • PO2=8 • LTOT • Rapid onset • Moderate SoB • Physical activity • Sats <90%, PO2 <7 • Confusion / decreased GCS • Cyanosis, oedema

  16. Minor Guidance • Constipation in children • Increasing organ donation • Infection control • Hyperglycaemia in ACS • Urology • Hip Fracture • Service experience for adults • Mental health • Physical health

  17. Constipation in ChildrenCG99 • Red Flags - • From birth • No meconium • “ribbon” stools >1yo • Leg weakness • Abdominal distension / vomiting • Green flags • Change in feed • Poor diet • Thriving • Slow onset • Normal meconium

  18. Organ DonationCG135 • Consider as part of normal End-of-Life care • MDT responsible; • Consultant, SNOD, Religious leader • Training • DCD vs BCD & principles of diagnosis • Triggers • Law & ethics • Physiological optimisation

  19. Infection ControlCG 139 • WASH YOUR HANDS • Training for cannulation etc • Catheters - indications for antibiotics • Known infection post change • Traumatic procedure

  20. Hyperglycaemia in ACSCG 130 • Maintain BM <11 • Do not use iv Insulin routinely

  21. Lower Urinary Tract Symptoms in MenCG 97 • Acute retention - catheterise immediately • Offer alpha-blocker prior to removing catheter

  22. Neck of Femur FractureCG 124 • Identify & treat correctable co-morbidities immediately • Analgesia for all • MRI if xRay negative

  23. Service User Experience • Adults (CG 138) • One of Nice Quality Standards • 14 Quality Statements • Adult Mental Health (CG 136) •  Health and social care providers should support direct self-referral to mental health services as an alternative to accessing urgent assessment via the emergency department.

  24. Conclusion • Huge number applicable • Timescales? • Proof? • Implementation

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