Emergency Department Handbook

• Trust medical standards of care
• Introduction to ED covers:
  • Advice
  • Clinical Records Protocol
  • Approved Abbreviations
  • Teaching
  • Clinical Audit Meeting
  • Research
• Locum guidance in ED
• Patient transport
• Letters to GPs
• Telephones and communication
  • Useful telephone numbers
  • Using the bleep system
  • Telephone enquiries
  • The red phone: emergency ambulance calls to the ED
• Legal issues
  • Police requests for information
  • Police statements
  • Unaccompanied children and consent
  • Legal status of children
  • Patient and parental access to medical records
• Patient assessment
  • Initial assessment of patients
    • Triage
    • National triage scale
    • POPS chart
    • Streaming to Primary Care
    • Triage for patients with deliberate self-harm
  • Patients aged 16+
  • Children with chronic health problems
  • Children with problems relating to a recent admission
  • Minor streaming
• Patients who do not speak English as a first language
• Senior supervision and support
  • Contacting the consultant on call
  • Senior doctor support
  • Medical co-ordinator role
• Escalation pathway
• Handover and acute referrals
  • Handover
  • Referrals to other teams
  • Process after referral
  • Referrals to clinics
  • PCCU referral
• Radiology
  • General info and making requests
  • Risk management for missed fractures
  • GP requests for x-rays
  • Ionising radiation regulations
• Lab requests
  • Venous blood samples
  • Capillary blood samples
  • Results
  • POCT: point of care testing
• Procedural sedation
  • Intravenous ketamine 
  • Use of sedation for non-painful procedures
  • Manipulation of fractures in the ED (intranasal opiates)
  • Potentially painful or distressing procedures
  • Sedation proforma
• Training and Education
• Leave
  • Booking study or annual leave
  • Sick leave
• Reattender with same complaint within 72 hours

• Prescribing
  • TTOs
  • Antibiotic prescribing
  • Out of hours medicines
• Antibiotic quick reference guide
• Antibiotic dosing
• Parenteral nutrition sepsis guide
• Analgesia
  • Intro and abbreviations
  • Oral analgesia
  • Intravenous opiates
  • Intranasal diamorphine
  • Intranasal fentanyl
  • Intranasal alfentanil
  • Intranasal ketamine
• Local anaesthetics
• Methods of sedation
• Procedural sedation
  • Intravenous ketamine 
  • Use of sedation for non-painful procedures
  • Manipulation of fractures in the ED (intranasal opiates)
  • Potentially painful or distressing procedures
  • Sedation proforma
• Dinoprostone for duct dependent cardiac disease

• Major incident plan
  • Information for ED staff
  • Instructions for senior ED doctor
  • Instructions for junior ED doctors
• Departmental incident plan
• Chemical incidents and contamination

• BLS: Basic Life Support
• Choking
• ALS: Advanced Life Support
• SVT
• Anaphylaxis / Allergic reactions
• Convulsions and Status Epilepticus
• Hypothermia
• Drowning
• Massive blood loss 
• Trauma Code Red 
• When to stop resuscitation
• Child death in the ED
• Adult life support statement
• Dinoprostone for duct dependent cardiac disease
• Belmont Rapid Infuser SOP

Mental health in children and young people

• Background and triage
• Deliberate self-harm
• Other presentations
• Patients over 16 years old
• Section 136
• Patients who abscond or do not wait to be seen
• Tier 4 inpatient care
• Parents in mental health crisis
• Useful resources

Disturbed or violent patients

• Introduction (and flow chart)
• Legal position on restraint
• Non-drug management
• Drug management – emergency tranquilisation
• Tranquilisation/post-restraint monitoring form

• BRUE: Brief, resolved, unexplained event
• CONI: care of the next infant
• Convulsions, fits and Status Epilepticus
  • Febrile convulsions
  • Afebrile fits
  • Neonatal seizures

Allergy

• Anaphylaxis and Allergic reactions

Endocrine

• Children on steroids
• Obesity
• Hypoglycaemia (non-diabetic)
• Diabetes – general patient management
• DKA
  • DKA guidelines
  • DKA calculator
• Diabetic hypoglycaemia

Fever and infection

• Febrile child under 5
• Febrile infant proforma 
• Sepsis
• Meningococcal disease
• Measles
• Petechial rash
• HSP
• Chicken pox and herpes zoster
• Notifiable diseases
• Immunisation
  • General immunisation information
  • Side effects of immunisations
  • Tetanus-prone wounds
  • Immunisation schedule
  • Un-immunised children
  • Contraindications for immunisations

Neurology

• Headache
• Reduced GCS
• Stroke in childhood
• Shunts

Poisoning

• Toxbase
• Ingestions
  • Essential oils
  • Deliberate self-harm
  • Alcohol ingestion
  • Illicit substance use
  • Disposal of controlled drugs
• Paracetamol overdose
  • Parvolex proforma

Respiratory

• Acute asthma and viral wheeze
• Pneumothorax
• Acute stridor and croup
• Inhaled foreign bodies
• Acute bronchiolitis
  • Guide to setting up Airvo in the ED
• Pneumonia (CAP)

Cardiology

• Chest pain
• Murmurs
• Hypercyanotic spells in Tetralogy of Fallot
• Dinoprostone for duct dependent cardiac disease
• Yorkshire and Humber Congenital Cardiac Network External Guidelines

Gastrointestinal

• Diarrhoea and vomiting
• Constipation and soiling

Genitourinary

• UTI
• Haematuria and proteinuria

Haematology

• Haematological problems
  • Background
  • Bleeding disorders
  • Children on anticoagulants
  • Sickle cell
  • Suspected ITP
• Venous thromboembolism

Dermatology

• Atopic eczema
• Neonatal skin conditions 
• Scabies
• Impetigo
  • Common fungal infections
  • Tinea capitis
• Petechial rash
• HSP
• Dermatology referral proforma

• Pain management
• Major Trauma
  • Background
  • Phone numbers
  • Transfers
  • Pre-hospital communication
  • Trauma call triggers
  • Trauma team activation
  • Trauma team composition
  • Consultant input
  • Actions before patient arrival
  • Receiving the patient
  • Primary survey
  • Use of imaging
  • Secondary survey
  • Documentation and audit
  • References
• Yorkshire and Humber Major Trauma Guidelines
• Belmont Rapid Infuser SOP
• Code Red Trauma
• Cardiothoracic trauma
• Massive blood loss
• Head injuries
• Cervical Spine injuries
• Fractures and dislocations – general principles
• Orthopaedic emergencies
• Compartment syndrome

Facial injuries

• Facial fractures
• Dental injuries
• Dental haemorrhage
• Dental infection and acute facial infections
• Emergency access to dental care

Limb fractures

• Summary

Leg injuries

• Femoral fractures
• Femoral nerve block
• Knee injuries
  • Atraumatic knee pain
• Ankle and foot injuries

Arm injuries

• Clavicle fractures
• Hand injuries
• Elbow injuries
  • Elbow fractures and positive fat pads
  • Pulled elbows
• Buckle fractures of the distal radius
• Trapped fingers, amputated fingers
• Long bone fractures in children under 2 years old
• Manipulation of fractures in the ED

Other injuries, symptoms, treatments

• Limping child
• Back pain
• Physiotherapy
• Wounds
  • Background
  • Dressings
  • Wound management
  • Nurse-led dressing clinic
• Bites
• Dog bites
• Needlestick injuries
• Burns

• Neonatal surgical problems
  • Umbilical hernia
  • Pyloric stenosis
  • Intussusception
  • Hypospadias
  • Atresias and Malrotation
• Abdominal pain
• Vomiting in babies
• Management of gastrostomy and jejunostomy tubes
• Inguinoscrotal problems
  • Background and differential diagnosis
  • Herniae and hydrocoeles
  • Testicular torsion
  • Torsion of appendix testis
  • Epididymo-orchitis
  • Undescended testes
• Penile inflammation
  • Phimosis
  • Paraphimosis
  • Balanitis and posthitis
  • Balanitis Xerotica Obliterans
• Swallowed foreign bodies
  • Defining hazardous foreign bodies
  • Button batteries [inc flow chart]
  • Magnets and super-strong magnets [inc flow chart]
  • Sharp or otherwise hazardous ingested FB flow chart
  • Upper third oesophageal FBs
  • Non-hazardous ingested FB flow chart
• ENT problems
  • Epistaxis
  • Nose injuries
  • Foreign bodies in the nose
  • Foreign bodies in the ear
  • Perichondritis
  • Haematoma of the pinna
  • Acute otitis media
  • Tonsillitis
• Neck lumps
• Eye problems
  • History
  • Examination
  • Differential diagnosis of eye signs and symptoms
  • Management plans by diagnosis
    • Acute onset of squint
    • Acute visual loss
    • Leukocoria – white pupil
    • Infective conjunctivitis
    • Lid lumps, styes, chalazion
    • Blepharitis
    • Pre-septal cellulitis
    • Orbital (post-septal) cellulitis
    • Acute dacryocystitis (inflammation of the lacrimal sac)
    • Keratitis
    • Uveitis, iritis
    • Foreign bodies in the eye
    • Chemical eye injuries
    • Blunt eye trauma
    • Orbital blow-out fractures
    • Penetrating eye trauma
    • Eye lid lacerations
  • Eye referrals flow chart
• Gastrointestinal bleeding
• Gynaecological problems
  • Vaginal discharge
  • Menstrual problems
• Emergency contraception
• Pregnancy and related problems
  • Definition and background
  • Legal considerations
  • Pregnancy testing in the ED
  • How to approach the possibly pregnant patient
  • What to do about a positive pregnancy test (well patient)
  • Miscarriage
  • Ectopic pregnancy
  • Hypertension in pregnancy
  • Normal delivery
  • Post-partum haemorrhage
• Female genital mutilation

• Safeguarding overview
  • Thresholds of need, Sheffield Safeguarding Children Board
  • ED safeguarding referrals
  • ED safeguarding alerts
  • ED safeguarding checklist
• Non-accidental injury
  • Presentation to the ED
  • ED management
  • Indications of possible abuse (inc Fabricated or Induced Illness)
  • Referral for medical assessment
  • Information sharing and confidentiality
  • Long bone fractures in children under 2
• Child sexual abuse
• Pathway for bruising or injury in non independently mobile children
• Dog bites in ED
• Assault pathway for children presenting to ED
• Social care and early help
• Paediatric liaison service
• Child death in the ED
• Safeguarding publications and links
• Teams and organisations to signpost to
• Who has parental responsibility
• Domestic abuse guideline
•  

This guideline covers:

• Definitions
• Background and health inequalities
• Communication
• Sensory processing
• Diagnostic overshadowing
• POPS and atypical presentations
• Reasonable adjustments
• ED resources
• ED Pledge