Princess Alexandra Hospital Emergency Department. Clinical Module. Clinical features of envenoming: Major toxin syndromes 1 :
|
|
- Adrian Cook
- 5 years ago
- Views:
Transcription
1 Princess Alexandra Hospital Emergency Department Clinical Module Toxicology Review Officer: Toxicology registrar Version no: 1 Approval date: February 2017 Review date: February 2019 Approving Officer Dr Colin Page Key Words: 1 Introduction While most snakebites do not result in envenoming, the potential for life threatening injury warrants all patients to receive high priority assessment and management even if they initially appear well. Clinical features of envenoming: Local: pain, swelling, bruising, lymphadenopathy Systemic: nausea, vomiting, abdominal pain, diarrhoea, diaphoresis & headache Major toxin syndromes 1 : Venom-induced consumptive coagulopathy o Complete if INR > 3.0, abnormal aptt and very high D dimer o Partial if INR < 3 and low but detectable fibrinogen level ( <1.5g/L) Neurotoxicity o Descending flaccid paralysis involving ocular muscles first, followed by bulbar, respiratory muscles and limb paralysis Myotoxicity o CK > 1000 with Myalgia or muscle tenderness Anticoagulant coagulopathy o aptt is moderately abnormal Thrombotic microangiopathy o Fragmented RBC on film with MAHA, thrombocytopenia and elevated creatinine Version No 1; Last reviewed February 2017 Page 1 of 6
2 2 Assessment Important features on history History of bite Time of bite First aid measures applied Early symptoms; eg collapse Known species if snake in captivity Relevant comorbidities; eg coagulopathies, renal impairment Relevant medications; eg anticoagulants, Important feature on examination Bite site: fang marks, bruising, local necrosis Regional lymphadenopathy Neurological examination; ptosis, ophthalmoplegia, bulbar weakness, limb weakness, respiratory muscle weakness Haematological examination; bleeding from bite site or cannula site, oral cavity or occult sites Investigations On arrival: FBC, EUC, CK, coags including fibrinogen & D dimer. Remember to document snakebite on the request form to assist processing in the lab. Version No 1; Last Reviewed February 2017 Page 2 of 6
3 VDK from bite site specimen can be sent if there are features of envenomation. Bite site swabs can be taken on admission and kept for later testing if envenomation develops. Bloods (CK, coags) should be repeated 1 hour post pressure bandage removal and at 6 and 12 hours post bite. 3 Management First aid Measures Application of a broad (15cm), elasticised pressure bandage to the entire affected limb with immobilisation is recommended for all patients with suspected snakebite. The pressure applied should be similar to that used for a sprained ankle. The application of a pressure bandage after 4 hours post bite is unlikely to be effective. The bandage can be removed once there is no clinical evidence of envenoming following the return of the initial blood results. Version No 1; Last Reviewed February 2017 Page 3 of 6
4 4 Disposition Patients with no evidence of envenoming: See Appendix Follow the Clinical Pathway This group should be observed for 12 hours with repeat testing (neurological examination, coags, CK one hour following the removal of the pressure bandage and at 6 and 12 hours following the bite. This group should be admitted to the Short Stay Unit under TOXE and the toxicology registrar should be notified Discharge should occur in daylight hours Ensure adequate tetanus prophylaxis Patients with evidence of envenoming: This group should receive an appropriate antivenom in a timely manner There is no role for redosing of antivenom Discuss this group with the toxicologist on call This group requires admission under the toxicology unit for observation and adjunctive therapy as required Full set of bloods (FBC, EUC, CK, coags, D dimer) should be repeated 6, 12, 18 and 24 hours post bite. This patient group should be recruited to the Australian Project (ASP) 5 Additional Information VDK from urine specimen can be used in envenomed patient if the bite site specimen is unavailable. False positive VDK results for brown snake are not uncommon and the result needs to be interpreted in the context of the clinical findings of the patient. One vial of the appropriate venom is sufficient to treat envenomed patients. There is no role for redosing of antivenom. Antivenom needs to be given in a resuscitation area with capacity to treat anaphylaxis should it occur. Premedication is not recommended. Acute systemic hypersensitivity occurs in 23% of patients, and is severe (hypotension) in 7% 2 See table below. Serum sickness occurs in 29% 2 See table below of patients given antivenom and is characterised by flu like symptoms and rash which develops 4 to 14 days after antivenom administration. It is treated with prednisolone 25mg for 5 days. Version No 1; Last Reviewed February 2017 Page 4 of 6
5 Antivenom is diluted 1:10 with saline and administered over minutes, dilution can be 1:5 in the paediatric population for larger volumes of antivenom. 3 The role of treating VICC with factor replacement is controversial. While studies have shown providing FFP does restore clotting function more rapidly this hasn t resulted in meaningful outcomes for the patient. It appears reasonable to administer FFP (rather than any other factor replacement, given these patients are deficient in factors I, V and VIII) to patients with life threatening bleeding secondary to VICC. 6 Reference 1. Isbister GK, Brown S, Page C et al. in Australia: a practical approach to diagnosis and treatment. MJA 2013; 199(11): Ryan N, Kearney RT, Brown S and Isbister GK. Incidence of serum sickness after the administration of Australian snake antivenom (ASP-22). Clin Toxicol 2016; 54(1): etg Toxicology and Wilderness 2016 ed. chapter. Version No 1; Last Reviewed February 2017 Page 5 of 6
6 7 Appendix Version No 1; Last Reviewed February 2017 Page 6 of 6
Snake Bites Sept 2014
Bites Sept 2014 Epidemiology 1000-300 snake bites/ye, 1-4 deaths/yr in Australia. 5-10% envenomation rate Most deaths due to haematological problems Clinical envenoming Local effects (pain, swelling, bruising)
More informationSnake bite: a current approach to management
Snake bite: a current approach to management Geoffrey K Isbister, Senior Research Fellow, Tropical Toxinology Unit, Menzies School of Health Research, Charles Darwin University, Northern Territory, Clinical
More informationClinical focus. Snakebite in Australia: a practical approach to diagnosis and treatment. Clinical focus. Summary. Clinical effects.
Clinical focus Geoffrey K Isbister BSc, FACEM, MD, Associate Professor, 1 and Clinical Toxicologist 2 Simon G A Brown MB BS, PhD, FACEM, Emergency Physician and Professor 3 Colin B Page MB ChB, FACEM,
More informationAppendix This appendix was part of the submitted manuscript and has been peer reviewed. It is posted as supplied by the authors.
Appendix This appendix was part of the submitted manuscript and has been peer reviewed. It is posted as supplied by the authors. Appendix to: Johnston CI, Ryan NM, Page CB, et al. The Australian Snakebite
More informationProduct Information BROWN SNAKE ANTIVENOM AUST R 74897
Product Information APPROVED NAME BROWN SNAKE ANTIVENOM AUST R 74897 DESCRIPTION BROWN SNAKE ANTIVENOM is prepared from the plasma of horses immunised with the venom of the brown snake (Pseudonaja textilis).
More informationChanges in serial laboratory test results in snakebite patients: when can we safely exclude envenoming?
Changes in serial laboratory test results in snakebite patients: when can we safely exclude envenoming? Graham Ireland, Simon G A Brown, Nicholas A Buckley, Jeff Stormer, Bart J Currie, Julian White, David
More informationPOLYVALENT SNAKE ANTIVENOM Product Information 1(5) Product Information POLYVALENT SNAKE ANTIVENOM (AUSTRALIA - PAPUA NEW GUINEA) AUST R 74899
POLYVALENT SNAKE ANTIVENOM Product Information 1(5) Product Information NAME OF THE MEDICINE POLYVALENT SNAKE ANTIVENOM (AUSTRALIA - PAPUA NEW GUINEA) AUST R 74899 DESCRIPTION POLYVALENT SNAKE ANTIVENOM
More informationSpecific treatment: Antivenom (AV) Therapy
Specific treatment: Antivenom (AV) Therapy It is never too late to give antivenom provided the indications are present: Only if features of systemic envenoming are present for bites of snakes in the red
More informationSTATE TOXINOLOGY SERVICES Toxinology Dept., Women s & Children s Hospital, North Adelaide SA 5006 AUSTRALIA
Family Elapidae www.toxinology.com record number SN0170 Scientific name combined Common name Black Mamba, Black-mouthed Mamba Global region in which snake is found CLINICAL OVERVIEW Mambas are amongst
More informationANTIVIPMYN TREATMENT PACKAGE
The Ontario Massasauga Rattlesnake Antivenom Depot Dr. T. J. Fargher, MB. Ch.B., F.C.P (SA), F.R.C.P(C) Medical Director 705-746-9321 ANTIVIPMYN TREATMENT PACKAGE FOR EASTERN MASSASAUGA RATTLESNAKE BITES
More informationSTATE TOXINOLOGY SERVICES Toxinology Dept., Women s & Children s Hospital, North Adelaide SA 5006 AUSTRALIA
Family Viperidae www.toxinology.com record number Common name Eyelash Palm Pit Viper SN0379 Scientific name combined Global region in which snake is found Central America + South America CLINICAL OVERVIEW
More informationSTATE TOXINOLOGY SERVICES Toxinology Dept., Women s & Children s Hospital, North Adelaide SA 5006 AUSTRALIA
Family Viperidae www.toxinology.com record number Common name Western Diamond Rattlesnake SN0419 Scientific name combined Global region in which snake is found North America + Central America CLINICAL
More informationSNAKEBITE / CROTALID ANTIVENOMS
DISCLAIMER: These guidelines were prepared by the Department of Surgical Education, Orlando Regional Medical Center. They are intended to serve as a general statement regarding appropriate patient care
More informationCBC with Differential. PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
DRUG AND TREATMENT Non Categorized SUB ED Snakebite Protocol (SUB)* Non Categorized ***(NOTE)*** This plan is designed to be used as part of a larger plan, not independently. Please do NOT order individually.
More informationCASE REPORT RENAL FAILURE AND DIC-LIKE SYNDROME FOLLOWING SNAKE BITES
CASE REPORT RENAL FAILURE AND DIC-LIKE SYNDROME FOLLOWING SNAKE BITES Fransciscus Ginting, Restuti, Endang, Tambar Kembaren, Yosia Ginting, Ricky Rivalino Sitepu Tropical Infenction Medicine - Internal
More informationAustralian Spider Bites. Dr Sanj Fernando
Australian Spider Bites Dr Sanj Fernando Funnel Web Spider Atrax robustus Funnel-Web Spider details Large spider - usually seen fangs (4mm long) can penetrate a nail aggressive - bites repeatedly venom
More informationHIGHLIGHTS OF PRESCRIBING INFORMATION
HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use North American Coral Snake Antivenin (Equine) safely and effectively. See full prescribing information
More informationDr. Cristina Gutierrez, Laboratory Director, CARPHA SARI/ARI SURVEILLANCE IN CARPHA MEMBER STATES
Dr. Cristina Gutierrez, Laboratory Director, CARPHA SARI/ARI SURVEILLANCE IN CARPHA MEMBER STATES SARI/ARI Surveillance in CARPHA Member States* Objectives of SARI Surveillance: To detect unusual or unexpected
More informationCollett s snake (Pseudechis colletti ) envenoming in snake handlers
Q J Med 2006; 99:109 115 Advance Access publication 24 January 2006 doi:10.1093/qjmed/hcl007 Collett s snake (Pseudechis colletti ) envenoming in snake handlers G.K. ISBISTER 1,2, M.R. HOOPER 3, R. DOWSETT
More informationSTATE TOXINOLOGY SERVICES Toxinology Dept., Women s & Children s Hospital, North Adelaide SA 5006 AUSTRALIA
Family Viperidae www.toxinology.com record number SN0200 Scientific name combined Common name Puff Adder, Common Puff Adder, African Puff Adder ( B. a. arietans ), Somali Puff Adder ( B. a. somalica )
More informationGUIDELINES FOR MANAGEMENT OF BLEEDING AND EXCESSIVE ANTICOAGULATION WITH ORAL ANTICOAGULANTS
GUIDELINES FOR MANAGEMENT OF BLEEDING AND EXCESSIVE ANTICOAGULATION WITH ORAL ANTICOAGULANTS This guideline covers the management of patients being treated with Vitamin K antagonists (VKA): Warfarin Acenocoumarol
More informationVenomous Snakebites in Two Children
Case Report Crit Care & Shock (2009) 12:53-60 Venomous Snakebites in Two Children Heda Melinda D. Nataprawira, Enny Harliany Alwi, Lesmana Syahrir, Tubagus Ferdi Fadilah, Tri Wahyu Murni Abstract Venomous
More informationMarine envenomations. Environmental. Jellyfish stings. Background. Objective. Discussion. Keywords. Ingrid Berling Geoffrey Isbister
Environmental Marine envenomations Ingrid Berling Geoffrey Isbister Background Marine stings are common but most are minor and do not require medical intervention. Severe and systemic marine envenoming
More informationThings to never miss in the office. Brett Houston MD FRCPC (PYG-5, hematology) Leonard Minuk MD FRCPC
Things to never miss in the office Brett Houston MD FRCPC (PYG-5, hematology) Leonard Minuk MD FRCPC Presenter Disclosure Faculty / Speaker s name: Brett Houston / Leonard Minuk Relationships with commercial
More informationCOAGULATION PROFILE AND ANALYSIS OF OUTCOME OF BLOOD COMPONENT THERAPY IN SNAKE BITE VICTIMS
COAGULATION PROFILE AND ANALYSIS OF OUTCOME OF BLOOD COMPONENT THERAPY IN SNAKE BITE VICTIMS Dr Aboobacker Mohamed Rafi 1, Dr Susheela J Innah Senior Resident Department of Transfusion Medicine Jubilee
More informationSTATE TOXINOLOGY SERVICES Toxinology Dept., Women s & Children s Hospital, North Adelaide SA 5006 AUSTRALIA
Family Elapidae www.toxinology.com record number SN0045 Scientific name combined Common name Thai Spitting Cobra, Isan Spitting Cobra Global region in which snake is found Southeast Asia CLINICAL OVERVIEW
More informationKey Points. Snakebites. Background
Snakebites Guideline developed by Branson Bolden, MD, in collaboration with the ANGELS team, August 16, 2013. Last revised by Branson Bolden, MD, August 30, 2016. Key Points Pit viper (rattlesnake, cottonmouth,
More informationPAEDIATRIC FEBRILE NEUTROPENIA CARE PATHWAY
PAEDIATRIC FEBRILE NEUTROPENIA CARE PATHWAY Purpose: This document is intended as a guide to the investigation and management of children presenting in Salisbury District Hospital with suspected neutropenic
More informationAppendix 3 PCC Warfarin Reversal
Appendix 3 PCC Warfarin Reversal Reversal of Warfarin and Analogues 1. Principle of Procedure Guidelines for the Reversal of Oral-anticoagulation in the Event of Life Threatening Haemorrhage Prothrombin
More informationSTORMY DENGUE with bloody problems. Anand M.Patil PICU MED/SURG TEAM Apollo Childrens Hospitals Chennai
STORMY DENGUE with bloody problems Anand M.Patil PICU MED/SURG TEAM Apollo Childrens Hospitals Chennai 1 HISTORY 4 ½ years girl Day 1: Fever, Lethargy, Low urine output Hypotension, high PCV,low platelets
More informationSTATE TOXINOLOGY SERVICES Toxinology Dept., Women s & Children s Hospital, North Adelaide SA 5006 AUSTRALIA
Family Elapidae www.toxinology.com record number SN0184 Scientific name combined Common name Mocambique Spitting Cobra, m Fezi, Mozambique Spitting Cobra Global region in which snake is found Sub-Saharan
More informationClinical profile & complications of neurotoxic snake bite & comparison of two regimens of polyvalent anti-snake venom in its treatment
Indian J Med Res 145, January 2017, pp 58-62 DOI: 10.4103/ijmr.IJMR_1319_14 Quick Response Code: Clinical profile & complications of neurotoxic snake bite & comparison of two regimens of polyvalent anti-snake
More informationAltered Mental Status Basic Emergency Care Course
Altered Mental Status Basic Emergency Care Course Objectives Recognize key history findings suggestive of different causes of altered mental status Recognize key physical findings suggestive of different
More informationHaematological Emergencies (Part 1) Ray Mun Koo Haematology Advanced Trainee Canberra Hospital
Haematological Emergencies (Part 1) Ray Mun Koo Haematology Advanced Trainee Canberra Hospital Case Number 1 43 year old male presenting with fevers, abdominal distension and weight gain over 2 weeks.
More informationSNAKE BITES IN NORTH KERALA, DEMOGRAPHIC PROFILE AND MEAURSES FOR PREVENTION Krishnadas T 1, Sasidharan P.K 2
SNAKE BITES IN NORTH KERALA, DEMOGRAPHIC PROFILE AND MEAURSES FOR PREVENTION Krishnadas T 1, Sasidharan P.K 2 HOW TO CITE THIS ARTICLE: Krishnadas T, Sasidharan P.K. Snake Bites in North Kerala, Demographic
More informationHeme (Bleeding and Coagulopathies) in the ICU
Heme (Bleeding and Coagulopathies) in the ICU General Topics To Discuss Transfusions DIC Thrombocytopenia Liver and renal disease related bleeding Lack of evidence in managing critical illness related
More informationDoes the traditional snakebite severity score correctly classify envenomated patients?
Clin Exp Emerg Med 216;3(1):34-4 http://dx.doi.org/1.15441/ceem.16.123 Does the traditional snakebite severity score correctly classify envenomated patients? Seungho Kang, Jeongmi Moon, Byeongjo Chun Department
More informationCase Presentation #4: A Pretty Worm
Case Presentation #4: Presented by Brent R. King, MD, FAAP, FACEP A three year-old child arrives via EMS with ptosis, stridor, hypersalivation, hypotonia, and poor respiratory effort. The symptoms began
More informationClinical Effects and Antivenom Dosing in Brown Snake (Pseudonaja spp.) Envenoming Australian Snakebite Project (ASP-14)
Clinical Effects and Antivenom Dosing in Brown Snake (Pseudonaja spp.) Envenoming Australian Snakebite Project (ASP-14) George E. Allen 1, Simon G. A. Brown 2, Nicholas A. Buckley 3,4, Margaret A. O Leary
More informationChapter. Severe Acute Respiratory Syndrome (SARS) Outbreak in a University Hospital in Hong Kong. Epidemiology-University Hospital Experience
content Chapter Severe Acute Respiratory Syndrome (SARS) Outbreak in a University Hospital in Hong Kong 3 Nelson Lee, Joseph JY Sung Epidemiology-University Hospital Experience Diagnosis of SARS Clinical
More informationStudy of clinical profile complications and outcome in patients of snake bite in pediatric age group
Original article: Study of clinical profile complications and outcome in patients of snake bite in pediatric age group A.M. Lingayat, P.R. Wankhade Department of Pediatrics, Government Medical College,
More informationProthrombin Complex Concentrate- Octaplex. Octaplex
Prothrombin Complex Concentrate- Concentrated Factors Prothrombin Complex Concentrate (PCC) 3- factor (factor II, IX, X) 4-factor (factors II, VII, IX, X) Activated 4-factor (factors II, VIIa, IX, X) Coagulation
More informationProtocol for IV rtpa Treatment of Acute Ischemic Stroke
Protocol for IV rtpa Treatment of Acute Ischemic Stroke Acute stroke management is progressing very rapidly. Our team offers several options for acute stroke therapy, including endovascular therapy and
More informationTRANSFUSION GUIDELINES FOR CARDIOTHORACIC UNIT 2006
TRANSFUSION GUIDELINES FOR CARDIOTHORACIC UNIT 2006 CTU blood product transfusion guidelines 2006 1 Summary of guidelines RED CELLS (10-15ml/kg) This applies to ward patients / icu patients who are stable.
More information2) An 87 year old female who is 2 weeks post TKR presents with a sore swollen knee. She has a history of atrial fibrillation. Her vital signs are:
EMQ - Rheumatology For each clinical vignette match the correct diagnosis. Reiter s syndrome Pseudogout Septic arthritis Gout Haemarthrosis Traumatic effusion Ankylosing spondylitis Rheumatoid arthritis
More informationINJURY BULLETIN. Envenomation. Queensland Injury Surveillance Unit. No 95 March 2007
INJURY BULLETIN QISU collects and analyses data from emergency department injury presentations on behalf of Queensland Health. Participating hospitals represent three distinct areas of Queensland. QISU
More informationCisplatin / Paclitaxel Gynaecological Cancer
Systemic Anti Cancer Treatment Protocol Cisplatin / Paclitaxel Gynaecological Cancer PROCTOCOL REF: MPHAGYNCIP (Version No: 1.0) Approved for use in: First line treatment for stage Ib-IV with minimal residual
More informationGuidelines on the Management of a Child with Sickle Cell Disease and low Haemoglobin
Guidelines on the Management of a Child with Sickle Cell Disease and low Haemoglobin Document Information Version: 2 Date: 28 th December 2013 Authors (incl. job title): Professor David Rees (Consultant
More informationThe research questions are presented in priority order, and are further elaborated with lay summaries and three-part questions where applicable.
Top 30 Emergency Medicine Research Priorities 23 January 2017 The rankings were established by consensus at the final prioritisation workshop run by the James Lind Alliance Emergency Medicine Priority
More informationCardiff & Vale (C&V) UHB Corporate Medicines Management Group (c MMG) SHARED CARE. Drug: AZATHIOPRINE Protocol number: CV 04
Cardiff & Vale (C&V) UHB Corporate Medicines Management Group (c MMG) SHARED CARE Drug: AZATHIOPRINE Protocol number: CV 04 Indication: RENAL, PANCREAS OR COMBINED RENAL PANCREAS TRANSPLANTATION LIVER
More informationHYPERSENSITIVITY REACTIONS
HYPERSENSITIVITY REACTIONS (HSR) TO ABACAVIR / LAMIVUDINE Important risk minimisation material for Healthcare Professionals Risk minimisation material for Abacavir / Lamivudine 1 Introduction Abacavir
More informationPDP 406 CLINICAL TOXICOLOGY
PDP 406 CLINICAL TOXICOLOGY Pharm.D Fourth Year ENVENOMATION Mr.D.Raju.M.Pharm., Lecturer POISONING Poisonous substances can be swallowed, injected, inhaled, absorbed. Poisoning and envenomation can be
More informationEffect of under filling tube
Effect of under filling tube 2 What constitutes underfilling? A 4.5ml vacutainer collection tube should contain at least 4ml of blood Less than that could give falsely prolonged clotting times ALSO be
More informationBritish Society of Gastroenterology. St. Elsewhere's Hospital. National Comparative Audit of Blood Transfusion
British Society of Gastroenterology UK Com parat ive Audit of Upper Gast roint est inal Bleeding and t he Use of Blood Transfusion Extract December 2007 St. Elsewhere's Hospital National Comparative Audit
More informationElements for a public summary. VI.2.1 Overview of disease epidemiology
VI.2 Elements for a public summary VI.2.1 Overview of disease epidemiology Coronary artery disease and as anticoagulant (inhibiting the clotting of the blood) in patients undergoing surgery to treat blockages
More informationRoutine, Every 2 hours, Starting today, If temperature greater than 38.5 C initiate Evaluation for Possible Sepsis Physician Order #829
Height Weight Allergies General Vital Signs [X] Frequent vital signs Indication: Q15 minutes x (# of occurrences): 4 Q30 minutes x (# of occurrences): 4 Q1 hour x (# of occurrences): Q2 hours x (# of occurrences):
More informationEnvironmental Injury and Illnesses. Dc. Anna Toplaghaltsyan
Environmental Injury and Illnesses Dc. Anna Toplaghaltsyan Yerevan 2018 BITES AND STINGS Insect bites and stings are a common and an annoying occurrence. Most bites are minor but the potential for a serious
More informationHemlibra (emicizumab-kxwh) NEW PRODUCT SLIDESHOW
Hemlibra (emicizumab-kxwh) NEW PRODUCT SLIDESHOW Introduction Brand name: Hemlibra Generic name: Emicizumab-kxwh Pharmacological class: Bispecific factor IXa- and factor X-directed antibody Strength and
More informationJohn Davidson Consultant in Intensive Care Medicine Freeman Hospital, Newcastle upon Tyne
John Davidson Consultant in Intensive Care Medicine Freeman Hospital, Newcastle upon Tyne Overview of coagulation Testing coagulation Coagulopathy in ICU Incidence Causes Evaluation Management Coagulation
More informationGeneral approach to the investigation of haemostasis. Jan Gert Nel Dept. of Haematology University of Pretoria 2013
General approach to the investigation of haemostasis Jan Gert Nel Dept. of Haematology University of Pretoria 2013 Clinical reasons to investigate haemostasis Investigating a clinically suspected bleeding
More informationDR J HARTY / DR CM RITCHIE / DR M GIBBONS
CLINICAL GUIDELINES ID TAG Title: Author: Speciality / Division: Directorate: Paracetamol Poisoning DR J HARTY / DR CM RITCHIE / DR M GIBBONS Medicine Acute Date Uploaded: 16 th September 2014 Review Date
More informationPolicy for the use of intravenous Iron Dextran (CosmoFer )
Policy for the use of intravenous Iron Dextran (CosmoFer ) Sharepoint Location Clinical Policies and Guidelines Sharepoint Index Directory General Policies and Guidelines Sub Area Haematology and Blood
More informationElements for a Public Summary Overview of disease epidemiology
VI.2 VI.2.1 Elements for a Public Summary Overview of disease epidemiology Indication: Treatment of blood clots Blood clots in the large veins of the legs, known as deep vein thrombosis (DVT), are a common
More informationDERBY-BURTON CANCER NETWORK CONTROLLED DOC NO:
OBINUTUZUMAB+CHLORAMBUCIL Regimen RDH; Day 1 and 2 Dose to be given on Ward Available for Routine Use in Burton in-patient Derby in-patient Burton day-case Derby day-case Burton community Derby community
More informationManaging Bleeding in the Patient on DOACs
Managing Bleeding in the Patient on DOACs Spring 2016 Jean M. Connors, MD Anticoagulation Management Services BWH/DFCI Hemostatic Antithrombotic Stewardship BWH Assistant Professor of Medicine, HMS Conflicts
More informationPost Tonsillectomy Haemorrhage
Princess Margaret Hospital for Children PAEDIATRIC ACUTE CARE GUIDELINE Post Tonsillectomy Haemorrhage Scope (Staff): Scope (Area): All Emergency Department Clinicians Emergency Department This document
More informationReversal of Novel Oral Anticoagulants. Angelina The, MD March 22, 2016
Reversal of Novel Oral Anticoagulants Angelina The, MD March 22, 2016 Argatroban Bivalirudin Enoxaparin Lepirudin Heparin Dabigatran Apixaban 1939 1954 1998 2000 1999 2001 10/2010 7/2011 12/2012 1/2015
More informationCAUTION: You must refer to the intranet for the most recent version of this procedural document.
Procedure for the use of Intravenous Iron Dextran (CosmoFer ) Sharepoint Location Sharepoint Index Directory Clinical Policies and Guidelines General Policies and Guidelines/ Haematology And blood transfusion
More informationLondon, 24 January 2000 EMEA/1952/00
The European Agency for the Evaluation of Medicinal Products Evaluation of Medicines for Human Use London, 24 January 2000 EMEA/1952/00 EMEA PUBLIC STATEMENT ON ABACAVIR (Ziagen) IMPORTANT SAFETY INFORMATION
More informationBMS Education Day 28 th January and 4th February 2013
BMS Education Day 28 th January and 4th February 2013 Category of Reaction 24 hours from the transfusion = DELAYED Infectious Bacterial contamination Viral HIV,
More informationMEDICAL ASSESSMENT FOR DEFILEMENT
Appendix 1: MEDICAL ASSESSMENT FOR DEFILEMENT Hosp No: Name... Age... Date of Birth... Address. Name of doctor examining patient Date and time of assessment Others present. Consent given by HISTORY Date
More informationACQUIRED COAGULATION ABNORMALITIES
ACQUIRED COAGULATION ABNORMALITIES ACQUIRED COAGULATION ABNORMALITIES - causes 1. Liver disease 2. Vitamin K deficiency 3. Increased consumption of the clotting factors (disseminated intravascular coagulation
More informationGuideline for Treatment of Head Injury in the Anticoagulated Patient
Guideline for Treatment of Head Injury in the Anticoagulated Patient GUIDELINE: GUIDELINE FOR TREATMENT OF HEAD INJURY IN THE ANTICOAGULATED PATIENT BACKGROUND: Chronic anticoagulation therapy is used
More informationJMSCR Vol 05 Issue 03 Page March 2017
www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i3.129 Early Prediction of Acute Kidney Injury
More informationGuidelines for Shared Care Centres and Community Staff
Reference: CG1410 Written by: Dr Jeanette Payne Peer reviewer Dr Jenny Welch Approved: February 2016 Approved by D&TC: 8th January 2016 Review Due: February 2019 Intended Audience This document contains
More informationKEY MESSAGES. There are three phases in dengue infection-febrile phase, critical phase and recovery (reabsorption) phase.
MANAGEMENT OF DENGUE INFECTION IN ADULTS (2 nd Edition) QUICK REFERENCE FOR HEALTH CARE PROVIDERS KEY MESSAGES Dengue is a systemic and dynamic disease. There are three phases in dengue infection-febrile
More informationCARE PATHWAY FOR CHILDREN AND YOUNG PERSONS WITH FEBRILE NEUTROPENIA, NEUTROPENIC SEPSIS OR SUSPECTED CENTRAL VENOUS LINE INFECTIONS
CARE PATHWAY FOR CHILDREN AND YOUNG PERSONS WITH FEBRILE NEUTROPENIA, NEUTROPENIC SEPSIS OR SUSPECTED CENTRAL VENOUS LINE INFECTIONS This Care Pathway has been developed by a multidisciplinary team. It
More informationApproach to disseminated intravascular coagulation
Approach to disseminated intravascular coagulation Khaire Ananta Shankarrao 1, Anil Burley 2, Deshmukh 3 1.MD Scholar, [kayachikitsa] 2.Professor,MD kayachikitsa. 3.Professor and HOD,Kayachikitsa. CSMSS
More informationSNAKEBITE / CROTALID ENVENOMATION
DISCLAIMER: These guidelines were prepared by the Department of Surgical Education, Orlando Regional Medical Center. They are intended to serve as a general statement regarding appropriate patient care
More informationABACAVIR HYPERSENSITIVITY REACTION
ABACAVIR HYPERSENSITIVITY REACTION Key Risk Minimisation Points: Abacavir Hypersensitivity Reaction (HSR) Abacavir is associated with a risk for hypersensitivity reactions (HSR) characterised by fever
More informationGuidelines on the Management of a Child with Sickle Cell Disease and low Haemoglobin
Guidelines on the Management of a Child with Sickle Cell Disease and low Haemoglobin Version: 6 Date: 2 nd March 2010 Authors: Responsible committee or Director: Review date: Target audience: Stakeholders/
More informationUHSM ED Pathway ELDERLY FALL / COLLAPSE
UHSM ED Pathway ELDERLY FALL / COLLAPSE Patient name / Pathway for patients who require assessment in ED after a fall or collapse Note: - It can be used if the patient has also sustained a minor head injury
More informationGUIDELINE: ASSESSMENT OF BRUISING & BLEEDING IN CHILDREN. All children in whom there is concern regarding bruising / bleeding
GUIDELINE: ASSESSMENT OF BRUISING & BLEEDING IN CHILDREN Reference: Bruising / Bleeding / NAI Version No: 1 Applicable to All children in whom there is concern regarding bruising / bleeding Classification
More informationCoagulation, Haemostasis and interpretation of Coagulation tests
Coagulation, Haemostasis and interpretation of Coagulation tests Learning Outcomes Indicate the normal ranges for routine clotting screen and explain what each measurement means Recognise how to detect
More informationTarget Audience: Emergency Medicine Residents (junior and senior level postgraduate learners), Medical Students
Rattlesnake Bite Authors: Laura Morrison, MD / Ryan Chuang, MD Reviewers: Shawn M. Varney, MD Target Audience: Emergency Medicine Residents (junior and senior level postgraduate learners), Medical Students
More informationHIGHLIGHTS OF PRESCRIBING INFORMATION
HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use ANASCORP safely and effectively. See full prescribing information for ANASCORP. ----------------------DOSAGE
More informationHow to reverse warfarin
Page 1 of 5 How to reverse warfarin Index: Anticoagulation Original article by: Michael Tam Resources Warfarin reversal: consensus guidelines, on behalf of the Australasian Society of Thrombosis and Haemostasis
More information2/2/2011. Blood Components and Transfusions. Why Blood Transfusion?
Blood Components and Transfusions Describe blood components Identify nursing responsibilities r/t blood transfusion Discuss factors r/t blood transfusion including blood typing, Rh factor, and cross matching
More informationBrandon. A 38-year-old victim. Pit viper envenomation. Bitten at: Tyler, Texas Treated at: Emergency room at regional medical center
Brandon Pit viper envenomation A 38-year-old victim Bitten at: Tyler, Texas Treated at: Emergency room at regional medical center History 0 1 hour after bite A man was bitten on a toe on his right foot
More informationHaematological Cancer Suspected (Adults & Children)
Haematological Cancer Suspected (Adults & Children) Link to NICE guidelines: https://www.nice.org.uk/guidance/ng47 Patient of any age presents with symptoms of possible haematological cancer If 60 years
More informationMANAGEMENT OF DENGUE INFECTION IN ADULTS (Revised 2 nd Edition) QUICK REFERENCE FOR HEALTHCARE PROVIDERS
1 KEY MESSAGES Dengue is a dynamic disease and presented in three phases - febrile phase, critical phase and recovery phase. Clinical deterioration often occurs in the critical phase and is marked by plasma
More informationInfluenza-Associated Pediatric Mortality rev Jan 2018
rev Jan 2018 Infectious Agent Influenza A, B or C virus BASIC EPIDEMIOLOGY Transmission Transmission occurs via droplet spread. After a person infected with influenza coughs, sneezes, or talks, influenza
More informationActive date July Ratification date: Review date January 2014 Applies to: Staff managing patients on warfarin. Exclusions:
Guideline Title: Guidelines for the management of warfarin reversal [key words : Beriplex, Octaplex, PCC, vitamin K, anticoagulant, anticoagulation] Authors: Dr Sarah Allford, Consultant Haematologist
More informationCLINICAL TOXICOLOGY UNIT
CLINICAL TOXICOLOGY UNIT Princess Alexandra Hospital 2015 Annual Report 2 Table of Contents Page Executive Summary 4 Section 1: Service Data Clinical Toxicology Unit staffing levels 6 Activities 6 Yearly
More informationPresumptive thrombotic thrombocytopenic purpura following a hump-nosed viper (Hypnale hypnale) bite: a case report
Withana et al. Journal of Venomous Animals and Toxins including Tropical Diseases 2014, 20:26 CASE REPORT Open Access Presumptive thrombotic thrombocytopenic purpura following a hump-nosed viper (Hypnale
More informationPulmonary Embolism Pathway
Pulmonary Embolism Pathway Ambulatory Care Pathway Dr. A. Zafar, Dr. A. Rehman, Dr. T. Malik September, 2011. Patient Identification Label Pulmonary Embolism Pathway Clinical History Comments Hospital
More informationMajor Haemorrhage Protocol. Commentary
Hairmyres Hospital Monklands Hospital Wishaw General Hospital Major Haemorrhage Protocol Commentary N.B. There is a separate NHSL protocol for the Management of Obstetric Haemorrhage Authors Dr Tracey
More informationA Care Pathway exists for the management of neutropenic fever. Copies of the care pathway document are available in EAU, A&E, Deanesly and CHU.
Subject: Neutropenic Fever Guideline for Junior Doctors Date of Implementation: January 2010 Date of Review: January 2012 Director Responsible for Implementation and Review: Policy location: Consultant
More informationGuidance for management of bleeding in patients taking the new oral anticoagulant drugs: rivaroxaban, dabigatran or apixaban
Guidance for management of bleeding in patients taking the new oral anticoagulant drugs: rivaroxaban, dabigatran or apixaban Purpose The aim of this guidance is to outline the management of patients presenting
More information