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Setup of the ED (Major incidents (Actions (Wards Clear as much as…

- - - - Conservative
        Keep voice calm and body language open
        Engage with patient and reassure trying to help
        Avoid patronising or making promises you cant keep
        Position yourself with easy escape
        Security and Police
      - Emergency sedation
        Last resort, senior staff
        Can mask signs of the acute illness and suppress airway protection reflexes (e.g. gag and cough)
        Can provoke adverse CV responses (hypotension,arrythmia)
        PO ideally, IV if not
        Lorazepam, plus haloperidol if psychotic
      - Physical restraint
        Only if someone likely to be hurt
        Minimum force needed to control
        Try to calm rather than exacerbate
        Hold clothing rather than limbs
        Hold limbs near a joint to restrict movement
        Never apply pressure to neck, throat, chest, or abdomen
      - After violence
        Report details in patient notes
        Incident form
        Report to senior staff and police (if needed)
- - - - GP follow up
        When to see GP
        Likely course of recovery
        Safety netting
        Formal written info
      - Outpatient clinic
        Often 4-6 weeks
        Letter will be sent with appt
        Formal written info
      - No follow up
        Minor illnesses
        Formal written info
    - - Identifying those unable to cope
        Self neglect (poor hygeine, dirty clothes)
        Weight loss (unable to cope, illness)
        Minor injuries (repeat falls)
        Impaired mobility (SOB, arthritis, pain etc.)
      - Information sources
        Patient family and carers
        GP, community support
      - Risk factors
        Cognitive decline/impairment e.g. dementia
        Change in physical condition e.g. poor mobility
        Living alone
        Poor social support
        Unsuitable home environment
        Poor financial cirrcumstances (food, heating)
      - Discharging
        Physiotherapy and OT assessments
        Home assessment if needed
        Equipment and adaptations
        Community services (district nurse,
        health visitor, carers, crisis teams, etc.)
- - - - NHS Direct
        24/7 info and advice
        Staffed by nurses
        Also internet sites
      - Other HCPs
        Senior to senior discussions
      - Telemedicine
        Link EDs, minor injury units, raiology and GP surgeries
        Emergencies diagnosed and treated quickly in suitable setting
- - - - Next of kin
        Info on death certification
        Info on funeral arranging
        Counselling contacts
        ED contact number
      - Others
        Suspicious deaths to Police
        Sudden deaths to Coroner
        Patoent's GP
        Cancel upcoming outpatient appointments
        Social/health workers as needed
      - Coroner
        Report all sudden deaths
        Name, DOB, address
        Next of kin details
        GP details
        Date/time arrival in ED and death
        Doctor who certified the death
        Details of incident and PMH
        When patient last saw a Dr
        Patient religion
- - - - In court
        Take oath before God or affirm w/o religious connatation
        Answer directly and simply
        Answer within the limits of your knowledge
      - Before
        Discuss with consultant
        Review notes, likely questions, likely procedures
        Copy of notes and investigations/treatment