Hospitals and Acute Services
http://hdl.handle.net/10147/631915
2024-03-27T16:33:51ZPressure Ulcers: A Practical Guide for Review
http://hdl.handle.net/10147/641253
Pressure Ulcers: A Practical Guide for Review
Health Service Executive
Aim: The aim of this document is to give services a practical guide to reviewing pressure ulcers which aligns to the six steps described in the HSE Incident Management Framework 2018. The scope of this document relates to service users within HSE and HSE-funded acute hospitals, mental health and social care inpatient/residential facilities and the community. This document should be read in conjunction with the HSE Incident Management Framework 2018.
2018-04-30T00:00:00ZProcedural Sedation of Adults in the Emergency Department [v1.0]
http://hdl.handle.net/10147/641227
Procedural Sedation of Adults in the Emergency Department [v1.0]
Uí Bhroin, Susan; Kidney, Emer; Sabbagha, Henrietta; Shields, Darragh; Moore, Anna
AIM
To provide a guideline that will assist staff in providing safe procedural sedation in the ED setting and to standardise the provision of procedural sedation across the country.
This document complements a procedural sedation proforma which should be used for all patients requiring procedural sedation in the ED. There is a sample included with this guideline but a local proforma may be in use in individual institutions.
2022-06-01T00:00:00ZManagement of Local Anaesthetic Systemic Toxicity (LAST) in the Emergency Department [v1.0]
http://hdl.handle.net/10147/641224
Management of Local Anaesthetic Systemic Toxicity (LAST) in the Emergency Department [v1.0]
Curran, Emma-May; O'Mahony, Roy; Meighan, Victoria
Local anaesthetic (LA) is a commonly used drug in the Emergency Department (ED) to provide pain relief. It can be used to provide local and regional anaesthesia and is generally safe and effective. Local anaesthetic systemic toxicity (LAST) is a life-threatening adverse event that can occur following administration of any type of LA, administered by any route, if a large amount reaches the systemic circulation.
Familiarity with maximum dosages of LA drugs is vital for patient safety when administering LA to avoid LAST. There is evidence that despite familiarity with LA drugs, NCHDs working in the ED are often unaware of safe dosing and management of toxicity.
LA drugs can be administered topically, subcutaneously and via perineural injection. Systemic absorption depends on rate of diffusion. The rate of diffusion is dependent on the site of injection and its vascular supply, individual drug lipophilicity and molecular weight and patient factors including age, weight and comorbidities. Increasing dose and rate of administration increases the rate of diffusion into systemic circulation and therefore increases the risk of systemic toxicity.
2023-04-01T00:00:00ZIntraosseous Access in Adult Patients [v1.0]
http://hdl.handle.net/10147/641077
Intraosseous Access in Adult Patients [v1.0]
Sheehan, Micheál
Intraosseous vascular access refers to the placement of a specialized hollow-bore needle through the cortex of a bone into the medullary space for infusion of medical therapy and laboratory tests. The IO route is an option when standard venous access would delay therapy or is not easily obtained.
2023-07-01T00:00:00ZThe use of Vasopressor Agents by Peripheral Intravenous Infusion in Adult Patients in the Emergency Department [v1.0]
http://hdl.handle.net/10147/641047
The use of Vasopressor Agents by Peripheral Intravenous Infusion in Adult Patients in the Emergency Department [v1.0]
Sabbagha, Henrietta; O'Reilly, Hugh; Coulter, Finn; Lee, Regina; O'Sullivan, Iomhar
Commencing vasopressors early in the resuscitation of the acutely unwell patient is critical. Literature reports an increased mortality risk in patients with septic shock who had a delay in initiation of vasopressor therapy. In one study, the odds ratio (OR) of death was 1.20 per hour delay, i.e. every hour delay was associated with a 20.4% increased probability of death.1 Delay in initiation of vasopressors whilst awaiting CVC placement is therefore unacceptable.
Traditionally, vasopressor agents were administered via a CVC, with the risk of peripheral extravasation often cited as the motivation for this. The practice of administering vasopressor agents peripherally is emerging with a recent systematic review of over 1300 patients reporting that extravasation events were uncommon (event rate 3.4%) with no reported incidents of tissue necrosis or limb ischemia.
PVC use for short-term resuscitation, until CVC can be safely placed, reduces time to initiation of vasopressors in critically unwell patients. The use of a guideline provides standardisation of care, empowers local policy development and improves familiarity with its use.
This guideline is adapted in most part, with permission, from the Intensive Care Society UK (ICS) Guidance published November 2020, with interim update September 2022. With similar healthcare settings, patient demographics, and practice principles, we believe this guidance document to be wholly applicable to the Irish EM setting.
Since the latest ICS update, there has been clinically significant literature publications. We have reviewed and included these in our guideline recommendations.
2024-02-28T00:00:00ZEmergency Management of Histamine Fish Poisoning (Scombrotoxic Fish Poisoning, Scombroid, Pseudo Allergic Fish Poisoning, Mahi Mahi Flush) / Histamine Poisoning in Adult Patients [v1.1]
http://hdl.handle.net/10147/640998
Emergency Management of Histamine Fish Poisoning (Scombrotoxic Fish Poisoning, Scombroid, Pseudo Allergic Fish Poisoning, Mahi Mahi Flush) / Histamine Poisoning in Adult Patients [v1.1]
Legge, John; McGlacken, Therese; Murray, Helena; Ryan, John
Histamine fish poisoning/histamine poisoning is a syndrome resembling an allergic reaction that occurs after eating food contaminated with high levels of histamine. It occurs a few minutes to a few hours after ingestion of contaminated food, typically fish or cheese.1 Commonly, patients present with flushing of the skin, an urticarial rash, diarrhoea, visual disturbance, light headedness and headache shortly after the ingestion of the contaminated food. Recovery occurs after a few hours. The condition can go unrecognised, with patients who present with this illness receiving treatment for another illness such as anaphylaxis and receiving a diagnosis of a food allergy.
2024-03-01T00:00:00ZBreast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL); SIMT Report
http://hdl.handle.net/10147/640951
Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL); SIMT Report
Hamilton, Vida
The current breast implant advisory is occurring due to the evolving knowledge of the epidemiology of BIA-ALCL. The Department of Health (DoH) requested a meeting with the Health Service Executive (HSE) and the Health Products Regulatory Authority (HPRA) in August 2019 when Allergan announced a global withdrawal of their BIOCELL macro-textured implants. As this is a relatively newly recognised condition and it takes, on average, eight years to develop, information regarding BIA-ALCL has changed over time.
In May 2019, Mark Magnusson et al placed the risk at 1:3345 in the New Zealand/ Australian population based on registry data. Previous information had placed the risk at 1:64,000 (Medicines and Healthcare products Regulatory Agency (MHRA), 2019), and indeed 1:500,000 (Brody et al., 2015) in earlier publications. In September 2020 a single site study by Nelson et al., revised the estimated the overall incidence of BIA-ALCL at 1.79 per 1000 patients (1 in 559) with textured implants and 1.15 per 1000 textured implants (1 in 871), with a median time to diagnosis of 10.3 years (range, 6.4–15.5 yrs.).
The HSE set up a multidisciplinary Serious Incident Management Team (SIMT) to review the literature and guide the national response. It was clinician-led with representation from the NCCP, Breast and Plastic Surgery, Radiology, Histopathology, the HPRA, QAV and HSE National Acute Operations, including HSE Communications. The Irish Private Hospitals Association were invited to join so they could avail of the group expertise and have access to all the documents developed and guidelines recommended by the group.
Based on the potential risk of 1:3345 in May 2019, it was agreed that individuals with Allergan BIOCELL macro-textured breast implants should be informed of the risk and the signs and symptoms of the condition so that should they develop any of these they would know to seek medical review. The average length of time to presentation with this disease post implant insertion is eight years and although the risk is low and treatment, when diagnosed early, is curative, the risk remains throughout life.
2020-11-25T00:00:00ZBell’s Palsy: Management in the Emergency Department [v1.0]
http://hdl.handle.net/10147/640883
Bell’s Palsy: Management in the Emergency Department [v1.0]
Grace, M.; Heffernan, L.; Maguire, S.; Conneely, C.
AIM:
To provide a guideline with an evidence-based approach for the assessment, management and follow up of Bell’s palsy in the ED, including consideration of key differential diagnoses for facial palsy.
2023-10-01T00:00:00ZTesticular Torsion [v1.0]
http://hdl.handle.net/10147/640851
Testicular Torsion [v1.0]
Prendergast, Conor; Collins, Patrick; Cronin, John; Melody, Laura; McGuire, Barry
AIMS:
To provide an evidence-based guideline for the assessment and management of male patients presenting to the ED with unilateral testicular pain which may represent a testicular torsion.
2022-08-01T00:00:00ZGuidance for Biological Medicines in Acute Hospitals
http://hdl.handle.net/10147/640827
Guidance for Biological Medicines in Acute Hospitals
National Steering Committee for Biological Medicines in Acute Hospitals
The purpose of the guidance is to provide expert opinion to help improve value and access to biological medicines in acute hospitals.
2019-04-08T00:00:00Z