Risk stratification tool for children aged under 5 years with suspected sepsis

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Risk stratification tool for children aged under 5 years with suspected sepsis"

Transcription

1 Risk stratification tool for children aged under 5 years with suspected sepsis Category Age Behaviour No response to social cues Appears ill to a healthcare professional Does not wake, or if roused does not stay awake Weak high-pitched or continuous cry Not responding normally to social cues No smile Wakes only with prolonged stimulation Decreased activity Parent or carer concern that child is behaving differently from usual Responds normally to social cues Content or smiles Stays awake or awakens quickly Strong normal cry or not crying Grunting Apnoea Oxygen saturation of less than 90% in air or increased oxygen requirement over baseline Oxygen saturation of less than 91% in air or increased oxygen requirement over baseline Nasal flaring Respiratory Under 1 year rate: 60 breaths per rate: breaths per moderate to high risk 1 2 years rate: 50 breaths per rate: breaths per 3 4 years rate: 40 breaths per rate: breaths per

2 Bradycardia: heart rate less than 60 beats per Capillary refill time of 3 seconds or more Reduced urine output For catheterised patients, passed less than 1 ml/kg of urine per hour Circulation and hydration Under 1 year Rapid heart rate: 160 beats per Rapid heart rate: beats per moderate to high risk 1 2 years Rapid heart rate: 150 beats per Rapid heart rate: beats per 3 4 years Rapid heart rate: 140 beats per Rapid heart rate: beats per Mottled or ashen appearance Skin Cyanosis of skin, lips or tongue Normal colour Non-blanching rash of skin Less than 36ºC Temperature Under 3 months 38 C or more 3 6 months 39 C or more Other Leg pain Cold hands or feet high to moderate risk This table is adapted from NICE s guideline on fever in under 5s.

3 Risk stratification tool for children aged 5 11 years with suspected sepsis Category Age Moderate to high risk criteria Behaviour Objective evidence of altered behaviour or mental state Appears ill to a healthcare professional Does not wake or if roused does not stay awake Not behaving normally Decreased activity Parent or carer concern that the child is behaving differently from usual Behaving normally Oxygen saturation of less than 90% in air or increased oxygen requirement over baseline Oxygen saturation of less than 92% in air or increased oxygen requirement over baseline Respiratory Aged 5 years Aged 6 7 years rate: 29 breaths per rate: 27 breaths per rate: breaths per rate: breaths per moderate to high risk criteria met Aged 8 11 years rate: 25 breaths per rate: breaths per Circulation and hydration Heart rate less than 60 beats per Capillary refill time of 3 seconds or more Reduced urine output For catheterised patients, passed less than 1 ml/kg of urine per hour moderate to high risk Aged 5 years Raised heart rate: 130 beats per Raised heart rate: beats per

4 Aged 6 7 years Aged 8 11 years Raised heart rate: 120 beats per Raised heart rate: 115 beats per Raised heart rate: beats per Raised heart rate: beats per Skin Mottled or ashen appearance Cyanosis of skin, lips or tongue Non-blanching rash of skin Other Leg pain Cold hands or feet No high or moderate to high risk

5 Risk stratification tool for adults, children and young people aged 12 years and over with suspected sepsis Category History from patient, friend or relative of new onset of altered behaviour or mental state History Objective evidence of new altered mental state History of acute deterioration of functional ability Impaired immune system (illness or drugs including oral steroids) Normal behaviour Trauma, surgery or invasive procedures in the last 6 weeks Respiratory rate: 25 breaths per New need for oxygen (more than 40% FiO2) to maintain saturation more than 92% (or more than 88% in known chronic obstructive pulmonary disease) rate: breaths per moderate to high risk Blood pressure Systolic blood pressure 90 mmhg or less or systolic blood pressure more than 40 mmhg below normal Systolic blood pressure mmhg moderate to high risk Circulation and hydration Raised heart rate: more than 130 beats per Not passed urine in previous 18 hours. For catheterised patients, passed less than 0.5 ml/kg of urine per hour Raised heart rate: beats per (for pregnant women beats per ) or new onset arrhythmia Not passed urine in the past hours For catheterised patients, passed ml/kg of urine per hour moderate to high risk Temperature Tympanic temperature less than 36 C Skin Non-blanching rash of skin Signs of potential infection, including redness, swelling or discharge at surgical site or breakdown of wound No non-blanching rash

6 Person with possible infection Think could this be sepsis? if they present with signs or symptoms that indicate infection, even if they do not have a high temperature. Be aware that people with sepsis may have non-specific, non-localising presentations (for example, feeling very unwell. Pay particular attention to concerns expressed by the person and family/carer. Take particular care in the assessment of people who might have sepsis who are unable, or their parent/carer is unable, to give a good history (for example, young children, people with English as a second language, people with communication problems) ASSESSMENT Assess people with suspected infection to identify: likely source of infection risk factors (see righthand box) Indicators of clinical of concern such as abnormalities of behaviour, circulation or respiration. Healthcare professionals performing a remote assessment of a person with suspected infection should seek to identify factors that increase risk of sepsis or indicators of clinical concern. People more vulnerable to sepsis the very young (under 1 year) and older people (over 75 years) or very frail people recent trauma or surgery or invasive procedure (within the last 6 weeks) Impaired immunity due to illness or drugs (for example, people receiving steroids, chemotherapy or immunosuppressants) Indwelling lines / catheters / intravenous drug misusers, any breach of skin integrity (for example, any cuts, burns, blisters or skin infections). If at risk of neutropenic sepsis - refer to secondary care Additional risk factors for women who are pregnant or who have been pregnant, given birth, had a termination or miscarriage within the past 6 weeks -gestational diabetes, diabetes or other co-morbidities; needed invasive procedure such as caesarean section, forceps delivery, removal of retained products of conception, prolonged rupture of membranes, close contract with someone with group A streptococcal infection, have continued vaginal bleeding or an offensive vaginal discharge). Sepsis not suspected no clinical cause for concern no risk factors. SUSPECT SEPSIS If sepsis is suspected, use a structured set of observations to assess people in a face-to-face setting. Consider using early warning scores in hospital settings. Parental or carer concern is important and should be acknowledged. Use clinical judgment to treat the person, using NICE guidance relevant to their diagnosis when available. Stratify risk of severe illness and death from sepsis using algorithm appropriate to age and setting

7 Managing suspected sepsis in children aged under 5 years - outside an acute hospital setting Stratify risk of severe illness and death from sepsis using the risk criteria in the stratification tool for children aged under 5 years Behaviour: No response to social cues Appears ill to a healthcare professional Does not wake, or if roused does not stay awake Weak high pitched or continuous cry Aged under 1 year: 160 beats per Aged 1 years: 150 beats per Aged 3 4 years: 140 beats per Heart rate less than 60 beats per at any age Aged under 1 year: 60 breaths per Aged 1 2 years: 50 breaths per Aged 3 4 years: 40 breaths per Grunting Apnoea Oxygen saturation of less than 90% in air or increased oxygen requirement over baseline Temperature: Aged under 3 months: 38 C or more Less than 36ºC Behaviour: Not responding normally to social cues No smile Wakes only with prolonged stimulation Decreased activity Parent or carer concern that child is behaving differently from usual Aged under 1 year: breaths per Aged 1 2 years: breaths per Aged 3 4 years: breaths per Oxygen saturation 91% or less in air or increased oxygen requirement over baseline Nasal flaring Aged under 1 year: beats per Aged 1 2 years: beats per Aged 3 4 years: breaths per Capillary refill time of 3 seconds or more Reduced urine output, or for catheterised patients passed less than 1 ml/kg of urine per hour Pale or flushed Pallor of skin, lips or tongue Temperature: Aged 3 6 months: 39 C or more Leg pain Cold hands or feet Responds normally to social cues Content or smiles Stays awake or awakens quickly Strong normal cry or not crying moderate to high risk Normal colour Provide information about symptoms to monitor and how to access medical care high risk Send patient urgently for emergency care (setting that has resuscitation facilities) Aged under 5 years and immunity compromised AND any moderate to high risk No Can definitive condition be diagnosed and treated in an out of hospital setting? Yes Treat definitive condition and / or provide information to safety net

8 Managing suspected sepsis in children aged under 5 years - in an acute hospital setting Stratify risk of severe illness and death from sepsis using the risk criteria in the stratification tool for children aged under 5 years Behaviour: No response to social cues Appears ill to a healthcare professional Does not wake, or if roused does not stay awake Weak high pitched or continuous cry Aged under 1 year: 160 beats per Aged 1 2 years: 150 beats per Aged 3 4 years: 140 beats per Heart rate less than 60 beats per at any age Aged under 1 year: 60 breaths per Aged 1 2 years: 50 breaths per Aged 3 4 years: 40 breaths per Grunting Apnoea Oxygen saturation of less than 90% in air or increased oxygen requirement over baseline Temperature: Less than 36ºC Aged under 3 months: 38 C or more 1 high risk criterion Arrange immediate review by senior clinical decision maker (paediatric or emergency care ST4 or above or equivalent). Carry out venous blood test for the following: blood gas including glucose and lactate measurement blood culture Full blood count C reactive protein Urea and electrolytes Creatinine Clotting screen Give i.v. antibiotics without delay, and at least within one hour. Discuss with consultant Behaviour: Not responding normally to social cues No smile Wakes only with prolonged stimulation Decreased activity Parent or carer concern that child is behaving differently from usual Aged under 1 year: breaths per Aged 1 2 years: breaths per Aged 3 4 years: breaths per Oxygen saturation of less than 91% in air or increased oxygen requirement over baseline Nasal flaring Aged under 1 year: beats per Aged 1 2 years: beats per Aged 3 4 years: breaths per Capillary refill time of 3 seconds or more Reduced urine output, or for catheterised patients passed less than 1 ml/kg of urine per hour Pale or flushed Pallor of skin, lips or tongue Temperature: Aged 3 6 months: 39 C or more Leg pain Cold hands or feet 2 or more moderate to high risk criteria Perform tests: venous blood for blood culture, FBC, CRP, U/E, creatinine, and blood gas for lactate Clinican review and results review within 1 hour Only 1 moderate to high risk criterion Clinician review and consider blood tests within 1 hour Responds normally to social cues Content or smiles Stays awake or awakens quickly Strong normal cry or not crying moderate to high risk Normal colour Suspected sepsis and no high risk or high to moderate criteria met Clinical assessment and manage according to clinical judgement Lactate > 4 mmol/l Give i.v. fluid (bolus injection) without delay Discuss with critical care Lactate 2 4 Give i.v. fluid (bolus injection) without delay Lactate < 2 Consider i.v. fluids (bolus injection) Carry out observations, at least every 30 s or continuous monitoring in ED. Consultant to attend if not already present if patient does not improve Lactate > 2 mmol / L OR assessed as having AKI* = escalate to high risk Lactate 2 mmol / L and no AKI* If no definitive condition identified, repeat structured assessment at least hourly Ensure review by a senior decision maker within 3 hours for consideration of antibiotics. Manage definitive condition / infection if diagnosed * See Acute kidney injury (NICE guideline CG169)

9 Managing suspected sepsis in children aged 5-11 years - outside an acute hospital setting Stratify risk of severe illness and death from sepsis using the risk criteria in the stratification tool for children aged 5 11 years Objective evidence of altered behaviour or mental state Appears ill to a healthcare professional Does not wake or if roused does not stay awake Aged 5 years: 29 breaths per Aged 6 7 years: 27 breaths per Aged 8 11 years: 25 breaths per Oxygen saturation of less than 90% in air or increased oxygen requirement over baseline Aged 5 years: 130 beats per Aged 6 7 years: 120 beats per Aged 8 11 years: 115 beats per Or heart rate less than 60 beats per at any age Not responding normally to social cues Decreased activity Parent or carer concern that the child is behaving differently from usual Aged 5 years: breaths per Aged 6 7 years: breaths per Aged 8 11 years: breaths per Oxygen saturation of less than 92% in air or increased oxygen requirement over baseline Aged 5 years: beats per Aged 6 7 years: beats per Aged 8 11 years: beats per Or capillary refill time of 3 seconds or more Reduced urine output, or for catheterised patients passed less than 1 ml/kg of urine per hour Leg pain Cold hands or feet Normal behaviour moderate to high risk Provide information about symptoms to monitor and how to access medical care high risk Aged 5 11 years and impaired immune system AND any moderate to high risk Can definitive condition be diagnosed and treated in an out of hospital setting? Yes Send patient urgently for emergency care (setting with facilities for resuscitation) No Treat definitive condition and / or provide information to safety net

10 Managing suspected sepsis in children aged 5-11 years - in an acute hospital setting Stratify risk of severe illness and death from sepsis using the risk criteria in the stratification tool for children aged 5 11 years Objective evidence of altered behaviour or mental state Appears ill to a healthcare professional Does not wake or if roused does not stay awake Aged 5 years: 29 breaths per Aged 6 7 years: 27 breaths per Aged 8 11 years: 25 breaths per Oxygen saturation of less than 90% in air or increased oxygen requirement over baseline Aged 5 years: 130 beats per Aged 6 7 years: 120 beats per Aged 8 11 years: 115 beats per Or heart rate less than 60 beats per at any age Not responding normally to social cues Decreased activity Parent or carer concern that the child is behaving differently from usual Aged 5 years: breaths per Aged 6 7 years: breaths per Aged 8 11 years: breaths per Oxygen saturation of less than 92% in air or increased oxygen requirement over baseline Aged 5 years: beats per Aged 6 7 years: beats per Aged 8 11 years: beats per Or capillary refill time of 3 seconds or more Reduced urine output, or for catheterised patients passed less than 1 ml/kg of urine per hour Leg pain Cold hands or feet Normal behaviour moderate to high risk 1 high risk criterion 2 or more moderate to high risk criteria Only 1 moderate to high risk criterion high to moderate risk Arrange immediate review by senior clinical decision maker (paediatric or emergency care doctor ST4 or above) to assess patient and consider diagnosis and management. Cary out venous blood test for the following: blood gas for glucose and lactate blood culture full blood count C reactive protein urea and electrolytes creatinine clotting screen. Clinician to review person s condition and venous lactate results within 1 hour Carry out venous blood test for the following: blood gas for glucose and lactate blood culture full blood count C reactive protein urea and electrolytes creatinine clotting screen. Clinician review for clinical assessment and consider blood tests within 1 hour Clinical assessment and manage according to clinical judgement Give i.v. antibiotics without delay, and at least within one hour. Discuss with consultant Lactate > 2 mmol / L Lactate 2 mmol / L Lactate > 4 mmol/l Give i.v. fluid (bolus injection) within 1 hour Refer to critical care Lactate 2 4 Give i.v. fluid (bolus injection) within 1 hour Lactate < 2 Consider i.v. fluids (bolus injection) Carry out observations, at least every 30 s or continuous monitoring in ED. Consultant to attend if not already present if patient does not improve If no definitive condition identified, repeat structured assessment at least hourly Ensure review by senior clinical decision maker within 3 hours for consideration of antibiotics. Manage definitive condition. If appropriate discharge with information depending on setting.

11 Managing suspected sepsis in children and young people aged years - outside an acute hospital setting Stratify risk of severe illness and death from sepsis using the risk criteria in the stratification tool for adults, children and young people aged 12 years and over Objective evidence of new altered mental state 25 breaths per OR new need for oxygen (more than 40% FiO2) to maintain saturation more than 92% (or more than 88% in known chronic obstructive pulmonary disease) 130 beats per or above Systolic blood pressure 90 mmhg or less or systolic blood pressure more than 40 mmhg below normal Not passed urine in previous 18 hours or for catheterised patients, passed less than 0.5 ml/kg of urine per hour History from patient, friend or relative of new onset of altered behaviour or mental state History of acute deterioration of functional ability Impaired immune system (illness or drugs including oral steroids) Trauma, surgery or invasive procedures in the last 6 weeks breaths per beats per (for pregnant women beats per ) OR new onset arrhythmia Systolic blood pressure mmhg Not passed urine in the past hours, or for catheterised patients passed ml/kg of urine per hour Tympanic temperature less than 36 C Signs of potential infection, including redness, swelling or discharge at surgical site or breakdown of wound Normal behaviour moderate to high risk criteria met No non blanching rash Provide information about symptoms to monitor and how to access medical care high risk Aged years and immunity compromised AND any moderate to high risk Can definitive condition be diagnosed and treated in an out of hospital setting? Yes Send patient urgently for emergency care No Treat definitive condition and/or provide information to safety net

12 Managing suspected sepsis in children and young people aged years - in an acute hospital setting Stratify risk of severe illness and death from sepsis using the risk criteria in the stratification tool for adults, children and young people aged 12 years and over Objective evidence of new altered mental state 25 breaths per OR new need for oxygen (more than 40% FiO 2 ) to maintain saturation more than 92% (or more than 88% in known chronic obstructive pulmonary disease) 130 beats per or above Systolic blood pressure 90 mmhg or less or systolic blood pressure more than 40 mmhg below normal Not passed urine in previous 18 hours, or for catheterised patients passed less than 0.5 ml/kg of urine per hour History from patient, friend or relative of new onset of altered behaviour or mental state History of acute deterioration of functional ability Impaired immune system (illness or drugs including oral steroids) Trauma, surgery or invasive procedures in the last 6 weeks breaths per beats per (for pregnant women beats per ) OR new onset arrhythmia Systolic blood pressure mmhg Not passed urine in the past hours, or for catheterised patients passed ml/kg of urine per hour Tympanic temperature less than 36 C Signs of potential infection, including redness, swelling or discharge at surgical site or breakdown of wound Suspected sepsis, but: Normal behaviour moderate to high risk No non blanching rash 1 high risk criterion Arrange immediate review by senior clinical decision maker (paediatric or emergency care ST4 or above or equivalent). Carry out venous blood test for the following: blood gas including glucose and lactate measurement blood culture Full blood count C reactive protein Urea and electrolytes Creatinine Clotting screen Give i.v. antibiotics without delay, and at least within one hour. Discuss with consultant 2 or more moderate to high risk criteria OR SBP: mmhg Perform tests: venous blood for blood culture, FBC, CRP, U/E, creatinine, and blood gas for lactate Clinican review and results review within 1 hour Only 1 moderate to high risk criterion Clinician review and consider blood tests within 1 hour Suspected sepsis and no high risk or high to moderate Clinical assessment and manage according to clinical judgement Lactate > 4 mmol/l OR SBP < 90 mmhg Give i.v. fluid (bolus injection) without delay Discuss with critical care Lactate 2 4 Give i.v. fluid (bolus injection) without delay Lactate < 2 Consider i.v. fluids (bolus injection) Lactate > 2 mmol / L OR assessed as having AKI* = escalate to high risk Lactate 2 mmol / L and no AKI* If no definitive condition identified, repeat structured assessment at least hourly Ensure review by a senior decision maker within 3 hours for consideration of antibiotics. Manage definitive condition / infection if diagnosed * See Acute kidney injury (NICE guideline CG169) Carry out observations, at least every 30 s or continuous monitoring in ED. Consultant to attend if not already present if patient does not improve

13 Managing suspected sepsis in adults and young people aged 18 years and over - outside an acute hospital setting Stratify risk of severe illness and death from sepsis using the risk criteria in the stratification tool for adults, children and young people aged 12 years and over Objective evidence of new altered mental state 25 breaths per OR new need for oxygen (more than 40% FiO2) to maintain saturation more than 92% (or more than 88% in known chronic obstructive pulmonary disease) 130 beats per or above Systolic blood pressure 90 mmhg or less or systolic blood pressure more than 40 mmhg below normal Not passed urine in previous 18 hours, or for catheterised patients passed less than 0.5 ml/kg of urine per hour History from patient, friend or relative of new onset of altered behaviour or mental state History of acute deterioration of functional ability Impaired immune system (illness or drugs including oral steroids) Trauma, surgery or invasive procedures in the last 6 weeks breaths per beats per (for pregnant women beats per ) OR new onset arrhythmia Systolic blood pressure mmhg Not passed urine in the past hours, or for catheterised patients passed ml/kg of urine per hour Tympanic temperature less than 36 C Signs of potential infection, including redness, swelling or discharge at surgical site or breakdown of wound Normal behaviour moderate to high risk Provide information about symptoms to monitor and how to access medical care high risk Can definitive condition be diagnosed and treated in an out of hospital setting? Yes Send patient urgently for emergency care (setting with resuscitation facilities) No Treat definitive condition and/or provide information to safety net

14 Managing suspected sepsis in adults and young people aged 18 years and over - in an acute hospital setting Stratify risk of severe illness and death from sepsis using the risk criteria in the stratification tool for adults, children and young people aged 12 years and over Objective evidence of new altered mental state 25 breaths per OR new need for oxygen (more than 40% FiO2) to maintain saturation more than 92% (or more than 88% in known chronic obstructive pulmonary disease) 130 beats per or above Systolic blood pressure 90 mmhg or less or systolic blood pressure more than 40 mmhg below normal Not passed urine in previous 18 hours, or for catheterised patients passed less than 0.5 ml/kg of urine per hour History from patient, friend or relative of new onset of altered behaviour or mental state History of acute deterioration of functional ability Impaired immune system (illness or drugs including oral steroids) Trauma, surgery or invasive procedures in the last 6 weeks breaths per bets per (for pregnant women beats per ) OR new onset arrhythmia Systolic blood pressure mmhg Not passed urine in the past hours, or for catheterised patients passed ml/kg of urine per hour Tympanic temperature less than 36 C Signs of potential infection, including redness, swelling or discharge at surgical site or breakdown of wound Suspected sepsis, but: Normal behaviour moderate to high risk 1 high risk criterion Arrange immediate review by senior clinical decision maker (person authorised to prescribe antibiotics, such as CT3/ST3 and above or advanced nurse practitioner). Carry out venous blood test for the following: blood gas including glucose and lactate measurement blood culture full blood count C reactive protein urea and electrolytes creatinine clotting screen. Give intravenous antibiotics without delay, and at least within one hour of identification of high risk criteria. 2 or more moderate to high risk criteria OR SBP: mmhg Clinician to review person s condition and venous lactate results within 1 hour Carry out venous blood test for the following: blood gas including lactate measurement blood culture full blood count C reactive protein urea and electrolytes creatinine. Only 1 moderate to high risk criterion Clinician review within 1 hour and perform blood tests if indicated Suspected sepsis and no high risk or high to moderate risk Clinical assessment and manage according to clinical judgement Use an intravenous antimicrobial from agreed local formulary and in line with local (where available) or national guidelines. Discuss with consultant Lactate > 4 mmol/l OR SBP < 90 mmhg Give i.v. fluid (500 ml over less than 15 s) without delay Refer to critical care Lactate 2 4 Give i.v. fluid (500 ml over less than 15 s) without delay Lactate < 2 Consider i.v. fluids. Lactate > 2 mmol / L OR assessed as having AKI* = escalate to high risk Lactate 2 mmol / L and no AKI* If no definitive condition identified, repeat structured assessment at least hourly Ensure review by a senior decision maker within 3 hours for consideration of antibiotics. Manage definitive condition / infection if diagnosed Carry out observations, at least every 30 s or continuous monitoring in ED. Consultant to attend if not already present if patient does not improve * See Acute kidney injury (NICE guideline CG169)

Sepsis: recognition, diagnosis and management

Sepsis: recognition, diagnosis and management Sepsis: recognition, diagnosis and management NICE guideline: short version Draft for consultation, January, 0 This guideline covers the recognition, diagnosis and early management of sepsis for all populations.

More information

Monitoring the condition of the mother during the first stage of labour

Monitoring the condition of the mother during the first stage of labour Before you begin this unit, please take the corresponding test at the end of the book to assess your knowledge of the subject matter. You should redo the test after you ve worked through the unit, to evaluate

More information

MODULE 6: Patient Assessment & Evaluation

MODULE 6: Patient Assessment & Evaluation MODULE 6: Patient Assessment & Evaluation Dengue Clinical Management Acknowledgements This curriculum was developed with technical assistance from the University of Malaya Medical Centre. Materials were

More information

Sepsis: Identification and Treatment

Sepsis: Identification and Treatment Sepsis: Identification and Treatment Daniel Z. Uslan, MD Associate Clinical Professor Division of Infectious Diseases Medical Director, UCLA Sepsis Task Force Severe Sepsis: A Significant Healthcare Challenge

More information

Sepsis. Introduction. Sepsis, septicaemia and blood poisoning

Sepsis. Introduction. Sepsis, septicaemia and blood poisoning Sepsis Introduction Sepsis, septicaemia and blood poisoning Sepsis is often referred to as either blood poisoning or septicaemia, although it could be argued that both terms are not entirely accurate.

More information

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic. Diabetic ketoacidosis in children and young people bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They

More information

Diabetic Ketoacidosis

Diabetic Ketoacidosis Princess Margaret Hospital for Children PAEDIATRIC ACUTE CARE GUIDELINE Diabetic Ketoacidosis Scope (Staff): Scope (Area): All Emergency Department Clinicians Emergency Department This document should

More information

INTRAVENOUS FLUIDS. Acknowledgement. Background. Starship Children s Health Clinical Guideline

INTRAVENOUS FLUIDS. Acknowledgement. Background. Starship Children s Health Clinical Guideline Acknowledgements Background Well child with normal hydration Unwell children (+/- abnormal hydration Maintenance Deficit Ongoing losses (e.g. from drains) Which fluid? Monitoring Special Fluids Post-operative

More information

POAC CLINICAL GUIDELINE

POAC CLINICAL GUIDELINE POAC CLINICAL GUIDELINE Acute Pylonephritis DIAGNOSIS COMPLICATED PYELONEPHRITIS EXCLUSION CRITERIA: Male Known or suspected renal impairment (egfr < 60) Abnormality of renal tract Known or suspected renal

More information

FEVER - INVESTIGATION & MANAGEMENT.

FEVER - INVESTIGATION & MANAGEMENT. Introduction Children < 6 weeks of age, any fever Children 6 weeks 3 months, any fever Children 3 months to 2 years, fever > 38.9 C When to use antipyretics &/or analgesia References Introduction Important

More information

Early Warning Scores (EWS) Clinical Sessions 2011 By Bhavin Doshi

Early Warning Scores (EWS) Clinical Sessions 2011 By Bhavin Doshi Early Warning Scores (EWS) Clinical Sessions 2011 By Bhavin Doshi What is EWS? After qualifying, junior doctors are expected to distinguish between the moderately sick patients who can be managed in the

More information

Sepsis: What You Should Know

Sepsis: What You Should Know Issues & Answers Sepsis: What You Should Know Answers to your questions about what it is and how it is treated in the ICU. 2003 SCCM Your doctor or the intensivist (a doctor with special expertise and

More information

Sepsis Awareness Month

Sepsis Awareness Month Aon Kenya Insurance Brokers Ltd Aon Hewitt Healthcare Division Sepsis Awareness Month Issue 11 September 2015 In this Issue 2 Getting to understand Sepsis 3 Stages in Sepsis Advancement 4 Diagnosis & Treatment

More information

Nephrotic syndrome. Paediatrics

Nephrotic syndrome. Paediatrics What is nephrotic syndrome? Nephrotic syndrome is a condition where too much protein from the blood leaks through the filters in the kidneys and into the urine (wee). This causes children with nephrotic

More information

Hot topics in Acute Medicine

Hot topics in Acute Medicine Hot topics in Acute Medicine Dr Ben Mearns FRCP Consultant Physician in Acute & Elderly Medicine Chief of Medicine Surrey & Sussex Healthcare NHS Trust @BenMearns ben.mearns@sash.nhs.uk Mr A - History

More information

Feverish illness in children Assessment and initial management in children younger than 5 years

Feverish illness in children Assessment and initial management in children younger than 5 years Feverish illness in children Assessment and initial management in children younger than 5 years NICE guideline Draft for consultation, November 2012 If you wish to comment on this version of the guideline,

More information

RITUXIMAB (Rituxan) Rituximab 2007 Page 1 of 5

RITUXIMAB (Rituxan) Rituximab 2007 Page 1 of 5 RITUXIMAB (Rituxan) Rituximab is FDA approved for the treatment of low-grade or follicular CD20-positive, B-cell non-hodgkin's lymphoma (NHL); treatment of diffuse large B-cell CD20-positive NHL; treatment

More information

Information for Patients

Information for Patients Royal United Hospital Bath NHS Trust Information for Patients Preventing blood clots during and after a stay in hospital Healthcare you can Trust What is a Deep Vein Thrombosis (DVT)? A DVT occurs when

More information

Preventing Venous Thromboembolism

Preventing Venous Thromboembolism Preventing Venous Thromboembolism (VTE) Patient Information Thrombosis Patient Safety Committee What is VTE? VTE is the name given to either a deep vein thrombosis (DVT) or a pulmonary embolism (PE). A

More information

Intro Who should read this document 2 Key Messages 2 Background 2

Intro Who should read this document 2 Key Messages 2 Background 2 Classification: Policy Lead Author: Nathan Griffiths, Consultant Nurse Paediatric Emergency Medicine Additional author(s): N/A Authors Division: Salford Healthcare Unique ID: DDCPan04(14) Issue number:

More information

Anaemia Patient information

Anaemia Patient information Anaemia Patient information What is anaemia? Anaemia is the result of either not having enough red cells to take oxygen around the body, or having faulty red cells that are unable to carry enough oxygen.

More information

Recommendation for management of febrile neutropenia in AML

Recommendation for management of febrile neutropenia in AML Recommendation for management of febrile neutropenia in AML Febrile neutropenia in AML is a high- risk medical emergency and individualisation of management is often warranted. This recommendation is to

More information

Management of Pre-Labour Rupture of Membranes at Term (PROM)

Management of Pre-Labour Rupture of Membranes at Term (PROM) Management of Pre-Labour Rupture of Membranes at Term (PROM) Definitions Pre-labour rupture of membranes (PROM) at term is defined as a rupture of the membranes prior to the onset of labour for women over

More information

Cellulitis. Patient information Leaflet. Leaflet no: GMed 005 Version 1.2

Cellulitis. Patient information Leaflet. Leaflet no: GMed 005 Version 1.2 Cellulitis Patient information Leaflet Leaflet no: GMed 005 Version 1.2 October 2013 What is Cellulitis? Cellulitis is a bacterial infection of the deep layer of skin (dermis) and the layer of fat and

More information

Acute Kidney Injury. An information guide

Acute Kidney Injury. An information guide TO PROVIDE THE VERY BEST CARE FOR EACH PATIENT ON EVERY OCCASION Acute Kidney Injury An information guide Acute Kidney Injury What is acute kidney injury (AKI)? Acute Kidney Injury or AKI is a sudden and

More information

The Family Library. Understanding Diabetes

The Family Library. Understanding Diabetes The Family Library Understanding Diabetes What is Diabetes? Diabetes is caused when the body has a problem in making or using insulin. Insulin is a hormone secreted by the pancreas and is needed for the

More information

CLINICAL SKILLS: THE 'DR ABCDE' ASSESSMENT

CLINICAL SKILLS: THE 'DR ABCDE' ASSESSMENT CLINICAL SKILLS: THE 'DR ABCDE' ASSESSMENT The 'DR ABCDE' approach to assessing an acutely unwell patient should be at the front of every junior doctor's mind whenever they get bleeped or asked to see

More information

NICE guideline Published: 9 December 2015 nice.org.uk/guidance/ng29

NICE guideline Published: 9 December 2015 nice.org.uk/guidance/ng29 Intravenous fluid therapy in children and young people in hospital NICE guideline Published: 9 December 2015 nice.org.uk/guidance/ng29 NICE 2015. All rights reserved. Contents Key priorities for implementation...

More information

Lothian Diabetes Handbook MANAGEMENT OF DIABETIC KETOACIDOSIS

Lothian Diabetes Handbook MANAGEMENT OF DIABETIC KETOACIDOSIS MANAGEMENT OF DIABETIC KETOACIDOSIS 90 MANAGEMENT OF DIABETIC KETOACIDOSIS Diagnosis elevated plasma and/or urinary ketones metabolic acidosis (raised H + /low serum bicarbonate) Remember that hyperglycaemia,

More information

Managing an Exacerbation of Your Chronic Obstructive Pulmonary Disease (COPD)

Managing an Exacerbation of Your Chronic Obstructive Pulmonary Disease (COPD) Managing an Exacerbation of Your Chronic Obstructive Pulmonary Disease Patient held record and self-management plan Keep this in a safe place and bring it with you to GP or hospital visits, including admissions.

More information

HOW MANY PATIENTS SUFFER FROM POST-OPERATIVE SEPSIS? WHAT IS SEPSIS?

HOW MANY PATIENTS SUFFER FROM POST-OPERATIVE SEPSIS? WHAT IS SEPSIS? SEPSIS: Information About Post-Operative Sepsis for Patients and Relatives WHAT IS SEPSIS? Sepsis is a life threatening condition that arises when the body s response to an infection injures its own tissues

More information

Health Care Decision Making Worksheet. Instructions

Health Care Decision Making Worksheet. Instructions Health Care Decision Making Worksheet Instructions Use this worksheet either to indicate current treatment preferences (which will be reflected in Maryland MOLST orders) or to clarify wishes for future

More information

DT- PACE chemotherapy for myeloma

DT- PACE chemotherapy for myeloma Patient information DT- PACE chemotherapy for myeloma Your doctors have suggested that you are likely to benefit from chemotherapy treatment. They are recommending a standard form of treatment called DT-PACE

More information

Paclitaxel and Carboplatin

Paclitaxel and Carboplatin PATIENT EDUCATION patienteducation.osumc.edu What is Paclitaxel (pak-li-tax-el) and how does it work? Paclitaxel is a chemotherapy drug known as an anti-microtubule inhibitor. Another name for this drug

More information

Summary of EWS Policy for NHSP Staff

Summary of EWS Policy for NHSP Staff Summary of EWS Policy for NHSP Staff For full version see CMFT Intranet Contact Sister Donna Egan outreach coordinator bleep 8742 Tel: 0161 276 8742 Introduction The close monitoring of patients physiological

More information

CLINICAL GUIDELINE FOR MANAGEMENT OF NEUTROPENIC SEPSIS IN CANCER PATIENTS 1. Aim/Purpose of this Guideline

CLINICAL GUIDELINE FOR MANAGEMENT OF NEUTROPENIC SEPSIS IN CANCER PATIENTS 1. Aim/Purpose of this Guideline CLINICAL GUIDELINE FOR MANAGEMENT OF NEUTROPENIC SEPSIS IN CANCER PATIENTS 1. Aim/Purpose of this Guideline 1.1. Systemic cancer treatments and immunological therapies can suppress the ability of the bone

More information

Chickenpox in pregnancy: what you need to know

Chickenpox in pregnancy: what you need to know Chickenpox in pregnancy: what you need to know Published December 2003 Contents Page number Key points 1 About this information 2 What is chickenpox? 2 What should I do if I come into contact with chickenpox?

More information

X-Plain Heart Valve Replacement Reference Summary

X-Plain Heart Valve Replacement Reference Summary X-Plain Heart Valve Replacement Reference Summary Introduction Sometimes people have serious problems with their heart valves. A heart valve repair or replacement surgery restores or replaces a defective

More information

Heart disorders (acquired) - children

Heart disorders (acquired) - children Heart disorders (acquired) - children Summary An acquired heart defect develops in children after a disease. There are four types of acquired heart defect. All children with heart defects have special

More information

RGN JOY LAUDE WATFORD GENERAL HOSPITAL, ENGLAND

RGN JOY LAUDE WATFORD GENERAL HOSPITAL, ENGLAND RGN JOY LAUDE WATFORD GENERAL HOSPITAL, ENGLAND Monitor patient on the ward to detect trends in vital signs and to manage accordingly To recognise deteriorating trends and request relevant medical/out

More information

GUIDELINES FOR MANAGEMENT OF PEDIATRIC DKA IMMEDIATE ASSESSMENT

GUIDELINES FOR MANAGEMENT OF PEDIATRIC DKA IMMEDIATE ASSESSMENT GUIDELINES FOR MANAGEMENT OF PEDIATRIC DKA IMMEDIATE ASSESSMENT PLEASE NOTE: the DKA protocol and supplementary material are designed as a guideline/algorithm for treating the majority of cases of DKA

More information

Chronic Kidney/Renal Disease

Chronic Kidney/Renal Disease What is chronic kidney disease or failure? Chronic Kidney/Renal Disease Kidney disease means that something is abnormal about the structure or function of one or both kidneys. Most often, kidney disease

More information

How to prevent blood clots whilst in hospital and after your return home

How to prevent blood clots whilst in hospital and after your return home How to prevent blood clots whilst in hospital and after your return home Patient information WHAT What IS is DEEP deep VEIN vein THROMBOSIS? thrombosis? Deep Vein Thrombosis DVT is a blood clot within

More information

Immune Thrombocytopenia (ITP)

Immune Thrombocytopenia (ITP) Immune Thrombocytopenia (ITP) ITP - What is it? ITP is a blood disorder affecting platelets in the blood. Platelets are small cells in your blood that help your blood to clot. In ITP the body s immune

More information

An avoidable death of a three-year-old child from sepsis

An avoidable death of a three-year-old child from sepsis An avoidable death of a three-year-old child from sepsis A report by the Health Service Ombudsman for England on an investigation into a complaint from Mr and Mrs Morrish about The Cricketfield Surgery,

More information

Mycophenolate Mofetil. Monitoring and Dosage Record For patients with neuromuscular disease

Mycophenolate Mofetil. Monitoring and Dosage Record For patients with neuromuscular disease This booklet has been written and developed by the Neuromuscular Clinical Nurse Specialists at The National Hospital for Neurology and Neurosurgery. For further information please contact the relevant

More information

Trust Guideline for the Management of: Condition or Procedure in Adults and / or Children

Trust Guideline for the Management of: Condition or Procedure in Adults and / or Children Trust Guideline for the Management of: Condition or Procedure in Adults and / or Children A clinical guideline recommended for use In: By: For: Key words: Written by: Acute Medicine Unit Medical Staff

More information

Deep vein thrombosis and being in hospital

Deep vein thrombosis and being in hospital Deep vein thrombosis and being in hospital Exceptional healthcare, personally delivered Deep vein thrombosis is a well defined medical condition that can develop when someone is ill or having an operation.

More information

Sores That Will Not Heal

Sores That Will Not Heal Sores That Will Not Heal Introduction Some sores have trouble healing on their own. Sores that will not heal are a common problem. Open sores that will not heal are also known as wounds or skin ulcers.

More information

Clinical Performance Director of Nursing Allison Bussey

Clinical Performance Director of Nursing Allison Bussey PGD 0314 Patient Group Direction Administration of Adrenaline (Epinephrine) 1:1000 (1mg/ml) Injection By Registered Nurses employed by South Staffordshire & Shropshire Healthcare Foundation NHS Trust This

More information

Patient Guide. Important information for patients starting therapy with LEMTRADA (alemtuzumab)

Patient Guide. Important information for patients starting therapy with LEMTRADA (alemtuzumab) Patient Guide Important information for patients starting therapy with LEMTRADA (alemtuzumab) This medicinal product is subject to additional monitoring. This will allow quick identification of new safety

More information

DeKalb Medical North Decatur Quality Measures for Surgical Care Improvement Project September 2011

DeKalb Medical North Decatur Quality Measures for Surgical Care Improvement Project September 2011 DeKalb Medical North Decatur Quality Measures for Surgical Care Improvement Project September 2011 Why does this matter? Surgical wound infections can be prevented. Medical research shows that surgery

More information

Preventing Venous Thromboembolism (VTE)

Preventing Venous Thromboembolism (VTE) Preventing Venous Thromboembolism (VTE) UHN Information about blood clots in veins, also known as Deep Vein Thrombosis and Pulmonary Embolism This brochure will help you to understand: Deep Vein Thrombosis

More information

Nurse Practitioner Emergency Services CLINICAL PRACTICE GUIDELINE

Nurse Practitioner Emergency Services CLINICAL PRACTICE GUIDELINE Nurse Practitioner Scope Adults with acute onset of diarrhoea +/- vomiting suitable for NP Medical Practitioner +/- Nurse Practitioner Underlying medical pathology / complex patient Chronic onset +/- recent

More information

Community health care services Alternatives to acute admission & Facilitated discharge options. Directory

Community health care services Alternatives to acute admission & Facilitated discharge options. Directory Community health care services Alternatives to acute admission & Facilitated discharge options Directory Introduction The purpose of this directory is to provide primary and secondary health and social

More information

Paediatric Advanced Warning Score (PAWS)

Paediatric Advanced Warning Score (PAWS) Paediatric Advanced Warning Score (PAWS) Prevention is better than cure. Spectrum of critical illness Ward level care HDU Care ICU Care Early admission may improve outcome ICU Outreach teams Medical Emergency

More information

INTRODUCTION TO THE EMERGENCY DEPARTMENT

INTRODUCTION TO THE EMERGENCY DEPARTMENT INTRODUCTION TO THE EMERGENCY DEPARTMENT Welcome to the Emergency Department. It is hoped that your time here will be both educational and enjoyable. The emergency department is called the gateway to the

More information

C Take control of OPD. and your life. Chronic Obstructive Pulmonary Disease. a practical guide to living with. brought to you by

C Take control of OPD. and your life. Chronic Obstructive Pulmonary Disease. a practical guide to living with. brought to you by C Take control of and your life Chronic Obstructive Pulmonary Disease OPD a practical guide to living with brought to you by MY PERSONAL PLAN I will work on the following areas to manage my COPD: Take

More information

0.18% w/v Sodium Chloride and 4% w/v Glucose Intravenous Infusion BP Solution for infusion (Sodium chloride, Glucose)

0.18% w/v Sodium Chloride and 4% w/v Glucose Intravenous Infusion BP Solution for infusion (Sodium chloride, Glucose) PACKAGE LEAFLET: INFORMATION FOR THE USER B. Braun Melsungen AG 34209 Melsungen, Germany 0.18% w/v Sodium Chloride and 4% w/v Glucose Intravenous Infusion BP Solution for infusion (Sodium chloride, Glucose)

More information

Paediatric fluids 13/06/05

Paediatric fluids 13/06/05 Dr Catharine Wilson Consultant Paediatric Anaesthetist Sheffield Children s Hospital. UK Paediatric fluids 13/06/05 Self assessment: Complete these questions before reading the tutorial. Discuss the answers

More information

Infliximab is used to treat psoriasis, psoriatic arthritis, and several other inflammatory conditions, including other inflammatory skin diseases.

Infliximab is used to treat psoriasis, psoriatic arthritis, and several other inflammatory conditions, including other inflammatory skin diseases. INFLIXIMAB What are the aims of this leaflet? This leaflet has been written to help you understand more about the medication infliximab. It tells you what it is, how it works, how it is used to treat skin

More information

Neonatal respiratory distress including CPAP

Neonatal respiratory distress including CPAP Department of Health Neonatal respiratory distress including CPAP Clinical Guideline Presentation v2.0 45 minutes Towards your CPD Hours Great state. Great opportunity. References: The Queensland Clinical

More information

Edema. Edema can also be caused by certain medical conditions or medications. It is also common in pregnant women.

Edema. Edema can also be caused by certain medical conditions or medications. It is also common in pregnant women. Edema Introduction Edema is swelling caused by extra fluid in the tissue of the body. It usually happens in the feet, ankles and legs, but it can involve your entire body. There are many causes of edema,

More information

trust clinical guideline

trust clinical guideline CG23 VERSION 1.0 1/7 Guideline ID CG23 Version 1.0 Title Approved by Transient Loss of Consciousness Clinical Effectiveness Group Date Issued 01/01/2013 Review Date 31/12/2016 Directorate Authorised Staff

More information

QUESTIONS TO ASK MY DOCTOR

QUESTIONS TO ASK MY DOCTOR Be a part of the treatment decision by asking questions QUESTIONS TO ASK MY DOCTOR FOR PATIENTS WITH ADVANCED STOMACH OR GASTROESOPHAGEAL JUNCTION (GEJ) CANCER CYRAMZA (ramucirumab) is used alone or in

More information

INTRODUCTION Thrombophilia deep vein thrombosis DVT pulmonary embolism PE inherited thrombophilia

INTRODUCTION Thrombophilia deep vein thrombosis DVT pulmonary embolism PE inherited thrombophilia INTRODUCTION Thrombophilia (Hypercoagulability) is a condition in which a person forms blood clots more than normal. Blood clots may occur in the arms or legs (e.g., deep vein thrombosis DVT), the lungs

More information

Epidural Continuous Infusion. Patient information Leaflet

Epidural Continuous Infusion. Patient information Leaflet Epidural Continuous Infusion Patient information Leaflet April 2015 Introduction You may already know that epidural s are often used to treat pain during childbirth. This same technique can also used as

More information

Gemcitabine and Cisplatin

Gemcitabine and Cisplatin PATIENT EDUCATION patienteducation.osumc.edu What is Gemcitabine (jem-site-a been)? Gemcitabine is a chemotherapy medicine known as an anti-metabolite. Another name for this drug is Gemzar. This drug is

More information

Nursing college, Second stage Microbiology Dr.Nada Khazal K. Hendi L14: Hospital acquired infection, nosocomial infection

Nursing college, Second stage Microbiology Dr.Nada Khazal K. Hendi L14: Hospital acquired infection, nosocomial infection L14: Hospital acquired infection, nosocomial infection Definition A hospital acquired infection, also called a nosocomial infection, is an infection that first appears between 48 hours and four days after

More information

Further information You can get more information and share your experience at

Further information You can get more information and share your experience at GS23 Laparoscopic Incisional Hernia Repair Further information You can get more information and share your experience at www.aboutmyhealth.org Local information If you have any questions or concerns about

More information

Hospital Acquired Thrombosis (Blood Clot)

Hospital Acquired Thrombosis (Blood Clot) Hospital Acquired Thrombosis (Blood Clot) Thrombosis Committee Patient Information Hospital Acquired Thrombosis Introduction Any patient admitted to hospital is potentially at risk of developing a blood

More information

Protecting your baby against meningitis and septicaemia

Protecting your baby against meningitis and septicaemia Protecting your baby against meningitis and septicaemia caused by meningococcal B bacteria MenB vaccine now available! Information about the MenB vaccine and recommended paracetamol use mmunisation The

More information

Gestational Hypertension

Gestational Hypertension Gestational Hypertension Introduction Hypertension is high blood pressure. High blood pressure that starts after 20 weeks of pregnancy is known as gestational hypertension. Approximately 8 out of every

More information

Pradaxa Introduction for New Users

Pradaxa Introduction for New Users Pradaxa Introduction for New Users Introduction Blood clots frequently happen in people who have diseases of the blood vessels or heart. They may pose a dangerous threat to some people. Blood clots may

More information

Total Abdominal Hysterectomy

Total Abdominal Hysterectomy What is a total abdominal hysterectomy? Is the removal of the uterus and cervix through an abdominal incision (either an up and down or bikini cut). Removal of the ovaries and tubes depends on the patient.

More information

RISK FOR INFECTION IN THE LATE PRETERM INFANT

RISK FOR INFECTION IN THE LATE PRETERM INFANT RISK FOR INFECTION IN THE LATE PRETERM INFANT Late preterm infants are at greater risk of having an infection caused by bacteria. An infection in the uterine environment is sometimes the reason for early

More information

Preventing blood clots (Venous Thromboembolism) when you have had a lower limb injury

Preventing blood clots (Venous Thromboembolism) when you have had a lower limb injury Preventing blood clots (Venous Thromboembolism) when you have had a lower limb injury Information for Patients The York Hospital Tel: 01904 631313 Scarborough Hospital Tel: 01723 368111 Working together

More information

ERYTHEMA MULTIFORME. What are the aims of this leaflet?

ERYTHEMA MULTIFORME. What are the aims of this leaflet? ERYTHEMA MULTIFORME What are the aims of this leaflet? This leaflet has been written to help you understand more about erythema multiforme. It tells you what it is, what causes it, what can be done about

More information

Self-management plan for COPD

Self-management plan for COPD Sheffield Clinical Commissioning Group Sheffield Teaching Hospitals NHS Foundation Trust Self-management plan for COPD This is your personal management plan The aim of the plan is to help you have better

More information

Quality Scorecard overall heart attack care overall heart failure overall pneumonia care overall surgical infection rate patient safety survival

Quality Scorecard overall heart attack care overall heart failure overall pneumonia care overall surgical infection rate patient safety survival Quality Scorecard s are required to report quality statistics to the s for Medicare and Medicaid Services (CMS) and the Department of Health (DOH). This information is made available at www.hospitalcompare.hhs.gov

More information

Total Vaginal Hysterectomy

Total Vaginal Hysterectomy What is a total vaginal hysterectomy? Is the removal of the uterus and cervix through the vagina. Removal of the ovaries and tubes depends on the patient. Why is this surgery used? To treat disease of

More information

PAIN MEDICINES AND YOUR KIDNEYS

PAIN MEDICINES AND YOUR KIDNEYS PAIN MEDICINES AND YOUR KIDNEYS What You Need to Know www.kidney.org National Kidney Foundation's Kidney Disease Outcomes Quality Initiative Did you know that the National Kidney Foundation's Kidney Disease

More information

Diabetic Ketoacidosis - Integrated Care Pathway

Diabetic Ketoacidosis - Integrated Care Pathway label Date:... /... /... Consultant: Time:...hours of doctor: Bleep Number Diabetic Ketoacidosis - Integrated Care Pathway Confirmation of diabetic ketoacidosis: all three of the following must be present

More information

WARNING, CONTRAINDICATIONS, WARNINGS AND PRECAUTIONS,

WARNING, CONTRAINDICATIONS, WARNINGS AND PRECAUTIONS, FACT SHEET BRANDED/GENERIC NAME: ABRAXANE for Injectable Suspension (paclitaxel protein-bound particles for injectable suspension) (albumin-bound) ABRAXANE is an albumin-bound form of paclitaxel with a

More information

Postpartum infection guideline (GL893)

Postpartum infection guideline (GL893) Postpartum infection guideline (GL893) Approval Approval Group Job Title, Chair of Committee Date Maternity & Children s Services Clinical Governance Committee Chair, Maternity Clinical Governance Committee

More information

Hysteroscopy. What is a hysteroscopy? When is this surgery used? How do I prepare for surgery?

Hysteroscopy. What is a hysteroscopy? When is this surgery used? How do I prepare for surgery? What is a hysteroscopy? This is a procedure where a doctor uses a thin tube with a tiny camera to look inside the uterus. There are no incisions. Saline solution is used to expand the uterus in order to

More information

Q2: And why is NICE recommending that this test should be carried out?

Q2: And why is NICE recommending that this test should be carried out? Podcast transcript Hello and welcome to this podcast on the NICE clinical guideline on pneumonia. I m with Michael Moore, Professor of Primary Care Research, National Clinical Champion for Antimicrobial

More information

INFUSE Bone Graft. Patient Information Brochure

INFUSE Bone Graft. Patient Information Brochure INFUSE Bone Graft Patient Information Brochure This Patient Guide is designed to help you decide whether or not to have surgery using INFUSE Bone Graft to treat your broken tibia (lower leg). There are

More information

The Fever and Antipyretic in Critically illness Evaluation study. (The FACE study)

The Fever and Antipyretic in Critically illness Evaluation study. (The FACE study) The Fever and Antipyretic in Critically illness Evaluation study (The FACE study) Rationale; Fever is associated with various critically ill conditions. The incidence of mild hyperthermia (defined more

More information

Cardio-Pulmonary Resuscitation (CPR): A Decision Aid For. KGH Patients And Their Families

Cardio-Pulmonary Resuscitation (CPR): A Decision Aid For. KGH Patients And Their Families Cardio-Pulmonary Resuscitation (CPR): A Decision Aid For KGH Patients And Their Families The goal of this pamphlet is to provide information about cardiopulmonary resuscitation (CPR) so you can be adequately

More information

This information explains the advice about tuberculosis (TB) that is set out in NICE guideline 33.

This information explains the advice about tuberculosis (TB) that is set out in NICE guideline 33. Tuberculosis: prevention, ention, diagnosis, management and service organisation Information for the public Published: 13 January 2016 nice.org.uk About this information NICE guidelines provide advice

More information

KIDNEY (RENAL) EMBOLISATION PATIENT INFORMATION

KIDNEY (RENAL) EMBOLISATION PATIENT INFORMATION KIDNEY (RENAL) EMBOLISATION PATIENT INFORMATION ADHB Urology Department; Reviewed FEB 2005 Ubix code UPEB4 1 The information contained in this booklet is intended to assist you in understanding your proposed

More information

New Zealand Consumer Medicine Information

New Zealand Consumer Medicine Information New Zealand Consumer Medicine Information Actilyse Alteplase What is in this leaflet This leaflet answers some common questions about Actilyse. It does not contain all available information. It does not

More information

TCH: Docetaxel, Carboplatin and Trastuzumab

TCH: Docetaxel, Carboplatin and Trastuzumab PATIENT EDUCATION patienteducation.osumc.edu TCH: Docetaxel, Carboplatin and Trastuzumab What is TCH? It is the short name for the drugs used for this chemotherapy treatment. The three drugs you will receive

More information

CELLULITIS. Cellulitis is a common presentation to the Emergency Department.

CELLULITIS. Cellulitis is a common presentation to the Emergency Department. CELLULITIS Introduction Cellulitis is a common presentation to the Emergency Department. The term cellulitis refers to an uncomplicated non-necrotizing acute infection of the skin that involves the mid

More information

Mycophenolate. Dosage and monitoring record for patients with interstitial lung disease

Mycophenolate. Dosage and monitoring record for patients with interstitial lung disease Mycophenolate Dosage and monitoring record for patients with interstitial lung disease This booklet contains information about your immunosuppressant treatment. Keep this booklet with you at all times

More information

Abdominal Surgery. Surgical removal of a mass or masses from the abdomen through an abdominal incision-either up and down or bikini cut.

Abdominal Surgery. Surgical removal of a mass or masses from the abdomen through an abdominal incision-either up and down or bikini cut. What is an abdominal surgery? Surgical removal of a mass or masses from the abdomen through an abdominal incision-either up and down or bikini cut. Why is this surgery used? To treat disease of the uterus,

More information

Deep Vein Thrombosis (DVT) and Warfarin

Deep Vein Thrombosis (DVT) and Warfarin Deep Vein Thrombosis (DVT) and Warfarin A guide to your diagnosis and treatment Information for patients, relatives and carers Anticoagulant Clinic Tel: 01904 726785 The York Hospital, Wigginton Road,

More information

Surgical removal of fibroids through an abdominal incision-either up and down or bikini cut. The uterus and cervix are left in place.

Surgical removal of fibroids through an abdominal incision-either up and down or bikini cut. The uterus and cervix are left in place. What is an abdominal myomectomy? Surgical removal of fibroids through an abdominal incision-either up and down or bikini cut. The uterus and cervix are left in place. When is this surgery used? Treatment

More information

Keeping track of your MS relapse symptoms. record your experience. share with your doctor.

Keeping track of your MS relapse symptoms. record your experience. share with your doctor. FROM RELAPSE TO RELIEF Keeping track of your MS relapse symptoms record your experience. share with your doctor. Tracking your MS relapse symptoms No matter what MS relapse treatment you re on or considering,

More information