Gloucestershire Hospitals

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Gloucestershire Hospitals"

Transcription

1 Gloucestershire Hospitals NHS Foundation Trust TRUST GUIDELINE EPILEPSY AND STATUS EPILEPTICUS MANAGEMENT 1. INTRODUCTION The aim of this guideline is to ensure safe management of Status Epilepticus in the Emergency Department and ACU, and the safe management of status epilepticus of tonic clonic seizures as recommended by NICE 2004 guidelines. Read this guideline in conjunction with the Management of Seizures care plan, First Fit Policy and Epilepsy and Pregnancy 2. DEFINITIONS Word/Term (9 point Arial bold) Status epilepticus Descriptor Any seizure lasting for at least 30 minutes or Repeated seizures lasting for a total of 30 minutes or longer, from which the person does not regain consciousness between each seizure. 3. ROLES AND RESPONSIBILITIES Post/Group Details Resources Review/ Monitoring Consultant Neurologist Responsibility for X X X X X X management of status epilepticus patients Provision of specialist advice to ED and ACU staff ITU staff Treatment of refractory Grades X X X X X status epilepticus patients 5-8 ACU/ED/Neurology medical/clinical staff Treatment of status epilepticus patients Referral to DCC if refractory state suspected or confirmed 4. MANAGEMENT OF STATUS EPILEPTICUS Grades Non Epileptic Attacks (previously referred to as Pseudo-status) Implementation Records Reporting HR X X X X X In non epileptic attacks motor activity may be evident, poor response to treatment, on/off pattern of seizure activity, there is lack of metabolic changes and the EEG and prolactin levels (within 20 minutes of seizure stopping) will be normal. 4.2 Phase I: Compensation 0-30minutes During this phase, cerebral metabolism is greatly increased because of seizure activity, but physiological mechanisms are sufficient to meet the metabolic demands and cerebral tissue is protected from hypoxia or metabolic damage. The major physiological changes are related to the greatly increased cerebral blood flow and metabolism, massive autonomic activity and cardiovascular changes. STATUS EPILEPTICUS MANAGEMENT V2.2 (Amended March 2013) PAGE 1 OF 6

2 Cerebral Changes Systemic and Metabolic Autonomic and Cardiovascular changes changes Increased blood flow Hyperglycaemia Hypertension Increased metabolism Lactic acidosis Increased cardiac output Energy requirements Increased central venous pressure matched by supply of oxygen and glucose (increased glucose and oxygen utilization) Increased lactate Massive catecholamine release concentration Increased glucose concentration Tachycardia Cardiac dysrhythmia Salivation Hyperpyrexia Vomiting Incontinence 4.3 Phase II: Decompensation 30 minutes and over During this phase, the greatly increased cerebral metabolic demands cannot be fully met, resulting in hypoxia and altered cerebral and systemic metabolic patterns. Autonomic changes persist and cardio respiratory functions may progressively fail to maintain homeostasis. Cerebral Changes Failure of cerebral autoregulation, thus cerebral blood flow becomes dependent on systemic blood pressure Systemic and Metabolic changes Consumptive coagulopathy, DIC (disseminated intravascular coagulopathy), multi-organ failure Autonomic and Cardiovascular changes Respiratory and cardiac impairment (pulmonary oedema, pulmonary embolism, respiratory collapse, cardiac failure, dysrhythmia) Hypoxia Hypoglycaemia Hyperpyrexia Hypoglycaemia Hyponatraemia Systemic hypoxia Falling lactate Hypokalaemia/ Falling blood pressure concentrations Hyperkalaemia Falling energy state Metabolic and respiratory Falling cardiac output acidosis Rise in intracranial pressure and cerebral oedema Hepatic and renal dysfunction Rhabdomolysis, myoglobulinuria Leucocytosis Note: The physiological changes listed above do not necessarily occur in all cases. The type and extent of the changes depend on aetiology, clinical circumstances and methods of therapy employed. Refer to Seizure Care Plan. STATUS EPILEPTICUS MANAGEMENT V2.2 (Amended March 2013) PAGE 2 OF 6

3 5. TREATMENT GUIDELINES FOR STATUS EPILEPTICUS IN ADULTS If seizure lasts for more than 5-10 minutes or repeated seizures occur with no regaining of consciousness. (Patients may have oral Clobazam or Clonazepam and or Buccal Midazolam or Rectal Diazepam to use at home first line) NB: If this patient is thought to be dying and in the last days/weeks of life, a different approach may be considered, see box below. If progresses Early (0-30 minutes) Early (0-30 minutes) Midazolam 2.5mg - 5mg IV bolus (In Elderly Patients 1-2.5mg IV) Repeat after 3-10 minutes if seizure persists Or Lorazepam to a maximum of 4mg IV bolus Repeat after minutes if seizure persists Or Diazepam 10mg IV bolus or rectally Repeat after minutes if seizure persists Maintain airway and give oxygen and monitor saturation levels ensure patient safety and dignity Monitor and record event Check history and initiate investigation if needed If progresses Established (30-60 minutes) Discuss with Senior Consultant Phenytoin IV infusion 15mg/kg at a rate not exceeding 50mg/minute (Cardiac Monitor during treatment) Or Phenobarbital IV infusion 10mg/kg (max. 1g) at 100mg/minute If progresses Refractory (over 60 minutes) Transfer to DCC Notes Check history of epilepsy, seizure type and description Check history of Non Epileptic Attack Disorder Check history of drug or alcohol abuse Investigate if no history of epilepsy Bloods - Glucose, U&E, Calcium, Magnesium, LFT, Gases and lactate, ph, FBC, culture, prolactin level, metabolic screen and correct accordingly If on Carbamazepine, Phenytoin or Phenobarbitone check levels but not for any other AED Urine - Toxicology Check temperature, neurological signs, haemodynamics, ECG, EEG Once seizure stopped turn patient into recovery position and observe closely Home once stable for 24 hours or back to normal seizure frequency Refer to Sue Higgins Epilepsy Specialist Nurse Tel: or written as per First Fit referral to review in clinic. Neurologist if A+E/ward review required For patients who are thought to be in the dying phase, a palliative approach is more appropriate. Consider stat Midazolam 5-10mg s/c for fitting and contact Specialist Palliative Care Team for advice on maintenance treatment. In hours GRH 5179, CGH 3447 and OOH ask for on-call Palliative Care Specialist via Switchboard. STATUS EPILEPTICUS MANAGEMENT V2.2 (Amended March 2013) PAGE 3 OF 6

4 5.1 Alternative Drug Regimes (Adult Doses) To be used after protocol has been followed under Consultant advice if seizures persist or patient hypersensitive to protocol regime. Clonazepam IV bolus/infusion 1mg over 2 minutes Lidocaine IV bolus/infusion mg/kg at <50mg/min (may repeat) Maintenance dose 3-4mg/kg/hour Lorazepam IV bolus/infusion 4mg 6. TRAINING To include all staff groups in the Emergency Department, ACU and Neurology to be updated annually by teaching session. 7. MONITORING OF COMPLIANCE Objective Frequency/timescale Methodology Monitoring treatment outcomes for status epilepticus patients Ongoing Review of relevant ACIs and annual report to Divisional Board. Exception monitoring of poor outcomes. 8. REFERENCES Chappell B, Crawford P. (2001) Epilepsy at your fingertips. London: Class Publishing. NICE Guidelines The Epilepsies: Diagnosis and management of the epilepsies in adults in primary and secondary care. London: NICE. Cockerell and Shorvon (1996). Epilepsy Current Concepts. London: CML. STATUS EPILEPTICUS MANAGEMENT V2.2 (Amended March 2013) PAGE 4 OF 6

5 STATUS EPILEPTICUS MANAGEMENT DOCUMENT PROFILE DOCUMENT PROFILE REFERENCE NUMBER A0089 CATEGORY Clinical VERSION 2.2 (amended March 2013) SPONSOR Dr Fuller, Consultant Neurologist AUTHOR Sue Higgins, Epilepsy Specialist Nurse (technical authoring support, Kym Ypres-Smith) ISSUE DATE November 2011 REVIEW DETAILS November 2014 review by Consultant Neurologist ASSURING GROUP Consultant Neurologists APPROVING GROUP Trust Policy Approval Group APPROVAL DETAILS 08/01/2013 D&T Meeting (minute 2.1) 08/11/ TPAG COMPLIANCE INFORMATION Compliance with NICE guideline (see below) CONSULTEES Consultant Neurologists: Dr Fuller, Dr Silva, Dr Martin, Dr Morrish; Acute Medicine Consultant: Dr Hauser DISSEMINATION DETAILS Upload to Policy Site; global ; cascaded via divisions KEYWORDS Status epilepticus RELATED TRUST DOCUMENTS Seizure Care Plan OTHER RELEVANT DOCUMENTS Management of Seizures care plan, First Fit Policy and Epilepsy and Pregnancy ASSOCIATED LEGISLATION AND CODES OF PRACTICE NICE Guidelines The Epilepsies: Diagnosis and management of the epilepsies in adults in primary and secondary care STATUS EPILEPTICUS MANAGEMENT V2.2 (Amended March 2013) PAGE 5 OF 6

6 Gloucestershire Hospitals NHS Foundation Trust EQUALITY IMPACT ASSESSMENT INITIAL SCREENING 1. Lead Name : Sue Higgins Job Title : Epilepsy Nurse Specialist 2. Is this a new or existing policy, service strategy, procedure or function? Existing 3. Who is the policy/service strategy, procedure or function aimed at? Staff - All Medical and Qualified Nursing staff 4. Are any of the following groups adversely affected by this policy: If yes is this high, medium or low impact (see attached notes): Disabled people: No Yes Race, ethnicity & nationality: No Yes Male/Female/transgender: No Yes Age, young or older people: No Yes Sexual orientation: No Yes Religion, belief & faith: No Yes If the answer is yes to any of these, proceed to full assessment. If the answer is no to all categories, the assessment is now complete. Date of assessment: Signature: Director: Completed by: Sue Higgins Job title: Epilepsy Nurse Specialist Signature: This EIA will be published on the Trust website. A completed EIA must accompany a new policy or a reviewed policy when it is confirmed by the relevant Trust Committee, Divisional Board, Trust Director or Trust Board. Executive Directors are responsible for ensuring that EIAs are completed in accordance with this procedure. STATUS EPILEPTICUS MANAGEMENT V2.2 (Amended March 2013) PAGE 6 OF 6

Seizures & Status Epilepticus Management

Seizures & Status Epilepticus Management Seizures & Status Epilepticus Management Airway, Breathing, Circulation Don t Ever Forget Glucose If on arrival the seizure is continuing treat with Lorazepam. This should be titrated if other antiepileptic

More information

โครงการ ศ นย ความเป นเล ศโรคลมช กรามาธ บด (Rama Epilepsy Excellent Center)

โครงการ ศ นย ความเป นเล ศโรคลมช กรามาธ บด (Rama Epilepsy Excellent Center) โครงการ ศ นย ความเป นเล ศโรคลมช กรามาธ บด (Rama Epilepsy Excellent Center) Difficult issues in managing seizures in the critically ill patients Apisit Boongird, MD Seizures in the critically ill patients

More information

Paediatric Clinical Guidelines: Status Epilepticus

Paediatric Clinical Guidelines: Status Epilepticus Paediatric Clinical Guidelines: Status Epilepticus Consultant: Dr Alastair Sutcliffe, Dr Christina Petrololous, Dr Tom Bailey Pharmacist: Simon Keady/Neil Tickner To be reviewed: Autumn 2010 The following

More information

EMS Branch / Office of the Medical Director. Active Seziures (d) Yes Yes Yes Yes. Yes Yes No No. Agitation (f) No Yes Yes No.

EMS Branch / Office of the Medical Director. Active Seziures (d) Yes Yes Yes Yes. Yes Yes No No. Agitation (f) No Yes Yes No. M07 Medications 2015-07-15 All ages EMS Branch / Office of the Medical Director Benzodiazepines Primary Intermediate Advanced Critical INDICATIONS Diazepam (c) Lorazepam (c) Midazolam (c) Intranasal Midazolam

More information

MOH CLINICAL PRACTICE GUIDELINES 2/2008 Prescribing of Benzodiazepines

MOH CLINICAL PRACTICE GUIDELINES 2/2008 Prescribing of Benzodiazepines MOH CLINICL PRCTICE GUIELINES 2/2008 Prescribing of Benzodiazepines College of Family Physicians, Singapore cademy of Medicine, Singapore Executive summary of recommendations etails of recommendations

More information

Gloucestershire Hospitals

Gloucestershire Hospitals Gloucestershire Hospitals NHS Foundation Trust TRUST NON CLINICAL POLICY MATERNITY SERVICES HEALTH RECORDS B0556 Any hard copy of this document is only assured to be accurate on the date printed. The most

More information

Version 2 This guideline describes how to manage patients who are showing signs and symptoms of alcohol withdrawal and Wernicke s Encephalopathy.

Version 2 This guideline describes how to manage patients who are showing signs and symptoms of alcohol withdrawal and Wernicke s Encephalopathy. Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Contact Name and Job Title (author) Directorate & Speciality A Guideline for the Management of Acute Alcohol Withdrawal

More information

Gloucestershire Hospitals

Gloucestershire Hospitals TRUST POLICY WEB PUBLISHING POLICY Any hard copy of this document is only assured to be accurate on the date printed. The most up to date version is available on the Trust Policy Site. All document profile

More information

Treatment of tonic-clonic status epilepticus

Treatment of tonic-clonic status epilepticus Chapter 33 Treatment of tonic-clonic status epilepticus MATTHEW C. WALKER and SIMON D. SHORVON Institute of Neurology, University College London, National Hospital for Neurology and Neurosurgery, Queen

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. Treating prolonged or repeated seizures and convulsive status epilepticus bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed

More information

Epilepsy Scotland Consultation Response. Scottish Ambulance Service Our Future Strategy Discussion with Partners. Submitted September 2009

Epilepsy Scotland Consultation Response. Scottish Ambulance Service Our Future Strategy Discussion with Partners. Submitted September 2009 Epilepsy Scotland Consultation Response Scottish Ambulance Service Our Future Strategy Discussion with Partners Submitted September 2009 Section 1: Accessing the right help in an emergency How can we work

More information

Hyperosmolar Non-Ketotic Diabetic State (HONK)

Hyperosmolar Non-Ketotic Diabetic State (HONK) Hyperosmolar Non-Ketotic Diabetic State (HONK) University Hospitals of Leicester NHS Trust Guidelines for Management of Acute Medical Emergencies Management is largely the same as for diabetic ketoacidosis

More information

Gloucestershire Hospitals

Gloucestershire Hospitals Gloucestershire Hospitals NHS Foundation Trust TRUST POLICY TRANSPORT POLICY Any hard copy of this document is only assured to be accurate on the date printed. The most up to date version is available

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

The early symptoms of acute salicylism are the triad of gastrointestinal distress, tinnitus or altered hearing, and hyperventilation.

The early symptoms of acute salicylism are the triad of gastrointestinal distress, tinnitus or altered hearing, and hyperventilation. POISONING SALICYLATES (ASPIRIN) Management Guidelines Emergency Department Princess Margaret Hospital for Children Perth, Western Australia Last reviewed: January 2007 Page 1 of 5 Dr Gary Geelhoed Dr Frank

More information

The Newcastle upon Tyne Hospitals NHS Foundation Trust. National Early Warning Score (NEWS) Policy

The Newcastle upon Tyne Hospitals NHS Foundation Trust. National Early Warning Score (NEWS) Policy The Newcastle upon Tyne Hospitals NHS Foundation Trust National Early Warning Score (NEWS) Policy Version.: 1.0 Effective From: 3 December 2014 Expiry Date: 3 December 2016 Date Ratified: 1 September 2014

More information

The new Heart Failure pathway

The new Heart Failure pathway The new Heart Failure pathway An integrated and seamless Strategy Dr Sunil Balani Definition of Heart Failure The inability of the heart to pump blood at a rate commensurate with the requirements of metabolising

More information

ACLS PHARMACOLOGY 2011 Guidelines

ACLS PHARMACOLOGY 2011 Guidelines ACLS PHARMACOLOGY 2011 Guidelines ADENOSINE Narrow complex tachycardias or wide complex tachycardias that may be supraventricular in nature. It is effective in treating 90% of the reentry arrhythmias.

More information

Laboratory Monitoring of Adult Hospital Patients Receiving Parenteral Nutrition

Laboratory Monitoring of Adult Hospital Patients Receiving Parenteral Nutrition Laboratory Monitoring of Adult Hospital Patients Receiving Parenteral Nutrition Copy 1 Location of copies Web based only The following guideline is for use by medical staff caring for the patient and members

More information

S9 Administer thrombolytic treatment in acute ischaemic stroke

S9 Administer thrombolytic treatment in acute ischaemic stroke S9 Administer thrombolytic treatment in acute ischaemic Screening and initiating treatment, overseeing competency of treatment About this workforce competence This competence is about the emergency administration

More information

ACCIDENT AND EMERGENCY DEPARTMENT/CARDIOLOGY

ACCIDENT AND EMERGENCY DEPARTMENT/CARDIOLOGY Care Pathway Triage category ATRIAL FIBRILLATION PATHWAY ACCIDENT AND EMERGENCY DEPARTMENT/CARDIOLOGY AF/ FLUTTER IS PRIMARY REASON FOR PRESENTATION YES NO ONSET SYMPTOMS OF AF./../ TIME DURATION OF AF

More information

Patient Group Direction Hospital: Bristol Royal Infirmary Department: UHBristol Thrombosis Service University Hospitals Bristol NHS Foundation Trust.

Patient Group Direction Hospital: Bristol Royal Infirmary Department: UHBristol Thrombosis Service University Hospitals Bristol NHS Foundation Trust. Patient Group Direction Hospital: Bristol Royal Infirmary Department: UHBristol Thrombosis Service University Hospitals Bristol NHS Foundation Trust. This Patient Group Direction (PGD) has been written

More information

1. What are anti-epileptic drugs? Anti-epileptic drugs (AEDs) are prescribed to control seizures. They do not cure epilepsy.

1. What are anti-epileptic drugs? Anti-epileptic drugs (AEDs) are prescribed to control seizures. They do not cure epilepsy. 14 FREQUENTLY ASKED QUESTIONS ON ANTI- EPILEPTIC DRUGS 1. What are anti-epileptic drugs? Anti-epileptic drugs (AEDs) are prescribed to control seizures. They do not cure epilepsy. 2. When should treatment

More information

Gloucestershire Hospitals

Gloucestershire Hospitals TRUST GUIDELINE In the case of hard copies of this policy the content can only be assured to be accurate on the date of issue marked on the document. The Policy framework requires that the policy is fully

More information

Naloxone: Effects and Side Effects

Naloxone: Effects and Side Effects Gregory W. Terman M.D., Ph.D. Professor Department of Anesthesiology and Pain Medicine and the Graduate Program in Neurobiology Mayday Pain and Society Fellow University of Washington Seattle, Washington

More information

Adult Home Oxygen Therapy. Purpose To provide guidance on the requirements for and procedures relating to domiciliary oxygen therapy.

Adult Home Oxygen Therapy. Purpose To provide guidance on the requirements for and procedures relating to domiciliary oxygen therapy. Contents Purpose... 1 Scope/Audience... 1 Categories for Home Oxygen Therapy... 2 Assessment for Home Oxygen Therapy... 3 Investigations... 3 Requests for home oxygen... 3 Provision of Home Oxygen... 4

More information

Community Ambulance Service of Minot ALS Standing Orders Legend

Community Ambulance Service of Minot ALS Standing Orders Legend Legend Indicates General Information and Guidelines Indicates Procedures Indicates Medication Administration Indicates Referral to Other Protocol Indicates Referral to Online Medical Direction Pediatric

More information

ELSO GUIDELINES FOR TRAINING AND CONTINUING EDUCATION OF ECMO SPECIALISTS

ELSO GUIDELINES FOR TRAINING AND CONTINUING EDUCATION OF ECMO SPECIALISTS ELSO GUIDELINES FOR TRAINING AND CONTINUING EDUCATION OF ECMO SPECIALISTS PURPOSE The "" is a document developed by the Extracorporeal Life Support Organization (ELSO) as a reference for current and future

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

Maintenance of abstinence in alcohol dependence

Maintenance of abstinence in alcohol dependence Shared Care Guideline for Prescription and monitoring of Acamprosate Calcium Author(s)/Originator(s): (please state author name and department) Dr Daly - Consultant Psychiatrist, Alcohol Services Dr Donnelly

More information

STUDY GUIDE 1.1: NURSING DIAGNOSTIC STATEMENTS AND COMPREHENSIVE PLANS OF CARE

STUDY GUIDE 1.1: NURSING DIAGNOSTIC STATEMENTS AND COMPREHENSIVE PLANS OF CARE STUDY GUIDE 1.1: NURSING DIAGNOSTIC STATEMENTS AND COMPREHENSIVE PLANS OF CARE WHAT IS A NURSING DIAGNOSIS? A nursing diagnosis is a clinical judgment about individual, family, or community responses to

More information

Rivaroxaban: Prescribing Guidance for the treatment of provoked venous thromboembolism (VTE)

Rivaroxaban: Prescribing Guidance for the treatment of provoked venous thromboembolism (VTE) Rivaroxaban: Prescribing Guidance for the treatment of provoked venous thromboembolism (VTE) Amber Drug Level 2 Leeds We have started your patient on rivaroxaban for the treatment of provoked VTE (deep

More information

Rivaroxaban: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF

Rivaroxaban: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF Leeds Rivaroxaban: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF Amber Drug Level 3 (amber drug with monitoring requirements) We have started your

More information

Shared Care Guideline-Use of Donepezil, Galantamine, Rivastigmine and Memantine in Dementia

Shared Care Guideline-Use of Donepezil, Galantamine, Rivastigmine and Memantine in Dementia Shared Care Guideline-Use of Donepezil, Galantamine, Rivastigmine and Memantine in Dementia Version: 3.0 Ratified by: Medicines Committee Date ratified: 16 th November 2011 Name of originator/author: James

More information

The Management of Status Epilepticus Bassel Abou-Khalil, M.D. Department of Neurology Vanderbilt University Medical Center

The Management of Status Epilepticus Bassel Abou-Khalil, M.D. Department of Neurology Vanderbilt University Medical Center The Management of Status Epilepticus- 2013 Bassel Abou-Khalil, M.D. Department of Neurology Vanderbilt University Medical Center None Disclosures Self assessment questions Q1- Which of the following is

More information

SEPSIS IN INFANTS AND CHILDREN- CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline

SEPSIS IN INFANTS AND CHILDREN- CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline SEPSIS IN INFANTS AND CHILDREN- CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline 1.1. This guideline is for the management of sepsis in Infants and children. For full guidance please see the Surviving

More information

Alcohol Withdrawal. Introduction. Blood Alcohol Concentration. DSM-IV Criteria/Alcohol Abuse. Pharmacologic Effects of Alcohol

Alcohol Withdrawal. Introduction. Blood Alcohol Concentration. DSM-IV Criteria/Alcohol Abuse. Pharmacologic Effects of Alcohol Pharmacologic Effects of Alcohol Alcohol Withdrawal Kristi Theobald, Pharm.D., BCPS Therapeutics III Fall 2003 Inhibits glutamate receptor function (NMDA receptor) Inhibits excitatory neurotransmission

More information

GMMMG Interface Prescribing Subgroup. Shared Care Template

GMMMG Interface Prescribing Subgroup. Shared Care Template GMMMG Interface Prescribing Subgroup Shared Care Template Shared Care Guideline for Selective Serotonin Reuptake Inhibitors (SSRIs) for the treatment of Obsessive Compulsive Disorder (OCD) and Body Dysmorphic

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

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

NHS FORTH VALLEY Multiple Sclerosis Service Management of MS Relapses

NHS FORTH VALLEY Multiple Sclerosis Service Management of MS Relapses NHS FORTH VALLEY Multiple Sclerosis Service Management of MS Relapses Approved 22/06/2010 Version Version 2 Date of First Issue 2002 Review Date 10/05/2016 Date of Issue 01/02/2010 EQIA Yes 22.06.10 Author

More information

This information relates to babies who are up to one month old.

This information relates to babies who are up to one month old. Published on Epilepsy Action (https://www.epilepsy.org.uk) Page generated on 19/06/2014 Babies and epilepsy Contents The causes of epilepsy in babies Types of seizures Diagnosis Treatment Long-term development

More information

DRUG TREATMENT OF ACUTE BEHAVIOURAL DISTURBANCE

DRUG TREATMENT OF ACUTE BEHAVIOURAL DISTURBANCE DRUG TREATMENT OF ACUTE BEHAVIOURAL DISTURBANCE IN GENERAL ADULT (18 65YRS) PSYCHIATRIC IN-PATIENTS This algorithm is a good practice guideline developed by multidisciplinary staff in NHS Lothian. You

More information

Gloucestershire Hospitals

Gloucestershire Hospitals Gloucestershire Hospitals NHS Foundation Trust TRUST GUIDELINE INFLIXIMAB PRESCRIBING AND ADMINISTRATION 1. INTRODUCTION Infliximab is an anti-tumour necrosis factor-α (Anti-TNF) antibody. It is from a

More information

Glasgow Assessment and Management of Alcohol

Glasgow Assessment and Management of Alcohol Glasgow Assessment and Management of Alcohol If you would like further information or advice on the alcohol screening and withdrawal management guideline(gmaws) please contact your local acute addiction

More information

PREPARATIONS: Adrenaline 1mg in 1ml (1:1000) Adrenaline 100micrograms in 1ml (1:10,000)

PREPARATIONS: Adrenaline 1mg in 1ml (1:1000) Adrenaline 100micrograms in 1ml (1:10,000) ADRENALINE Acute hypotension Via a CENTRAL venous line Initially 100-300 nanograms/kg/minute 0.1-0.3 microgram/kg/minute adjusted according to response up to a maximum of 1.5 micrograms/kg/minute. Increase

More information

MODERATE SEDATION RECORD (formerly termed Conscious Sedation)

MODERATE SEDATION RECORD (formerly termed Conscious Sedation) (POLICY #DOC-051) Page 1 of 6 WELLSPAN HEALTH - YORK HOSPITAL NURSING POLICY AND PROCEDURE Dates: Original Issue: September 1998 Annual Review: March 2012 Revised: March 2010 Submitted by: Brenda Artz

More information

Planning: Patient Goals and Expected Outcomes The patient will: Remain free of unusual bleeding Maintain effective tissue perfusion Implementation

Planning: Patient Goals and Expected Outcomes The patient will: Remain free of unusual bleeding Maintain effective tissue perfusion Implementation Obtain complete heath history including allergies, drug history and possible drug Assess baseline coagulation studies and CBC Assess for history of bleeding disorders, GI bleeding, cerebral bleed, recent

More information

Seizure Acute Management: Emergency Department v.1.2

Seizure Acute Management: Emergency Department v.1.2 Seizure Acute Management: Emergency Department v.1.2 Executive Summary Test Your Knowledge Inclusion Criteria Patient presenting with epileptic seizure Explanation of Evidence Ratings Summary of Version

More information

Guidelines for the Use of Naloxone in Palliative Care in Adult Patients

Guidelines for the Use of Naloxone in Palliative Care in Adult Patients Guidelines for the Use of Naloxone in Palliative Care in Adult Patients Date Approved by Network Governance May 2012 Date for Review May 2015 Changes between Version 1 and 2 1. Guideline background 2.

More information

Maternal Safety Bundle for Severe Hypertension in Pregnancy

Maternal Safety Bundle for Severe Hypertension in Pregnancy Maternal Safety Bundle for Severe Hypertension in Pregnancy Severe Hypertension in Pregnancy: Key Elements Risk Assessment & Prevention Diagnostic Criteria When to Treat Agents to Use Monitoring Readiness

More information

Adjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour.

Adjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour. Shared Care Guideline for Prescription and monitoring of Naltrexone Hydrochloride in alcohol dependence Author(s)/Originator(s): (please state author name and department) Dr Daly - Consultant Psychiatrist,

More information

Review Date: March 2012. Issue Status: Approved Issue No: 2 Issue Date: March 2010

Review Date: March 2012. Issue Status: Approved Issue No: 2 Issue Date: March 2010 Title: Multiple Sclerosis guidelines for the use of beta-interferon, glatiramer acetate, natalizumab, mitoxantrone and other disease Authors Name: Dr P Talbot Contact Name: Dr Paul Talbot Contact Phone

More information

INTOXICATED PATIENTS AND DETOXIFICATION

INTOXICATED PATIENTS AND DETOXIFICATION VAMC Detoxification Decision Tree Updated May 2006 INTOXICATED PATIENTS AND DETOXIFICATION Patients often present for evaluation of substance use and possible detoxification. There are certain decisions

More information

This guideline is for the management of Adult patients with Diabetes Mellitus using insulin pump therapy during admission to hospital

This guideline is for the management of Adult patients with Diabetes Mellitus using insulin pump therapy during admission to hospital CLINICAL GUIDELINE FOR THE MANAGEMENT OF ADULT PATIENTS DIABETES MELLITUS USING INSULIN PUMP THERAPY (Continuous Subcutaneous Insulin Infusion (CSII)), DURING ADMISSION TO HOSPITAL 1. Aim/Purpose of this

More information

DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) SHARED CARE AGREEMENT FRAMEWORK

DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) SHARED CARE AGREEMENT FRAMEWORK DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) SHARED CARE AGREEMENT FRAMEWORK ACAMPROSATE CALCIUM (Campral EC) for alcohol abstinence ESCA: Adjunct in the treatment of chronic alcohol dependence (under

More information

Fit, (falls) and funny turns. Richard J Davenport Consultant Neurologist Edinburgh

Fit, (falls) and funny turns. Richard J Davenport Consultant Neurologist Edinburgh Fit, (falls) and funny turns Richard J Davenport Consultant Neurologist Edinburgh The plan Epilepsy nuggets 10 things I would like GPs to know This week s FS clinic What is epilepsy? Characterised by two

More information

Adult Modified Early Warning Score (MEWS) Policy and Escalation Pathway Version 3.0

Adult Modified Early Warning Score (MEWS) Policy and Escalation Pathway Version 3.0 Policy Statement: The purpose of this policy is to provide clear guidance and instruction to staff with regard to the Trust s approach to the use of the adult Modified Early Warning Score & Escalation

More information

ALCOHOL DETOXIFICATION (IN-PATIENTS) PRESCRIBING GUIDELINE

ALCOHOL DETOXIFICATION (IN-PATIENTS) PRESCRIBING GUIDELINE ALCOHOL DETOXIFICATION (IN-PATIENTS) PRESCRIBING GUIDELINE Authors Sponsor Responsible committee Ratified by Consultant Psychiatrist; Pharmacist Team Manager Medical Director Medicines Management Group

More information

CHESHIRE EAST COUNCIL DRIVER MEDICAL

CHESHIRE EAST COUNCIL DRIVER MEDICAL BLOCK LETTERS PLEASE: CHESHIRE EAST COUNCIL DRIVER MEDICAL FULL NAME OF APPLICANT:.. DATE OF BIRTH.... ADDRESS:............. POST CODE... This certificate, which must be completed by a Registered Medical

More information

Prescribing Framework for Donepezil in the Treatment and Management of Dementia

Prescribing Framework for Donepezil in the Treatment and Management of Dementia Hull & East Riding Prescribing Committee Prescribing Framework for Donepezil in the Treatment and Management of Dementia Patients Name:.. NHS Number: Patients Address:... (Use addressograph sticker) GP

More information

White, circular, biconvex, uncoated tablets with a score line on one side, plain on the other.

White, circular, biconvex, uncoated tablets with a score line on one side, plain on the other. Nausicalm Cyclizine hydrochloride Ph. Eur. 50 mg Presentation White, circular, biconvex, uncoated tablets with a score line on one side, plain on the other. Uses Actions The active ingredient-cyclizine

More information

Naltrexone Shared Care Guideline for the treatment of alcohol dependence and opioid dependance

Naltrexone Shared Care Guideline for the treatment of alcohol dependence and opioid dependance Naltrexone Shared Care Guideline for the treatment of alcohol dependence and opioid dependance Introduction Indication/Licensing information: Naltrexone is licensed for use as an additional therapy, within

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

Nature of disability. Hospital Details +91 44 22568009 +91 33 25111359. TEL : +91 22 6711 6618 / 09 l FAX : +91 22 26156290 +91 11 49637953

Nature of disability. Hospital Details +91 44 22568009 +91 33 25111359. TEL : +91 22 6711 6618 / 09 l FAX : +91 22 26156290 +91 11 49637953 Nature of disability Hospital Details TEL : +91 22 6711 6618 / 09 l FAX : +91 22 26156290 +91 11 49637953 +91 44 22568009 +91 33 25111359 Information Sheet for Guest Requiring Medical Clearance (to be

More information

Bakersfield College Associate Degree Nursing NURS B28 - Medical Surgical Nursing 4

Bakersfield College Associate Degree Nursing NURS B28 - Medical Surgical Nursing 4 1 Bakersfield College Associate Degree Nursing NURS B28 - Medical Surgical Nursing 4 Unit 1 - COURSE This unit will present the instructional syllabus and define the Student Learning Outcomes (SLO) for

More information

ACID- BASE and ELECTROLYTE BALANCE. MGHS School of EMT-Paramedic Program 2011

ACID- BASE and ELECTROLYTE BALANCE. MGHS School of EMT-Paramedic Program 2011 ACID- BASE and ELECTROLYTE BALANCE MGHS School of EMT-Paramedic Program 2011 ACID- BASE BALANCE Ions balance themselves like a see-saw. Solutions turn into acids when concentration of hydrogen ions rises

More information

BIPOLAR DISORDER IN PRIMARY CARE

BIPOLAR DISORDER IN PRIMARY CARE E-Resource January, 2014 BIPOLAR DISORDER IN PRIMARY CARE Mood Disorder Questionnaire Common Comorbidities Evaluation of Patients with BPD Management of BPD in Primary Care Patient resource Patients with

More information

Appendix L: HQO Year 1 Implementation Priorities

Appendix L: HQO Year 1 Implementation Priorities Appendix L: HQO Year 1 Implementation Priorities Chronic Obstructive Pulmonary Disease (Source: COPD Chairs) Non-Invasive Positive Pressure Ventilation Early Ambulation If possible, seek patient preferences

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

NORTH WALES CRITICAL CARE NETWORK

NORTH WALES CRITICAL CARE NETWORK NORTH WALES CRITICAL CARE NETWORK LEVELS OF CRITICAL CARE FOR ADULT PATIENTS Throughout the work of the North Wales Critical Care Network reference to Levels of Care for the critically ill are frequently

More information

Professional Certificate in Primary Care Psychology

Professional Certificate in Primary Care Psychology Professional Certificate in Primary Care Psychology The NAPPP Primary Care Psychology Certificate training program requires the completion of 10 courses. Each course awards 15 CE credit hours. NAPPP is

More information

Head Injury. Dr Sally McCarthy Medical Director ECI

Head Injury. Dr Sally McCarthy Medical Director ECI Head Injury Dr Sally McCarthy Medical Director ECI Head injury in the emergency department A common presentation 80% Mild Head Injury = GCS 14 15 10% Moderate Head Injury = GCS 9 13 10% Severe Head Injury

More information

Hospice and Palliative Medicine

Hospice and Palliative Medicine Hospice and Palliative Medicine Maintenance of Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills

More information

Epilepsy 101: Getting Started

Epilepsy 101: Getting Started American Epilepsy Society 1 Epilepsy 101 for nurses has been developed by the American Epilepsy Society to prepare professional nurses to understand the general issues, concerns and needs of people with

More information

Hypertension Guidelines

Hypertension Guidelines Overview Hypertension Guidelines Aim to reduce Blood Pressure to 140/90 or less (140/80 for diabetics), adding drugs as needed until further treatment is inappropriate or declined. N.B. patients do not

More information

Clinical Commissioning Policy: Disease Modifying Therapies For patients With Multiple Sclerosis (MS) December 2012. Reference : NHSCB/D4/c/1

Clinical Commissioning Policy: Disease Modifying Therapies For patients With Multiple Sclerosis (MS) December 2012. Reference : NHSCB/D4/c/1 Clinical Commissioning Policy: Disease Modifying Therapies For patients With Multiple Sclerosis (MS) December 2012 Reference : NHSCB/D4/c/1 NHS Commissioning Board Clinical Commissioning Policy: Disease

More information

PHOSPHATE-SANDOZ Tablets (High dose phosphate supplement)

PHOSPHATE-SANDOZ Tablets (High dose phosphate supplement) 1 PHOSPHATE-SANDOZ Tablets (High dose phosphate supplement) PHOSPHATE-SANDOZ PHOSPHATE-SANDOZ Tablets are a high dose phosphate supplement containing sodium phosphate monobasic. The CAS registry number

More information

Gilenya. Exceptional healthcare, personally delivered

Gilenya. Exceptional healthcare, personally delivered Gilenya Exceptional healthcare, personally delivered Your Consultant Neurologist has suggested that you may benefit from treatment with Gilenya. The decision to start this form of treatment can be difficult.

More information

The causes of collapse can be broadly categorised into : syncope, weakness and seizures.

The causes of collapse can be broadly categorised into : syncope, weakness and seizures. VICAS Winter Conference 2010 Cork, Ireland Mike Martin COLLAPSE & ARRHYTMIAS Mike Martin MVB, DVC, MRCVS. Specialist in Vet Cardiology Veterinary Cardiorespiratory Centre, Thera House, Kenilworth, Warwickshire.

More information

Docetaxel + Carboplatin + Trastuzumab (TCH) Adjuvant Breast Cancer

Docetaxel + Carboplatin + Trastuzumab (TCH) Adjuvant Breast Cancer Docetaxel + Carboplatin + Trastuzumab (TCH) Adjuvant Breast Cancer Background: A non-anthracycline based regimen for high-risk, HER 2 positive breast cancer in the adjuvant setting (BCIRG 006). Patient

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

F.E.E.A. FONDATION EUROPEENNE D'ENSEIGNEMENT EN ANESTHESIOLOGIE FOUNDATION FOR EUROPEAN EDUCATION IN ANAESTHESIOLOGY

F.E.E.A. FONDATION EUROPEENNE D'ENSEIGNEMENT EN ANESTHESIOLOGIE FOUNDATION FOR EUROPEAN EDUCATION IN ANAESTHESIOLOGY créée sous le Patronage de l'union Européenne Detailed plan of the program of six courses 1. RESPIRATORY 1. ESPIRATORY AND THORAX 1.1 Physics and principles of measurement 1.1.1 Physical laws 1.1.2 Vaporizers

More information

**Form 1: - Consultant Copy** Telephone Number: Fax Number: Email: Author: Dr Bernard Udeze Pharmacist: Claire Ault Date of issue July 2011

**Form 1: - Consultant Copy** Telephone Number: Fax Number: Email: Author: Dr Bernard Udeze Pharmacist: Claire Ault Date of issue July 2011 Effective Shared Care Agreement for the treatment of Dementia in Alzheimer s Disease Donepezil tablets / orodispersible tablets (Aricept / Aricept Evess ) These forms (1 and 2) are to be completed by both

More information

Chronic Post-Stroke Seizures

Chronic Post-Stroke Seizures Excessive Neuronal Activity Following Ischemic Neuronal Injury: The Identification i of Acute and Chronic Post-Stroke Seizures David E. Burdette, M.D. Assistant Professor of Neurology Wayne State University

More information

LEARNING DISABILITIES POLICY v1.0

LEARNING DISABILITIES POLICY v1.0 LEARNING DISABILITIES POLICY v1.0 Policy Statement: This policy will ensure that the services provided by the Trust are equally and easily accessible to the diverse communities it serves. Key Points This

More information

Health Check (Intellectual Disability)

Health Check (Intellectual Disability) Page 1 Health Check (Intellectual Disability) Use of a specific form to record the results of the health assessment is not mandatory but the health assessment should cover the matters listed below. The

More information

The Clinical Evaluation of the Comatose Patient in the Emergency Department

The Clinical Evaluation of the Comatose Patient in the Emergency Department The Clinical Evaluation of the Comatose Patient in the Emergency Department patients with altered mental status (AMS) and coma. treat patients who present to the Emergency Department with altered mental

More information

KING FAISAL SPECIALIST HOSPITAL AND RESEARCH CENTRE (GEN. ORG.) NURSING AFFAIRS. Scope of Service PEDIATRIC INTENSIVE CARE UNIT (PICU)

KING FAISAL SPECIALIST HOSPITAL AND RESEARCH CENTRE (GEN. ORG.) NURSING AFFAIRS. Scope of Service PEDIATRIC INTENSIVE CARE UNIT (PICU) PICU-Jan.2012 Page 1 of 7 Number of Beds: 18 Nurse Patient Ratio: 1:1-2 : The Pediatric Intensive Care Unit (PICU) provides 24 hour intensive nursing care for patients aged neonate through adolescence.

More information

Title of Guideline. Thrombosis Pharmacist)

Title of Guideline. Thrombosis Pharmacist) Title of Guideline Contact Name and Job Title (author) Guideline for patients receiving Rivaroxaban (Xarelto ) requiring Emergency Surgery or treatment for Haemorrhage Julian Holmes (Haemostasis and Thrombosis

More information

Philip Moore DO, Toxicology Fellow, PinnacleHealth Toxicology Center Joanne Konick-McMahan RN MSRN, Staff RN, PinnacleHealth

Philip Moore DO, Toxicology Fellow, PinnacleHealth Toxicology Center Joanne Konick-McMahan RN MSRN, Staff RN, PinnacleHealth Philip Moore DO, Toxicology Fellow, PinnacleHealth Toxicology Center Joanne Konick-McMahan RN MSRN, Staff RN, PinnacleHealth I. II. Background A. AWS can occur in anyone who consumes alcohol B. Risk correlates

More information

Gloucestershire Hospitals

Gloucestershire Hospitals Gloucestershire Hospitals NHS Foundation Trust TRUST POLICY DATA QUALITY FAST FIND: For information on the Trust s Data Quality standards, see Section 7. For information on the Trust s computer systems,

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

Southern Derbyshire Shared Care Pathology Guidelines. Hyponatraemia in Adults

Southern Derbyshire Shared Care Pathology Guidelines. Hyponatraemia in Adults Southern Derbyshire Shared Care Pathology Guidelines Hyponatraemia in Adults Purpose of Guideline The investigation and management of adult patients with newly diagnosed hyponatraemia. Hyponatraemia can

More information

Levels of Critical Care for Adult Patients

Levels of Critical Care for Adult Patients LEVELS OF CARE 1 Levels of Critical Care for Adult Patients STANDARDS AND GUIDELINES LEVELS OF CARE 2 Intensive Care Society 2009 All rights reserved. No reproduction, copy or transmission of this publication

More information

Enoxaparin for long term anticoagulation in patients unsuitable for oral anticoagulants

Enoxaparin for long term anticoagulation in patients unsuitable for oral anticoagulants Enoxaparin for long term anticoagulation in patients unsuitable for oral anticoagulants Traffic light classification- Amber 2 Information sheet for Primary Care Prescribers Relevant Licensed Indications

More information

Overview. Geriatric Overview. Chapter 26. Geriatrics 9/11/2012

Overview. Geriatric Overview. Chapter 26. Geriatrics 9/11/2012 Chapter 26 Geriatrics Slide 1 Overview Trauma Common Medical Emergencies Special Considerations in the Elderly Medication Considerations Abuse and Neglect Expanding the Role of EMS Slide 2 Geriatric Overview

More information

Alcohol use disorders: sample chlordiazepoxide dosing regimens for use in managing alcohol withdrawal

Alcohol use disorders: sample chlordiazepoxide dosing regimens for use in managing alcohol withdrawal Alcohol use disorders: sample chlordiazepoxide dosing regimens for use in managing alcohol withdrawal February 2010 NICE clinical guidelines 100 and 115 1 These sample chlordiazepoxide dosing regimens

More information

Acute Myocardial Infarction (the formulary thrombolytic for AMI at AAMC is TNK, please see the TNK monograph in this manual for information)

Acute Myocardial Infarction (the formulary thrombolytic for AMI at AAMC is TNK, please see the TNK monograph in this manual for information) ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY Guidelines for Use of Intravenous Alteplase (Tissue Plasminogen Activator (t-pa)), Activase in the Treatment

More information

What s new, and why, in Neurology 4?

What s new, and why, in Neurology 4? What s new, and why, in Neurology 4? All topics in Neurology 4 have been extensively reviewed and updated by the expert writing group, to provide concise evidence-based advice for the busy practitioner.

More information