C&C August

Hi all

Thanks to those who gave their apologies for C&C today, and thanks to both those who managed to make the effort.

We unfortunately won't be able to use Hornby any more as telecare have moved in.

Discussion topics were intended to be:

Case Studies- BYO, and…

An 82 yo lady with SOB, atrial fibrillation, dementia, and norovirus. Ambulance called because she was short of breath when walking to the toilet for her GI upset (24hours of violence either end). Her daughter was concerned about her because her dementia and cognition appeared worse than normal.

Initial RR 30, SPO2 84%, HR 110 AF, BP 135/65, T 38.2
30 mins later, RR 28, SPO2 92%, HR 140, BP 110/65.

Known conditions are AF and dementia.

Unfortunately she died 4 hours after she was taken to hospital. It would've been a great case for discussion. It has been an excellent reflective case for me and great discussion for us all. Unfortunately I can't publish too many details, but have a think:

1) What would your treatment have been?
2) What do you we think was the cause of her eventual cardiac arrest? Was it inevitable?
3) Is our pathophysiology of sepsis and AF as good as it should be?

Articles of the month

In addition to whatever others brought along, this was up for discussion:

Yale et al. (2017) Faster use and fewer failures with needle free nasal glucagon vs injectable glucagon in severe hypoglycaemia. Diabetes Research Review 98

Discusses a better safety profile AND more reliable uptake in IN vs IM. The biggest issue was the kit provided for IM glucagon either bent the needle or provided a SC dose. Anecdotally I've found the same thing, and have been using an IM needle for a while.

Contribute and add discussion to any of the points you see fit- look forward to seeing you at the next C&C.


2 Comments Add yours

  1. Tatsu Kuwasaki says:

    What was her GCS and CRT?


    1. Andrew O says:

      GCS 14, E4V4M6, with known dementia, and cCRT 3sec, PCRT 5sec with peripheral vascular disease.


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