The first update bundle of 2023 includes a new guideline for Agitated patients. This will sit alongside the existing guidance for acute behavioural disturbance (ABD). JRCALC are also in the process of developing new guidance on delirium. Agitation can have multiple causes and the clinical management can be challenging. The focus should be on identifying and treating, or arranging to treat the underlying cause.
In addition there are a number of updates to existing guidelines:
Acute coronary syndrome (ACS):
Full review and update of ACS. This includes a new section on health inequalities, women and racial differences. Strengthened wording, re. need to reduce on-scene time if possible.
Clopidogrel will be removed from JRCALC as part of the ACS update. Follow local policies/guidelines for P2Y12 inhibitor antiplatelet agents (e.g. ticagrelor, prasugrel).
‘Trauma emergencies in adults-overview’ and ‘Spinal injury and spinal cord injury guidance’
Additional wording added in relation to women and TXA administration. Additional wording added around extrication, care during entrapment, self-extrication and time on scene. These changes are in relation to a Delphi study of rescue and clinical subject matter experts on the extrication of patients following a motor vehicle collision >> https://pubmed.ncbi.nlm.nih.gov/35725580/
Also, a study around use of TXA in major trauma has concluded that administration of TXA to patients with bleeding trauma reduces mortality to a similar extent in women and men, but women are substantially less likely to be treated with TXA and if they are treated, it is at a later stage than for men. This will now be highlighted in the text and in the key points in ‘Trauma emergencies in adults-overview’ >> https://pubmed.ncbi.nlm.nih.gov/35597623/
A number of small changes will be made to the following medicines:
- Aspirin
- Buccal midazolam
- Penthrox
- Rectal Diazepam
Page for age: For ages at birth and one month the respiratory rate will be changed to 40-60.
Further resources tab: New resources will be added as links:
- Health Education England e learning
- ‘Don’t forget the Bubbles’ website.
- ‘Mind the Gap: A handbook of clinical signs in Black and Brown skin’
The JRCALC committee would like to record their appreciation to all who have contributed to these updates and to the continued development of JRCLAC Clinical Guidelines.