JRCALC Clinical Updates
New JRCALC Guidelines/medicines:
| GUIDELINE | UPDATE |
| Delirium | A completely new guideline. This guideline must be considered in conjunction with the Acute Behavioural Disturbance (ABD) and Agitated Patients guidelines. Delirium is often not recognised and is associated with poor outcomes. Details the numerous causes and suggests the need to consider delirium early in the assessment of the patient.Includes the 4AT Screening tool for delirium. Includes guidance on which patients may need admission or if a community referral is appropriate. |
Updates, Corrections, and Additional Guidance to Existing JRCALC Guidelines (Sept 2023)
| Guideline/medicine: | Update: |
| Glycaemic emergencies in adults and children | A full review and update. Includes more information and images about devices such as insulin pumps. Now includes guidance on pre-hospital ketone testing which should be performed when indicated and where ketone meters are available. New section on diabetes mental health and diabulimia. |
| Alcohol-use disorders | A new paragraph is included on alcoholic ketoacidosis which can occur when a person who is alcohol dependent or has had a prolonged alcohol binge, abruptly stops drinking and at the same time stops eating. |
| Limb trauma | A full review and update. Includes new guidance and images on fracture reduction and management of patella dislocation. More detail on hip fractures. |
| Heat related illnesses | A full review and update. New table of medications predisposing to heat related illness. |
| Steroid-dependent patients | The guidance is updated to place more emphasis on administering hydrocortisone for trauma as well as medical conditions, due to the physiological stress on the body for steroid dependent patients. This follows a coroner’s inquest where a patient died as a result of an acute adrenal crisis, caused by Addison’s disease and precipitated by the trauma of a fall and fractured hip. Insufficient administration of steroid medication by medical professionals was found to be a contributory factor in this patient’s death. |
| Hydrocortisone | Amended dosage for children ages 6 and 9 months to be in line with BNF, and wording amended to emphasise that it is indicated for trauma. |
| Breech birth | A revised standalone guideline for the management of breech birth with a new algorithm. This has been informed by evidence where it is available and learning from adverse incidents and coroners inquests. Includes guidance on practical procedures and manoeuvres to deliver a breech baby, with images, photos and links to short video clips. Includes specific guidance on when to leave scene immediately, details around when birth is imminent or not imminent, maternal positioning (semi recumbent and all fours positions), timings and when to perform manoeuvres if needed. |
| COPD | Small amendment in assessment and management of COPD to state that a 12 lead is to be performed ‘if indicated’. |
| Adrenaline | In 2021 ILCOR changed the Adrenaline dose at birth to 20mcg/kg and Resus UK followed. Our dose ranges in Page for Age now have a Birth to one month range. The change is to give 20mcg/kg for age birth to one month. |
| ALS in children | Paediatric wording in ALS – section 3.1 of wording changed from:ALS procedures (e.g. establishing vascular access) must not delay the transfer of the child to hospital – start and continue good-quality BLS on scene as the priority. Attempt ALS procedures en-route, if practical; oxygenation, ventilation and chest compressions remain the priority.Changed to:Initiate the delivery of good quality BLS on scene, prioritising oxygen delivery, ventilation and chest compressions. ALS procedures including defibrillation if indicated, airway management and establishing IV/IO access to deliver therapies for reversal of hypovolaemia/hypoglycaemia should be considered where resources, training and skillset permit, but should not inappropriately delay transfer to definitive care. |
| ALS | ALS double sequential defibrillation. Amended paragraph to say:4.8 Dual Sequential Defibrillation (DSD)JRCALC does not support use of dual sequential defibrillation. DSD involves the use of two separate manual defibrillators, delivering shocks at the same time or in rapid succession. Usually the pads from the second defibrillator are placed in an antero-posterior position to deliver a current at a different angle to the antero-lateral pads. A recent study has shown that when used for defibrillation of refractory VF, DSD is no more effective than when compared to antero-posterior pad orientation alone; the latter already being a technique recommended for defibrillation of refractory VF. Additionally, DSD is not recommended practice and it is not licensed or recommended by the defibrillator manufacturers as there is a documented risk of damage to the defibrillators.For cases of VF where conventional antero-lateral pad position has failed to successfully defibrillate, check that the pads are correctly positioned before considering changing to antero-posterior pad positioning (a fresh set of pads is not necessary). The reference is: https://costr.ilcor.org/document/double-sequential-defibrillation-strategy-for-cardiac-arrest-with-refractory-shockable-rhythm-als-tf-sr |