SaHF DMBC Volume 1 Edition 1.1.pdf - Shaping a healthier future

Exclusion criterion
Mental health
Additional information
o Paraesthesia in the extremities
o Any other clinical suspicion of cervical spine injury
Head injury associated with GCS < 13 at presentation
GCS < 15 when assessed 2 hours after the injury
History of significant Loss of Consciousness
More than one episode of vomiting
Persistent headache
Suspected open or depressed skull fracture
Sign of basal skull fracture
o haemotympanum, „panda‟ eyes, cerebrospinal fluid
otorrhoea, Battle‟s sign
Post traumatic seizure
Focal neurological deficit
Significant amnesia
Dangerous Mechanism of injury
pedestrian/cyclist stuck by a car, ejection from vehicle, fall from
over 1 meter or 5 stairs
Overdose
Other significant self harm (adults). NB. Mental Health Trust
advice is that this criterion should be open-ended and subject to
clinical judgment. For example, a „simple laceration‟ would be inscope
for the UCC.
Any self harm (children)
Severe withdrawal, delirium tremens and withdrawal seizures (as
these are very likely to require medical admission)
Acute psychosis with disturbed behaviour.
Acute confused state/ delirium
Require a secure environment (ie the main Emergency Dept) for
assessment including suicide risk using current screening tool
In addition to the exclusion criteria set out above, the following exclusion criteria will apply to
paediatric patients:
Figure 7.34 UCC clinical exclusion criteria (children)
Exclusion criterion
Acutely ill children
Children with signs of
severe or life threatening
asthma
Paediatric head injury
Additional information
All children identified as „acutely ill‟ using Paediatric Early
Warning System (PEWS)
too breathless to talk or feed
respiration 40 breaths a minute in children over 5 years or > 50
breaths per min 5 minutes
Abnormal drowsiness
2 or more discrete episodes of vomiting
Clinical suspicion of non-accidental injury
Post-traumatic seizure
Use AVPU to assess level of alertness.
Suspicion of skull injury or tense fontanelle
Any sign of basal skull fracture
o haemotympanum, „panda‟ eyes, cerebrospinal fluid
7b. Work of the Emergency and Urgent Care CIG 155