Page 263 - Registrar Orientation Manual 2016

Document reference:
5295
Effective date:
14 Oct 2014
Expiry date:
14 Oct 2017
Page:
2 of 9
Title:
Speciality Referral Guidelines
Type:
Guideline
Version:
05
Authorising initials:
See the Memo on “Working in the Emergency Department“ for further details about working in ED.
CHILDREN
Paediatric Medicine sees all children with medical conditions up to their 15th birthday.
In occasional circumstances, Paediatrics may take certain patients beyond their 15th birthday if they have a chronic life-long condition and are still managed long term as outpatients under the service.
Paediatric Surgery sees most surgical and traumatic conditions in children up to their 15th birthday.
Paediatric Surgery usually manages (with exceptions noted):
• Trauma except those single system conditions managed by other services:
o Orthopaedics manage fractures/dislocations/spinal injuries o Maxillo-Facial manage facial injuries
o Plastics manage hand injuries
• Abdominal and thoracic surgical conditions, for example acute surgical abdomen, diaphragmatic hernia, empyema, pneumothorax, incarcerated herniae
• Genito-urological issues: testicular/ovarian torsion, urinary calculi, PUJ obstruction with pain
• Inhaled/ingested foreign bodies requiring endoscopic removal (bronchoscopy, oesophagoscopy)
• VP shunt issues/ hydrocephalus if previously under Paediatric Surgery (otherwise Neurosurgery)
Paediatric Surgery does not manage:
• Wounds that can be treated by the ED under ketamine or similar sedation
• Constipation in the rare instance that inpatient consultation is required this should be dealt with by Paediatric Medicine
• UTI, D&V which should be managed by Paediatric Medicine
ADULTS PROBLEM Abdominal Pain
Acute Arthritis
Alcohol/Drug Withdrawal
Anaemia
Aortic Dissection
SERVICE General Medicine Urology
O&G
General Surgery
Orthopaedics General Medicine
Community Drug & Alcohol Service
General Medicine Relevant Service
General Medicine
Cardiothoracic Surgery
Cardiology
DETAILS AND EXCEPTIONS
Pyelonephritis, UTI, gastro-enteritis
Proven ureteric stone requiring admission Gynaecological cause or due to confirmed pregnancy
All other patients with abdominal pain
Suspected septic arthritis
Gout or rheumatological condition
CADS normally only take elective referrals but they may be called for advice during normal office hours
Only if severe withdrawal symptoms (see Link)
If complicating a pre-existing condition or a non-GIT
source of bleeding (e.g. epistaxis or vaginal bleeding)
If suspected occult GIT blood loss or anaemia of unknown cause and requiring admission for transfusion
Involving ascending aorta/arch (“Type A”) Distal to left subclavian artery (“Type B”)