If I suspect a flare up of gca, should I be seen quickly in A & E?
If I suspect a gca flare up, should I be seen qui... - PMRGCAuk
If I suspect a gca flare up, should I be seen quickly in A & E?
24 Replies
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PMRproAmbassador
Now how do you mean the question? Do you mean "Should I go to A&E?" or do you mean "Will they see me quickly in A&E?"
Should you go to A&E - that depends. Do you have a rheumatology helpline? They should be your first port of call providing they get back to you quickly. Or the GP practice if they are open - don't let a receptionist palm you off with "it isn't an emergency". If the GP thinks the hospital is the right place, they can phone and/or send you with a letter to be taken more seriously.
Will they see me quickly at A&E? That is another question. The pressures on the ED at present mean you may have a long wait and out of hours there is unlikely to be a rheumatologist available to be asked for advice. Is the ED at the hospital where you are seen by rheumatology? If not, there may not even be a rheumatologist attached to the hospital.
The advice used to be for GCA patients to keep a high dose of pred in reserve and if they had any symptoms of a flare, especially any visual symptoms or severe GCA-type headache, to take the dose immediately and then seek medical advice straight away.
Why are you asking? Have you got any symptoms you think may be due to the GCA no longer being well controlled?
in reply to PMRpro
I was told by rheumatology that if I have a GCA flare, go to A&E to get a CRP blood test. I waited six and a half hours, was sent to emergency GP, where I was told they don't do blood tests.
Exactly. That isn't the way the ED works in most hospitals, they triage, if the traige nurse isn't familiar with GCA they would class it non-urgent and you would see the GP. So it is best to contact your GP and get sent to the ED with a letter. The other option out of hours would be to call 111 and explain that to start with, You might get to speak to the OOH GP who could arrange the blood test. But the rheumy is a bit optimistic - it is unlikely the CRP would have risen much/that quickly.
What is a high dose of pred to keep in reserve? I was once told to have 40 x 5mg preds in reserve for asthma but it never happened.
I think they used to suggest 60mg - you should take it and seek medical help.
I was not clear on the asthma thing. The plan would have been 10 on day 1, 9 on day 2, 8 on day 3... Just in case anyone thought 200mg was suggested.
DorsetLadyPMRGCAuk volunteer
Depends what symptoms you have, and how severe- and yes, if you have by sight disturbances.
This is usual procedure for a flare - but do you have symptoms now or is it just a hypothetical question?
My esr went from 20 to 40 in two hours last time. So was worried. Was told GCA was a medical emergency
GCA should be considered an medical emergency. Especially pre diagnosis, pre medication.. but it doesn’t always get treated as such.
The problem with ESR it’s not specific to GCA, it can be raised by many things… and to go from 20 to 40 within 2 hours certain requires further investigation.
in reply to DorsetLady
Yes I was fast tracked on that occasion
ncfaaeos in reply to
As far as I understand it, GCA is a medical emergency. The problem is that not all doctors seem to recognize it. I went for a very long time before it was diagnosed, which resulted in damage to my aorta.
ESR will rise faster than CRP which is why it is actually quite useful in PMR/GCA. GCA IS a medical emergency - but most triage nurses at the ED won't be that aware and are unlikely to take the word of a patient just turning up at the door. As Pixix says, if you go via a doctor or even an optician who is part of the CUES emergency system, you are more likely to be listened to in the ED.
An ED is not a mini-hospital, it is there to keep you alive until there is an appropriate specialist departmental doctor to see you and I know of no ED that has an on-call rheumatologist - it is probably why a lot of doctors go into it, working days and no weekends is very appealing!
When it comes down to it, if you are left waiting in the ED, it is fairly comforting: there are a lot of people far worse off than you going tp the head of the queue. Once you are on treatment with steroids for GCA, you will no longer be considered an emergency. Whether that is correct or not may be a moot point but will depend on the situation.
in reply to PMRpro
I am in remission at the moment but have the red markers it has come back. I am not on medication at the moment. The emergency GP clinic at the hospital was full of people being sent there by a & e. I don't mind the wait, but couldn't understand why I was sent to gp, and neither could they. It seemed to be full of people with colds, who seemed to be using a & e as a doctors surgery. I have always had good treatment by rheumatology and the hospital in the past.
I am in remission at the moment but have the red markers it has come back. I am not on medication at the moment
Pity you didn’t say that at the beginning…because you do require meds… so please ring nhs 111 and seek advice stating what issues you have.
Nextoneplease in reply to
Right! I suggest you call 111 immediately and explain your red flags. Emphasise that you are in remission and have no emergency steroids. Don’t take no for a answer, my impression is that you need to be seen.
Good luck x
As DL says, that is a very different situation - but it does illustrate that triage at the ED may not be aware of the red flags and why the pathway should be via a doctor BEFORE arriving at the door of the ED and if you can't see your own GP, you need 111 and speak to a doctor, using the correct trigger terms.
Of course the emergency GP was full of triaged patients from the ED - the ones who can't tell the difference between something the pharmacist could have dealt with at the weekend or even a bit of thought could have been sorted themselves and what belongs in the ED. It is a major problem everywhere because of the difficulty people have in seeing their own GP.
A friend of mine was seriously sick with undiagnosed Hepatitiswhenshe arrived in A&E, but there was a dreadful car crash near the city that evening, &, naturally, those people who were in a critical condition were treated before her. There were 3 with life threaten8ng injuries, & it’s a small A&E dept. I don’t think it’s possible to answer your question, as it depends on too many factors. Don’t forget that everybody who goes to the emergency & accident area has ‘an emergency’! If they don’t, then they shouldn’t be there, & Theres a lot of advertising in England about that & other alternatives are offered in places. Round here, we now have a walk-in surgery 24/7 that should be used, if possible. That helps, too, I think. If you are seen by your Dr or another physician & they believe you need to be seen as an emergency & have a life threatening condition, then they will arrange transport & send you with a letter, & you will be expected on arrival. Just my thoughts…
It is very difficult to see a gp where I live. We have had 30,000 new houses built and no extra gp surgeries. Rheumatology have said to go to A & E.
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