JRCALC Clinical Guideline Updates Bundle No. 8 – Feb 2022

NB: Each individual organisation reviews the new JRCALC guidance and decides on the local clinical and operational practice. The introduction of a new medicine or procedure may take some time to be operationalised into an organisation.



New JRCALC Guidelines/medicines

Steroid-dependent PatientsNew guideline covering assessment and management of steroid-dependent patients with emphasis on hydrocortisone administration. The existing wording in Medical Emergencies in Adults is removed as it is now superseded by this new guideline.
PrednisoloneNew JRCALC medicine.
Indications: Asthma and COPD.
MagnesiumNew JRCALC medicine.
Indications: Asthma, eclampsia, severe pre-eclampsia and torsades de points.


Updates, Corrections, and Additional Guidance to Existing JRCALC Guidelines

Medicines OverviewUpdated. Table of routes of administration deleted as this is detailed in each medicine guideline.
Trauma Emergencies in Adults,
Trauma Emergencies in Children
New guidance around assessment and management of hanging added, with reference also added to Trauma Emergencies in Children.
Asthma in Adults and ChildrenUpdated guidance to include magnesium for life threatening asthma, and prednisolone.
Maternity Care (including Obstetric Emergencies Overview)New guidance on waterbirths included in 7. Special Considerations section. Emphasis on getting a woman in labour out of the water prior to giving birth.
Medical Emergencies in Adults, Falls in Older Adults, Trauma Emergencies in Adults New wording around frailty scoring added: consider using the clinical frailty scale, as per local pathways.
A link in Further Resources to the NHS Clinical Frailty app will be added.
Glucose Gel 40%Maximum dose changed from 2 tubes to no maximum dose.
Tranexamic AcidRemoval of wording in indications. The indication for TXA in women with post-partum hemorrhage if the patient continues to bleed remains. The following text has been removed:
Obstetric Emergencies
• Life threatening bleeding due to disorders of obstetric origin (e.g. antepartum haemorrhage, suspected placental abruption).
• Women who are pregnant and/or breastfeeding should have tranexamic acid administered in life threatening haemorrhage.
Sickle Cell Disease and Pain Management in AdultsAlignment to advise oral, intramuscular, or subcutaneous administration of opioid rather than IV in sickle cell disease.
HydrocortisoneUpdated indications: COPD and pregnant women with known Addison’s Disease who are in established labour (regular painful contractions)
ChlorphenamineThe IV route is re-included as a route for anaphylaxis for alleviating distressing cutaneous symptoms, only after emergency treatment with adrenaline and the patient is stable and oral anti-histamine administration is not possible.
Buccal midazolamAddition of dosages for child aged three months and one month. The rectal 2.5mg diazepam will no longer be manufactured, and those trusts that have buccal midazolam will be able to use the dosages as detailed in JRCALC and follow local procedures for administration. Trusts that do not have buccal midazolam will need to follow local procedures for managing seizures in small children.