Humeral Brace – Application

Inclusion Criteria – All closed neurovascular intact adult humeral shaft fractures Exclusion Criteria – Intra-articular fractures of either the proximal or distal humerus, and surgical neck of humerus. Packet contains black humeral brace and blue sling. Size is based on mid humeral circumference and brace length, as per chart. The hypoallergenic fabric casing holds two …

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Acidosis & VBG’s

We are frequently asked to check the lactate on Venous Blood Gases (VBG’s), by the nursing staff. However, remember to look at the first result (pH) it is the most important. Acidosis: Unless you have a good reason (e.g. you know its due to DKA) you should be investigating and performing an Arterial Blood Gas …

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#RCEMasc 2019 – Day 3

AIRWAYS-2 ETT vs SGA (i.e. iGel) in out of hospital cardiac arrest (trauma and kids excluded) Headline Results:  Survival with good neurological out come (MRS 0-3) – No difference around 2.75% (for those that required either SGA or ETT) Easiest – SGA easier achieving ventilation within 2 attempts (87.4% vs 79%) Displacement – SGA suffer …

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#RCEMasc 2019 – Day 2

Paracetamol 12hr SNAP regime: 2014 & 2019 What is it?  Pre-NAC – 4mg Ondansetron IV Bag 1 – 2hr 100mg/kg NAC in 200ml 5% Dex Bag 2 – 10hr 200mg/kg NAC in 1000ml 5% Dex Advantages Saves 9hrs Significant reduction in anaphylactoid reactions 2% vs 11% Significant reduction in gastric symptoms (if either ondasetron or 12hr regime …

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#RCEMasc 2019 – Day 1

For those back home its been an interesting 1st day at the conference  – and the top 5 are 1. Learning from Child Death Great session, presented by both clinical staff and parents, around the death of a 3yo with Down’s syndrome, from sepsis. Highlighted some key points that we can all do better: Communication: …

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Haematoma Block – Colles’

Haematoma blocks can be a safe and effect method of pain relief to facilitate reducing Colles’ fractures. What to give? 1% Lidocaine Onset 10-15min Offset up to 2hr 3mg/kg (maximum dose) 70kg patient could have up to 210mg Volume 1% Lidocaine = 10mg/ml  70kg = 210mg / 10 = 21ml Signs of TOXICITY  Sensory Disturbance: …

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Diabetic Hyperglycaemia (Kids)

Diabetic children sometimes attend ED with hyperglycaemia, but not in DKA (what should we do?) Paeds have produced some advice to follow: Ketones over 0.6? <0.6: Encourage fluids & food, may need an insulin correction >0.6: ask Question 2 Are there clinical features of DKA? NO: Encourage fluids & food, decide Insulin correction, will need …

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