Author: embeds
NEW: Burns Referral Pathway
A new burns referral pathway has been developed with Mid Yorks to securely send images of the patients burn. Allowing the burns team to arrange the most appropriate follow-up for your patient.
This requires BOTH online referral & phone call
The Process
- GoTo – Burns Homepage (NHS computers ONLY)
- Select – New Referral (NO login required)
- Complete – the following sections (* means required field)
- Referrers Details – you will need an NHS email address
- Patient Details
- Injury Details – Answering “Yes” to airway burns or fluid resuscitation will open further boxes
- Additional Details – Patient’s phone number and address (only appears if NO airway or resuscitation issues)
- Checklist – Ensure ALL completed and submit
- Sending an Image – After submission a QR code will appear to send an image you will need to us the SID App
- Launch the SID App on mobile device – Yours or ED Co-Ordanator (apple/android)
- Scan the QR code
- Consent the patient – Patient Information Leaflet
- Take Photo of Injury – this will not be saved on the device
- Phone Burns team – They can review the details and images and better advise you on management.
Resources
Lateral Canthotomy
Retrobulbar Haematoma secondary to blunt eye injury is a a rare but potentially sight threatening injury.
- Blood collects in the retrobulbar space
- Pushing the eye forward to accommodate the extra volume.
- The Orbital Septum (made up of the eyelids and ligaments that attach them to the orbital rim) restricts this forward movement, creating a compartment syndrome for the eye. Thus threatening the patients sight if not treated quickly.
Recognition
- Severe pain
- Red/Congested conjunctiva
- Exophthalmos with proptosis – eye pushed forward
- Internal ophthalmoplegia – impairment or loss of the pupillary reflex.
- Visual flashes
- Loss of vision – initially colour vision, progressing to local visual loss.
However, this may only be recognised on CT if there is significant facial injury and altered conscious level.
Treatment
Call Ophthalmology immediately to attend. If there is going to be any significant delay, it may be necessary for ED to preform a Lateral Canthotomy, to allow the eye to move forward, reduce the orbital pressure & preserve the patients sight.
Kit needed
- Lidocaine with adrenaline (needle & syringe)
- Clamp – ideally curved to crush the tissues
- Forceps
- Scissors
Resources
- Royal College of Ophthalmologists – Traumatic Orbital Emergencies
- Making a training model – Great article covering it HERE
- Tips not in the paper
- Creme Fraiche Pot – works (use 53mm paper tube to hold eye in place)
- Cut square hole 34x34mm
- Rubber band cut 40mm slit
- Reinforce the Eyelid corners with foam so the rubber band doesn’t stick (i.e. small square facing down
- When applying the foam eye lids ensure cants at the corners of the square
- Tips not in the paper
HS-Trop [arriving 8th May]
On the 8th of May we are changing our current troponin test to a HS-Trop (high sensitivity troponin). This will allow us to exclude ACS earlier in the patient journey, however it does mean getting used to new numbers and a new protocol. Read more
NEWS 2 & Clinical Response
AAGBI – Intubation Check List
Simple pre-intubation checklist for the whole team to be aware of so we can make intubation in ED as safe as possible.
PDF: Full Version (included tracheostomy displacement algorithm)
Pre-Arrival Blood (O-ve)
On rare occasions you may receive a pre-alert, where you want blood available for the patient when they arrive (for example in major haemorrhage). This process has been agreed with transfusion so this can be done safely and responsibly. Read more
Delirium in the ED
Delirium is one of a number of geriatric syndromes and has significant associated morbidity and mortality.
3 subtypes of delirium
- Hyperactive – easies to spot, one we are most familiar with. Characterised by agitation/aggression/hallucinations “the non cooperative patient”
- Hypoactive – harder to spot. Characterised by drowsiness, less responsive, vacant, sleeping more at home
- Mixed
Remember there is NO SUCH THING AS A “POOR HISTORIAN” !! – Just a poor clinician! If your patient is not cooperating and can’t tell you very much then you need to find out why!!! Read more
Headache – ACP/MG teaching
Slides available – here
Main topics of discussion were:
- Primary vs Secondary headache
- Red Flags
- Temporal Artritis
- Venous Sinus Thrombosis – its variable presentation, and need to highlight in the CT request.