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Post ROSC CT Protocol

Within ED we often have little information about the patient we are resuscitating. Post-ROSC (return of spontaneous circulation )we commonly perform CT head, but evidence and Resus Council Guidance suggests extending this scan can pick up important pathology that can otherwise be missed (13%).

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Neuro-Obs

Neurological Observations MUST include the following:

  • A full set of NEWS2 observations
  • ACVPU assessment (alert, new confusion, voice, pain, unresponsive)
  • GCS (Glasgow coma scale)
  • Pupillary responses
  • Assessment of Limb power

Head Injury – Level 1

Head injury is witnessed, reported, suspected, or cannot be excluded.

  • There is any new onset of neurological symptoms or deterioration.
  • The patient complains of pain / tenderness to the head
  • Extra consideration should be given to patients currently prescribed anticoagulant medication at the time of the fall.

Post fall Neurological Observations must be completed for at least 12 hours and at the above intervals as a minimum:

During this time If there is any deterioration in the patient’s condition including level of consciousness, pupil reaction, limb power, cardiovascular observation you must revert to ½ hourly neurological observation and seek URGENT medical review.

Patients should be reviewed if no change in condition at 12 hours to ascertain if neurological observations are still indicated – this decision must be documented in the medical notes.

Under no circumstances should Neurological observations be omitted because the patient is asleep

Head Injury – Level 2

Admitted with Head Injury

  • With a sudden deterioration in their level of consciousness
  • Who are unconscious on arrival to hospital
  • Post first seizure

During this time If there is any deterioration in the patient’s condition, including level of consciousness, pupil reaction, limb power or cardiovascular observation you must revert to ½ hourly neurological observations and seek URGENT medical review. Patients should be reviewed if no change in condition at 12 hours to ascertain if neurological observations are still indicated – this decision must be documented in the medical notes.

Under no circumstances should Neurological observations be omitted because the patient is asleep.

Intracerebral/Subarachnoid Haemorrhage OR Stroke
  • Acute Primary Intracerebral/Subarachnoid  haemorrhage
  • Any other Ischaemic stroke 
  • Post Thrombolysis /Thrombectomy for Stroke patients only

During this time If there is any deterioration in the patient’s condition, including level of consciousness, pupil reaction, limb power or cardiovascular observation you must seek URGENT medical review and revert to ½ hourly neurological observations as a minimum, or ¼ hourly, if still within the first 2 hours post thrombolysis.

Under no circumstances should Neurological observations be omitted because the patient is asleep.

Major Trauma: STOP>SORT>GO

YAS crews may on occasions (rarely) bring us a Major Trauma patient that meets the criteria for bypass to the MTC because they have a problem that the crew cannot manage, or they won’t survive to LGI e.g. an unmanageable airway/ incompressible haemorrhage. In these instances we will get a pre-alert either from the crew or more likely the Major Trauma Triage Co-ordinator in EOC with some information but primarily the reason the patient is coming to us.

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Paediatric Blast Injury

Save the Children, have published a used full guide on management on blast injuries in children. Taking you through pre-hospital, ED and inpatient care.

Although blast injury is rare in the UK it’s worth a read as an adjunct to APLS/ATLS training.

  • Recognising “Blast Lung” – which may be subtle initially and develop over hours (p51)
  • Prophylactic antibiotics
  • Compartment syndrome and fasciotomy (p105)
  • Burns Fluids and escharotomies (p112)

Ful Guide[PDF] – HERE

Lower Limb DVT

Signs and Symps

No single feature is diagnostic:

  • Single limb oedema – Most specific
  • Leg pain – 50% but is nonspecific
  • Calf pain on dorsiflexion of the foot (Homan’s sign)
  • Tenderness of deep veins – 75% of patients
  • Warmth AND/OR erythema (although blanching is possible)
  • A palpable, indurated, cordlike, tender subcutaneous venous segment

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