Posterior shoulder dislocation is far less common than anterior dislocation. But it is commonly missed with some sources stating 50% of posterior dislocations are missed in the ED. Read more
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Hyperkalaemia
Remember: is it a haemolysed blood sample? (you can do an iSTAT)
Severity
- Mild: 5.5-5.9mmol/l – No urgent action required (Dietary & Medication modification & GP F/U)
- Moderate: 6.0-6.4mmol/l – Follow treatment guide (maybe suitable for discharge)
- Severe: ≥6.5mmol/l OR ECG changes – Follow treatment guide, must admit
Consenting for Blood Transfusion
We frequently consent for Blood Transfusion, but what risks do we tell the patients about and how common are those risks?
Dislocated Shoulder (Teaching Video)
Great review of shoulder reduction, techniques and sedation.
Learning points:
- Most techniques will work 80% of the time (Best results tailor the technique to the patient)
- Kocker’s shouldn’t be used in # greater tuberosity
- Cunningham technique looks interesting (I’m going to give this a go)
- Traction is the what causes the most pain. Reduce the traction & Reduce the sedation required
Necrotising Fasciitis
Necrotising fasciitis (NF) is a rare but serious bacterial infection that affects the soft tissue and fascia (Fournier gangrene, is NF affecting the perineum). In many cases NF progresses rapidly and early recognition and treatment is vital to halt progress. The mainstay of treatment is IV antibiotics and aggressive surgical debridement. Any delay increased the amount of tissue loss as well as the mortality. Read more
DVLA – Driving & Medical Conditions
For many conditions the patient should be informed to stop driving and inform the DVLA of their condition. It is the patients responsibility to inform the DVLA, and we should encourage them to do so.
[There is a £1000 fine AND the risk of prosecution] Read more
SAH – NICE 2022
Headache is a common presentation to ED and Subarachnoid Haemorrhage (SAH) is the diagnosis we never want to miss. However, working out who needs a scan can be difficult as 50% of patients presenting with a subarachnoid have no neurological deficit.
- ‘Thunder Clap’ headache peak of pain within 5min is a RED-FLAG
- Although, most patients with ‘Thunder Clap’ don’t have SAH, this should not deter emergent investigation
- Patients may present more subtlety the following should make you consider the diagnosis:
- neck pain or stiffness (limited or painful neck flexion on examination)
- photophobia
- nausea and vomiting
- new symptoms or signs of altered brain function (such as reduced consciousness, seizure or focal neurological deficit)
- Always be suspicious if the patient has communication difficulties.
Silver Trauma
The population is ageing and thus our ‘typical’ trauma patient is also changing. In 2017 the TARN report “Major injury in older people” highlighted the following issues:
- The typical major trauma patient: has changed from a young and male to being an older patient.
- Older Major Trauma Patients (ISS>15): A fall of <2m is the commonest mechanism of injury
- Triage/Recognition of ‘Silver Trauma’ is POOR
- Pre-hospital: Not identified hence taken to TU’s (Here) not MTC’s (Leeds).
- The ED: Often seen by Junior Staff and endure significant treatment delays.
- Hospital: Much less likely to be transferred to specialist care.
- Outcomes: More likely to die, but those who survive have similar levels of disability to younger people.
Status Epilepticus (ADULT)
Thanks to Giulia Giovannetti for developing this.
Hypothermic Arrest [Adult]
True Hypothermic Arrest is thankfully rare in the UK. However, when it does happen it is resource intense and prolonged. The ERC 2021 guidance has introduced a new decision step HOPE score to the algorithm, once the Initial phase of resuscitation has been completed without ROSC.
If the is HOPE score is <0.1 the team may which to consider terminating CPR [Warning: Adults ONLY Children have better survival] Read more
