Category: Trauma

RCEM CPD 2019 Day 1

 HEAD AND NECK

Tracheostomy Emergency Care Dr Brendan McGarth

www.Tracheostomy.org.uk

Needs to distinguish Tracheostomy from laryngectomy as a laryngectomy has no connection to the upper airway however a tracheostomy may have a connection so gives you 2 options for an airway.

Trachostomy problems commonly seen in the ED:-
Tube obstructions
Tube displacement
Stoma problems
Skin problems

Tracheostomy Emergency Pathway

Laryngectomy Emergency Algorithm

Online learning  modules available at the link

www.e-lfh.org.uk/programmes/tracheostomy-safety/

 

The Impact of Dental Presentations to the ED  — Chetan Trivedi 

Facial imaging his a high dose of radiation to senative tissues in often young people therefore careful examination is required prior tor Xrays.

Predictors of radiological abnormality in facial trauma-

Tenderness over maxillary
Step deformity in maxillary
Sensory loss over site of injury
Change in bite
Subconjunctival haemhorrhage
Broken teeth
Periorbital haematoma
Abnormal eye signs

Predictors of radiological abnormality in mandibular trauma-
Restricted or painful mouth opening
Tenderness over mandible
Sensory loss over site of injury
Change in bite/painful bite
Broken teeth
Step deformity

Try to assess carefully prior or to imaging

 

Acute OphthalmologyFelipe Dhawahir-Scala

https://www.beecs.co.uk

Viral conjunctivitis all have preauricular or submandibular lymphadenopathy, highly contagious.

Do not give chloramphenicol to contact lens wearers use something with a broader spectrum.

Urgent conditions (reasons to get an ophthalmologist out of bed) —

Acute angle closure glaucoma -red painful eye, semi dilated pupil, – start iv acetazolamide immediately

Orbital cellulitis – eye doesn’t move, colour vision loss, fever, chemosis,  proptosis -start Ciprofloxacin and clarithromycin orally, image and call ophthalmology.

 

 

Vertigo – Peter Johns 

Concerning features- new or sustained headache or neck pain it’s a stroke or vertebral artery dissection until we prove it isn’t.

A central cause …Unable to walk or stand unaided, Weakness in limbs, the Deadly d’s… dysarthria,  diplopia, dysphagia, dysarthria,  dysphoria.

Short episodes of Vertigo  (spinning/dizziness) on getting up/rolling over in bed, no spontaneous or gaze provoked nystagmus.
(End gaze nystagmus so normal variant,  look to 30 degrees only.)
Need dix-hallpike testing likely BPPV – posterior canal BPPV.
Treat with Epley manoeuvre.

Horizontal Canal BPPV – Dix-hallpike manoeuvre is negative and they are less clear which side they turn to to get dizzy.

Spontaneous or gaze provoked nystagmus for days, nausea and vomiting and gait disturbance likely to be Vestibular neuronitis.

Test using HINTS plus Exam– nystagmus,  test of skew, head impulse test, hearing loss. All components have a central or peripheral result for each component. If all 4 are peripheral results then it is a acute Vestibular neuroitis

Vestibular migraine – 30% never get headache,  can last hours or days.
More common in women, perimenopausal, often get photophobia, phonophobia, nausea, vomiting and other typical migraine symptoms.

You tube – peter Johns (links here)

 

Head Injury

Background

  • Defined as any traumatic injury to the head other than superficial facial injuries.
  • The commonest cause of death and disability in people age 1-40 in the UK.
  • Account for 1.4 million ED attendances each year, 95% of these are minor head injuries that can be managed in the ED.

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CDU – Trauma (Significant mechanism but NO injury)

This pathway is for those patients who despite having a significant mechanism of injury, has survived relatively unscathed. Although they don’t require admission they could do with a period of observation.

This is not for patients that should be admitted but specialities are refusing. Escalate to your senior

Specific admission criteria

  • Significant Mechanism of injury
  • NO injury OR illness requiring admission
  • GCS over 13
  • Does NOT require spinal immobilisation

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