The population is ageing and thus our ‘typical’ trauma patient is also changing. In
highlighted the following issues: 2017 the TARN report “Major injury in older people”
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.
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 (ABG)
URM! anyone for Rock Paper Scissors OK (RPSOK)
Assessment of nerve function after upper limb injury in children has been shown to be poorly documented. The following assessment tool has been shown to improve.
A selection of patient, relative, and general resources designed to assist those presenting with self injury, and those who care for them.
We all recognise the importance of ensuring patients with Parkinson’s disease (PD) get their medication, but..
What do you do if the patient can’t swallow?
We will need to work out what alternative routes we could use, for example dispensable via NG or patches, and what dose. For an ED clinical it is most likely beyond us and we need help! However, that may be extremely difficult to get especially Out of Hours
Excellent website that can give you options – select the patients normal regime (initially just one line but you can add as many as needed) and press calculate. It gives you a dispensable and patch dose, which can help the discussion with pharmacy about where we can get it
Haematoma blocks can be a safe and effect method of pain relief to facilitate reducing Colles’ fractures.
What to give?
Offset up to 2hr
3mg/kg (maximum dose)
70kg patient could have up to 210mg
Volume 1% Lidocaine = 10mg/ml
Signs of TOXICITY
Sensory Disturbance: Facial tingling, Numbness, Metallic taste, Tinnitus, Vertigo
Functional Disturbance: Slurred speech, Seizures, Reduced GCS
Cardiovascular: Hypotension, Palpitations
Treatment – ABCD, see LA-Toxicity [HERE] Asepsis
Remember you are putting a needle into a sterile fracture and bone infection never ends well.
Chloro prep or Betadine – ensure it has time to dry
Sterile Gloves (particularly when learning)
No-Touch technique (Only if proficient)
Find fracture site – move approx. 1cm proximally
Insert needle – bevel down & at approx. 30°, towards the fracture
Hit bone & slide – forward into the fracture
Aspirate – you should be able to aspirate some blood, but not always (however, its should not flow too easily, if it does are you in a vessel?)
Inject – this often needs a bit of pressure, infiltrate approx. 1/4 of the volume.
Fanning (this is not always necessary but seems to improve outcome) b.
Withdrawal needle a little – keeping it under the skin.
Change angle & advance – into the fracture
Aspirate and Infiltrate – more lidocaine
Repeat – do this several times so you have walked needle across the fracture (Use approx. 1/2 the lidocaine)
Ulna styloid (Only needed if fracture or tender) c.
Find Ulna styloid
Insert needle – straight onto the styloid
Inject – you are not normally going into the fracture but leaving a bolus approx.1/4 Give the patient 10-15min while you set up for reduction for it to achieve peak effect – then check how its working. (getting the patine to move their wrist is a good test)
ENP’s – DOP’s forms can be found here
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 to be monitored
YES: Will need Paeds admission
Nausea and vomiting in pregnancy is common and at best an unpleasant experience for the patient, and at worst can be life threatening. It normal
starts @ 4-7/40, peaks @ 9/40, and finishes @ 20/40.
We need to conduct a thorough history and examination looking for causes other than a high βHCG. these include: