Category: Learning
Major Trauma Network
We are part of the West Yorkshire Major Trauma Network with our MTC at LGI
We know that from time-time patient are brought to us and we find injuries that are more appropriate to manage at the MTC. This is inevitable as the on scene triage tool is never going to identify every major trauma patient – this is a failing of the tool not the crew. The decision tree below can help you arrange transfers in the most timely and appropriate manner. Read more
CPAP Set-Up
NIPPV 3 machines are used throughout the trust to deliver NIV and CPAP – and should be commenced in ED if transfer to ward/ICU is adding significant delay
- NIV/CPAP is NOT an Aerosol Generating Proceedure (AGP) [as of Sept 2022]
- CPAP/EPAP levels of 8-15cmH2O
This video demonstrates how to set up CPAP on the NIPPV 3
TXA – Tranexamic Acid
TXA a bleeding wonder drug!
Crash 2 Study (2010)
- Multi-Centre RCT of the use of TXA in trauma
- Inclusion – Adult trauma patients with ≥1 of
- Suspicion of significant haemorrhage
- HR ≥110bpm
- sBP ≤90mmHg
- Treatment – 1g TXA IV over 10min then a second 1g TXA IV over 8hrs
- Outcome – Significant reduction in Death, bleeding with NO increase in clots(thrombotic disease)
- Most benefit seen if given early (<3hr – NNT 53)
Acidosis & VBG’s
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)
Resources for Patients with Self Injury
A selection of patient, relative, and general resources designed to assist those presenting with self injury, and those who care for them.
Dabigatran Reversal
Bleeding on Dabigatran?
- <C>ABCD – as usual trying to stop bleed
- Bloods: FBC, Clotting, U&E, G&S
- Discuss with Haematologist (esp. if taken within 12-24hr)
- Idarucizumab (PRAXBIND) 5g IV
- Found in Emergency Drug cupboard
- We experienced delay finding as spelt wrong in the catalogue!
Gentamicin – Prescribing on EPR
Do NOT use this regime for:
- Pregnant women
- Children under 16 years
- Urology surgery prophylaxis patients
- ANY patient who has ascites, limb amputation, cystic fibrosis, endocarditis, major burns, Cisplatin Chemotherapy, renal transplant.
Domestic Abuse
Domestic abuse can affect anyone and often its not readily disclosed on an ED admission. We must be alert to the fact some of our patients may be attending with domestic abuse. Please explore concerns and escalate if you’re unsure. Our colleagues in the Pennine Domestic Violence Group have kindly drawn this a guidance up for us.
Be #urosceptical
Ditch the Dipstick – for patients >65Yrs or Catheterised!
Approx. 50% of over 65’s and most of those with catheters have asymptomatic bacteriuria. The patient will not benefit from treatment and often gives us premature closure (i.e. we blame a fictitious UTI for the patients symptoms and stop thinking). Read more
