Unfortunately the the normal pathway for investigation of PE performs poorly in pregnancy RCOG have the following pathway
In the Emergency Department (ED) lower leg immobilisation after injury is a necessary treatment but is also a known risk factor for the development of venous thromboembolism (VTE). This accounts for approximately 2% of all VTE cases which are potentially preventable with early pharmacological thromboprophylaxis.
Average life expectancies are often longer than you imagine and after 100yrs life expectancy increases!
However, Clinical frailty score is often more predictive.
Study shows that the rate of change in frailty has a significant impact on life expectancy. People with “Stable” growth in frailty score remaining at their base line but the faster the CFS changes more impact that has.
So its worth asking how things have changed over the last year.
Frailty has a significant influence on recovery and mortality in relation to both “MINOR” and “MAJOR” trauma.
Rib injury is probably more important than most of us realise – suggesting 15% increase in mortality for every rib a frail person fractures. JRCALC have since updated guidance to recommend “rib spring” rather than “gentle palpation” in examination.
Mater hospital Dublin have introduced a review clinic for patients following significant traumas.
Mater hospital – Adult only ED
Silver Trauma Review Clinic
A really common presentation elderly patients that can be tricky with a higher baseline probability of cardiac causes.
Get up and Go test
We often over test look for the simple things first they are the most common.
Most patients would prioritise time with love ones rather than fruitless time with us.
Emergency Laparotomy: CFS is more predictive than age
Covid:
In-hospital CPR: frailty can predict outcome in UK trial
Ombudsman states: End of Life
But our communication needs to be clear to patients and families, not just saying “they are sick” but how sick. And not just what we are not going to do but what we are going to do for the patient.
90% of hypercalcaemia is due to either malignancy or hyperparathyroid.
Severity: Adjusted Calcium (Ca)
Bell’s Plays is a lower motor neurone (LMN) lesion of the facial nerve (CN VII), which causes one side of the face to “droop” [1% of cases are bilateral], and patients are often concerned that it is a stroke.
However, unlike in stroke the whole face is affected, in stroke and other upper motor neurone (UMN) lesions the upper portion of the face is unaffected due to input from both sides of the brain. Read more
Hypoglycaemia (Blood glucose under 4.0 mmol/l) is potentially fatal and should be treated. it may be defined as “mild” self-treated, or “severe” treated by a third party i.e. you.
Hypoglycaemia is a common side-effect of insulin and sulfonylureas (they start with gli-) as they both work by lowering glucose concentration in the blood. Other diabetic medications work by preventing glucose rise, thus posing a lesser risk.
Start at step 3 above (while managing ABC), the choice of whether to use IV glucose or IM glycogen will be determined by practicality of achieving IV/IO access.
Although you will need to follow the remaining steps the patient will almost certainly require admission.
Hypokalaemia (low potassium), is a common problem. It is found in 14% of outpatients and 20% of inpatients, however only 4-5% of those are of clinical significance.
We are regularly doing blocks next to major vessels. So warn the patient of the symptoms, & keep them monitored(at least 15 min).
Symptoms of local anaesthetic toxicity
Use conventional therapies to treat:
PDF: Quick Reference Handbook – Guidelines for crises in anaesthesia
C-spine injury ranges from the obvious fracture-dislocation to the less obvious ligamentous injury, affecting about 2.5% of blunt trauma patients. However, ALL of them are serious and can lead to life changing injuries, that we obviously don’t want to miss. Unfortunately reported miss rates range from 4-30%. [IJO 2007]
