Save the Children, have published a used full guide on management on blast injuries in children. Taking you through pre-hospital, ED and inpatient care.
Although blast injury is rare in the UK it’s worth a read as an adjunct to APLS/ATLS training.
Recognising “Blast Lung” – which may be subtle initially and develop over hours (p51)
Compartment syndrome and fasciotomy (p105)
Burns Fluids and escharotomies (p112)
Ful Guide[PDF] – HERE
In the case of patient with
Massive Haemorrhage weather that be from Trauma, Surgical, O&G, UGIB, you can activate the MTP Remember:
Do the Basics – don’t forget ABCD
Inform Transfusion and get someone to run a G&S sample down
FFP can take up to 45min and platelets come from Leeds
If you no longer need the MTP – inform transfusion and return products ASAP
NHS England have published this fantastic resource
[Click here] covering Major Incidents including; gunshot, crush, nerve agents and much more.
This is not to replace our trusts “Major Incident Plan”, however its a great learning resource and worth going through
So a patient comes to ED after white powder thrown is at them
what do you do? Your initial response can help them and everyone in the department!
Ask them to leave the department
Going to garage was useful
Inform Nurse in Charge and Consultant
Dynamic risk assessment
Performed by nursing/medical staff while outside
Return to ED
If you haven’t seen the Initial Operational Response (IOR) training video please watch it.
The patient can then be thoroughly assesses, to identify the substance involved (this may involve witnesses, police info and symptomatology), and treated appropriately.
Police should be informed of the incident for several reasons: 1. Public safety, 2. To collect the evidence and possible find out what it was for you. (if this is not a criminal act Public health England can advise on return/disposal of personal effects)
Inform Manager On-Call of incident as it may disrupt the functioning of ED and can provide support.
Patient symptom-free and substance unknown
In our recent case Public Health England advised
Discharge with advice:
“if developing symptoms to return to the ED via ambulance but the patient must be aware that they must inform 999 of the original exposure.” Resourses
NHS England, Public Health England and the Health Protection Agency have produced several very useful resources for us to use – BUT First. Basics
Health Protection Agency Teams – HERE
In hours: 0113 386 0300
Out of hours: 114 304 9843
ECOSA (Emergency Coordinated Scientific Advice System) – 0300 3033 493
UK NPIS – 0344 892 0111 Guides
REMOVE – REMOVE – REMOVE
At reception ask them to go outside to designated area and staff will be with them shortly. Inform Nurse in Charge!
Use the disrobing card to get the patient to safely remove and bag up clothes. Do your best to maintain privacy.
If we have ample warning or the number of patients will be significant, it may be worth deploying the decontamination tent but remember setting this up is time consuming.
Getting some of the rarer antidotes has recently been clarified across Yorkshire
( Accessing rarely used antidotes-SOP)
Simple pre-intubation checklist for the whole team to be aware of so we can make intubation in ED as safe as possible.
PDF: Full Version (included tracheostomy displacement algorithm)