Posterior shoulder dislocation is far less common than anterior dislocation. But it is commonly missed with some sources stating 50% of posterior dislocations are missed in the ED. Read more
Category: MSK
Paediatric Ketamine Sedation
RCEM 2012 Safe sedation in the ED and RCEM Ketamine for paediatric procedural sedation guideline. Please read these documents in full or participate in RCEM learning for further information.
Adult Sedation
This guideline is a brief summary of the RCEM 2012 Safe sedation in the ED and RCEM – Pharmacological Agents for Procedural Sedation and Analgesia in the Emergency Department – March 2019. Please read these documents in full or participate in RCEM learning elearning for further information. Read more
COVID-19 (VTE prophylaxis in Lower Limb Injury)
During the Covid-19 pandemic alternatives to LMWH have been agreed – [For those who can’t inject themselves]
Lower Back Pain: Red & Yellow Flags
Each year 1:15 of the adult population will seek medical help for Lower Back Pain, that is 2.6 million patients in the UK. Most Lower Back Pain is not serious and will revolve within 8 weeks, with analgesia and self physio.
However, this is not the case for some. This may be due to serious underlying pathology ‘RED Flags‘, or psychological factors that indicate chronicity ‘Yellow Flags‘.
Read moreCT Abdo/Pelvis & Pregnancy Testing
Radiology are now requesting blood pregnancy testing reproductive females from 10-35days from last period. But what is wrong with urine pregnancy testing?
Read moreSilver Trauma
The population is ageing and thus our ‘typical’ trauma patient is also changing. In 2017 the TARN report “Major injury in older people” highlighted the following issues:
- 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.
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)
Humeral Brace – Application
Inclusion Criteria – All closed neurovascular intact adult humeral shaft fractures
Exclusion Criteria – Intra-articular fractures of either the proximal or distal humerus, and surgical neck of humerus.
Read moreRock Paper Scissors OK (RPSOK)
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.
