Penthrox is an inhaled, patient controlled analgesic for use with moderate to severe acute pain associated with trauma. Not to be used in atraumatic pain, chronic pain, children or pregnancy.
Rapid onset of analgesia lasting 25-60 minutes depending on rate and depth of inhalation. Wears off 10 minutes after last inhalation.
Recent Incident: Bat contact was not recognised (effectively touching a bat without gloves means treatment is recommended)
Important: Rabies Vaccine is in short supply and we must do a UKHSA risk assessment. Call RIgS 09:30-17:00 7 days, OR complete Form
Rabies is an acute viral encephalomyelitis caused by members of the lyssavirus genus. The UK has been declared “Rabies-Free”. However, it is known that even in “Rabies-Free” counties the bat population posse a risk.
In the UK the only bat to carry rabies is the Daubenton’s Bat [Picture on the Left] and this is not a common bat in the UK. The UK and Ireland are Classified as “low-risk” for bat exposure. Despite our “low-risk” status in 2002 a man died from rabies caught in the UK from bat exposure.
Although rabies is rare it is fatal so we must treat appropriately, Public Health England – Green book details this.
To establish patients risk and thus treatment you need to establish the Exposure Category and Country Risk [Link to Country Risk]
Obviously patients with wounds will need appropriate wound care and cleaning, specifics for rabies are below.
If in ANY doubt, or you feel you need advice about treatment contact: On-Call Microbiologist (who will contact PHE or Virology advice)
You will likely need to liaise with the duty pharmacist to obtain vaccine or HRIG – which may need to be sent from a different hospital. [it is probably worth trying to obtain the 1st weeks treatment if possible, to avoid treatment delays]
IN HOURS 08:30AM-5PM PLEASE CALL PHARMACY TO INFORM THEM TO EXPECT A DELIVERY OF IMMUNOGLOBULIN SO THIS CAN BE SEGREGATED FOR THE CORRECT PATIENT. PLEASE ASK TO SPEAK TO THE RESPONSIBLE PHARMACIST CRH (4218/4279) HRI (2422/7123)
Rabies and Immunoglobulin Service (RIgS), National Infection Service, Public Health England, Colindale (PHE Colindale Duty Doctor out of hours): 0208 327 6204 or 0208 200 4400
Fitting ASPEN collars is import – for both the comfort and function of the collar. The DENS study has been looking at the effectiveness on collars in peg fractures. Preliminary results suggest limited benefit, which made be due to the fact the many patients remove the collar early as not comfortable.
There is was a national shortage of Intranasal Diamorphine therefore many departments are now more comfortable using Intranasal Fentanyl as a replacement for rapid provision of opioid analgesia in children.
Dose is 1.5micrograms/Kg for the initial dose and 0.75micrograms/kg 10 minutes later if required.
Draw up the appropriate dose plus 0.1ml to allow for the dead space in the Mucosal Atomizer Device
Attach the MAD to the syringe
Sit the child at 45 degrees insert MAD loosely into the nostril and press the plunger
Doses greater than 0.5ml should be split between 2 nostrils
This is a relatively common presentation within the ED that has a myriad of possible diagnoses ranging from sprain to malignancy. One thing to remember is that patients and relatives will look for a traumatic reason for limb pain, and may link it to minor injuries that would not have caused it. Read more
To clarify the immobilisation strategy for patients requiring Poly-Trauma CT Scans (anything more than an isolated CT Head)
As part of a short series on very basic principles of wound closure we are going to discuss the use of adhesive strips. This practical advice is intended offer some guidance in the use of adhesive strips, assumes the full assessment of the wound has already occurred and the wound is suitable for this method of closure.
Read moreOr Boxer’s Knuckle. This is a rupture of the sagittal band of the MCPJ joint, most commonly of the middle finger.
Used for a several types of knee injury, the knee splint provides support and comfort to the knee joint, whilst allowing for the patient to weight bear as appropriate.
The below indicative video demonstrates application of a leading brand.
The process is very similar with other manufacturers, but the specific manufacturer’s instruction should be adhered to for the splint applied.
Splints should be applied next to the skin, and certainly not over baggy clothing, as this may lead to movement of the splint, not providing the correct support.
