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 more
Radiology are now requesting blood pregnancy testing reproductive females from 10-35days from last period. But what is wrong with urine pregnancy testing?
The population is ageing and thus our ‘typical’ trauma patient is also changing. In
highlighted the following issues: 2017 the TARN report “Major injury in older people”
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.
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 more
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.
Haematoma blocks can be a safe and effect method of pain relief to facilitate reducing Colles’ fractures.
What to give?
Offset up to 2hr
3mg/kg (maximum dose)
70kg patient could have up to 210mg
Volume 1% Lidocaine = 10mg/ml
Signs of TOXICITY
Sensory Disturbance: Facial tingling, Numbness, Metallic taste, Tinnitus, Vertigo
Functional Disturbance: Slurred speech, Seizures, Reduced GCS
Cardiovascular: Hypotension, Palpitations
Treatment – ABCD, see LA-Toxicity [HERE] Asepsis
Remember you are putting a needle into a sterile fracture and bone infection never ends well.
Chloro prep or Betadine – ensure it has time to dry
Sterile Gloves (particularly when learning)
No-Touch technique (Only if proficient)
Find fracture site – move approx. 1cm proximally
Insert needle – bevel down & at approx. 30°, towards the fracture
Hit bone & slide – forward into the fracture
Aspirate – you should be able to aspirate some blood, but not always (however, its should not flow too easily, if it does are you in a vessel?)
Inject – this often needs a bit of pressure, infiltrate approx. 1/4 of the volume.
Fanning (this is not always necessary but seems to improve outcome) b.
Withdrawal needle a little – keeping it under the skin.
Change angle & advance – into the fracture
Aspirate and Infiltrate – more lidocaine
Repeat – do this several times so you have walked needle across the fracture (Use approx. 1/2 the lidocaine)
Ulna styloid (Only needed if fracture or tender) c.
Find Ulna styloid
Insert needle – straight onto the styloid
Inject – you are not normally going into the fracture but leaving a bolus approx.1/4 Give the patient 10-15min while you set up for reduction for it to achieve peak effect – then check how its working. (getting the patine to move their wrist is a good test)
ENP’s – DOP’s forms can be found here
Neck of fifth Metacarpal (Boxer’s) fractures are a common injury, and how we treat them locally is changing.
James Heilman, MD [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)] Read more
One of the most common shoulder injuries, acromioclavicular joint (ACJ) dislocations account for around 9% of shoulder girdle injuries