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.
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.
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?
- 1% Lidocaine
- Onset 10-15min
- 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]
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 field
- 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.
b. Fanning (this is not always necessary but seems to improve outcome)
- 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)
c. Ulna styloid (Only needed if fracture or tender)
- 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.
One of the most common shoulder injuries, acromioclavicular joint (ACJ) dislocations account for around 9% of shoulder girdle injuries
A new burns referral pathway has been developed with Mid Yorks to securely send images of the patients burn. Allowing the burns team to arrange the most appropriate follow-up for your patient.
This requires BOTH online referral & phone call
- GoTo – Burns Homepage (NHS computers ONLY)
- Select – New Referral (NO login required)
- Complete – the following sections (* means required field)
- Referrers Details – you will need an NHS email address
- Patient Details
- Injury Details – Answering “Yes” to airway burns or fluid resuscitation will open further boxes
- Additional Details – Patient’s phone number and address (only appears if NO airway or resuscitation issues)
- Checklist – Ensure ALL completed and submit
- Sending an Image – After submission a QR code will appear to send an image you will need to us the SID App
- Launch the SID App on mobile device – Yours or ED Co-Ordanator (apple/android)
- Scan the QR code
- Consent the patient – Patient Information Leaflet
- Take Photo of Injury – this will not be saved on the device
- Phone Burns team – They can review the details and images and better advise you on management.
A common sporting injury, especially in disciplines that require stop start sprints or rapid changes of direction