Dog, and other mammalian bites, are a common presentation with the ED.
They can be easy to treat, but need some particular attention if we are going to get them right.
Animal Bites – Mammalian
Category: MSK
Limping Child
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
Paediatric Ketamine Sedation
RCEM 2022 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 2022 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
Mallet Finger
Mallet Deformity is an inability to maintain extension of the distal phalanx of the finger at the distal intraphalangeal joint.
Retrobulbar haemorrhage
What is retrobulbar haemorrhage?
- Rapidly progressing haemorrhage into the retrobulbar space which is rare but potentially sight threatening.
- Retrobulbar haemorrhage causes a rapid rise in intraorbital volume and pressure.
- If not treated it can quickly lead to retinal ischaemia and infarction resulting in permanent visual impairment or complete visual loss.
#NoF – Fractured Neck of Femur
BOAST Guidance
- #NoF patients (or other fragility fracture) who requiring CT Head (for head injury) also be performed a CT Neck
- Fragility fractures indicate the patient is at high risk of also sustain C-Spine injury.
- Also the pain is likely distracting and the patient is often over 65yrs old so Canadian C-Spine rules will not apply.
Hx/Exam
- Why did They Fall? – was this a collapse?
- Are they sick? – Co-morbidity/illness is common in this group and must be recognised
- Anticoagulants? – This affects treatment
- On Warfarin – If INR >1.5 (or unavailable) Vit-K 5mg
- Other injuries? – >65’s the most common mechanism of TARN major trauma is fall <2m
- Typically – Pain hip/buttock, shortened, externally rotated
- Atypical – Few signs (can they lift their leg & is rotation at the hip painful)
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.
