Category: Resus

Massive Transfusion Pathway

In the case of patient with Massive Haemorrhage weather that be from Trauma, Surgical, O&G, UGIB, you can activate the MTP

Remember:

  • Do the Basics – don’t forget ABCD
  • Inform Transfusion and get someone to run a G&S sample down
  • FFP can take up to 45min and platelets come from Leeds
  • If you no longer need the MTP – inform transfusion and return products ASAP
major haemorrage

PDF:MTP

 

2. HAZMAT – Suspected Contamination Incident

So a patient comes to ED after white powder thrown is at them what do you do? Your initial response can help them and everyone in the department!

  1. Ask them to leave the department
    • Going to garage was useful
    • Inform Nurse in Charge and Consultant
  2. Dynamic risk assessment
    • Performed by nursing/medical staff while outside
  3. Decontaminate
  4. Return to ED

If you haven’t seen the Initial Operational Response (IOR) training video please watch it.

The patient can then be thoroughly assesses, to identify the substance involved (this may involve witnesses, police info and symptomatology), and treated appropriately.

Police should be informed of the incident for several reasons: 1. Public safety, 2. To collect the evidence and possible find out what it was for you. (if this is not a criminal act Public health England can advise on return/disposal of personal effects)

Inform Manager On-Call of incident as it may disrupt the functioning of ED and can provide support.

 

Patient symptom-free and substance unknown

In our recent case Public Health England advised

  • 4-6hr observation
  • Discharge with advice:
    • “if developing symptoms to return to the ED via ambulance but the patient must be aware that they must inform 999 of the original exposure.”

Resourses

Major Trauma Network

We are part of the West Yorkshire Major Trauma Network with our MTC at LGI

WYMTN: Guides

We know that from time-time patient are brought to us and we find injuries that are more appropriate to manage at the MTC. This is inevitable as the on scene triage tool is never going to identify every major trauma patient – this is a failing of the tool not the crew. The decision tree below can help you  arrange transfers in the most timely and appropriate manner. Read more

CPAP Set-Up

NIPPV 3 machines are used throughout the trust to deliver NIV and CPAP – and should be commenced in ED if transfer to ward/ICU is adding significant delay

  • NIV/CPAP  is NOT an Aerosol Generating Proceedure (AGP) [as of Sept 2022]
  • CPAP/EPAP levels of 8-15cmH2O

This video demonstrates how to set up CPAP on the NIPPV 3

 

ECG placement & mis-LEADing ECG’s

  • V1: 4th intercostal space (ICS), RIGHT margin of the sternum
  • V2: 4th ICS along the LEFT margin of the sternum
  • V4: 5th ICS, mid-clavicular line
  • V3: midway between V2 and V4
  • V5: 5th ICS, anterior axillary line (same level as V4)
  • V7: Left posterior axillary line, in the same horizontal plane as V6.
  • V8: Tip of the left scapula, in the same horizontal plane as V6.
  • V9: Left paraspinal region, in the same horizontal plane as V6.

Read more

COVID-19 (Awake Self-Proning)

There is increasing evidence that Awake Self-Proning of our Covid-19 patients can improve oxygenation. Proning the patient can has several effects which can dramatically improve their SaO2

  • Improves Ventilation to back of the lung (the back of the lung contains more alveoli than the anterior lung)
  • Improves Perfusion – as blood supply to the back of the lung is always better than the front
  • Improves Clearance of secretions
  • Be patient can take 15-20min

Contraindications (all seem obvious)

Absolute contraindications:

  • Respiratory distress (RR ≥ 35, PaCO2 ≥ 6.5, accessory muscle use) 
  • Immediate need for intubation 
  • Haemodynamic instability (SBP < 90mmHg) or arrhythmia 
  • Agitation or altered mental status 
  • Unstable spine/thoracic injury/recent abdominal surgery 

Relative Contraindications: 

  • Facial injury 
  • Neurological issues (e.g. frequent seizures) 
  • Morbid obesity 
  • Pregnancy (2/3rd trimesters) 
  • Pressure sores / ulcers