Radiology are now requesting blood pregnancy testing reproductive females from 10-35days from last period. But what is wrong with urine pregnancy testing?
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TXA – Tranexamic Acid
TXA a bleeding wonder drug!
Crash 2 Study (2010)
- Multi-Centre RCT of the use of TXA in trauma
- Inclusion – Adult trauma patients with ≥1 of
- Suspicion of significant haemorrhage
- HR ≥110bpm
- sBP ≤90mmHg
- Treatment – 1g TXA IV over 10min then a second 1g TXA IV over 8hrs
- Outcome – Significant reduction in Death, bleeding with NO increase in clots(thrombotic disease)
- Most benefit seen if given early (<3hr – NNT 53)
Dabigatran Reversal
Domestic Abuse
Domestic abuse can affect anyone and often its not readily disclosed on an ED admission. We must be alert to the fact some of our patients may be attending with domestic abuse. Please explore concerns and escalate if you’re unsure. Our colleagues in the Pennine Domestic Violence Group have kindly drawn this a guidance up for us.
Rare Antidotes – how to get
Getting some of the rarer antidotes has recently been clarified across Yorkshire (Accessing rarely used antidotes-SOP)
Thomas Spint – how to apply
Invented by a Welshman ‘Hugh Owen Thomas’, the introduction of this simple device in World War 1 went on to reduce the mortality of #femurs from 80% to 16%.
The Kit
- Measuring Tape
- Thomas splint – Adult or Paediatric (depending on size)
- Hoop – Sizing guide can be found here
- Slings
- Hoop Pad
- Skin Traction – Adult or Paediatric
- Padding rolls x 2
- Bandages (wide) x 2
- Tape
- Scissors
- Tongue Depressors x 2
Measuring
Measure the Inside Leg (unbroken leg) and add 30cm/12inch (to give room for the traction)
Adjusting Splint
Adjust length to the above measurement. ensuring the Hoop is at an angle with the lateral (outside leg) higher than the medial (inside leg).
Set up
- Apply the hoop Pad (to reduce pressure and secure to tight)
- Apply the 4 slings (lowest should be 40cm from base)
- Apply padding along slings
- Creat a small padding for behind the knee
Application
- Ensure Adequate analgesia (this hurts) – typically Opiates and entonox
- Femoral nerve block may be helpful (however, this is variable due to the innovation of the femur and reduces the more distal the fracture)
- Check Genitals not trapped – by the hoop
- Apply skin traction & and bandage from ankle to thigh
- Secure the tight Clip – remembering to put the padding under the clip and velcro round
The Knot
1. take the strings and pass one over and one under the sides of the frame.
2. secure tightly with a Reef Knot
3. pass strings down (one over and one under) around the base, bringing them back over the Reef Knot and back around the base. This makes a pulley system.
4. Tension the pulley system and tie-off using a bow
5. Pass the tongue depressors (2 tongue depressors tapped together), twist the tongue depressors to achieve the required tension, and lock off against the side.
Bandage & Elevate
- Bandage the leg to the sling using the bandage – to keep secure
- Place a pillow or blankets under the splint to elevate the heel – To prevent pressure sores
Eye Clinic Referral Criteria
What should you send to Eye Clinic and how soon?
Lower Limb ED Physio Referrals
Lower limb (LL) and especially knee injuries are a very common presentation within the ED, but in the acute phase can be difficult to give a definitive diagnosis and an appropriate treatment / referral plan.
Upper Limb ED Physio Referrals
Upper limb (UL) and especially shoulder injuries are a fairly common presentation within the ED, but in the acute phase can be difficult to give a definitive diagnosis and an appropriate treatment / referral plan.