Category: Trauma

VFC/Orthopedic – Trust Treatment & Follow-Up

Select the appropriate body area for guidance table

No Spinal injuries, back pain, Cauda Equina, foot drop etc to be referred to VFC
 

Patients that will not be suitable & need a “face-to-face” as below

  • Homeless patients
  • Prisoners
  • Non English Speaking Patients
  • Inpatients
  • Patients with Hearing Difficulties
  • Phoneless Patients
  • Injuries Associated with Domestic or Child Abuse
  • Children under 2 Years of Age
Hand Injury Referral
Our local hand surgeons have requested the following reduce the number of transfers to BRI
 
Hand Trauma – Refer to BRI:
  • All soft tissue pathology (tendon, nerve, nailbed, complex wounds, infections, compartment syndrome, necrotising fasciitis)
  • Open hand fractures, regardless of location
  • Phalangeal fractures
  • Any case requiring an on-call opinion
T&O (VFC or F2F Clinic) – HRI:
  • Closed fractures proximal to the MCPJ (metacarpal and proximal onwards)
  • UCL injuries and similar (e.g. boxer’s knuckle)
  • Simple dislocations without fracture or with small bony avulsion
  • Mallet finger (with clear documentation of whether bony or non-bony)
No Follow-Up Required:
  • Simple wounds
  • Closed extra-articular tuft fractures
Upper Limb

Lower Limb

5th MT zones

LA – Toxicity

We are regularly doing blocks next to major vessels. So warn the patient of the symptoms, & keep them monitored(at least 15 min).

Symptoms of local anaesthetic toxicity

  • Circumoral and/or tongue numbness
  • Metallic taste
  • Lightheadedness/Dizziness
  • Visual/Auditory disturbances (blurred vision/tinnitus)
  • Confused/Drowsiness/Fitting
  • Arrhythmia
  • Cardio-Resp Arrest

Remember – Do basics WELL

Without Cardio-Resp Arrest

Use conventional therapies to treat:

  • Seizures
  • Hypotension
  • Bradycardia
  • Tachyarrhythmia (Lidocaine should not be used as an anti-arrhythmic therapy)

In Cardio-Resp Arrest

  • CPR – using standard protocols (Continue CPR throughout treatment with lipid emulsion)
  • Manage arrhythmias – using standard protocols
  • Consider the use of cardiopulmonary bypass if available
  • Recovery from LA-induced cardiac arrest may take >1 h
  • Lidocaine should not be used as an anti-arrhythmic therapy

PDF: Quick Reference Handbook – Guidelines for crises in anaesthesia

 

Head Injury

Background

  • Defined as any traumatic injury to the head other than superficial facial injuries.
  • The commonest cause of death and disability in people age 1-40 in the UK.
  • Account for 1.4 million ED attendances each year, 95% of these are minor head injuries that can be managed in the ED.

Read more