In the Emergency Department (ED) lower leg immobilisation after injury is a necessary treatment but is also a known risk factor for the development of venous thromboembolism (VTE). This accounts for approximately 2% of all VTE cases which are potentially preventable with early pharmacological thromboprophylaxis.
Category: Trauma
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
Intranasal Fentanyl
There is currently a national shortage of Intranasal Diamorphine therefore we are using Intranasal Fentanyl as a replacement.
Dose is 1.5micrograms/Kg for the initial dose and 0.75micrograms/kg 10 minutes later if required.
Drug Delivery
Draw up the appropriate dose plus 0.1ml to allow for the dead space in the Mucosal Atomizer Device
Attach the MAD to the syringe
Sit the child at 45 degrees insert MAD loosely into the nostril and press the plunger
Doses greater than 0.5ml should be split between 2 nostrils
Contraindications
- Blocked nose due to upper respiratory illness or epistaxis
- Respiratory depression
- Hypovolaemia
- Altered consciousness
- Hypersensitivity to fentanyl
- Children below 1 year old
Penthrox (Methoxyflurane)
Penthrox is an inhaled, patient controlled analgesic for use with moderate to severe acute pain associated with trauma. Not to be used in atraumatic pain, chronic pain, children or pregnancy.
Rapid onset of analgesia lasting 25-60 minutes depending on rate and depth of inhalation. Wears off 10 minutes after last inhalation.
Contraindications (CHECK ALLL):
Animal Bites – Mammalian
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.
Mallet Finger
Mallet Deformity is an inability to maintain extension of the distal phalanx of the finger at the distal intraphalangeal joint.
CT 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 moreTXA – 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
Bleeding on Dabigatran?
- <C>ABCD – as usual trying to stop bleed
- Bloods: FBC, Clotting, U&E, G&S
- Discuss with Haematologist (esp. if taken within 12-24hr)
- Idarucizumab (PRAXBIND) 5g IV
- Found in Emergency Drug cupboard
- We experienced delay finding as spelt wrong in the catalogue!
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.
