Primary Eyecare Acute Referral Scheme
Category: Trauma
Rhabdomyolysis
We often worry about patients developing rhabdomyolysis and consequently developing AKI. However, there is much debate and little consistency in the published data, over how to diagnose and who needs admission to treat. So its important to consider both clinical context along with laboratory values
Rape & Sexual Assault
Don’t
Preform intimate examinations on Sexual assault/Rape patients
- Unless life-threatening injuries are suspected e.g Haemorrhage.
- As our examination will inevitably destroy evidence that may aid this patient’s case
Do’s
- Consider contamination injury (HIV, HepB, HepC) – Guide
- Consider emergency contraception
- Children must have police referral for safeguarding and discussion with social care. The paediatricians in CHT may be able to offer support in navigation of services but the responsibility for non-urgent medical assessment lies with specialists at SARC.
- Refer to The Sexual Assault Referral Centre, either via Police or Self referral
FERNO Traction Splint
How to apply the FERNO traction splint for our in-hospital patients
Fascia Iliaca Block – FIB
VTE prophylaxis in lower limb Immobilisation (ED – 2023)
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.
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.
