#NoF – Fractured Neck of Femur

December 20, 2017

Update: BOAST Guidance If a patient with a #NoF (or other fragility fracture requiring admission) has received a head injury requiring CT a CT Neck… Read more

Achilles Tendon Rupture

May 5, 2019

A common sporting injury, especially in disciplines that require stop start sprints or rapid changes of direction   Read more

Acromioclavicular Joint Injuries

May 10, 2019

  One of the most common shoulder injuries, acromioclavicular joint (ACJ) dislocations account for around 9% of shoulder girdle injuries   Read more

Adult Sedation

June 4, 2020

This guideline is a brief summary of the RCEM 2012 Safe sedation in the ED and RCEM – Pharmacological Agents for Procedural Sedation and Analgesia… Read more

Animal Bites – Mammalian

July 17, 2018

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… Read more

Burns Referral Pathway

May 8, 2019

A new burns referral pathway has been developed with Mid Yorks to securely send images of the patients burn. Allowing the burns team to arrange… Read more

C-Spine Injury

September 4, 2018

C-spine injury ranges from the obvious fracture-dislocation to the less obvious ligamentous injury, affecting about 2.5% of blunt trauma patients. However, ALL of them are… Read more

COVID-19 (VTE prophylaxis in Lower Limb Injury)

April 20, 2020

During the Covid-19 pandemic alternatives to LMWH have been agreed – [For those who can’t inject themselves] Read more

CT Abdo/Pelvis & Pregnancy Testing

December 11, 2019

Radiology are now requesting blood pregnancy testing reproductive females from 10-35days from last period. But what is wrong with urine pregnancy testing? Read more

Dabigatran Reversal

September 16, 2019

Bleeding on Dabigatran? <C>ABCD – as usual trying to stop bleedBloods: FBC, Clotting, U&E, G&SDiscuss with Haematologist (esp. if taken within 12-24hr)Idarucizumab (PRAXBIND) 5g IVFound… Read more

Dislocated Shoulder (Teaching Video)

December 1, 2018

Great review of shoulder reduction, techniques and sedation.  Learning points: Most techniques will work 80% of the time (Best results tailor the technique to the… Read more

Domestic Abuse

August 27, 2018

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… Read more

Elbow Crutches

May 22, 2018

Measuring for and advising patients on the use of elbow crutches is an important skill for ED staff. Read more

Eye Clinic Referral Criteria

January 8, 2019

What should you send to Eye Clinic and how soon? Read more

Fracture Clinic is Changing

March 26, 2019

Fracture Clinic is changing to Virtual Fracture Clinic (VFC) It’s been found that 30% of patients referred to fracture clinic where discharged with only advice… Read more

Haematoma Block – Colles’

September 27, 2019

Haematoma blocks can be a safe and effect method of pain relief to facilitate reducing Colles’ fractures. What to give? 1% Lidocaine Onset 10-15min Offset… Read more

Head Injury

February 27, 2018

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… Read more

Humeral Brace – Application

October 6, 2019

Inclusion Criteria – All closed neurovascular intact adult humeral shaft fractures Exclusion Criteria – Intra-articular fractures of either the proximal or distal humerus, and surgical… Read more

LA – Toxicity

December 22, 2017

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

Limping Child

April 21, 2018

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… Read more

Lisfranc Injuries

February 9, 2019

A Lisfranc injury describes an injury of the foot between the metatarsal and tarsal spaces. Around 20-40% of lisfranc injuries are initially missed, so a… Read more

Lower Back Pain: Red & Yellow Flags

December 14, 2019

Each year 1:15 of the adult population will seek medical help for Lower Back Pain, that is 2.6 million patients in the UK. Most Lower… Read more

Lower Limb ED Physio Referrals

May 31, 2018

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… Read more

Mallet Finger

May 19, 2018

Mallet Deformity is an inability to maintain extension of the distal phalanx of the finger at the distal intraphalangeal  joint. Read more

Morton’s Neuroma

October 24, 2018

Morton’s Neuroma is a painful condition resulting from the fibrous thickening of the plantar interdigital nerve of the foot.   Often described as feeling like… Read more

Nail Trephination

May 9, 2018

Bleeding under the nail from blunt trauma can be very painful. Lucky we have the tools on hand to ease some of that pain. Read more

Neck of 5th Metacarpal Fractures

June 21, 2019

Neck of fifth Metacarpal (Boxer’s) fractures are a common injury, and how we treat them locally is changing.   Read more

Octaplex – work fast its an EMERGENCY!

December 16, 2017

In recent incidents we have had significant delays in giving OCTAPLEX, So ….. Activate EARLY in head injury patients on warfarin. Order on EPR &… Read more

Paediatric Clavicle Fracture

March 26, 2018

Clavicle fracture is a common presentation and some patients can be managed at home without fracture clinic follow up. Inclusion Criteria Isolated mid-shaft clavicle fracture… Read more

Paediatric Ketamine Sedation

June 4, 2020

RCEM 2012 Safe sedation in the ED and RCEM Ketamine for paediatric procedural sedation guideline. Please read these documents in full or participate in RCEM… Read more


October 5, 2018

  Infection in the skin fold (or paronychium) to lateral edge of the nail (of the finger or toe, but most commonly finger). Leads to a… Read more


December 8, 2018

Primary Eyecare Acute Referral Scheme Read more

Posterior Shoulder Dislocation

December 3, 2020

Posterior shoulder dislocation is far less common than anterior dislocation. But it is commonly missed with some sources stating 50% of posterior dislocations are missed… Read more

Rabies [notifiable disease]

July 17, 2018

Recent Incident: Bat contact was not recognized (effectively touching a bat without gloves means treatment is recommended) Rabies is an acute viral encephalomyelitis caused by members of… Read more

Radial Buckle Fractures

March 26, 2018

Some Radial Buckle #’s in children can be managed with: Well fitting splint  Advice sheet This decision tree must be followed to identify suitable patients… Read more

Rape & Sexual Assault

March 6, 2018

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… Read more

Rare Antidotes – how to get

August 30, 2018

Getting some of the rarer antidotes has recently been clarified across Yorkshire (Accessing rarely used antidotes-SOP) Read more


January 15, 2019

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… Read more

Rock Paper Scissors OK (RPSOK)

October 4, 2019

URM! anyone for Rock Paper Scissors OK (RPSOK) Assessment of nerve function after upper limb injury in children has been shown to be poorly documented.… Read more

Safeguarding Adult & Child

January 7, 2018

Safeguarding is massively important but often not done! This can be due to lack of recognition OR not knowing what help there is. Often our… Read more

Sex, Bites, and Needle Sticks

February 28, 2018

First Aid (ALL) Encourage bleeding Wash with copious amounts of water or saline Don’t Suck Don’t use Caustic agents   Read more

Silver Trauma

October 21, 2019

The population is ageing and thus our ‘typical’ trauma patient is also changing. In 2017 the TARN report “Major injury in older people” highlighted the… Read more

Tetanus – Wounds

July 26, 2018

Changes in: Tetanus prone and High Risk definitions Immunisation schedule Primary: 2, 3 & 4 months old Boosters: 3½ – 5yrs and 13-15yrs Warning: Immunisation… Read more

Tetanus Immunoglob­ulin – SHORTAGE

July 4, 2018

Changes in: Tetanus prone and High Risk definitions Recently there have been supply problems with Human Tetanus Immunoglob­ulin, currently we are using the alternatives below. Post-Exposure… Read more

Thomas Spint – how to apply

February 3, 2019

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… Read more

Tick Bites

July 17, 2018

Though less common locally than in some areas, tick bites pre and post removal do offer some concern to patients. Read more

TXA – Tranexamic Acid

October 16, 2019

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… Read more

Upper Limb ED Physio Referrals

April 28, 2018

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… Read more

Vaccination Schedules UK & International

March 27, 2019

Working out what your patient might have been vaccinated for can be tricky, and more so if they were raised outside of the UK. Luckily… Read more

VTE prophylaxis in Lower Limb Injury

December 16, 2017

Consider in ALL over 16’s with lower limb immobilisation. Bloods not required for everyone. Prescribe for 2 weeks (to cover any delay to # clinic)… Read more