Author: embeds
Burns Referral Pathway
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 the most appropriate follow-up for your patient.
This requires BOTH online referral & phone call
The Process
- GoTo – Burns Homepage (NHS computers ONLY)
- Select – New Referral (NO login required)
- Complete – the following sections (* means required field)
- Referrers Details – you will need an NHS email address
- Patient Details
- Injury Details – Answering “Yes” to airway burns or fluid resuscitation will open further boxes
- Additional Details – Patient’s phone number and address (only appears if NO airway or resuscitation issues)
- Checklist – Ensure ALL completed and submit
- Sending an Image – After submission a QR code will appear to send an image you will need to us the SID App
- Launch the SID App on mobile device – Yours or ED Co-Ordanator (apple/android)
- Scan the QR code
- Consent the patient – Patient Information Leaflet
- Take Photo of Injury – this will not be saved on the device
- Phone Burns team – They can review the details and images and better advise you on management.
Resources
Lateral Canthotomy
Like tension pneumothorax the biggest step is deciding to do it – Remember it it sight saving and they heal well
Retrobulbar Haematoma secondary to blunt eye injury is a a rare but potentially sight threatening injury.
- Blood collects in the retrobulbar space
- Pushing the eye forward to accommodate the extra volume.
- The Orbital Septum (made up of the eyelids and ligaments that attach them to the orbital rim) restricts this forward movement, creating a compartment syndrome for the eye. Thus threatening the patients sight if not treated quickly.
Recognition
![](https://i0.wp.com/www.embeds.co.uk/wp-content/uploads/2019/05/retrobulbar-haematoma.png?resize=215%2C300&ssl=1)
- Severe pain
- Red/Congested conjunctiva
- Exophthalmos with proptosis – eye pushed forward
- Internal ophthalmoplegia – impairment or loss of the pupillary reflex.
- Visual flashes
- Loss of vision – initially colour vision (esp. red), progressing to local visual loss.
However, this may only be recognised on CT if there is significant facial injury and altered conscious level.
Treatment
Call Ophthalmology immediately to attend. If there is going to be any significant delay, it may be necessary for ED to preform a Lateral Canthotomy, to allow the eye to move forward, reduce the orbital pressure & preserve the patients sight.
Kit needed
- Lidocaine with adrenaline (needle & syringe)
- Clamp – ideally curved to crush the tissues
- Forceps
- Scissors
Resources
- Royal College of Ophthalmologists – Traumatic Orbital Emergencies
- Making a training model – Great article covering it HERE
- Tips not in the paper
- Creme Fraiche Pot – works (use 53mm paper tube to hold eye in place)
- Cut square hole 34x34mm
- Rubber band cut 40mm slit
- Reinforce the Eyelid corners with foam so the rubber band doesn’t stick (i.e. small square facing down
- When applying the foam eye lids ensure cants at the corners of the square
- Tips not in the paper
NEWS 2 & Clinical Response
AAGBI – Intubation Check List
Simple pre-intubation checklist for the whole team to be aware of so we can make intubation in ED as safe as possible.
PDF: Full Version (included tracheostomy displacement algorithm)
Pre-Arrival Blood (O-ve)
On rare occasions you may receive a pre-alert, where you want blood available for the patient when they arrive (for example in major haemorrhage). This process has been agreed with transfusion so this can be done safely and responsibly. Read more
Headache – ACP/MG teaching
Slides available – here
Main topics of discussion were:
- Primary vs Secondary headache
- Red Flags
- Temporal Artritis
- Venous Sinus Thrombosis – its variable presentation, and need to highlight in the CT request.
Fitting – ACP/MG teaching
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
Dislocated Shoulder (Teaching Video)
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 patient)
- Kocker’s shouldn’t be used in # greater tuberosity
- Cunningham technique looks interesting (I’m going to give this a go)
- Traction is the what causes the most pain. Reduce the traction & Reduce the sedation required