All patients presenting with a suspected native hip dislocation following trauma (including falls from standing) must have a primary survey done to assess for other injuries.
Early Senior input (if not trauma team) and Resus
Neurovascular status of the affected limb must be assessed and documented.
Dislocation of Prosthetic Hip
Relatively common and frequently low energy
All patients should be assessed with low threshold to treat as trauma
Remember the biggest cause of ISS >15 Major Trauma in UK is older patients falling from standing height
Neurovascular status of the affected limb must be assessed and documented.
If there is neurovascular compromise then move to Resus and inform ED senior
There is was a national shortage of Intranasal Diamorphine therefore many departments are now more comfortable using Intranasal Fentanyl as a replacement for rapid provision of opioid analgesia in children.
Intranasal (IN) fentanyl is a safe, non-invasive and effective analgesic for children with moderate to severe pain
Fentanyl should be used in combination with non-pharmacological and other pharmacological pain management
It can be used in conjunction with nitrous oxide for procedural sedation or prior to procedural sedation with ketamine
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
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
As part of a short series on very basic principles of wound closure we are going to discuss the use of adhesive strips. This practical advice is intended offer some guidance in the use of adhesive strips, assumes the full assessment of the wound has already occurred and the wound is suitable for this method of closure.
Used for a several types of knee injury, the knee splint provides support and comfort to the knee joint, whilst allowing for the patient to weight bear as appropriate.
The below indicative video demonstrates application of a leading brand.
The process is very similar with other manufacturers, but the specific manufacturer’s instruction should be adhered to for the splint applied.
Splints should be applied next to the skin, and certainly not over baggy clothing, as this may lead to movement of the splint, not providing the correct support.
Walker Boots are an alternative to conventional casting materials, which immobilises the foot and ankle at 90 degrees, where the limb doesn’t need to completely non weight bearing.
Most commonly in the ED setting used to gently restrict movement of a joint, either due to injury of the sturcutres of the joint, or in order prevent stressing of wound closure.
The below shows a double wool and crepe bandage to the knee, which is also known as a Robert Jones bandage, the technique can be applied to other limbs, and for a single layer simply stop after the first layer of bandage is applied.
Robert Jones bandages are useful in the absence of appropriately sized knee splints, or if the patient is unable to tolerate a splint.
Note that although the text of the video states to finish mid-calf the bandage material should be extended past the calf to the top of the ankle as is the practice shown.
