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.
Category: MSK
Rare Antidotes – how to get
Getting some of the rarer antidotes has recently been clarified across Yorkshire (Accessing rarely used antidotes-SOP)
Neck of 5th Metacarpal Fractures
Neck of fifth Metacarpal (Boxer’s) fractures are a common injury, and how we treat them locally is changing.
Acromioclavicular Joint Injuries
One of the most common shoulder injuries, acromioclavicular joint (ACJ) dislocations account for around 9% of shoulder girdle injuries
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
Achilles Tendon Rupture
A common sporting injury, especially in disciplines that require stop start sprints or rapid changes of direction
Lisfranc Injuries
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 high degree of clinical suspicion is required.
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
Eye Clinic Referral Criteria
What should you send to Eye Clinic and how soon?
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
