MyCpdZw - Protocols Details

HAND INJURIES

Hand injuries are common and can invlove a variety of structures such as the skin, tendons, nerves, blood vessels, bones and joints.

Diagnosis

These are common in the Emergency Department.

Preservation & restoration of maximal normal function is essential.

Identify & document all injuries, vascular, tendon & nerve deficits & refer appropriately.

Management

1. Analgesia with digital block, local infiltration, nerve blocks, Bier’s block or IV analgesia,

2. X-Ray if there is possible bony injury or foreign body (consider USS),

3. Clean open injuries & remove all debris,

4. Suture with a 5-0 non-absorbable material,

5. Antibiotics if extensive wounds or “open” fractures,

6. Splinting in neutral position with arm elevated,

7. All wound should be reviewed by medical officer within a couple of days,

8. Sutures should be removed after 5-7 days, longer if over extensor surface of joint.

Fingertip skin loss:

If small, treat with non-adherent dressings, changed every couple of days.

Larger areas of skin loss,or where there is none exposure, should be referred to general surgical

or plastics specialists.

Tendon injuries:

Remember failure to flex at the;

· DIPJ = Divided flexor digitorum profundus,

· PIPJ = Divided flexor digitorum superficial &

· The IPJ of the thumb = Divided flexor pollicus longus.

Tendon injuries should generally all be repaired by a Plastic/orthopaedic surgeon, preferably within

24 hours. Partial extensor tendon division (up to 80%) may be treated by splinting after discussion

with medical officer/ “Plastics”.

Digital Nerve injury:

Operative repair for thumb, ulna border of hand, distal index finger & digits of dominant hand unless

distal to the DIPJ.

Palmar surface infections & tendon sheath infection: Elevate, splint, Flucloxacillin with early review

as might need incision for drainage

Recent Protocols

COVID 19

COVID 19 is a disease caused by the most recently discovered coronavirus which is a large family of corona viruses causing illnesses. In humans it causes Respiratory infections for example Severe Acute Respiratory Disease (SARs) PRESENTATION Fever 77-98% Cough 46-82% Myalgia/Fatigue 11-52% Shortness of breath 3-31% Incubation period 14 days, most people develop symptoms between 5-6ays from exposure Stage1 (Early infection). Stage 2. Stage 3(Hyperinflation phase) Viral response---------------------------Pulmonary Phase----------------------Host Response *Anyone presenting with flu like symptoms should be assumed to be a COVID 19 case until proven otherwise*

WARFARIN OVERDOSE/ TOXICITY

Overdose of the oral anticoagulant warfarin (Coumadin), or drug interactions with warfarin, can lead to toxicity. Similarly, toxicity can result from exposure to superwarfarins, which are long-acting anticoagulants used in rodenticides. ... Warfarin is the most common oral anticoagulant in current use

SUICIDAL IDEATION

Suicidal ideation, also known as suicidal thoughts, is thinking about or having an unusual preoccupation with suicide.

SPINAL CORD INJURY

Emergency signs and symptoms of a spinal cord injury after an accident may include: Extreme back pain or pressure in your neck, head or back. Weakness, incoordination or paralysis in any part of your body. Numbness, tingling or loss of sensation in your hands, fingers, feet or toes. Loss of bladder or bowel control.