Extremity Trauma

Limb injuries following trauma are extremely common ED presentations. Some limb injuries can be life threatening External exsanguination from arterial bleeding “internal bleeding” from femoral or other long bone fractures an adult can bleed 1.5L from a single femoral # crush syndrome Other limb injuries are “limb” threatening mangled limbs Read more…

Paramedic handover

Unless the patient is requiring an immediate life-saving intervention, the paramedic handover should be taken prior to moving the patient to the trauma bed. The handover should be systematic with full attention given by all team members. The handover length should ideally take 30-60 seconds.   A suggested handover tool Read more…

Haemothorax

  A haemothorax is a collection of blood in the pleural space. It can be caused by penetrating or blunt thoracic trauma.     Clinical signs   Patients with a massive haemothorax are generally unstable – this should be detected clinically (as part of the primary survey)   Smaller haemothoraces Read more…

Thoracostomy considerations

Needle thoracocentesis for tension pneumothorax In a patient with a suspected tension pneumothorax, traditional trauma teaching advocated for rapid decompression on the affected side with a 14-16G needle in the 2nd intercostal space in the mid clavicular line.   The issues There is a growing body of evidence that this Read more…

Elderly patients

  Due to a decline in birth rates and increased life expectancy, New Zealand’s population is aging. In 2018, 15% of New Zealanders were aged 65 years or older and by 2051, this is projected to steadily increase.   From https://www.health.govt.nz/nz-health-statistics/health-statistics-and-data-sets/older-peoples-health-data-and-stats   This is significant as the elderly have increased Read more…

Bariatric patients

In 2016, worldwide 13% of adults, (650 million) were obese1, however  New Zealand had  the 4rd highest prevalence of obesity in the world at 32.3%  (behind USA and Mexico and Chile)2. Traditionally obesity has been defined as a BMI of >30 kg/m2, but recently redefined as “a chronic, relapsing, multifactorial, neurobehavioural Read more…

Pregnancy

General principles Excellent maternal resuscitation is the best treatment for the fetus While fetal radiation exposure is an important consideration – this needs to be balanced with investigations which are in the best interests of the mother Even seemingly minor mechanisms (eg: fall from standing, low speed RTC) can cause Read more…