Management of the Acute Patient & Trauma Flashcards
Define an acute patient
- Patient who is having severe symptoms which appear rapidly
State points to be aware of when working with an acute patient
- Patient could be in a lot of pain
- May have breathing difficulties
- Unresponsive
- Uncooperative
- Limited in ability to move and comply with instructions
- Condition where normal anatomy is altered
- Could be attached to monitoring equipment
When working with an acute patient you must that the patient can…
- Identify themselves
- Communicate with you
- Sit upright unassisted
- Take and hold a breath for the duration of the exposure
- Tolerate the image detector behind their back
- Be considered an infection risk
- Be monitored during the examination
When working with an acute patient you must check that the equipment can…
- Be moved out of the FOV
- Be removed for the duration of the examination
- Be considered a siginifcant artefact
- Physically impede the x-ray equipment
- Be considered as sterile or an infection risk
When monitoring a conscious patient what should be considered
- Listen to their manner and rate of speech
- Does this explain their mental or emotional state?
- Make eye contact, verbalise your actions
- Remember, attending emergency is usually stressful regardless
When monitoring an unconscious patient what should be considered
- Monitor their blood pressure, oxygen saturation, heart rate
- What is their Pallor like?
- If they are brought to the department, they should have a medical escort
- Do you know where the adult and paediatric crash carts are
- If in doubt get help or call 2222
How can we confidently identify an unresponsive patient?
- All admitted patients should have an identifying wristband on always
- All patients who have been brought to the hospital unresponsive with no-one to identify them will be assigned a unique ‘unknown’ ID
What is the Glasgow Coma Scale
- Used to determine state of consciousness by assigning a score (3-15)
- The lower the number assigned, the more likely a brain injury has been sustained
What is the potential problem with the GCS
GCS may not be the best idea as patients could come in drunk or on drugs
What is the Golden Hour?
This is the first 60 minutes after traumatic injury where rapid investigation and treatment can lead to increased patient outcomes
Describe the triage system
- Immediate / Critical
- Very Urgent
- Urgent
- Standard
What is consent
- Permission or Agreement
- The principle that an individual gives permission before they receive tests / treatments
Why is consent important
- Ethical Requirement
- Legal Requirement
What is the consequences when their is failure to obtain consent
- Negligence
- Sexual Harassment
- Battery
Who can obtain consent?
- Initially the Referrer
- Health Professional undertaking the examination
- Health Professional assisting in the examination
When should you get consent?
- Before the procedure
What is valid consent?
- Must be given voluntarily
- Individual must be appropriately informed
- Individual must have the capacity to consent
State the 3 types of consent
- Implied Consent
- Expressed Consent
- Documenting Consent
Describe implied consent
- Agreement signed by behaviour
- Agreement signed by an informed patient
- Compliance is not implied consent
- Always try to seek verbal consent prior to undertaking the procedure
Describe Expressed Consent
- Required for investigation / treatments which carry significant risks
- Law does not always require written format as long as the patient is legally competent, volunteers their consent and has been well informed prior to the treatment
Describe documenting consent
Details of express consent being obtained should be recorded this mean explicity writing on the request card within the patients notes, or on the RIS / Track system
How do we obtain consent when a patient is unresponsive
- If no relatives present a decision is made by the emergency doctor
- Decisions must be made in the best interest of the patient
When is rapid imaging used
if a person has sustained injuries a patient may be sent for a CT
When is mobiles used?
- Used when their is no possible way for the patient to come to the department
When is it ok to use mobiles
- If the patient is too unwell to come to the department
- Patient is being monitored or unstable and unable to be transported
- Patient is intubated
- Patient is an infection risk
- Patient is peri / post arrest
- Is immunocompromised
- Just come out of theatre
When is it not ok to use mobiles
- Too many members of the public
- Patient management is not likely to be changed by the provision of imaging
- Clinical information is not provided or justified
- The technical limitations of the machine will not produce a diagnostic image
Advantages of mobiles
- Patient does no have to. move anywhere
- Staff may be on hand to assist
- Monitoring equipment and medication can continue to be used
- Digital mobile machine can provide image immediately
- If patient is quarantined the rest of the hospital is not at risk
Disadvantages of using mobiles
- Lots of dynamic factors, people in your controlled area
- Patient may not be able to adopt any valuable position to an image to be taken
- Staff may leave you on your own
- Mobile images are less diagnostic accuracy than departmental
- Exposure of yourself or to others
What is the most common mobile examination request?
- Chest x-ray
What are clinical indications for a chest radiograph
- Perforation
- Chest Pain
- Traumatic Injury
- Sepsis of unknown origin
- Decreased Oxygen saturation
- Assessment of invasive lines and tubes
- Shortness of breath
Who can request an image
Anyone who has IR(ME)R 2017 authorisation within their scope of practice
What is a major incident?
These are incidents or serious situations in which a number of people are threatened with death or severe injury such that special procedures are required for their reception and treatment
How do we know a major incident is happening?
- “Major Incident Standby!”
- “Major Incident Declared!”
- “Major Incident Cancelled!”
What happens once a major incident is declared?
- Ambulance Control Centre will designate 4 appropriate hospitals to receive casualties
- Order depends on the location of the incident to the hospitals
- Ambulance Control Centre will alert the hospitals, and Respons Team from the 4th hospital is sent out to assess and coordinate casualties
How will the emergency department respond to a major incident
They will try clear the waiting room and all bays of all non-life threatening injuries, either treating or sending them home
How will radiology respond to a Major incident
- Assign a Lead member of staff
- Assign a Receptionist role
- Ensure all stock is ready
How can staff decompress from a major incident
Discussions around the event that have happened, try to attend them and gain some closure
