Archive | Emergency Care Learning

Update: Tranexamic Acid in Children

The Royal College of Paediatrics and Child Health have recently published an Evidence Statement, regarding the use of tranexamic acid (TXA) in children who have suffered traumatic injuries. The guidance recognises the strong evidence for the use of TXA in the context of trauma in adults.  However, a degree of caution needs to be exercised in the extrapolation of this to the treatment of paediatric injuries.

The following key points have been stated in the guidance:

  • Tranexamic acid reduces mortality in adult trauma
  • Early administration is vital for efficacy
  • Due to the lack of published data on the use of tranexamic acid in paediatric patients who have undergone major trauma there is no evidence for a specific dose in this situation
  • The RCPCH and NPPG Medicines Committee recommend a pragmatic dosage schedule – 15mg/kg tranexamic acid loading dose (max 1g) over 10 minutes followed by 2mg/kg per hour

RCPCHThe full guidance can be downloaded here from the RCPCH website.

 

 

 

 

 

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Tranexamic Acid update

red_blood_cellsSince the CRASH2 trial was published in 2010, there has been a huge amount of work to ascertain how best to deliver tranexamic acid practically, particularly in the prehospital environment.

The benefits of tranexamic acid almost seemed too good to be true.  It’s cheap, easy to carry, has been used for decades within hospital and GP settings – and seems to offer absolute benefits in promoting haemostasis, with no side effects.  It also fits very well into the ‘damage limitation’ approach that has changed much of prehospital trauma care over the last few years.  In addition, military experience, particularly from Afghanistan, has accelerated the availability of high quality practical data on its use in challenging environments.

Now, there is some solid and pragmatic advice on the administration of tranexamic acid, including a Cochrane review which has been published in December last year:

>> Blood-clot promoting drugs for acute traumatic injury

It appears that it is now at a point that many practitioners can and should be considering its use.  Especially for areas where transfer to a surgical or major trauma unit is likely to be delayed – such as rural and remote areas of Scotland – it could offer vital life-saving benefits of reduced blood loss and extended survival times in the context of major trauma.

Administration is relatively straightforward.  Where there is evidence of a ‘positive primary survey’ – i.e. where pulse, blood pressure/capillary refill time or respiration rate are impaired due to suspected haemorrhage, resulting from trauma in the last 3 hours, the following treatment is suggested:

  • Inject two 500mg vials (1g) of tranexamic acid into a 100mL bag of normal saline.  Give this IV over 10-20 minutes (loading dose).
  • Inject two 500mg vials (1g) of tranexamic acid into a 500mL bag of normal saline.  Give this IV over 8 hours (maintenance dose).

Commonly, where transfer to hospital or extrication takes less than 30 minutes, the maintenance dose can be more safely given once the patient is in a facility that can provide an IV pump to give this over a more exact time.

httpv://www.youtube.com/watch?v=7oekncvAXGs

 

Crash 3 Trial

The investigators are now busy conducting the Crash 3 trial which will look at the effects of tranexamic acid specifically on traumatic brain injury.  They’ve produced a video explaining the new trial procedure – which also highlights some of the key points of using tranexamic acid above.

httpv://www.youtube.com/watch?v=7jdjSAiiCmc

 

 

 

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BASICS Scotland Conference 2013

basics3BASICS Scotland is delighted to announce that next year’s annual conference is going to be held on Saturday 31st August at the Westerwood Hotel, Cumbernauld.

Accommodation will be available from just £95 (Dinner, Bed & Breakfast) and will include an invitation to the evening black tie dinner evening event on Saturday 31st August.

Booking forms will be available in the new year… watch this space.

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EZIO Skills

Intra-osseous access to the intravascular space has fast been developed for more general and adult use over the last five years.  Innovation has been sped up by the experienced gained from military settings, including Afghanistan.

Whether you’ve become a seasoned EZIO user, or haven’t seen this before, the following videos may be handy to review/refresh what can make IO access more attractive than persevering for IV access.  Having been issued with one of these myself, and had the occasion to use it on several occasions, it’s clear the the initial fear felt (including those watching who are unfamiliar with the process) is rapidly dissipated by the ease of use in severe cases, such as trauma or cardiac arrest situations.

BASICS Scotland responders are lucky to have the continuing support from the Sandpiper Trust, and if you are a regular responder for  the Scottish Ambulance Service, you can apply to add one of these to your kit.

httpv://www.youtube.com/watch?v=qkTCKOBiQws

httpv://www.youtube.com/watch?v=ff_vqePp_jw

 

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Conference: Retrieval 2013

The Emergency Medical Retrieval Service is once again proud to host Retrieval 2013, the UK’s leading conference covering prehospital, transfer and retrieval medicine on the 25th & 26th April 2013.

Speakers include:

  • Derek Feeley – CEO, NHS Scotland
  • Dan Ellis – Medical Director, MedSTAR Adelaide Australia
  • Martin Ruth – Clinical Lead, RAF Aeromed
  • Russell McDonald – Associate Professor, Co director EM Fellowship programme, University of Toronto
  • Claire Westrope – ECMO Transport Consultant & Paediatric Intensivist Leicester
  • David Ohlen – Medical Director, Airborne Intensive Care Sweden
  • Anni Ridsdill Smith – Director Airate Lt

This year we have dedicated sessions for nursing and paramedic staff involved in prehospital care, transfer and retrieval along with interactive case based discussions and a free paper session.  Following previous years there is also dedicated paediatric and neonatal sessions as well as prehospital care.  Further sessions will focus on Human Factors in medicine as well as Innovation and Quality Improvement.

The conference is again being held at the Beardmore Conference Centre, Scotland’s top residential conference centre.

Cost for registration remains the same as last year provided you register before the 1st January 2013.

You can download the conference registration form here and the abstract form here.

Click here to view Retrieval 2013 programme

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BASICS Scotland: Adult Tele-Education

BASICS Scotland Responder (staged)

Places are available for the BASICS Scotland Adult Immediate Medical Care course, to be delivered via videoconference from January 2013.

The course will include the following skills:

  • Scene Safety and Mechanisms of Injury
  • Spinal Management
  • Patient Assessment
  • Airway, Breathing & Circulation Management
  • Secondary Survey
  • Packaging for Transport
  • Live RTC Scenario with participant interaction

The sessions will include a mix of formally delivered education, along with interactive practical sessions.

The deadline for applications is November 30th 2012.  Further details are available from the following documents:

>> Information Sheet

>> Booking Form

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Diving Emergencies

Photo by David Burton (Creative Commons).

Rural practitioners probably come across diving emergencies more often than other medical professionals.  Reasons for this include

  • participation in local rescue teams (including lifeboat and coastguard teams)
  • requests to attend incidents in a BASICS capacity where divers have surfaced – but too quickly
  • emergency or delayed presentations to the surgery or community hospital, often when signs are more advanced

The Bends

There are some specific recommendations when dealing with diving emergencies.  One of the most important conditions to be aware of is ‘the bends’ or decompression illness – caused by formation of nitrogen bubbles in the blood stream, which can lead to neurological problems including stroke.

If someone presented to your local A&E unit, would you know what to do?  There are a number of sources for assistance.

In summary, emergency management of a diver presenting with symptoms of the bends should include:

  • keep the patient lying flat to avoid bubbles migrating to the brain
  • high flow oxygen
  • management of hypothermia and dehydration, common especially after prolonged dives
  • early expert advice and rapid transfer to a hyperbaric facility, if advised that this is necessary

This video from the Diving Diseases Research Centre in Plymouth explains more about the condition.

httpv://youtu.be/FVUFFeC_Sqk

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Initial Assessment of a Trauma Patient

These videos, produced by Oxford Medical School, demonstrate the assessment of a trauma patient.  Clear, well-recorded and up to date, they should be useful to update or confirm current practice.  However, they do have a slant towards hospital (as opposed to BASICS or prehospital assessment, which is sometimes more appropriate in the community hospital setting).

httpv://www.youtube.com/watch?v=hLuC0T7RsKI&feature=relmfu

View the other trauma videos from Oxford Medical School.

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