HMI205 - Accident and emergency

What is the normal vital signs of an adult?

How to do DRSABCD

What is the Australasian triage system (ATS)

Tool used to calculate the appropriate wait times for assessment and treatment of a patient.

There are 5 categories of the ATS

Category 1:

• Resuscitation

• immediate

•  i.e. heart attack, major car accident

C2: 

• Emergency

• within 10 mins

• I.e. severe blood loss, overdose

C3:

• Urgent

• Within 30 mins

• I.e. head injury (conscious), breathing difficulties, infection

C4:

• Semi-urgent

• Within 1

• I.e. Possible fractures

C5:

• Non-urgent

• Within 2 hrs

• I.e common cold

What is the Glasgow coma scale (GCS)?

Assessment of a person's level of consciousness, particularly after a brain injury, by evaluating:

• eye

• verbal

• motor responses.

What are the different scales of GCS?

Low GCS 3 and normal GCS is 15

• Lower score, higher risk of death

  • GCS 13-15 mild

  • GCS 3-8 severe
    
    

GCS can change very quickly

What is a trauma call?

Notifies trauma team that an emergency is en route and gives time to department to prepare.

Code brown might be activated: Multiple and/or major emergency

Who are in the trauma team?

• Team leader: ED consultant in control of the team, remains hands off, allocates roles, prepares prior to patient arrival, makes critical decisions

• Nurses

• Doctors

• Radiographers 

• Administration - for IDing the patient and getting medical records

• Specialist consultants - i.e. if there is open femur fracture, you want ortho

What is the radiographer’s role in a trauma call?

• Make sure there is a request form or someone is actively putting in a request 

• ID - can be pseudonym first and then once patient is identified, the images can be matched up

• Consent - In resus, team leader is making the decision so listen to them.

• Use markers

• Lead aprons

What are the pros and cons of bringing patient from ED/resus to the x-ray room?

PROs	CONs
Better range of mobility Reduce dose (AEC, confined space) Easier to do multiple regional x-rays	Not always practical due to severity of patient condition

What are the pros and cons of doing Mobile x-ray machine to resus?

PROs	CONs
Flexible	No AEC Artefacts Radiation safety

What kind of trolley is this?

Mobile trolley

• under table draw/space for cassette

• Remove detector when moving patient supine/erect

What equipment is this?

Slider detector case

• Used between slide sheets

• Helps to put detector behind patient

• Wipe them down to present coss infection

What are some radiographer communications?

• What images do u require?

• If they ask for multiple things, “Shall i just do a trauma series for now and then u guys get what you need for the immediate care and then well work out the rest after?”

• Are you likely to remove the trauma board soon? If not there is going to be artefact on the image, are you still happy for me to do it?

• Coming in with the xray machine….for a lateral CV… ill be shooting across there.

• Who isn’t wearing lead apron or doesn’t have to remain here?

• Stablising head and neck when moving them.

5 step advocacy for the airway doctor to go wear a lead apron

What is a trauma series?

• Supine AP chest

• AP pelvis

• Hori-beam C-spine

How do we do trauma positioning modifications?

• Minimise movement

• Move bucky and beam instead of patient

• Accept there will be some artefacts

• Make sure there is a nurse or doctor supporting the neck

How do a trauma modification for an AP scapula?

How do a trauma modification for an AP Elbow?

How do a trauma modification for an Lateral Elbow?

How do a trauma modification for a Lateral wrist`?

How do a trauma modification for a lateral forearm?

How to do a trauma modification DP and oblique foot x-ray.

How to do a trauma modification lateral foot x-ray

How to do a trauma modification lateral Y-scapula

1. Roll patient 45 degrees.

2. If collared patient, use piano stool

3. Supine with flat detector (might elongate the anatomy)

How to do a trauma modification lateral hip

Clements Nakayama if both hips are affected.

• Use upright bucky.

• Turn patient 45 degrees to show femoral neck.

• CR 20 degrees inferiorly from horizontal

• Make sure the patient is at the edge of the bed and close to the detector

  
  

Trauma Image critique soft tissue signs of injury

J: Joint effusion

A: Air

I: Increased densities

L: Lipohaemarthrosis

S: Soft tissue swelling

Trauma Image critique bony signs of injury

• L - linear lucency

• I - increased sclerosis

• C - cortical disruption

Trauma Image critique Alignment of joints, sign of injury

• Intact - normal alignment

• Not intact - widened, sublexed, dislocated

Diagnosis vs aesthetic. If you cannot get a better image than the one you have right now, what can you do?

Ask the radiologist.

Check if they have any other scans that can visualise it better.

Patient pain?

What are the Hospital emergency codes?

Blue - medical emergency

Red - fire/smoke

Orange - Evacuation

Yellow - internal disaster, infrastructure failure, or severe operational capacity overload

Grey - unarmed person showing aggressive, combative, or threatening behavior

Black - armed or aggressive person, a hold-up, or a hostage situation

Brown - external emergency that brings a sudden, heavy influx of patients

Purple - Bomb threat

If your patient starts to deteriorate and you need to call a code, what do you call?

2222

Patients with COPD have naturally low oxygen saturation. If they’re oxygen at 90, is that a code?

No because patients with COPD have normally low oxygen saturation.

When to call a MET call?

Call hem when worried about their breathing, circulation issues, suddenly confused, dropping out of consciousness.

After a patient as had a contrast reaction, you need to ….

document it

What are some mild contrast reactions? And what are your steps to patient care?

• Mild itching

• Itchy throat

• Runny nose

• Nausea and vomitting

What are some moderate contrast reactions? And what are your steps to patient care?

Call met call because they will probably require stronger medication

• Edema of the face

• Chest pain

• Bronchospasm

• Prolonged nausea and vomiting

• Sensation of suffocation

• Blood pressure goes down

• hives

What are some severe contrast reactions? And what are your steps to patient care?

CODE BLUE

• Anaphylactic shock

• Suffocation

• Convulsions

• Seizure

• Difficulty talking and swelling of tongue