Peripheral Vascular Injury Management

Hard findings Soft findings
  • Absent distal pulses
  • Pulsatile bleeding
  • Audible bruit
  • Palpable thrill
  • Expanding or pulsatile hematoma
  • Distal signs of ischemia such as pallor, cyanosis, decreased temperature
  • Palpable but diminished (sometimes grouped with hard)
  • Isolated peripheral nerve injury
  • History of haemorrhage in the field
  • Unexplained hypotension
  • Complex fracture
  • Stable, non-pulsatile hematoma
  • Proximity of injury to major vascular structures
  • Blind clamping of vessels can lead to nerve damage.
  • Target systolic blood pressure in hypotensive resuscitation is 90.
  • Major vascular injuries should be repaired within six hours to prevent long-term damage.



How useful are physical examination manoeuvres for an adult patient with suspected meningitis?


The Kernig, Brudzinski and Jolt Accentuation signs have limited utility in assessing patients with acute meningitis. The poor sensitivities mean that meningitis cannot be ruled out if the signs are not present (remember sn[out]). The relatively high specificities mean that your suspicion might increase if the signs are present (remember sp[in]) but unfortunately the associated low positive likelihood ratios show that no exam manoeuvre can reliably rule in the diagnosis. All three must be used with caution and in conjunction with other supporting laboratory and historical data.



When is ABG useful to investigate oxygenation?


Almost never. For patients with an adequate oximetry waveform, pulse oximetry is usually superior to ABG for measuring oxygenation. ABG is only useful to investigate oxygenation when:

  • Pulse oximetry waveform is unreliable.
  • Diagnosis of methemoglobinemia.
  • Calculation of the PaO2/FiO2 ratio to guide a specific therapeutic decision.



IV/IO Dextrose Rule of 50!


How to correct hypoglycaemia:

  • Neonate 5 ml/kg of 10% Dextrose (10×5=50)
  • Infant 2 ml/kg of 25% Dextrose (25×2=50)
  • Older child or Adult 1 ml/kg of 50% Dextrose (50×1=50)

How to make different Dextrose solutions:

  • 50 ml of 50% Dextrose + 50 ml NS = 25% Dextrose
  • 50 ml of 50% Dextrose + 150 ml NS = 12.5% Dextrose

Cut, Drain & Give some Antibiotics

Antibiotics after I&D lead to significantly better outcomes with significantly fewer antibiotic-treated participants having clinical failure requiring a new antibiotic or another drainage procedure. New abscesses may develop in 10.1 percent of the antibiotic group compared to 19.1 percent of the placebo group.



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#WDR2016 World Day of Remembrance for Road Traffic Victims

The World Day of Remembrance for Road Traffic Victims (WDR) is commemorated on the third Sunday of November each year – to remember the many millions killed and injured on the world’s roads, together with their families, friends and many others who are also affected. It is also a Day on which we thank the emergency services and reflect on the tremendous burden and cost of this daily continuing disaster to families, communities and countries, and on ways to halt it.