This week we held the first F2 teaching day for our newest rotation of junior doctors at Leicester Royal Infirmary’s ED. We had a smörgåsbord of topics from mental health, through to minor injuries and managing head injuries.
Here's a summary of some of the key learning points from the day…
Physical health needs:
Observe the patient, look for any injuries or evidence of self-harm
Assess their cognition
Is the environment safe for you?
Is the environment safe for the patient?
Does the patient have any potential weapons on them?
Remove anything that could be used to harm themselves
Any thoughts to harm self or others
Any desire to leave
Assessment of Risk
What were they thinking at time of episode?
Did they want to die?
Lethality of episode:
Would it have resulted in death?
Made efforts not to be found
Any current thoughts to self-harm
Do they have any regrets?
Protective or Adverse factors:
Aspects can be protective and/or adverse…
Jobs, relationships, friends and family
Risk factors and past/current mental health problems.
A person is presumed to have capacity and can refuse treatment…
Person must understand the information given to them
Retain the information
Weigh up the information to come to a decision
Communicate that decision
If refusing, explore why they are refusing and consequences of refusing.
Intentional and Non-Intentional overdoses are managed in the same way at the start.
What was taken?
Consider activated charcoal if within 60 minutes
How much was taken?
When was it taken?
Was anything else taken with it? (e.g. alcohol or other drugs)
Check on Toxbase.org for investigations…
Bloods (FBC, U&E, LFT, CK, Clotting, VBG)
ECG (rate, rhythm, QTc)
Once treated get Mental Health assessment (if indicated)
Why? How? When? Are they on anticoagulation? Consider and know the CT Head NICE Guidance (see below).
When examining head injuries in patients always check…
Eyes and CNs
Ears – haemotympanum?
Have a good feel at the lumps and bumps → if boggy, large or unsure get a senior to have a feel.
Any evidence of seizure? Wet themselves or bitten their tongue?
CPR is not a treatment for #ordinarydying. Every instance of futile CPR - which is what will happen if nobody has sorted out the protection of a DNACPR for someone whose life is coming to an end - is a tragedy. Please, doctors, nurses, patients, families - #havetheconversation. pic.twitter.com/t7yp6qm8Jd— Linda Dykes (@DrLindaDykes) February 11, 2018