The session was held in the resus room after morning handover. An EM ST3 was the clinician in resus, supported by ED nursing staff (Band 5s). An ED SpR was available for advice and top cover if required. ITU were available by bleep.
Non clinical
Inter-departmental teamwork
Leadership and role allocation
Time critical decision making
Multi-disciplinary communication
Clinical (Medical)
Reversal of anticoagulation
Management of agitated head injury patient
Neuroprotective measures
Management of raised Intracranial pressure
Clinical (Nursing)
Drawing up and administration of Octaplex
Task prioritisation and allocation
Neuroprotective measures
Faculty: Alex Belcher, Ben Short, Joe Schrieber, Ben Atkinson
SLO 3 – Identify sick adult patients, be able to resuscitate and stabilise and know when it is appropriate to stop
SLO 4 – Care for injured patients across the full range of complexity
HiLLO 5 - Doctors specialising in Intensive Care Medicine can identify, resuscitate and stabilise a critically ill patient, as well as undertake their safe intra-hospital or inter-hospital transfer to an appropriately staffed and equipped facility.
HiLLO 12 - Doctors specialising in Intensive Care Medicine understand the special needs of, and are competent to manage patients with neurological diseases, both medical and those requiring surgery, which will include the management of raised intracranial pressure, central nervous system infections and neuromuscular disorders.
The Case
70yr old female who falls from a low stepladder sustaining head injury with brief LOC and right wrist injury. Mobile at scene and taken by her husband to Gosport where she was redirected to ED as on a DOAC for AF.
After being cleared from other injuries on arrival (apart from head injury and wrist injury), a CT was requested and pending. Sitting in ambulatory majors with a GCS of 15 and normal observations she suddenly becomes acutely confused and agitated so brought into resus by the nursing team on a trolley
Initial ED assessment in resus – patient very agitated and combative and unable to get any monitoring or detailed assessment from her….
The patient had deteriorated due to the intracranial bleed and appropriate measures taken to stabilise her, prepare her for RSI and subsequent diagnostic imaging and definitive treatment. The use of cognitive aids were vital to ensure mistakes were not made and to reduce the cognitive load from the team during a stressful situation.
