Chris Bretheron and Hamez Gacefari discuss the James Lind Alliance Priority Setting Partnership for Major Trauma. Topics include research priorities, patient engagement, and global research collaboration. Also covered are studies on nail bed repair in pediatric finger injuries and sickle cell disease guidelines. Exciting insights into the challenges and advancements in emergency medicine.
Nail bed repair in children may not require nail replacement after injury, as shown by a multicenter randomized trial.
Timely and tailored analgesia is crucial for managing sickle cell disease emergencies, emphasizing IV options and supportive care strategies.
Choosing appropriate observation locations in the ED for sickle cell patients involves patient needs, nursing care, and environmental factors.
Deep dives
Nail Bed Repair and Pediatric Finger Injuries
A study on nail bed repair in children showed that replacing the nail may not be necessary after a nail bed injury. Current practice involves removing, suturing, and replacing the nail, but the study questioned this approach. The research conducted a multi-center randomized trial, focusing on a surgical intervention in pediatrics. It aimed to evaluate the need for nail replacement, with results showing no significant difference in infection rates or cosmetic appearance at 12 months, questioning the necessity of nail replacement in nail bed injuries.
Sickle Cell Disease Guidelines
The podcast discusses the importance of recognizing sickle cell disease as a medical emergency and providing early, tailored analgesia to patients in vaso-occlusive crisis. The guidelines emphasize the need for timely pain management, often requiring IV analgesia, and considering subcutaneous or intranasal options, particularly in pediatric patients or those with needle phobia. Supportive care strategies like hydration, antiemetics, and regular pain reassessment are crucial for effective patient management.
Management and Considerations
Additional considerations for sickle cell disease include managing constipation from opioid use and providing thromboprophylaxis when indicated. Patient observation, sedation scoring, and adjunctive therapies like heat packs and massage are recommended. Psychological and relaxation techniques are advised, although their feasibility in the emergency department may vary. Close monitoring and comprehensive care are highlighted to ensure optimal treatment outcomes and patient well-being.
Location for Observing Sickle Cell Patients in ED
It is essential to determine the most suitable location for observing sickle cell patients in the emergency department (ED). Discussions around patient needs, nursing care, and environmental factors like noise levels are critical in deciding between recess areas and regular cubicles for patient observation. Tailoring the observation location based on individual patient requirements and considering the variable nature of ED settings is crucial.
Research Priorities in Major Trauma Management
The James Lind Alliance's work on major trauma research priorities highlights key areas for future exploration. Focus areas include multidisciplinary teamwork for enhanced patient care, improving detection and treatment of surgical complications, enhancing psychological support for patients and families, determining important patient outcomes post-trauma, optimizing pain relief strategies, and early involvement of allied healthcare professionals. The top priorities emphasize the need for patient-centered research and collaboration across healthcare disciplines.
Happy June! This month for the June 2024 episode of the RCEM Learning Podcast, Rob and Liz talk us through a New in EM section on nailbed repair in paediatric finger bed injury. We have the first in a two-parter on Sickle Cell Disease in our Guidelines for EM section and then Rob speaks with Chris Bretheron and Hamez Gacefari about the James Lind Alliance Priority Setting Partnership for Major Trauma. We then end with New Online. If you'd like to email us, please feel free to do so here.
(05:32) New in EM - Nailbed repair in paediatric finger injuries
