Analysis finds A&E units closed to ambulances almost 500 times in just three months this winter.
Urgent response time targets only met in six out of last 49 months
The number of times hospital A&E units in England have had to close their doors to ambulances has almost doubled this winter compared with the previous three, new research from the Nuffield Trust health think-tank reveals. The authors say that the extra time paramedics are having to spend on the road as a result is a factor in the service’s inability to meet its targets for urgent requests for an ambulance.
Showing posts with label patient_handling. Show all posts
Showing posts with label patient_handling. Show all posts
Monday, 6 March 2017
Coventry position: Patient positioning technique to perform sciatic nerve block at popliteal fossa
Regional Anesthesia and Pain Medicine. Conference: 41st Annual Regional Anesthesiology and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine, ASRA 2016. United States. Conference Start: 20160331. Conference End: 20160402. 41 (5) (no pagination), 2016. Date of Publication: September-October 2016.
A sciatic nerve block at the level of popliteal fossa is one of the most useful and widely performed blocks in our practice. Sciatic nerve block results in complete anaesthesia of the entire lower limb below the knee, with the exception of a strip of skin on the medial leg and foot, which is innervated by the saphenous nerve. Ultrasound guided sciatic nerve block at the popliteal fossa is performed with the lateral approach with patient in the supine position or with the lateral or posterior approach with patient in the prone position. Having an assistant to hold the leg, oxford position, placing the leg on the chair are some of the positioning techniques that have been described in the literature so far to perform sciatic popliteal block in a supine patient. (1) we would like to bring to your attention of our practice of using carter Braine limb support for positioning the leg in a supine position Results/Case report Although scanning the nerve in the popliteal fossa might be easier, positioning the patient prone can be more cumbersome. However many times, due to trauma or other considerations, it's not feasible to have the patient lie prone. If the sciatic nerve block is performed with patient in supine position, sufficient space must be made to accommodate the transducer beneath the knee and thigh. This can be accomplished either by resting the foot on an elevated footrest or flexing the knee while an assistant stabilizes the foot and ankle on the bed. Different techniques have been described in the literature to position the leg to perform popliteal block in a supine patient like having an assistant to hold the leg, oxford position, placing the leg on the chair etc.(2) Whilst the patient is supine, the leg to be operated upon is positioned on the Carter Braine support with 60 - 90 degrees flexion at hip and knee. This is to make sure that there is no undue stretch on the nerves, muscles or tendons and the patient's leg is comfortably positioned. This technique also allows room for the probe to be tilted caudally to bring the angle of incidence to 90 degrees to the nerve. With this positioning technique, both in plane, in axis and in plane, out of axis block can be performed with ease. Discussion The advantages of this positioning technique are that it is easy to use and easily accessible. Most importantly, there is no need for an extra person to hold the leg, thereby freeing up that person to inject the local anaesthetic. We have been using this technique for the last few years with very good success and had been extremely popular amongst the anaesthetic nurses. In conclusion, this positioning technique using Carter Braine arm support is convenient to the patient, operator and his assistant, easy to use and aids in optimizing ergonomics to improve the outcome.
UHCW Research: Jillela S. and Sadasivan R.
A sciatic nerve block at the level of popliteal fossa is one of the most useful and widely performed blocks in our practice. Sciatic nerve block results in complete anaesthesia of the entire lower limb below the knee, with the exception of a strip of skin on the medial leg and foot, which is innervated by the saphenous nerve. Ultrasound guided sciatic nerve block at the popliteal fossa is performed with the lateral approach with patient in the supine position or with the lateral or posterior approach with patient in the prone position. Having an assistant to hold the leg, oxford position, placing the leg on the chair are some of the positioning techniques that have been described in the literature so far to perform sciatic popliteal block in a supine patient. (1) we would like to bring to your attention of our practice of using carter Braine limb support for positioning the leg in a supine position Results/Case report Although scanning the nerve in the popliteal fossa might be easier, positioning the patient prone can be more cumbersome. However many times, due to trauma or other considerations, it's not feasible to have the patient lie prone. If the sciatic nerve block is performed with patient in supine position, sufficient space must be made to accommodate the transducer beneath the knee and thigh. This can be accomplished either by resting the foot on an elevated footrest or flexing the knee while an assistant stabilizes the foot and ankle on the bed. Different techniques have been described in the literature to position the leg to perform popliteal block in a supine patient like having an assistant to hold the leg, oxford position, placing the leg on the chair etc.(2) Whilst the patient is supine, the leg to be operated upon is positioned on the Carter Braine support with 60 - 90 degrees flexion at hip and knee. This is to make sure that there is no undue stretch on the nerves, muscles or tendons and the patient's leg is comfortably positioned. This technique also allows room for the probe to be tilted caudally to bring the angle of incidence to 90 degrees to the nerve. With this positioning technique, both in plane, in axis and in plane, out of axis block can be performed with ease. Discussion The advantages of this positioning technique are that it is easy to use and easily accessible. Most importantly, there is no need for an extra person to hold the leg, thereby freeing up that person to inject the local anaesthetic. We have been using this technique for the last few years with very good success and had been extremely popular amongst the anaesthetic nurses. In conclusion, this positioning technique using Carter Braine arm support is convenient to the patient, operator and his assistant, easy to use and aids in optimizing ergonomics to improve the outcome.
UHCW Research: Jillela S. and Sadasivan R.
Thursday, 14 July 2016
Modified Valsalva manoeuvre for supraventricular tachycardia
New Eyes on Evidence from NICE:
A UK randomised controlled trial found that using a modified version of the Valsalva manoeuvre, where the patient was laid flat and raised their legs immediately after the move, was more effective than the standard manoeuvre at restoring normal heart rate in people who presented to emergencydepartments with an abnormally fast heart rate.
A UK randomised controlled trial found that using a modified version of the Valsalva manoeuvre, where the patient was laid flat and raised their legs immediately after the move, was more effective than the standard manoeuvre at restoring normal heart rate in people who presented to emergencydepartments with an abnormally fast heart rate.
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