INJURIES

RECENT injuries (i.e. within 24 hrs) should be dealt with in the A&E Dept.. Outside normal hours you need to consider whether urgent attention is required and if it is the A&E Dept. is equipped to deal with injuries whereas the emergency doctor service is not.

WHAT are the criteria for an out of hours visit to A&E?

• PAIN. If you are in a lot of pain following an injury and simple painkillers are ineffective.
• FRACTURES (broken bones). Suspected fractures of large bones - e.g. arms, legs. (If you think that you have a fracture don't eat or drink anything in case you need an anaesthetic). Small bone fractures - e.g. fingers - could often wait for normal hours.
• HEAD INJURIES. If the patient has been knocked out, is dazed or drowsy, is bleeding from nose or ears or is vomiting then they should be checked. Again, nothing to eat or drink.
• CHEST injuries - especially if there is pain or difficulty breathing.
• ABDOMINAL injuries. It is wise to be cautious if you think someone has had an abdominal injury as serious damage often gives rise to quite minimal symptoms. Nothing to eat or drink please until you've been checked.
• UNABLE to stand unaided after an injury. This may indicate a fracture or serious joint damage - again nothing by mouth.
• BLEEDING. This may either be through a wound or internally. If you can't stop the bleeding from a wound by direct pressure then it may need suturing. Also a dirty, deep or widely gaping wound will need attention. Sometimes bleeding may be into the tissues - in which case there may be massive swelling and/or a lot of pain. This can be serious and should be checked.
• LOSS OF FUNCTION. In the immediate aftermath of an injury you may experience some numbness or inability to use a limb. If this recovers quickly it is unlikely to be important  but if it persists then it should be checked.
• EYE injuries. If you can't see normally, if the eye is painful or if the eye could have been hit by a flying object, large or small then it should be checked - and in any case if you're at all worried. If any potentially damaging substance has gone into the eye wash it out with copious amounts of water - then go to A&E.
• SPINAL injuries. The neck is especially vulnerable in sports injuries, falls, fights and road accidents. If you think that you've suffered a neck injury check it out. If there is real cause for concern then it is best not to move or be moved but summon the ambulance whose crew will be highly trained in dealing with the first aid of neck injuries. The rest of the spine is much less vulnerable in healthy young people and it takes major trauma to cause serious damage. However conditions such as osteoporosis and cancer can seriously weaken the spine  in some individuals. Numbness, severe localised pain and loss of control of bladder and/or bowels indicate a possible serious problem - it might be wise to ring us or A&E first before deciding what to do as the doctor may need to visit to asses the urgency of the problem and the patient will not be mobile.
• NOSEBLEEDS. Try to stop it yourself first. Pinch the soft part of the nose firmly for ten minutes by the clock sitting with your head forward and mouth open. Release to check if it has stopped. If it hasn't then repeat this process up to twice more. If the nose is still bleeding after the third time then go to A&E.
• BURNS AND SCALDS. These injuries start off sterile and yet infection is a major problem. Initially apply lots of cold running water for at least five minutes. Then keep the wound clean - if you have to apply anything, usually it's best not to, then, unless you have a non-stick dressing to hand, clingfilm is as good as anything. Anything other than small superficial burns and scalds should be checked especially if they involve fingers, toes or the face where serious damage can most easily be done. If in doubt as to whether a wound needs to be seen then ring the duty doctor or A&E. The practice nurse will check and redress the smaller burns and scalds for you during normal hours - ring first please.
• POISONING - accidental or intentional. Although not an injury this is best dealt with through A&E. If the patient is unconscious then call an ambulance - protecting the airway by putting the patient in the recovery position (on their side, neck slightly extended) and removing any vomit from the mouth and throat with your fingers. If the patient is awake but you know what they have taken is potentially serious - e.g. Paracetamol - then go straight to A&E. If you are uncertain as to the seriousness of a possible poisoning or are uncertain about what to do as first aid then ring A&E - they may have to ring for advice themselves from the Poisons Centre. The only action you need to take before ringing for advice is to give milk where a caustic or corrosive substance has been swallowed.
• ANYTHING not covered here. Either ring first or go straight to A&E - depending on the seriousness and urgency of the problem.

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