----- Original Message -----
From: Jeremy Mayhew <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, December 01, 1999 8:38 PM
Subject: Re: Times to treatment.
> > What analgesia were you thinking of giving, Jeremy? I try and use a
> femoral nerve block, as this provides profound
> > analgesia without all the confusion, paucity of movement which will lead
> to pressure sores and nausea that you get
> > with the standard opiates. If you do this in the home all well and good,
> but if you simply give an opiate then the
> > process is started.
>
>
> A typical scenario would be 11pm, I would probably give pressure sore
> inducing opiate with an oral top up for the small hours if required. Are
> nerve blocks now routine on the ortopaedic wards too for holding people
til
> next trauma list?
>
> If so it just demonstrates another point about "out of hours emergency
> care" - the need for a standardised, evidence based approach, using care
> pathways from point of patient contact to definitive treatment and
involving
> and educating all involved every step of the way.
>
> There are 70 GP's in our co-op rota. Few have had any form of emergency
> management refresher, so you'll almost certainly get 20 or so different
> options of management.
>
> And before we turn it into GP bashing, the same happens in hospitals, or
at
> least it did when I did my medical jobs 4 years ago!
>
> The point? A&E should form the backbone of demanding and setting high
> standards for emergency out of hours care, both in and out of hospital. It
> is the obvious focal point for developing excellence.
>
>
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