So there I was stood outside of our university simulation house with bags in hand, two cameras pointed at me and Emily aka ‘Gemma’ making very convincing painful screams. It is fair to say I was a little apprehensive, but a few months of planning had led to this point so I gave it my best shot. When I look back at the video I definitely find myself cringing at times. However below are detailed some points for discussion that made me think.
Pain Score - someone asked when watching the video why I had not obtained a pain score prior to giving GemmaEntonox. At the time my rationale was I could see she was clearly in pain and as long as her pain score started to go down things would be moving in the right direction. However pain is clearlysubjective and I think it may have been important to discuss pain levels and my management plan with Gemma earlier on.
Manual stabilisation of the ankle - throughout the video myself and James only stabilise the injury site when either removing footwear or applying the vacuum splint. Arguably we should have provided some sort of manual stabilisation when we suspected a fracture; at least that is what my dusty copy of Nancy Caroline seems to suggest! However with limited hands I don’t think I would necessarily change what our management here. I think analgesia took priority, which needed a set of baseline observations whilst communicating and taking a history from Gemma.
Sharp safety – I think you can see the look on my face in the video fairly clearly when I realise that I have cracked open the morphine* ampoule and can’t get the protective cover off of my drawing up needle. At the time the best solution seemed to be to pass the syringe to James, but this probably doesn’t constitute best practice. Top tip: loosen the protective cover first. Lesson learned!
Drug safety checks – Morphine is a drug that I see administered a lot in clinical practice and I am confident with the indications and contraindications. However it wouldn’t have been detrimental to the patient care to take a few seconds and confirm them with my pocket JRCALC and potentially prevent a drug error. With regards to drug safety I personally like the TRAMP mnemonic taught to me: T – Time R – Route A – Amount M – Medication P – Patient
Amount of analgesia – As far as I am aware there is no hard and fast rule as when to move a patient to the ambulance versus pain score given. However I think it is safe to assume when dealing with a fracture/dislocation movement may increase pain and therefore I could have definitely given some more analgesia prior to moving Gemma given her pain score was at 6/10.
I hope the above made for an interesting read, it definitely made me crack open the text books and dig a little deeper.
*no actual morphine was used, instead a water ampoule was drawn up and squirted onto the floor next to Emily.