Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
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UNIT 7: Management of wounds, burns, bites, stings and inoculation injuries by
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
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4.2 Explain the contraindications to using local anaesthesia.
4.3 Explain how to administer a ring block.
4.4 Explain the complications of using a ring block.
5. Understand how to close a wound using sutures.
5.1 Explain the preparation for wound closure using sutures.
5.2 In a simulated setting demonstrate suturing techniques.
5.3 Explain complications of wound closure when using sutures.
5.4 Explain the aftercare advice required following suturing.
6. Be able to treat individuals requiring inoculation.
6.1 Explain the range of inoculations administered in minor injuries settings.
6.2 Explain how individuals are assessed for inoculations.
6.3 Explain how inoculations are administered.
6.4 Administer a range of inoculations.
7. Be able to manage the treatment of minor injuries to skin.
7.1 Treat individuals with
wounds
stings
animal and insect bites
human bites
burns.
7.2 Provide aftercare advice to individuals with:
wounds
stings
animal and insect bites
human bites
burns.
8. Be able to evidence the clinical management of minor injuries to skin.
8.1 Produce clinical case management records for individuals presenting with:
wounds
stings
animal and insect bites
human bites
burns.
Assessment Methods:
There is no assessment information available for this unit. Assessments used should be fit for purpose for the unit and learners, and generate evidence of achievement for all the assessment criteria.
Assessment Information:
For standardisation purposes, assessment of this unit must be conducted using the Emergency Nurse/Paramedic Development Programme for Autonomously Managing Minor Injuries, commissioned by the Chief Executive Officers of University Health Boards Wales, the Wales Ambulance Services Trust (WAST) and Wales University Council of Deans for Health (CYNGOR).
Wounds must include:
knowledge of abrasions
cuts
subungual haematoma
degloving injuries
nail bed injury
infections.
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
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Stings must include:
knowledge of anaphylaxis
bees
wasps
hornet
horsefly
tick
jelly & weaver fish.
Bites must include, knowledge of bites that are:
human
cat
dog
rodent
horse or coral injury and
must include a range of bite sites:
face
fingers
hands
fight bite.
Burns must include:
knowledge of erythema
partial & full thickness
burns management to face
neck
perineum
full circumferential
frost bite.
Red flag - is defined as a condition, sign or symptom considered to be urgent and should not be missed.
Wound closure methods must include:
steristrip
suturing
glue.
Preparation must include:
preparing the patient
preparing and selecting equipment
health and safety
consent
infection prevention and control
local anaesthesia.
Administer a range of inoculations must include the following:
tetanus
prophylactic treatment for HIV
hepatitis B.
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
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Treat individuals with wounds must include:
pain management
local anaesthesia (including ring blocks)
wound exploration
removal of foreign bodies
pressure irrigation
inoculation status
treatment of infection
medication
wound closure, including suturing
referral to other healthcare professionals.
Treat individuals with stings must include:
anaphylaxis management
pain management
removal of stings and spines
wound protection
medication
referral to other healthcare professionals.
Treat individuals with bites must include, both animal/insect and human and:
pain management
biochemical and microbiological investigation
bite cleaning
wound closure
wound protection
inoculation status
medication
referral to other healthcare professionals.
Treat individuals with burns must include:
pain management
inoculation status
wound cleaning
prevention of infection
wound protection
medication
referral to other healthcare professionals.
LO 7 - LO 8 Evidence must be given for a minimum of five cases.
If not specifically stated in the assessment information, a plural statement in any assessment criteria means a minimum of two.
For Health and Social Care, Clinical Care, early years Care and the care of Children and Young People:
To meet standards for clinical governance, organisational liability, professional and regulatory requirements, all new units containing assessments that are competence based and are for learners who are employed in, or volunteering in, health and social care, clinical care or childcare settings:
learners must have completed any mandatory H&S training or education required for their job role
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
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context-specific health and safety must be explicitly stated WITHIN individual units.
Assessor Requirements:
Registered practitioners with a minimum of two years experience of working in minor injuries settings as:
an emergency nurse/paramedic/advanced care practitioner
Consultant nurse or
Consultants in emergency medicine.
© 2016 Agored Cymru
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
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Wound assessment and management [ RCEM CAP38 HAP34 & HAP 11 environmental emergencies]
The EP will be able to assess the patient with increasing complex wounds, providing analgesia, wound exploration, identification of damaged underlying structures, repair where appropriate and closure
Knowledge Assessment
Methods
NMC
Understand the principles of asepsis C, Mi, PE, A
Know the anatomy of the underlying structures especially phalanges, hand, wrist and face
C, Mi, PE, A
Know how to assess a wound in terms of mechanism of injury, underlying structures and complications
C, Mi, PE, A
Know of special types of wound: puncture, wounds into joints, amputation, de-gloving, frost bite and presence of foreign bodies
C, Mi, PE, A
Be able to classify and describe wounds C, Mi, PE, A
Understands the principles of managing wounds caused by bites (cat bites, fight bites, animal bites in which crush injury could be a complication, UK envenomous ) including the assessment and prophylactic management of hepatitis B, Hepatitis C & HIV risk
Know how to manage wounds in the immunocompromised patient C, Mi, PE, A
Know how to use local anaesthetic techniques to produce pain-free wounds and when local anaesthetic is not going to work
C, Mi, PE, A
Know the indications for tetanus & other infectious disease prophylaxis e.g.
hepatitis B, Hepatitis C, HIV.
C, Mi, PE, A
Know different wound closure techniques C, Mi, PE, A
Know the indications for delayed closure of wounds and antibiotic treatment knows when to refer for exploration of wound e.g. tendon injury
Skills
Be able to determine the depth and size of a wound PE, A
Be able to demonstrate the administration of local anaesthetic subcutaneously and in ring blocks
Be able to demonstrate the ability to explore a wound and recognise injury to structures
D Be able to demonstrate the technique of wound toilet including irrigation under
pressure and removal of foreign bodies to reduce risk of infection and skin tatooing
D PE, A
Provides good anaesthesia of wounds by use of local and regional nerve blocks Mi, C, D, S PE, A Considers the complications posed by chronic conditions or treatments such as
coagulation disorders or anticoagulant therapy & takes appropriate timely action.
Able to identify those cases needing specialist care e.g. eyelid lacerations, lips involving the margin, tendon injuries
Mi, C, PE, A
Demonstrate wound closure and use of dressings D PE, A
Know when to review a wound and make the appropriate arrangements Mi, C PE, A Behaviour
Recognise when to refer a complex wound for further care C PE, A
Ensures follow-up, providing antibiotics appropriately Mi, C PE, A
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
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Wounds
The EP will be able to evaluate a child with a wound and formulate a management plan and implement any appropriate intervention
Assessment Methods
NMC:
Knowledge
Be able to identify wounds that are possibly caused by non-accidental injury e.g. cigarette burns, burns, torn penal frenulum, genital wounds
AA, C, Mi, PE, A Skills
Using distraction techniques to enable effective infiltrating local anaesthetic, wound exploration, irrigation and closure and minimise distress.
AA, C, Mi, PE, A
Minor Burns [RCEM C3AP1e]
The EP will be able to evaluate the patient who presents with minor burns and to identify and refer life-threatening presentations, to produce a valid differential diagnosis, appropriate investigation and implement a management plan.
Burns - to be able to evaluate the patient with burns, commence resuscitation, relieve pain and refer appropriately
Knowledge Assessment
Methods
NMC
Be able to understand the patho-physiology of burns Mi, C, PE, A
To recall how to assess the size and identify the depth of burn i.e.
erythema, superficial partial thickness, deep partial thickness and full thickness
Mi, C, PE, A
To recall the risks to the upper and lower airway from heat and inhalation injury
Mi, C, PE, A
To recall the importance of burns in special areas (face, joints, perineum) and management of these burns differ
Mi, C, PE, A
To rationalize the difference between wound and burn management To recall the current burn wound management and appropriate dressings
To recall the indications for referral to burns/specialist centres Mi, C, PE, A Skills
Recognise the burns patient who has an airway at risk and potentially requires intubation
Mi, C PE, A
To relieve pain effectively and promptly Mi, C, D PE, A
To be able to diagnose the depth and appropriately manage minor burns Mi, C, D PE, A Behaviour
To identify those patients that need referral to a specialist centre Mi, C
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
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Needlestick injury [RCEM C3AP7]
The EP will be able to evaluate the patient who presents with a needlestick injury and be able to risk asses injury and start initial appropriate investigation and management plan
Knowledge Assessment
Methods
NMC Be able to identify those patients who need prophylactic treatment for HIV,
hepatitis B and tetanus using departmental protocols.
AA, C, Mi PE, A
Appropriate timely referred of high risk injuries requiring specialist treatment and advice
Knows which tests should be undertaken from whom and when AA, C, Mi PE, A
Skills
Ensure prompt care Mi, C PE, A
Behaviours
Handle issues sensitively Mi, C
Ensure appropriate follow-up with GP/Occupational Health or other specialists Mi, C PE, A
Abbreviations: mi: mini-cex; C/CbD: case based discussion; MSF/M: multisource feedback, D/DOPS: direct observations procedural skill, PS: patient survey, AA: Audit assessment tool.
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