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Educating EDs on Aesthetic Complications Aesthetics explores why we need to increase awareness about aesthetic complications within hospital emergency departments According to aesthetic nurse prescriber and NHS emergency department (ED) nurse Julia Mansell, there has been an increasing number of cosmetic complications presenting to her ED at King’s College Hospital London over the last year. The NHS does not currently collect data on complications that present due to aesthetic procedures, but in Mansell’s hospital the rise was enough to enlist the help of the Complications in Medical Aesthetics Collaborative (CMAC), which has since set out a plan to deliver educational presentations to emergency departments across the UK. Mansell explains, “I was recently contacted by one of the emergency nurse practitioners because a patient had presented with periorbital cellulitis and hardening of filler, four weeks post tear trough treatment. The original injector was not able to manage the complication and referred the patient to their local emergency department, who weren’t aware of how to manage the complication. This was not the first complication I had been made aware of and it’s possible there may be many more as there are currently no audit requirements on this type of attendance.” After alerting CMAC founding board member and prescribing pharmacist Gillian Murray, they decided to arrange teaching to doctors and nurse practitioners in the ED, starting at King’s. She adds that the talks are designed to raise the awareness of certain presentations and symptoms that will occur following an aesthetic complication, which will deteriorate if not addressed. The rise in complications coming through
emergency department doors is not limited to King’s, according to aesthetic practitioner Dr Alexander Parys, who has been holding his own complication educational sessions for emergency staff. He comments, “I left the NHS a few years back and at the time I was still working as an emergency department registrar. Back then, filler complications were relatively unheard of. Unfortunately, this has completely changed now and my colleagues still in the department all repeat year on year increases in cosmetic procedure complications, and it seems to be showing no sign of slowing down.” With aesthetic complications becoming a growing concern, Aesthetics explores why practitioners believe it’s important for the specialty to be taking time to educate healthcare counterparts.
The problem Chair of CMAC and aesthetic practitioner, Dr Lee Walker, believes the main issue which surrounds aesthetic patients presenting to emergency departments is the risk of misdiagnosis – and consequently mistreatment. He comments, “Local emergency departments are not best placed to recognise and manage complications caused by dermal fillers, as the aetiology, pathology and management form no part of medical undergraduate or postgraduate training. NHS pathways for non-urgent cosmetic wounds may take time to receive wound care, when these wounds should be more efficiently and effectively managed by the clinician who caused the
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injury (if they are a clinician).” At the recent King’s College Hospital London CMAC presentation, the group presented a series of images to the attendees and invited thoughts on diagnosis, which reinforced this discrepancy. Dr Walker says, “It was acknowledged by the emergency staff that they may not recognise the specific signs of a vascular occlusion as the presentation is unique to the face and to vascular occlusions caused by dermal fillers. In addition, a recent history of dermal filler injections is not always disclosed by the patient and is not routinely asked when taking a history, so this is something we need to advise emergency department doctors to start doing.” Dr Parys has noted similar concerns, stating that when he’s presented to emergency department doctors, they are often surprised at the range of complications that can occur from aesthetic procedures and how similarly they can present to other diagnosis. Dr Parys adds that another problem is that emergency departments are not usually equipped to properly deal with a serious aesthetic complication, such as a vascular occlusion. He comments, “Even if the medics working there have trained in aesthetics and are aware of how to manage certain complications, many EDs do not have hyaluronidase to hand, nor would they know where to locate some. This means they’re unable to effectively treat patients who present with these concerns, which is why I always recommend they have some in stock.”
Improving practice The number of non-medically trained injectors in the UK is rising, which practitioners say is problematic. Dr Walker comments, “CMAC recognise that due to the lack of standards in education, and the absence of regulation, patients can either be sent to, or self-refer to, local emergency departments when complications arise. This is entirely inappropriate (with the exception of ocular symptoms)1 and can be avoided if clinicians are appropriately trained and competent in the diagnosis and management of their own complications. This can only be achieved if they are medically qualified. Medical practitioners also have a responsibility to seek complications prevention and management training.” Dr Parys emphasises that practitioners should ensure they are fully prepared and have thorough support in place for patients postprocedure so they know exactly what to do should a complication arise. He says, “This
Reproduced from Aesthetics | Volume 8/Issue 8 - July 2021