Prioritisation 5
Scenario
You are the night ST3 at a Major Trauma centre. Please take the handover and arrange the trauma list for tomorrow morning. You have an SHO overnight with you.
Patient list
- 50YO swollen knee, septic
- 65YO open tib fib
- 90YO NOF intracapsular
- 85YO periprosthetic hip fracture
- 54YO tibial plateau, Shatzker 6
- 4YO both bone forearm fracture
Are there any questions you would like to ask regarding the cases?
- Location – MTC
- II – ½ day list and II present for whole list
- Theatres – no other theatres available during the day
- Consultant – General trauma, not happy to do tibial plateau or periprosthetic hip fractures. Happy to do THRs/Hemis
- Consented, marked and COVID/MRSA – All complete
- Kit – available
- Allergies – nil allergies
50 YO Swollen knee | Native Knee Aspiration taken – gram stain positive Patient septic (spiking temperatures, Tachycardic, hypotensive) Septic 6 started NBM
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65YO Open tib fib | Isolated injury – ATLS performed No gross contamination (no aquatic, sewage or agricultural) BOAST guideline management until now, ABX, Tetanus, photographs, saline soaked gauze and plastics involvement In Backslab acceptable position 5cm wound No signs of compartment syndrome High mechanism of injury Time of injury (just come in) – should be within 12 hours, definitive soft tissue coverage within 72 hours.
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90YO NOF intracapsular | Isolated injury – ATLS performed Not on anticoagulation CXR, ECG and NOF proforma followed Time of injury – today at 10am (BPT within 36 hours’ time to surgery) Seen by Orthogeriatrics AMTS 9/10 Walks with ZF NICE guidelines state as mobilises with ZF patient should be for Hemiarthroplasty. NVI
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85YO periprosthetic hip fracture | CT not done Consultant not happy to perform D/W lower limb surgeons Closed, isolated injury Medically stable No significant co-morbidities Orthogeries review NVI
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54YO tibial plateau, Schatzker 6 | Closed, isolated injury No compartment syndrome CT not performed yet – scheduled for this evening NVI In above knee backslab, comfortable
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4YO both bone forearm fracture | Closed, isolated injury No NAI concerns No compartment syndrome NVI Angulation (manipulation has been performed in A+E latest angulation and rotation <5 degrees, no shortening).
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Emergency case for overnight
- Swollen knee
Theatre list the next day
- Open tib fib
- NOF
Delayed until specialist consultant
- Schatzker 6 – CT for planning
- Periprosthetic consultant not happy to do procedure – CT for planning
No operation required
- 4 year old both bone forearm fracture – discuss in MDT but rotation acceptable
