Prioritisation 7
You have 10 minutes to complete the following scenarios.
Scenario
You are the ST3 at a major trauma centre, ½ day trauma list tomorrow. II present. SHO overnight present.
- 77YO DHS
- 88YO tibial laceration
- 66YO NOF intracapsular
- 99YO NOF Intracapsular
- 33YO ?compartment syndrome
- Location – MTC
- II – ½ day theatre list, II present for theatre list. No other theatres tomorrow.
- Consultant – Lower limb consultant
- Consent, COVID, MRSA – All complete, patients are ready
- Kit – available
- Allergies – nil
77YO DHS | Isolated NV intact CXR, ECG, orthogeries assessment completed Hb stable Comprehensive geriatric assessment within 72h FIB should be performed for pain management Surgery within 36 hours of injury (patient attended 11am) No anticoagulation No co-morbidities
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88YO tibial laceration | Isolated injury No bony injury NVI Hb stable Plastics agree to manage patient
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66YO NOF intracapsular | Isolated NV intact CXR, ECG, orthogeries assessment completed Hb stable Comprehensive geriatric assessment within 72h FIB should be performed for pain management Surgery within 36 hours of injury (patient attended 9am) No anticoagulation No comorbidities Gardens 4 AMTS 10/10, Mobilises independently, NICE recommend THR
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99YO NOF intracapsular | Isolated NV intact CXR, ECG, orthogeries assessment completed Hb stable Comprehensive geriatric assessment within 72h FIB should be performed for pain management Surgery within 36 hours of injury (patient attended this evening) On warfarin – INR is 3.5 (requires discussion with haem and Vit K + rechecking INR) Gardens 3, AMTS 7/10, Mobilises with a ZF – NICE guidelines recommend hemiarthroplasty
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33YO ?Compartment syndrome | Post Tibial nail procedure NVI Extreme pain even 30min post bandages removed Surgery should occur within 1 hour from diagnosis of compartment syndrome.
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Emergency
- 30YO ? compartment syndrome
Theatre list order
- 66YO NOF intracapsular
- 77YO DHS
Referral to plastics
- 88YO tibial laceration
Further work up
- 99YO NOF intracapsular
