Prioritisation 8
You have 10 minutes to complete the following scenario.
Scenario
You are the ST3 at a Major Trauma Centre. You have come in at 7am to plan the list for the day. All patients have been marked and consented by the night team.
You have a 1 theatre session list.
50YO M | Dislocated shoulder, NV intact |
11YO M | Fall from monkey bars, Supracondylar fracture, Gartland 3 |
65YO F | Fall on ward, Periprosthetic hip fracture, Vancouver B3 |
30YO M | Fall, sustained midshaft tibial fracture |
80YO F | Fall, sustained neck of femur fracture |
- L – Major Trauma Centre
- II – Available all day, dedicated paeds trauma list also available
- Kit – All kit available
- Consultant – upper limb consultant – Not happy to do complex lower limb procedures
- Allergies – none
- All patients have had COVID tests and MRSA swabs, all negative
50YO M Dislocated shoulder | NV intact ATLS performed, isolated injury X-Ray performed – no humeral neck fracture No attempt at reduction in ED ED willing to give sedation Time of presentation to ED 7am Patient fit and well no comorbidities
|
11YO M | Fall from monkey bars, Supracondylar fracture, Gartland 3 ATLS performed, isolated injury NV intact, warm well perfused Time of injury 2am last night Patient fit and well no comorbidities Closed
|
65YO F | Fall on ward, Periprosthetic hip fracture, Vancouver B3 Consultant not happy to do procedure Patient fit and well no comorbidities Hip placed 2010
|
30YO M | Fall from motorbike, sustained midshaft tibial fracture Patient fit and well no comorbidities Open fracture – no gross contaminants Time of injury 10pm (high energy should therefore be operated on within 12 hours) ATLS performed isolated injury BOAST guidelines followed – tetanus and Abx provided In back slab and post reduction x rays completed No compartment syndrome NVI Gustilo Anderson 2 – no requirement for plastics
|
80YO F | Fall, sustained neck of femur fracture PMH – HTN, Dementia, Hypothyroidism Hb 110, clotting normal, U+E normal Isolated injury Intracapsular
|
- 50YO dislocated shoulder – attempted reduction in ED
- 11YO on dedicated paediatric list
Final order of list
- 80YO F with NOF for hemiarthroplasty
- 30YO open fracture as dirty case
65YO postponed until suitable consultant to do case
I would attempt a closed reduction in theatre failing that I would perform an open reduction. I would delay the hemiarthroplasty if the shoulder reduction is not able to be performed on CEPOD or another suitable list.
