Prioritisation Station 9

You have 10 minutes to complete the following scenario.

Scenario

You are the ST3 at a District general hospital. You have come in for your night oncall at 8pm. Please take a handover from the night reg. Your consultant will phone you to find out what is pending for this evening and what the list if for tomorrow. 

You have a 2 session theatre list tomorrow.

65YO M

On the ward, referred by medics with a red hot swollen knee joint

32YO F

Open Tibia/fibula fracture in A+E. Patient fell off of a motorbike.

12YO M

Both bone forearm fracture

90YO F

Neck of femur fracture

72YO F

Neck of femur fracture

 

Location – District general hospital

II for full list, CEPOD overnight

Consultant – lower limb

All kit available

SHO oncall with you (CT1)

72YO with neck of femur has Latex allergy, All patients have COVID and MRSA

65YO M

HR 110, BP 115/80, Temp 39, RR 13

Native knee

Patient not been started on antibiotics

No aspirate taken

Admitted with UTI 3 days ago

Not weight bearing on affected knee

No bloods

XR normal

No significant PMH

 

32YO F

ATLS performed – isolated injury

Tib/fib NV intact

Tetanus and Abx not given yet

No aquatic, sewage or agricultural contamination

DGH does not manage these scenarios normally – normally sent to MTC

Time of injury 6pm

Gustilo Anderson 2

 

12YO M

Both bone forearm fracture

Isolated, NV intact

No concerns of NAI, fell from monkey bars

Deformity 15 degrees of angulation, 30 degrees rotation

No attempt at reduction made in ED

A+E will allow for attempt at reduction under intranasal diamorphine

 

90YO F

Neck of femur fracture

7pm (BPT 36 hours from injury)

Extra-capsular – intertrochanteric

Hb 70, U+E normal

HTN

No anticoagulants

FiB performed

Isolated injury, NVI

 

72YO F

Neck of femur fracture

Intra-capsular

Gardens 2

Patient normally fit and well, AMTS 9/10, walks independently, no significant PMH. Likely to return to baseline activities in next 2 years.

Bloods normal

No anticoagulants

Isolated injury, NVI

Hb 110, U+E normal

FiB performed

Latex allergy

Urgently assess 65YO male and perform aspirate, given observations septic 6 should be undertaken. If patient remains septic despite this overnight washout will be required on CEPOD. Consultant should be informed urgently.

Send SHO down to A+E to review open fracture – open fracture should be discussed with MTC.

 

Following above attempt reduction of both bone forearm fracture if angle <10 malrotation <30 following this and NVI then can be managed in cast alone.

 

Potential list for tomorrow

  • 72YO for THR (Latex free)
  • 90YO for DHS need to transfuse pre-operatively

 

If washout of knee does not occur overnight then should be first either on CEPOD if available for use/separate theatre to maintain sterility. If using main theatre will need to be latex free to avoid delay and there will need to be a deep clean prior to the THR.

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