Prioritisation 1

You have 10 minutes to complete the following scenario.

Scenario

You are the ST3 at the MTC. You have come in at 7am to plan the list for the day.

You have a 2 theatre session list.

All patients are marked and consented.

55YO F

Fall onto outstretched hand, sustained a Distal radius fracture

30YO M

2 day history of swollen red hot knee

45YO F

Fall, sustained a midshaft tibial fracture

8YO M

Both bone forearm fracture, son of anaesthetist

12YO

Supracondylar fracture

 

Location MTC

II available 2 session list. No extra theatres. No separate paeds list 

Consultant happy to do anything

COVID -ve, MRSA -ve

Kit available

No allergies 

55YO F,   Fall onto outstretched hand, sustained a Distal radius fracture
Isolated injury?Trauma call/ATLS
Intra/Extra articular?Intra (72 hours to operate), Extra (1 week)
When did the injury occur?Intra (72 hours to operate), Extra (1 week)
Attempt at reduction in ED?If re-displaced time to operate 72 hours
Closed injury?Open needs 12-24 hours operation unless agricultural/sewage/aquatic.
NV intact?4 hours revascularisation/urgent reduction if nerves
Any significant co-morbidities?Anticoagulation etc.
In a backslab currently? 
30YO M. 2 day history of swollen red hot knee
Native vs ProstheticAspiration on ward
Cultures taken? Including joint aspirate?Immediate start to Abx
Is the patient septic? BP/Temp/RR/O2/HRUrgency
Any significant co-morbidities?Diabetic, IVDU, anticoagulation
On Abx?/fluid recussitated? 
45YO F.  Fall, sustained a midshaft tibial fracture
Isolated injury?Trauma call/ATLS
Closed injury?If open treat as per BOAST
If open ? contaminant

Agricultural/aquatic/sewage – urgent operation

12 hours for high energy

24 for low energy

NV intact? 
Compartment syndrome?1 hour to operate with compartment syndrome
In an above knee backslab?/X-Ray post reduction?Post reduction X-Rays required
Any significant co-morbidities 
8YO M.  Both bone forearm fracture, son of anaesthetist
Isolated injuryYes/no
NAI 
Closed?If open treat as per BOAST
NV intact?Urgent if symptoms/split cast
Attempted reduction?/X-RayShould be attempted in A+E if policy
In backslab?Above elbow backslab
Degree of reduction?As less than 10 <45 deg rotation, <15 deg angulation, 1cm shortening
12YO.  Supracondylar fracture
Isolated injury 
NAI 
Closed?Open/impending open urgent surgery
NV intact?

?AIN ? Median ? radial ? ulnar

Pale/pulseless overnight surgery

In backslab? 

55YO F

Fall onto outstretched hand, sustained a Distal radius fracture

–       Intrarticular

–       Closed

–       NV intact

–       In backslab

30YO M

2 day history of swollen red hot knee

–       Septic

–       Native

–       Aspirate taken

45YO F

Fall, sustained a midshaft tibial fracture

–       Open injury

–       No contamination with agricultural, aquatic, sewage material

–       Isolated injury

8YO M

Both bone forearm fracture, son of anaesthetist

–       30 rotation, 10 degrees displacement, no shortening

–       No NAI

12YO

Supracondylar fracture

–       Pulseless + Pink

–       No nervous compromise

CEPOD overnight

  • 30YO male with septic knee (lifethreatening)

 

Theatre in morning

  1. 12YO supracondylar fracture (Child/BOAST guidelines dictate early management)
  2. 45YO open fracture – IF CEPOD available in the morning to be done there (BOAST, do in separate theatre to keep theatre clean)
  3. 55YO distal radius (Least urgent case requiring surgery)

 

No need for operation

  • 8 YO both bone forearm
  • Should have his images reviewed by consultant within 72 hours and fracture clinic appointment within 7 days.