Prioritisation 3

You have 10 minutes to complete the following scenario.


You are the night ST3 in an Major Trauma Centre taking handover. You are on call with an SHO. Tomorrow there is a 1 session AM list, II is present.

  • 45YO male post tibial nail who is complaining of pain
  • 5YO female with a supracondylar fracture. The hand is pink and pulseless.
  • 85YO with an intracapsular neck of femur fracture.
  • 50YO with a bimalleolar ankle fracture
  • 80YO with an extracapsular neck of femur fracture
  • 40YO with an open Tib Fib, Gustilo Anderson 2.

Location – MTC

II/Theatre – 1 session list and II not present

Consultant – General lower limb consultant

Kit – All available

Allergies – none

45YO tibial nail

Tibial nail performed 6 hours ago

Compartments feel tense

Patient has had a lot of opiates

NV intact

5 YO



No NAI concerns

Pink and pulseless no nervous compromise

Injury occurred 1 hour ago

Vascular available

85 YO

Displaced intracapsular

AMTS 6/10, normally housebound.

No anticoagulation

For Hemiarthroplasy

50 YO

Day 0 today

Not swollen presently

Isolated injury, closed and NVI

In plaster

80 YO


Patient co-morbid with HTN, AF, COPD, PPM

INR 4, PPM check needed

40 YO

Isolated injury

Occurred today. High energy mechanism of injury

No contamination

Overnight limb threatening

5YO isolated supracondylar – attempt reduction to restore blood supply. Vascular to be informed.

45YO tibial nail -if paediatric patient takes significant amount of time. BOAST dictate theatre within 1 hour. Discussion with plastic surgical colleagues to see if they can perform fasciotomy. Or senior reg also attend.


Order for tomorrow:

Open fracture

Hemi arthroplasty

Ankle – swell check in morning and keep elevated



NOF – needs optimisation etc. can still meet BPT of 36 hours.