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
No NAI concerns
Pink and pulseless no nervous compromise
Injury occurred 1 hour ago
AMTS 6/10, normally housebound.
Day 0 today
Not swollen presently
Isolated injury, closed and NVI
Patient co-morbid with HTN, AF, COPD, PPM
INR 4, PPM check needed
Occurred today. High energy mechanism of injury
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:
Ankle – swell check in morning and keep elevated
NOF – needs optimisation etc. can still meet BPT of 36 hours.