Prioritisation 7

You have 10 minutes to complete the following scenarios.

Scenario

You are the ST3 at a major trauma centre, ½ day trauma list tomorrow. II present. SHO overnight present.

  • 77YO DHS
  • 88YO tibial laceration
  • 66YO NOF intracapsular
  • 99YO NOF Intracapsular
  • 33YO ?compartment syndrome
  • Location – MTC
  • II – ½ day theatre list, II present for theatre list. No other theatres tomorrow.
  • Consultant – Lower limb consultant
  • Consent, COVID, MRSA – All complete, patients are ready
  • Kit – available
  • Allergies – nil

77YO DHS

Isolated

NV intact

CXR, ECG, orthogeries assessment completed

Hb stable

Comprehensive geriatric assessment within 72h

FIB should be performed for pain management

Surgery within 36 hours of injury (patient attended 11am)

No anticoagulation

No co-morbidities

 

88YO tibial laceration

Isolated injury

No bony injury

NVI

Hb stable

Plastics agree to manage patient

 

66YO NOF intracapsular

Isolated

NV intact

CXR, ECG, orthogeries assessment completed

Hb stable

Comprehensive geriatric assessment within 72h

FIB should be performed for pain management

Surgery within 36 hours of injury (patient attended 9am)

No anticoagulation

No comorbidities

Gardens 4

AMTS 10/10, Mobilises independently, NICE recommend THR

 

99YO NOF intracapsular

Isolated

NV intact

CXR, ECG, orthogeries assessment completed

Hb stable

Comprehensive geriatric assessment within 72h

FIB should be performed for pain management

Surgery within 36 hours of injury (patient attended this evening)

On warfarin – INR is 3.5 (requires discussion with haem and Vit K + rechecking INR)

Gardens 3, AMTS 7/10, Mobilises with a ZF – NICE guidelines recommend hemiarthroplasty

 

33YO ?Compartment syndrome

Post Tibial nail procedure

NVI

Extreme pain even 30min post bandages removed

Surgery should occur within 1 hour from diagnosis of compartment syndrome.

 

Emergency

  • 30YO ? compartment syndrome

Theatre list order

  • 66YO NOF intracapsular
  • 77YO DHS

Referral to plastics

  • 88YO tibial laceration

Further work up

  • 99YO NOF intracapsular