Prioritisation 8

You have 10 minutes to complete the following scenario.

 

Scenario

You are the ST3 at a Major Trauma Centre. You have come in at 7am to plan the list for the day. All patients have been marked and consented by the night team.

You have a 1 theatre session list.

 

50YO M

Dislocated shoulder, NV intact

11YO M

Fall from monkey bars, Supracondylar fracture, Gartland 3

65YO F

Fall on ward, Periprosthetic hip fracture, Vancouver B3

30YO M

Fall, sustained midshaft tibial fracture

80YO F

Fall, sustained neck of femur fracture

 

  • L – Major Trauma Centre
  • II – Available all day, dedicated paeds trauma list also available
  • Kit – All kit available
  • Consultant – upper limb consultant – Not happy to do complex lower limb procedures
  • Allergies – none
  • All patients have had COVID tests and MRSA swabs, all negative

50YO M Dislocated shoulder

NV intact

ATLS performed, isolated injury

X-Ray performed – no humeral neck fracture

No attempt at reduction in ED

ED willing to give sedation

Time of presentation to ED 7am

Patient fit and well no comorbidities

 

11YO M

Fall from monkey bars, Supracondylar fracture, Gartland 3

ATLS performed, isolated injury

NV intact, warm well perfused

Time of injury 2am last night

Patient fit and well no comorbidities

Closed

 

65YO F

Fall on ward, Periprosthetic hip fracture, Vancouver B3

Consultant not happy to do procedure

Patient fit and well no comorbidities

Hip placed 2010

 

30YO M

Fall from motorbike, sustained midshaft tibial fracture

Patient fit and well no comorbidities

Open fracture – no gross contaminants

Time of injury 10pm (high energy should therefore be operated on within 12 hours)

ATLS performed isolated injury

BOAST guidelines followed – tetanus and Abx provided

In back slab and post reduction x rays completed

No compartment syndrome

NVI

Gustilo Anderson 2 – no requirement for plastics

 

80YO F

Fall, sustained neck of femur fracture

PMH – HTN, Dementia, Hypothyroidism

Hb 110, clotting normal, U+E normal

Isolated injury

Intracapsular

 

  • 50YO dislocated shoulder – attempted reduction in ED
  • 11YO on dedicated paediatric list

 

Final order of list

  • 80YO F with NOF for hemiarthroplasty
  • 30YO open fracture as dirty case

 

65YO postponed until suitable consultant to do case

I would attempt a closed reduction in theatre failing that I would perform an open reduction. I would delay the hemiarthroplasty if the shoulder reduction is not able to be performed on CEPOD or another suitable list.