Clinical Mock 2

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How would you manage this situation?

How would you manage this situation?

Prompts

Encourage the candidates to follow a structured answer here. Prompt them along the ABCDE examination with time for the remaining questions. Ensure circulation is covered in detail.

Aim for 3 minutes for this question.

Main concern:

Trauma case, high impact of injury.

I would ensure a trauma call has been put out, urgently attend to this patient with the trauma team present, and assess them according to the ATLS principles.

Ask the nurses to do observations including oxygen saturations, respiratory rate, heart rate, temperature and blood pressure.

C-Spine:

I would ensure 3-point immobilisation of the c-spine with a block, collar and tape.

Airway:

I would communicate with patient. He is alert and orientated, therefore, his airway is likely patent.

Breathing

I would note his observations, particularly respiratory rate and oxygen saturations.

 I would then provide high flow oxygen at 15L through a non-rebreathe mask

 I would inspect, palpate, percuss and auscultate the chest

 I would look for signs of obvious injury including, flail chest, bruising, reduced air entry, additional noises.

 Additionally I would ask for an urgent chest x-ray, ABG

Circulation

 I would note his observations, particularly temperature, HR, BP

 I would assess the patient for signs of hypovolaemia including capillary refill time, fluid status and JVP.

 I would asses heart sounds, listening for murmurs or muffled heart sounds.

 I would request IV access with 2 wide bore cannula in antecubital fossa and take Bloods- FBC, CRP, U&Es, coagulation screen, cross match and group and save.

 I would look for other signs of bleeding in the chest, abdomen, pelvis, long bones and look for blood on the floor.

 I would put the patient in a pelvic binder.

 I would provide IV fluid resuscitation with fluid challenge if the patient is hypotensive and have a low threshold for initiating a major haemorrhage protocol

 I would perform a FAST scan for intra-abdominal injury.

Disability

 I would Assess GCS, assess for signs of head injury- pupils, focal neurology and check his blood glucose

Exposure

 I would exposure from head to toe, looking for any obvious signs of bleeding, bruising, obvious fractures

Summarise:

 This 33-year old gentleman was involved in high-impact road traffic accident and is now presenting with frank haematuria. I would therefore be most concerned about injury to the urinary tract or to the pelvis.

Additional:

 I would alert my seniors, request a trauma series CT scan including head, neck, chest, abdomen and pelvis, discussing and approving the scans with a radiologist.

 This scenario may require theatre so I would ensure the patient is fasted, consented, booked on NCEPOD.