Trauma and Post-OP Management: Scenario 1

00:01 So, we won't be going too much of detail about trauma because specifically to a couple of scenarios and then we can go through some of the things you need to know in the exam.

00:15 Just a quick scenario.

00:20 Yeah.

00:22 That's what we see.

00:24 Okay, so the management of patient in A&E, so the way we're going to take the scenario is to see if they give you anything in an EMQ, related to trauma you should be able to answer it.

00:36 (inaudible) to what type of trauma it is.

00:38 So, what I'm going to do, Yep, ABC, C-spine, go on, tell me a few more things.

00:46 So, tell me a couple more things about the airway specifically, airway.

00:57 Chin lift, jaw thrust.

00:59 What's a contraindication for nasopharyngeal airway? Basilar skull fractures Okay, how much oxygen do we give? Patients with COPD? 15 liters, very good.

01:11 Okay, circulation.

01:13 Tell me more about circulation.

01:18 Pulse pressure, capillary refill, okay.

01:25 Okay.

01:28 Fine, yeah.

01:29 Okay, and then what would you do along with C? Flux IV fluids.

01:35 Fluids, what fluids, trauma, Hartmann's? Okay.

01:38 How much would you give in a child? 20mil per kl for? 20 mil per kl is fine, I think just thought about the children, 20 mil per kl is fine.

02:01 Right, what else are you worried about? So ABC, Blood loss? Apart from that? One is blood loss, still in circulation.

02:19 Well, maybe peripheral pulses, that's what I was commenting to, peripheral pulses, okay.

02:23 Then, you still you do D, E.

02:27 What else? So, you're done A, B, C, D, E, patience stabilized, you'd done a secondary survey.

02:32 What's next? What else are you thinking of? Particular to the leg specifically? What are you going to do for the leg? Reduce some, where any? Analgesia character.

02:54 For analgesia, but you said reducing, would you reduce this? Okay.

03:00 You said that if there is blood loss, you reduce it.

03:03 Does it, do you reduce it for that? There's a specific indication, huh? Yes.

03:13 With more specific, you're on the right track.

03:15 No.

03:16 You reduce it if you can see a kink to vessel, if you can see an arterial and if you see the posterior tibial artery, which is kink there and you can see by reducing it.

03:24 You can sort of unkink it, then you reduce it.

03:27 But if it is divided, you can't you do, there is no point in reducing it because you'll make it worse.

03:31 Okay? So, reduction is only if you can see a kink vessel, whereby pulling it, you will be able to reduce it.

03:37 Okay.

03:38 Are you worried about about compartment syndrome? Okay, but can you get compartment syndrome in an open fracture? That's right, yes.

03:47 You can get compartment syndrome in the posterior compartment for example or in the thigh.

03:52 So compartment syndrome is something you need to reconsidering.

03:55 Fine.

03:56 Okay, so...

04:05 I don't think we miss anything, have we? No, good.

04:07 Okay.

04:11 Well, come to the next slide here.

04:13 Yes.

04:14 Now, pain relief, tetanus toxoid, antibiotics.

04:19 What antibiotics would you give? And co-amoxiclav, would you give metronidazole? But if you're give co-amoxiclav then probably don't have to.

04:36 If you're given cefrotux cefuroxime, then you have to admit in assault.

04:40 So otherwise, just augmentin.

04:43 What? Thank you.

04:48 Okay, just augmentin is fine.

04:49 Okay, then catheterise, viability of the limb, sensation of the limb, compartment syndrome, x-ray, fracture reduction, nil by mouth for, not NBM, nil by mouth, NBM.

05:02 Okay.

05:02 So, this is a standard principle you need to follow in your exam, for every fracture.