Polytrauma scenario
candidate brief
You are the resus doctor. Urgent Treatment Centre is sending over a patient from the other end of the hospital site as they have fallen down a full flight of stairs and looks unwell. They will arrive in 5 minutes.
actor brief
PMH: prosthetic heart valve on warfarin - was told to always tell HCPs that he's on warfarin so is pretty much the first thing he mentions
Last INR was within range
examiner brief
80yo fall down full flight of stairs - walked to UTC, became more unwell so was sent to ED by porter. Porter is unable to give any history.
Patient can initially give his own history and is quite keen to do so.
Initial obs
RR 24, SpO2 88% on air → 94% on 15L
HR 80, BP 128/83
GCS 15/15
O/E
Bruising over chest and abdomen
Tender and guarding in abdomen particularly in LUQ
At minute 3, patient becomes more hypotensive and tachycardic
- Wash hands, introduce self
- Confirm patient identity
- Check need for analgesia
- Puts out trauma call
- Immediate C spine immobilisation - facilitates 3 point immobilisation
- Takes appropriate history
- Confirms team competencies
- Facilitates primary survey
- Reversal of anticoagulation
- Activate major haemorrhage protocol
- Prepares for surgical chest drain
- Requests appropriate investigations
- bloods - group and save, cross match
- trauma CT
- Leads team well
- Global mark from examiner