Silver trauma scenario
15/1/26
candidate brief
The triage nurse asks you to assess Mrs Patterson, who has come in after a fall.
actor brief
You are a 75yo who, while gardening today, fell down 3 steps and hit your head on a flowerpot. You had some neck pain immediately. Your nephew was there at the time and brought you to hospital.
The neck pain is quite bad - you didn't have time to take any painkillers. Only if specifically prompted, you tell the doctor you also have a funny pins and needles feeling going down your right arm, which you attributed to trying to break your fall.
PMH: rheumatoid arthritis, fatty liver, AF
DHx: methotrexate, folic acid, adcal D3, apixaban
Lives alone, nephew visiting while on holiday
You mostly want to know when you can go home.
examiner brief
75yo fall down 3 steps outdoors, hit head on flowerpot, had immediate severe neck pain
Driven by nephew to ED
o/e
Sitting on trolley
Large bruise over forehead and face - no subconjunctival haemorrhage
No external wound
Unable to rotate head actively due to pain
- Washes hands, introduces self
- Confirms patient identity
- Checks patient comfort before starting
- Demonstrates C-spine precautions
- States need for 3 point immobilisation
- Performs primary survey
- Gets key history re head injury
- Past medical history, drug history, allergies
- Offers analgesia
- Considers reversal of anticoagulation
- Arranges appropriate investigations: bloods, CT head + C-spine
- Address patient's concerns
- Global mark examiner
- Global mark patient