And I heard a crack

 

This SAQ is worth 10 marks

A 19 year old man has presented to your rural ED after falling on to his out-stretched handwhile playing basketball.

He is complaining of wrist pain. There are no wounds visible.

AP and lateral Xrays of his wrist are given.

View attached:  Attachment 1  Attachment 2

Question 1.
List the 2 main abnormalities shown on the Xrays. (2 marks)


1. ___________________________________________________________________________________________________

2. ___________________________________________________________________________________________________



Question 1.
List the 2 most serious possible immediate complications of this injury. (2 marks)


1. ___________________________________________________________________________________________________

2. ___________________________________________________________________________________________________



Question 1.
You have elected to perform a Bier’s block in your management of this injury.

List the steps involved in performing a Bier’s block, including drugs, doses and endpoints where appropriate. (6 marks)

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This SAQ is worth 10 marks

A 19 year old man has presented to your rural ED after falling on to his out-stretched handwhile playing basketball.

He is complaining of wrist pain. There are no wounds visible.

AP and lateral Xrays of his wrist are given.

Question 1.
List the 2 main abnormalities shown on the Xrays. (2 marks)

  • (trans-scaphoid) Peri-lunate dislocation
  • scaphoid fracture


Question 1.
List the 2 most serious possible immediate complications of this injury. (2 marks)

Median nerve injury, vascular compromise

Question 1.
You have elected to perform a Bier’s block in your management of this injury.

List the steps involved in performing a Bier’s block, including drugs, doses and endpoints where appropriate. (6 marks)

Consent – 1 mark 

Preparation – cardiac monitor, IV access *2 (one each arm – below fracture) 

Cuff – inflate to 100mmHg above systolic BP 

LA – prilocaine 2.5mg/kg 

(Manipulate fracture and plaster) – not essential in this question 

Cuff to stay up at least 30min (CRITICAL ERROR) – 1 mark 

Deflate cuff and observe 15 min for toxicity 

 

Q3 – ½ mark for concept, extra ½ mark for specifics

 

Total pass – 7/10 

 

 




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