Doctor Instruction:
During a road traffic accident, a 21-year-old male motorbiker was injured during a hit-and-run incident. He was unconscious initially with a GCS of 15 on arrival. Ultrasound showed free fluid in the paracolic gutter. X-ray and examination showed left open tibia and fibula fracture. His left limb has gone cold and pulseless. Blood investigations on admission were all normal, except for raised CRP and WBC.
You are given a preparation station prior to this station, with case notes and vital charts. Entries in chronological order:
Examination on admission: right hand swollen, abrasions left upper abdomen, open fracture left leg. Abdomen soft and non-tender. GCS 15.
Bloods: Hb, U&Es, LFTs, coagulation screen normal.
CXR: normal.
XRays: right hand MC fracture, left tibia and fibula fractures.
Tetanus and antibiotics were given in A&E.
2 litres of normal saline were given.
Group & saving pending.
Patient has been reviewed by the general registrar on call stating abrasion from left flank, abdomen soft, no need for emergency laparotomy for now, to request ultrasound abdomen.
Ultrasound Abdomen: difficult examination, ?left hypochondriac free fluids, suggest CT AP for further investigation.
Nursing entry a few minutes ago, left leg became pale and cold with DP/PT pulses not palpable. Worsening pain.
You are the surgical senior house officer on call in orthopaedics. Your registrar is currently busy in theatre. Please summarise your case to the trauma consultant on call over the telephone and discuss the next step forward.
Questions from Trauma Consultant: