Author: Jennifer Todd / Editor: Nick Tilbury / Reviewer: Jennifer Todd / Codes: SLO4, TC1, TC2, TP7 / Published: 03/08/2023
A 20-year-old male is brought in the Emergency Department (ED) after coming off his motorbike whilst filtering through traffic. He reports hitting the central reservation and coming to an abrupt stop. His right boot was torn off in the accident.
There was no loss of consciousness or amnesia surrounding the incident. He is complaining of pain exclusively in his right foot/lower leg and denies any other injuries.
On arrival he is sat upright on the trolley and is GCS 15 . His observations are HR 97, BP 144/92, Sats 99% RA.
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Question 1 of 3
1. Question
What is your initial management?
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Question 2 of 3
2. Question
His cervical spine is clinically cleared. There are no chest, abdominal or pelvic injuries found.
His right ankle is significantly swollen and his toes are dusky purple and cold. There is a palpable dorsalis pedis pulse but a capillary refill of 3-4 seconds. He has extreme pain on palpation over the ankle, foot, heel and calf. He is not tolerating passive movements of the ankle or toes.
What are the three most likely differential diagnoses at this point?
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Question 3 of 3
3. Question
He has been sent for x-ray as shown below. He has fractures to the calcaneal bone and distal third of the fibula. His pain remains intolerable despite 10mg IV morphine.
What is your further management?
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Module Content
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9 responses
good case with 3 good questions- enough options to make me think
good case
Good case
Good key learning points
very helpful module
very good module
helpful case
A good case and relevant questions to answer.
Great Revision