Question

A 40-year-old man is brought to the casualty with history of RTA and injury to the right thigh.
How will you assess this patient?

Hint:

In trauma patients, always prioritize the ABCDE approach to stabilize the patient. Detailed examination and timely investigations are essential to identify hidden injuries.

Answer 1

Step 1: Primary Survey (ABCDE Approach).
The first step is to perform a primary survey to assess and stabilize the patient's condition. This includes:
- A: Airway: Ensure the patient's airway is patent and there is no obstruction. If necessary, clear the airway and provide oxygen.
- B: Breathing: Check for adequate breathing and chest movement. Ensure there is no pneumothorax, hemothorax, or other breathing issues.
- C: Circulation: Assess the patient's circulatory status, including pulse, blood pressure, and signs of shock. Control any external bleeding, especially from the thigh.
- D: Disability: Assess the patient's neurological status using the Glasgow Coma Scale (GCS). Check for any signs of head injury or altered consciousness.
- E: Exposure: Expose the patient to fully assess all injuries while preventing hypothermia. Look for other injuries, especially if there is a history of trauma like a road traffic accident (RTA).

Step 2: Secondary Survey.
Once the primary survey is completed and the patient is stabilized, perform a more detailed secondary survey to assess the injury to the right thigh and any other possible injuries. This includes:
- Thigh Examination: - Inspect the thigh for any signs of external trauma such as abrasions, lacerations, or deformity. - Palpate the thigh for tenderness, crepitus, or abnormal swelling. Check for any obvious fractures or signs of a hematoma. - Assess the range of motion in the hip and knee joints to rule out joint injuries. - Perform a neurovascular assessment of the lower limb, checking for any signs of nerve damage (e.g., femoral nerve) or compromised blood flow (e.g., femoral artery).
- Abdominal Examination: Given the mechanism of injury (RTA), assess for any signs of abdominal trauma, which could include organ injury or internal bleeding.
- Pelvic and Chest Examination: Assess for any signs of pelvic fractures or chest injuries, especially if the RTA involved impact to the abdomen or chest.

Step 3: Investigations.
- X-ray: Perform an X-ray of the right thigh to check for fractures or dislocations, especially of the femur or patella. A pelvic X-ray may also be needed if the mechanism of injury suggests a pelvic fracture.
- CT Scan: A CT scan of the abdomen or chest may be necessary if there is suspicion of internal injuries due to the impact.
- Blood Tests: Check for hemoglobin levels to assess blood loss and coagulation status. Crossmatch blood if significant trauma or blood loss is suspected.

Step 4: Conclusion.
The initial assessment should focus on stabilizing the patient, followed by a thorough evaluation of the thigh injury and other potential traumatic injuries. Radiological investigations are crucial for diagnosing fractures or internal damage.