Question

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

Hint:

Always assess the neurovascular status of the limb after trauma, as compartment syndrome and other vascular injuries can cause severe complications if not managed promptly.

Answer 1

Step 1: Initial Stabilization.
- Airway, Breathing, and Circulation: First, ensure that the patient's airway is clear, and he is breathing adequately. Administer oxygen if necessary. Establish two large-bore IV lines for fluid resuscitation if signs of shock are present. Monitor blood pressure, heart rate, and oxygen saturation.
- Resuscitation: If the patient shows signs of hypovolemia (e.g., tachycardia, hypotension), initiate IV fluid resuscitation with normal saline or Ringer's lactate. Blood transfusion may be needed if there is significant blood loss.

Step 2: Pain Control.
- Analgesia: Administer pain relief as needed. Non-steroidal anti-inflammatory drugs (NSAIDs) or opioids may be given for pain management, depending on the severity of pain. Ensure that pain relief does not mask signs of more serious injuries (e.g., abdominal or head trauma).

Step 3: Focused Examination.
- Thigh Injury: After stabilization, perform a detailed examination of the thigh. This includes checking for any deformity, swelling, or bruising. Palpate the femur, hip, and knee to assess for fractures. Check for signs of vascular or nerve injury, such as absent pulses or sensory loss in the leg.
- Imaging: Perform X-rays of the thigh to assess for fractures or dislocations. A pelvic X-ray may be required if there is suspicion of associated pelvic fractures. If the thigh injury is severe or there is suspected internal injury, a CT scan may be indicated.

Step 4: Fracture Management.
- Fractures of the Femur: If a femur fracture is diagnosed, apply traction or a splint to immobilize the limb. Surgery, such as open reduction and internal fixation (ORIF), may be required depending on the type and location of the fracture.
- Soft Tissue Injury: If there is a soft tissue injury, such as a contusion or hematoma, elevate the leg and apply ice packs to reduce swelling. In severe cases, surgical intervention may be necessary to repair the muscles or tendons.

Step 5: Monitoring for Complications.
- Neurovascular Monitoring: Continuously monitor for signs of neurovascular compromise in the affected limb, such as changes in color, temperature, or pulse.
- Infection Prevention: Administer tetanus prophylaxis if there is an open wound. Provide antibiotics if there is a risk of infection, especially with open fractures.
- Postoperative Care (if surgery is required): After surgery, ensure proper wound care, monitoring for infection, and rehabilitation to regain function in the limb.

Step 6: Conclusion.
The management of this patient involves stabilizing him initially, followed by a focused examination and appropriate imaging. Treatment will depend on the extent of the injury, including fracture management, soft tissue care, and monitoring for complications. Pain control and preventing further harm to the limb are crucial.