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Scenario: Crushed Ankle


Please note: The users who submit scenarios have declared that all patient details are fiction. We cannot guarentee the accuracy of any suggested treatment or the realism of suggested observations. You should judge these for yourself.



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Scenario Overview:
You are dispatched by ambulance control to a collapsed female in a car at a petrol station. On arrival you are met by the petrol station manager who shows you the car with the patient. The patient stepped out the car without putting the hand brake on and the car has jolted forward about 10ft crushing the right foot between the curb and the car. On arrival by the drivers door is a pool of blood. The patient is in the vehicles passenger seat. The patient is pale in colour, alert but sleepy. On looking at the patients right foot there is a clear open fracture site with bone clearly visible from the foot. The patient is able to describe that she was paying at the kiosk when she dropped her money.
Difficulty:
Ambulance Crew (non HCP)
How the scenario should progress:
patient remains stable , should consider major trauma centre and paramedic assistance, considerations regards pain management - entonox , paracetomol,
Patient 1:
Name: lucy kella     Age: 40    Sex: Female
Medication: citalopram,
Allergies: NKDA
Past medical/family/social history: depression anxiety
Findings on examination: ABC is ok, patient has some bruising on right leg and calf area with clear open fracture wound 2-3cm in length over the top of the right foot
Possible treatment from first aiders: full primary and secondary surveys, patient should have wound cleaned and dressed and appropriate splint applied, considerations for pain relief within scope of practice. paramedic support should be called for pre hospital antibiotics and further pain relief. patient should be transported to major trauma centre.
Time after start: initial obs +5 +10 +15 +20 +30 +40
Response: ALERT ALERT ALERT ALERT ALERT ALERT ALERT
Airway: CLEAR CLEAR CLEAR CLEAR CLEAR CLEAR CLEAR
Breathing? YES YES YES YES YES YES YES
Respirations: 28 25 22 22 20 18 18
Pulse: 156 130 102 100 98 87 87
Oxygen Sats: 97 97 99 98 97 98 99
Pain Score: 9 8 8 5 4 4 4
Blood Pressure: 88/44 90/45 90/55 90/55 91/53 94/46 94/64
Temperature: 34.5 35.0 35.3 35.5 35.8 35.8 36.0
Blood Glucose: 4.1 4.5 6.5
GCS: 15 15 15 15 15 15 15



Tips for the patient actors:
This injury was extremely painful for the patient however they where extremely lethargic but still responsive. Patient's axitey also made assessment difficult as they did hyperventilate once situational awareness set in.

Scenario submitted by: Anonymous