Prioritisation
Trauma List Scenario #1
Scenario
You have 10 minutes to ask any questions and formulate your list.
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Scenario | Your consultant has requested you to organise the trauma list for the following day. The following patients are awaiting operations. You have a full-day trauma list and a half-day afternoon hip list. An experienced staff grade will handle the trauma list for the entire day, while an experienced consultant will take care of the hip list.
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PDF Download | Download PDF file containing patient list and additional patient information. The additional patient information is for the examiner so Have a colleague read the additional information section and download the PDF with the patient information for each question - you have 10 minutes to ask questions and formulate your list order.
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Background
Background Questions
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It's a good idea to get into the habit of asking a set of questions prior to asking about individual questions these include theatre related and patient related questions. You don't need to ask absolutely all of these but find out a set that work for you; my questions I would ask are as follows:
Theatre Related
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Am I in an MTC / DGH?
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Are there any other allied specialities available (e.g. plastics / vascular / general surgery)?
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Is there any additional CEPOD or Elective list capacity?
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Do we have XR available?
Patient Related
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Are all the patients in hospital?
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Have all the patients been consented, marked and swabbed?
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Have all patients been optimised for theatre and ready to go?
Scenario Background
Theatre Related | You are in an MTC with allied specialities available. There is a CEPOD list available, however, unsure what is currently on there. You have XR available in the full list only.
Patient Related | All patients are currently in the hospital and have been consented, marked and swabbed. Patient number 6 is awaiting an USS to confirm a collection as the SHO was unsure.
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List Order
Below is a suggestion trauma list template. Remember to articulate your reasons for the list order and considerations for each at the end the of the scenario.
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Overnight CEPOD List
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Patient #3 - Infected TKA
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This patient is an orthopaedic emergency ​
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They have a positive gram stain and are septic
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They require emergency washout to reduce septic load and should be performed overnight
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I would contact on call anaesthetist and CEPOD list
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Theatre List 1 - Full Day List
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Patient #2 - Open Tibial Fracture
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This patient should be operated on the next available trauma list as per BOAST guidelines​
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Patient #5 - Tibial Plateau Fracture
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Closed NV intact injury that is optimised for theatre​
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Need XR for this case
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Patient #1 - Intra-articular Distal Radius Fracture
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Closed, NV intact injury​
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Should undergo theatre in <72 hours as per BOAST guidelines
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Need XR for this case
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Patient #6 - Diabetic Foot Abscess​
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This is an infected case awaiting USS​
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Despite them being diabetic they are non-insulin dependent and could be fed light early breakfast
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State you would expedite USS and discuss with anaesthetist about diabetic medication, glucose monitoring and when they could eat until
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Theatre List 2 - Half Day List
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Patient #4 - Intracapsular NOF# for THA
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This patient should undergo theatre within 36 hours as per BOAST guidelines​
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XR is not required
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Hip surgeon available and should be performed on their list
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This would be a relatively easy prioritisation station. The important aspects are to establish the unwell patient (Septic TKA) and need for overnight surgeon alongside managing the XR availability and ensuring the hip surgeon performs the NOF# THA.
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