Fracture of femur, shock (899/1700)

A young male met with a RTA and is suspected to have a femur fx. His BP is 90/60mmHg. What is the next immediate action?

a. XR
b. IV fluids
c. Put leg splint
d. Send bloods for inv
e. US









































answer: C

Source: Apley system of Orthopaedics and fractures 9th ed 2010 (considered the bible of ortho)

note, external bleeding is referenced above, however the same principle applies to closed limb bleeds causing catastrophic hemorrhage:


4 comments:

  1. Mahfuza30 September 2016 at 16:04

    I think it is I/v fluid and it is the next important step to prevent shock. Splint is the second most important. They want to see if we can manage an emergency situation and in my opinion here they are not asking for your ortho knowledge.

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    Replies
    1. Swatej Hanspal11 January 2017 at 15:15

      I agree with Mahfuza. Although splinting may reduce the rate of ongoing hemorrhage, patient is already hypotensive. 1st step should, i think, be securing IV access and starting fast fluids. It doesn't take long. Splinting can follow.

      Delete
  2. Obinna9 April 2017 at 20:25

    But I think minimizing blood loss is more important than giving IV fluids; which in itself cannot truly replace blood loss

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    Replies
    1. Joe6 June 2017 at 12:25

      actually it should be done at the same time as the principles of ABCDE or CABC or whatever technique you follow states that there is no actual hierarchy but of its components should be done at the same time or near the same time hence we have a trauma team, going back to the question both answers maybe correct but the definite the correct answer will be in the mind of the examiner and his bias in formulating the question and its answer

      Delete

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