You are the on-site anaesthetist in a large regional centre and have been called to the Emergency Department to assist with the management of a 70-year-old woman who was brought in by ambulance ten minutes ago after falling down the stairs at home.
The patient lives independently and was discovered at the base of the stairs by her visiting daughter this morning after having fallen down the stairs last night. The patient was unable to reach the telephone to call for help and was not wearing her personal alarm button.
The patient is sitting up on a trolley and appears short of breath.
Observations:
HR - 113 bpm, BP - 148/92 mmHg non-invasively, SpO2 - 92% on oxygen 15 l/min via non-rebreather mask, GCS - 12 (E3 V4 M5)
Past medical history:
- atrial fibrillation
- chronic back pain
Regular medications:
- apixaban 2.5 mg bd
- buprenorphine transdermal patch 15mcg/hour
- digoxin 125 mcg daily
- perindopril 2 mg daily
Sections covered in this viva
Assessment of flail segment with intercostal catheter managementDifferential diagnosis of hypotension and tachycardia from rhabdomyolysisFailed serratus blocks and analgesic options for extubation