Duchenne Muscular Dystrophy with Femur Fracture

You are the anaesthetist on call in a tertiary metropolitan hospital. You are notified that the next patient on the emergency list is a 14-year-old boy with a history of Duchenne muscular dystrophy. He has a compound displaced midshaft fracture of his femur after a mechanical fall down several stairs at home yesterday. He is scheduled for insertion of an intramedullary (IM) nail by the orthopaedic team. Medical History Duchenne muscular dystrophy - Under the care of a regular neurologist - One inpatient admission for a lower respiratory tract infection six months ago - Self-ambulant around the home but uses a wheelchair for longer distances - Gastrostomy tube for nocturnal enteral feeding due to dysphagia and poor nutritional state Medications Prednisolone 2.5 mg once daily Observations HR 102 bpm BP 110/64 mmHg SpO2 96% on room air Temp 36.8°C RR 28 breaths per minute Weight 38 kg Height 160 cm BMI 14.8 kg/m2