Femoral Fracture

Scenario:

Patient has had a mountain biking crash in the Cairngorms and is lying on the floor of the trail groaning in pain, there is an obvious deformity to the right femur.

D – ensure trail is closed to any mountain bikers descending.

R – groaning in pain

(C) – C-spine should be immobilised due to mechanism and cannot be cleared due to distracting injury.

A – airway is patent, trachea is central.

B – RR is 26, O2 sats are 98%, chest expansion is equal and symmetrical, no chest wall deformity or visible wounds.

C – BP is 123/84mmHg, HR is 107. PCR is > 2 seconds due to cold, CCR < 2 seconds. Check chest, abdo, pelvis, long bones. ?Pelvic fracture due to mechanism, obvious right femoral fracture.

D – temperature 36C, pupils equal and reactive to light, Alert.

E – secondary survey, bleeding from a laceration on the casualty's back, minor wound but needs to be spotted.

Priorities: C-spine appropriately immobilised, traction splint for femur, pelvic binder, maintain temperature, find the injury to the back as commonly missed.