Fall Scenario (ECA)

As you start your observations, your colleague completes a quick primary survey and begins assessing the injury. What obvious sign is more indicative of a neck of femur fracture when first assessing an injury to the hip?

The observations you collect are: HR 105, RR 20, SpO₂ 98%, BP 142/78, Temp 36.8, BM 5.6. What is this patient’s NEWS score?

As you collect your observations, you notice the patient does not appear bothered about her injury and is chatting in a confused manner, as she normally does. Her baseline behaviour is that she cannot understand most subjects and is unable to hold a conversation. She is physically very well, but her cognitive ability is severely declined. You ask her if she is in any pain, and she states that she has no pain. Should you further explore the patient’s pain and ask if she can rate her pain from 0–10?

You do not think simply asking about the patient’s pain is appropriate. What scoring tool can you use to help you measure this patient’s pain?

You apply the Abbey Pain Scale to your patient and find a score of 9. What does this equate to?

Your colleague prepares to give pain relief. Why is early pain management important?

As pain relief is being given, you assess the injury. You can see the leg is shortened and externally rotated. What other signs may indicate a fractured neck of femur?

You see a number of signs associated with a neck of femur fracture. What risk factors in an elderly patient may add to your suspicion of a possible fracture?

Osteoporosis contributes to neck of femur fractures primarily by:

Your colleague did not get a good opportunity to fully assess the injury initially. Once you have established a suspected neck of femur fracture, should a neurovascular assessment distal to the injury be completed?

Once pain relief has been given and the patient appears more comfortable, you consider extrication. What does JRCALC recommend to immobilise the injured leg?

You immobilise the leg to provide comfort during extrication and use a scoop stretcher for transfer to hospital. Why is prompt conveyance to the nearest appropriate hospital important in suspected fractures?

Why do some patients report pain in their groin when they have sustained a neck of femur fracture further up the thigh?

You can rule out a suspected neck of femur fracture if the patient can weight bear and perform a straight leg lift, even if there is pain?

A neck of femur fracture can occur in the frail elderly population without any trauma. What is this type of fracture known as?