What are your first actions for your management of this patient?

The patient’s observations are within normal parameters and there are no injuries apparent, so you help her up back onto the bed. Her pain decreases slightly to 3/10. As you move her into a more accessible position, you notice multiple grade 1 pressure sores on her heels, head, shoulders and elbows with a grade 2 on her sacral area. This is your only abnormal finding.

What is a grade 2 pressure sore?

All observations and assessments you have completed are normal and the patient seems to be in good spirits since she is now back on her comfortable bed. She has poor mobility due to peripheral lymphoedema and requires a frame to mobilise. She has a PMH of chronic kidney disease stage 2, hypertension, high cholesterol, multiple TIAs, and is currently awaiting results to see if she has heart failure.

Given the history of events, what condition would you consider at this point that may influence your acute management of this patient?

What considerations should you take when assessing a long lie and the associated risks of rhabdomyolysis? TICK ALL THAT APPLY

If the patient has been on the floor for over an hour, the previous considerations when assessing a long lie must be considered, and they must be assessed and admitted to hospital regardless?

What further conditions would we be concerned about as an implication of a rhabdomyolysis diagnosis?

Would a patient with suspected rhabdomyolysis be better suited for either Ibuprofen or paracetamol pain relief?

You decide as crew that Paracetamol would be better due to the associated dehydration with a rhabdomyolysis diagnosis. What other treatment can we provide for a patient with suspected rhabdomyolysis?

You decide IV fluids can be used as you recognise the potential detrimental effects on the patient’s kidneys, and her dehydrated state. You now consider the patient’s future management. Where would you consider this patient be best suited to continue care and treatment, where appropriate and with suitable services within your area?

In a patient diagnosed with rhabdomyolysis, in roughly what percentage of patients does acute kidney injury develop over the days following insult?

What other potential causes are there for rhabdomyolysis? TICK ALL THAT APPLY

What is the classic triad of signs and symptoms associated with rhabdomyolysis?

What blood test measurement is predominantly used to diagnose the likelihood of rhabdomyolysis in a patient?

How long may it take for main symptoms to present and creatine kinase to reach maximum blood concentration so you can gain an accurate measurement?

Approximately how often would this triad of symptoms present in a patient with diagnosed rhabdomyolysis, highlighting the necessity of a good patient history taking?