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 Case
#15 Putting Humpty Dumpty back together again
A 50 y/o female presents 9 hours after a
fall. She walked home from the bar, tripped
going into her home (lives alone) and
thought she may have sprained her ankle.
When she woke up 8 hours later, her ankle
was ‘killing her’ and she noted her leg bone
was sticking out! She called 911.
PMH negative except for HTN, CABG
SH Alcohol on weekends, no smoking, teaches
at the community college
ROS: no LOC, headache, head trauma, neck
pain, chest pain, syncope, SOB, abd pain,
change in stool or urination, no rash, no
fever, no vomiting.
Meds: Hydrochlorothiazide
PE PB=145/85, HR=92, RR=20, Temp =98F
HEENT unremarkable. Non-tender neck, full
ROM
Heart RRR No Murmur
Lungs: clear bilaterally
Abd Unremarkable, non-tender
Ext: Tibia sticking out of large laceration
at medial portion of ankle. The ankle is
obviously distorted, and appears to be
dislocated. You are able to doppler pulses.
You initiate IV, Oxygen, Monitor, Undress
the patient, and draw pre-op labs. You
administer 7 mg of morphine, and IV
antibiotics. You order a STAT portable ankle
x-ray, which revealed a comminuted fibula
fracture and the dislocated tibia. (You also
initiate a trauma workup, IV antibiotics,
and pre-op EKG).
The orthopedic surgeon you called requests
reduction in the ED and cardiac clearance
before surgery, noting that the bone has
been sticking out for over 9 hours now
(outside the 6 hour window), and that the
patient needed cardiac clearance prior to
surgery.
You set up for conscious sedation. You
decide to use propofol.
1. What allergy questions do you need to
ask?
2. What is propofol infusion syndrome?
3. What are the side effects of propofol?
Click here for answers and to respond
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Previous Articles
Pulmonary (01/29/08)
Pediatric (01/22/08)
Neurologic (01/014/08)
Cardiovascular (01/07/08)
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Renal (12/26/07)
Cardiovascular (12/19/07)
Pediatric (12/12/07)
Neurologic (12/05/07)
Trauma (11/27/07)
Trauma (11/20/07)
Neurologic (11/13/07)
Pediatric (11/12/07)
Cardiovascular (10/29/07)
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