Your first day as a doctor

It's all a question of accountability and salvageability. We'll have to wait for the post mortem. If the cause of death is clearly exsanguination from pelvis fracture (as opposed to, say, a non-survivable brain injury), then yes, the ortho reg could be held entirely accountable for this man's death.

To be struck off? Well... that depends on the nature of the delay. If he was busy brushing his teeth, then yes, no more fancy sports cars for him I'm afraid. If he lived 2 hours away, why the hell is he working at our hospital? If he got pulled over by the police for speeding, then... I don't know.

Yes, rolling the patient in retrospect was a bad idea, but we had to assess him for urethral rupture, otherwise I would have whacked a catheter in him, which could have been catastrophic. Peritoneal lavage is a no no, unless we wanted fountains of blood spraying everywhere. He had oxygen as soon as the ambulance got there (ABC!) as well as pain relief, but he was soon unconscious anyway. And we called everyone (anaesthetists, surgeons, orthopaedics) as soon as he arrived - not that the person that mattered ever got there in time...

And yes, the foundation doctors (only F2's, we don't have F1's in our A&E) were very useful for small tasks (e.g. blood labelling and requesting), bleeping seniors and record keeping. Talking to relatives is best left to consultants, especially with a catastrophe like this.

In the end, this gentleman's injuries gave him a calculated mortality of 100%, so one could argue we should have abandoned any attempts to save him as soon as he arrived. Try telling that to a hospital full of doctors, nurses, paramedics and relatives. Would have saved a lot of time, effort and money though. C'est la vie.

This link has a good classification of pelvic fractures and their suggested management


http://www.patient.co.uk/doctor/Pelvic-Fractures.htm

Back to the case - a couple of the correct answers have filtered through now, so I shall tell you what happened..

Legally though - wouldn't he only be in trouble if damage was caused by his breach of duty of care... (e.g. night watchmen case with the cyanide - hospital didn't have enough staff but as they would probably never have spotted cyanide poisoning it doesn't count)
I know that's for a hospital not the person but I assume it's the same.

Obviously - GMC is another kettle of fish, they can apply stricter standards.

Its like watching scrubs without the hot women and jokey atmosphere.

Wtf? Why have so many people negged you for this?

Ibuprofen

20ml of a drug that I don't know

the air mask

And shock him

Because I was a bit mean in my summary.

Could you do clinical cases on a regular basis and guide us/give us feedback?

Well I will for the next couple of weeks as I'm at home recovering from a tonsillectomy, but after that I'm back in A&E full time. I'll post another case again in a bit. Something less technical this time.

A 46 year old man is brought by ambulance to A&E following a suicide attempt, involving an overdose of an undisclosed amount of paracetamol and amitriptyline, plus two litres of cider. He has no previous psychiatric history.

Registered blind (secondary to diabetes), single and living alone, and having recently been fired from his job, he decided to take his own life, but immediately after ingesting the tablets, called an ambulance to seek help with the voices in his head telling him to kill himself.

At 4 hours post ingestion, and after absconding several times, the patient refuses to give blood due to a phobia of needles. The psychiatric team refuse to take over care of the patient until deemed medically fit, but no-one in the department is able to persuade him to allow blood to be taken.

What would you do next?

I would just sing this,