Hard to rouse after knee surgery

Instructions

You are an intern on the orthopaedic ward. It is 3 am, and the nurse has called you to see Giulia Caruso, 74, the night after her right knee replacement, who is hard to rouse and breathing slowly, with pauses.

1. 1

   Assess and manage the patient using an A to E approach

2. 2

   Outline to the examiner:

   • Your most likely diagnosis
   • Next steps in management, including relevant investigations

• A nurse is at the bedside and will carry out your instructions; describe procedures and painful stimuli rather than doing them
• You do not need to take a full history
• You do not need to summarise your findings