Station - Instructions for candidate
You are an intern on the orthopaedic ward of a Perth metropolitan hospital.
Vikram Iyer, a 42-year-old truck driver, presented to the Emergency Department at 11 am with a closed tibial shaft fracture sustained when a pallet fell on his leg at work. He was treated with a backslab and admitted for observation prior to planned surgery tomorrow. The ward nurse has called you at 5 pm because his pain is escalating rapidly despite analgesia and he is becoming increasingly distressed. You are to assess him now.
| Ward nurse's observations | HR 108, BP 148/94 mmHg, RR 21, SpO2 97% on room air, temperature 37.4 C, pain score 8/10. Patient very distressed, says pain came on in the last 30 minutes and is much worse than this morning. |
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Your tasks are to:
- Take a focused history of the escalating pain and relevant background.
- Perform a focused lower limb neurovascular examination of the injured leg. Describe to the examiner what you would like to examine and the relevant findings will be provided to you.
- State your most likely diagnosis and one differential diagnosis to the examiner.
- Outline your immediate management plan to the examiner, including any urgent actions.
- You do NOT need to summarise your history and examination findings to the examiner before giving your diagnosis.
- Findings will be provided by the examiner on request.
This is a 10-minute station, with 2 minutes of reading time.