ankle injury

Question 1

25 y.o. man who weighs 70kg fell while playing football and sustained an injury to his right ankle. he was stretchered off the pitch and is now in the resuscitation room complaining of severe pain. you are working in the A+E department where you examine him and are happy with his airway, breathing and circulation. his ankle injury is his only problem though he is screaming in agony from it.

(a)(i) what would you give him for pain relief? specify the drug type and give one example

Answer 1

• morphine sulphate
• opioid

Question 2

(a)(ii) what route of administration would be most appropriate?

Answer 2

IV

Question 3

he is still in pain

(b)(i) the nurse asks if he may have some Entonox. what is this?

Answer 3

• 50% O2 and 50% NO anaesthetic gas
• analgesic (equivalent of 15mg morphine given subcutaneously)

Question 4

(b)(ii) list 2 groups of pts who should not be given Entonox in an EMed setting

Answer 4

1. consciously impaired
2. pts with a confirmed / presumed PTX

Question 5

he is now pain free. you examine the ankle and find a closed injury. there is a lot of swelling and deformity of the ankle joint but the skin appears to be intact although under some tension and you are concerned that you cannot feel a pulse in the foot.

(c)(i) what is the most appropriate ix?

Answer 5

XR of the ankle with an AP and lateral view

Question 6

(c)(ii) what additional measures would make him more comfortable before he goes through this?

Answer 6

attempt to reduce the fracture and immobilise it in a back slab plaster cast

Question 7

(c)(iii) if the x-ray demonstrates a fracture/dislocation of the ankle, how should this be treated?

Answer 7

attempt to reduce the fracture in a short cast. if this cannot be achieved then an open reduction internal fixation is indicated.

Question 8

(d) he is immobilised in plaster for 6 weeks

list 3 possible complications that are likely in this time

Answer 8

1. compartment syndrome
2. DVT/PE
3. muscle atrophy