Initial Assessment and Simultaneous Resuscitation:

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On arrival, manage the patient using an A to E approach according to the Advance Trauma Life Support Algorithm.

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• Airway with C-spine control

  • Check that airway is patient

• Breathing

  • oxygen saturations, examine chest, examine work of breathing, breathing depth

  • if concerns give high flow oxygen through a non-rebreathe mask

• Circulation

  • pulse, blood pressure, capillary refill time, skin turgor, fluid input/output

  • ensure IV access- 2 large bore etc- bloods as above, consider catheter

  • Give fluid challenge 500ml of crystalloid solution. If evidence of heavy bleeding apply pressure and activate Major Haemorrhage Protocol. Avoid deep probing open any neck wounds

  • If hypovolaemic think “blood on the floor + four more” - intrathoracic, intraperitoneal, retroperitoneal, pelvis/thigh – areas of internal haemorrhage

• Disability - GCS, pupils, blood sugar, temperature

• Exposure-  systemic signs of shock, other injuries

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Provide constant reassessment during this acute phase.

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Specific Limb Examination

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• Lower limb position – 90% of dislocations are posterior and appear shortened and internallyrotated. Although beware, with anterior dislocations the limb is held in external rotation with mild flexion and abduction.

• Range of movement

• Neurovascular status – Documenting this is key!

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Cover patient with blanket at the end to prevent hypothermia.

 Escalation

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This patient should be discussed with the orthopaedic registrar immediately. If it is a simple dislocation, then the patient will need an urgent closed reduction in A&E or in theatre under sedation/anaesthetic. However, they will need revision surgery if there is evidence of implant failure, loosening or malposition. This will be beyond your competence and you should be aware of your limitations. 

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