Don’t climb fences or have a surgeon for a brother

Setting 29yo M Fall Arrived at 4:42am  waiting room Department ramping through night Multiple doctors on sick leave No Green Registrar in morning shift Seen at 8:18am through ambulatory care

ED Assessment HISTORY EXAMINATION Slipped climbing a fence at 18:00 Landing on top of fence striking his left ribs Pleuritic L sided pain Couldn’t sleep with the pain EXAMINATION Reproducible pain HR 65, Sats 100% Abdo soft, non-tender Chest clear

ED Assessment Impression Plan Musculoskeletal pain NSAIDS Home Represent if worsening pain/SOB

Thoughts? What about if……. Had some diaphoresis at home Bilateral shoulder pain Brother of a Surgeon at Gold Coast Hospital

Thoughts? Representation Category 4  waiting room Noted at handover Brought into Resuscitation room

FAST

CT abdo

Grade 2 splenic laceration Large haemoperitoneum No arterial extravasation of contrast Admitted to trauma HDU Successfully treated conservatively

Issues Impacting Multiple factors at play! Triage Supervision Bed block Night shift and the waiting room