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

3. 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

4. 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

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

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

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

10. FAST

11. CT abdo

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

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