1. Case presentation 96.04.24 Intern 黃毓琦

2. Personal profile  Name : 簡 X 涵  Gender : female  Age : 49 years old  Chart number : 23506199  Arrival date at ED : 96/03/22  Time : 07:42 am

3. Injury mechanism  She fell down from stairs (3~4 steps) this morning (7:00am)  Left foot pain without initial loss of consciousness was noted  CC: Left foot pain

4. Pre-hospital evaluation and management  sent to KMUH ER  Head :ILOC, dizziness, headache, nausea/vomiting, amnesia, vertigo  Neck: pain, stiff, soreness  Chest: pain, dyspnea  Abdomen: pain, discomfort  Limbs and skin : left foot pain, swelling, deformity

5. AMPLE history  Allergies: denied  Medication: nil  Past illness: –DM:(-) –HTN:(-) –Hepatitis B carrier (-) –Other systemic diseases: denied –Operation history: C/S  Last Meal :last night (21:00)

6. Initial evaluation (KMUH) A (airway) / B (breathing): Collar fixation: (-) Collar fixation: (-) Airway: speech: normal respiration: smooth Airway: speech: normal respiration: smooth airway obstruction sign airway obstruction sign foreign body in the mouth foreign body in the mouth Trachea Trachea Breathing sound Breathing sound

7. C (circulation): Rate: brachial a., carotid a., femoral a., dorsalis pedis a. Rate: brachial a., carotid a., femoral a., dorsalis pedis a. Cuff BP : 136/86 mmHg Cuff BP : 136/86 mmHg Skin condition: appearance, temperature, Skin condition: appearance, temperature, humidity humidity

8. D (disable): GCS: E4V5M6 GCS: E4V5M6 Pupil response: od: ? os: ? Pupil response: od: ? os: ? E ( exposure ) : left foot pain, swelling, deformity left foot pain, swelling, deformity

9. Secondary evaluation (KMUH ER)  Left foot x-ray AP & lateral view

10. UpToDate

11. LearningRadiology.com

13. 96/03/22 08:03AM  Left foot Lisfranc fracture-dislocation (tarsometatarsal ; TMT joint )

14. Plan  Consult orthopedics for surgical intervention

15. Lab data (96/03/22)

17. Chest x-ray

18. Tentative diagnosis  Left foot Lisfranc fracture-dislocation

19. Operation  Sent to OR at 11:20  CRIF and short leg splint

21. Post-op x-ray  96/03/22 18:57 Impression 1) Status after internal fixations for fracture dislocation at the fracture dislocation at the tarsometatarsal joints of left tarsometatarsal joints of left foot with improved alignment. foot with improved alignment. 2) Status after splint fixation for left foot. foot.

23. After admission  Admission to 13ES66-02 –Pain relief agents and rehabilitation was done –Close observation of post operation condition  MBD on 96/03/26

24. Thanks for attention