A Warfarinised Elderly Man with a Fall: A Case of Fractured Neck of Femur
A branching clinical case simulation for a patient presenting with shortened, externally rotated left leg after a fall at home. Take a history, examine, investigate, diagnose and treat while the patient responds to every decision, then see the score by clinical domain with the reasoning for each mark.
Year 4medium20 min5 stages
- Patient
- 88 years, male
- Presenting complaint
- Shortened, externally rotated left leg after a fall at home
- Decision stages
- History, Examination, Investigations, Treatment, Monitoring
The presentation
You are the emergency department doctor at a district general hospital. Mr. Arthur Whitfield, an 88-year-old gentleman, is brought in by ambulance after a fall at home. He is on warfarin for atrial fibrillation. He has a shortened, externally rotated left leg and rates his pain as 9 out of 10. He is alert but distressed. The AMU registrar is ready to review. Your task is to assess and manage his care.
What this case teaches
Provide effective analgesia including a fascia iliaca block; manage anticoagulation reversal before surgery; assess for the cause of the fall; plan surgery within 36 hours; prevent delirium.
How the case unfolds
- 1Initial Assessment: Focused HistoryHistory
- 2Focused Examination and Pain ManagementExamination
- 3Requesting InvestigationsInvestigations
- 4Management of the Fracture and AnticoagulationTreatment
- 5Post-Procedure Care and Delirium PreventionMonitoring
The decisions available at each stage, and what each one costs or earns, appear when you run the case.
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A free account opens the simulator: the patient's observations move with your decisions, and every choice is scored and explained.
Taught in
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Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.