Elderly Hip Fracture Journey Flashcards
time limits within hip fracture care?
transferred to orthopaedics within 4 hrs
receive bundle of care within 24 hrs
surgery within 36 hrs
receive assessment within 3 days if frail
mobilisation/physio within 2 days of surgery
occupational therapy within 3 days of admission
discharged within 30 days
important aspects of initial admission?
rapid triage through A&E
rapid X rays
pain relief
avoid long time on trolley
what are the “big 6” interventions before leaving A&E?
analgesia (exp for X rays) early warning score pressure area inspection bloods fluids delirium screening
traditional vs newer pain relief model?
traditional = morphine but lots of side effects newer = local nerve blocks - less side effects, lasts longer and can be given in A&E
how is delirium recognised?
CAM (confusion assessment method) = 3 criteria:
- inattention
- altered conscious level or disorganised thinking
- acute change/fluctuating cognitive level
4 AT tool helps identify
how is delirium managed?
manage predisposing factors and precipitating factors (drugs, pain etc)
propagating factors (environment, infection,constipation)
treat underlying cause
non-pharmacological methods (same nursing team, use family etc)
what is the inpatient bundle of care?
cognitive
nutritional
pressure area
falls
risk factors for pressure ulcers?
30 or more lying on a hard surface
delays to surgery
frail/malnourished patients
failure to mobilise early
nutrition prior to surgery?
no patient should be repeatedly fasted
oral fluids encouraged up to 2 hrs before surgery
what is the clinical standard for hip fracture surgery?
cemented hemi-arthroplasty unless clinical indication otherwise
how quickly should a frail patient receive a geriatric assessment?
within 3 days of admission
what is the frailty scale?
CSHA scale
very fit - severely frail (1-7 scale)
important aspects of fluid management?
peri-operative period is critical fluid overload risk clinical assessment fluid choice resuscitation vs maintainance
when is pain control needed during patient journey of hip fracture?
on admission
on transferring to X ray
pre/intraoperatively
post operatively
pragmatic approach to post op analgesia?
paracetamol (oral/IV) regularly
- codeine (starting from 15mg and increased)
- morphine as required or regular (small dose)
- oxycodone if confused on morphine (small dose)
