Approach to the Critical Patient

Immediate priorities

Hemorrhage and shock assessment

Damage control resuscitation triggers

Fat embolism syndrome recognition

FES triad and timing

Stabilization and escalation triggers

Fracture stabilization

ICU activation criteria

History

Mechanism and presentation

Mechanism of injury

Presenting symptoms

Associated symptoms and alarm features

Alarm features requiring urgent evaluation

Review of systems

Past medical history and risk factors

Relevant comorbidities

Risk stratification factors

Physical Exam

Vital signs and general appearance

Hemodynamic assessment

General appearance

Limb examination

Inspection and palpation

Neurovascular examination

Secondary survey

Ipsilateral joint assessment

Skin and systemic findings

PITFALLS

Missed associated injuries

Differential Diagnosis

Life-threatening diagnoses

Hemorrhagic shock

Fat embolism syndrome

Compartment syndrome

Vascular injury

Fracture-related mimics

Pathologic fracture from malignancy

Bisphosphonate-associated atypical femur fracture

Femoral stress fracture

Hip fracture (femoral neck, intertrochanteric)

Laboratory Tests

Hemorrhage and transfusion labs

Complete blood count

Type and screen or crossmatch

Coagulation studies

Metabolic and perfusion labs

Basic metabolic panel

Lactate

Liver function tests

Fat embolism and rhabdomyolysis labs

FES supportive labs

Urinalysis

Diagnostic Tests

Scoring Systems

Injury Severity Score

Gurd and Wilson criteria for fat embolism syndrome

Gustilo-Anderson open fracture classification

MRI

MRI femur indications

MRI brain in FES

CT

CT for fracture characterization

CT angiography

CT for FES complications

Whole-body CT in polytrauma

Ultrasound

FAST examination

Vascular duplex ultrasound

Ultrasound-guided femoral nerve block

Disposition

Admission criteria

All adult femoral shaft fractures require admission

ICU admission criteria

Surgical timing and transfer

Timing of definitive fixation

Transfer criteria

Consult triggers

Mandatory consultations

Treatment

Immediate stabilization and analgesia

Initial stabilization

Multimodal analgesia

Resuscitation and blood management

Hemorrhage control

Open fracture wound management

Definitive surgical treatment

Intramedullary nailing: gold standard

Damage control orthopaedics pathway

VTE prophylaxis

Chemical prophylaxis

Mechanical prophylaxis

Special Populations

Pregnancy

Physiologic considerations

Analgesia considerations

Fetal monitoring

Geriatric

Low-energy mechanism and osteoporosis

Atypical fractures from bisphosphonate use

FES risk higher in elderly

Post-operative recovery considerations

Pediatrics

Age-based treatment algorithm

Nonaccidental trauma consideration

Analgesia in pediatrics

Hardware removal in pediatrics

Background

Epidemiology

Incidence and demographics

Mortality and morbidity

Coding

Pathophysiology

Fracture mechanics

Blood loss mechanisms

Fat embolism pathophysiology

Compartment syndrome mechanism

Therapeutic Considerations

IMN as gold standard: evidence base

VTE prophylaxis evidence

Analgesia evidence

Damage control orthopaedics rationale

Patient Discharge Instructions

copy discharge instructions

Femur fracture post-operative home care

Return to ER warning signs

Follow up schedule

Activity guidance

References

Guidelines and key sources

Society guidelines

Landmark trials

Key references

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.