Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Fractured neck of femur:management guidelinesFractured neck of femur[Dr Anne Scase, Dr Fateh Shekhawat and Dr Matthew Wyse, 2003-05;appraised by Dr Scase, January 2010]These guidelines have been agreed with the orthopaedic surgeons.They have been issued to all the surgeons and you should work withthem.Patients with fractured neck of femur should be listed on the traumalist in the morning before any other cases, including children. Theonly exceptions to this are for life- or limb-threatening surgery.Aims:• Reduction in starvation time.• Time from admission to theatre less than 24 hours.• Improved planning of trauma lists.Fluid management1. Cannulas (at least 18 SWG) must not be sited in the antecubitalfossa.2. Patients with intracapsular fracture will need maintenance fluidonly (e.g. Hartmann’s solution). This includes making up thefluid missed since their fall.3. Patients with extracapsular fractures will have lost approximately1000 mL blood and require fluid resuscitation as well asmaintenance fluid.4. Give 500 mL colloid (e.g. Gelofusine) at least, before startingmaintenance fluid of 2000 mL isotonic crystalloid in 24 hoursunless contraindicated.5. If in doubt about the fluid management, contact the traumaanaesthetist.Anaesthetists Handbook January 2010 151