Extremity Trauma, Peripheral Nerve Blocks, Compartment Syndrome, and Tourniquet Pathophysiology — WACS Viva & Clinical Scenarios (Orthopaedics & Trauma)

Exam-style extremity trauma, peripheral nerve blocks, compartment syndrome, and tourniquet pathophysiology viva scenarios with examiner probes and model…

Scenarios covered

• SCENARIO 1: A 22-year-old male (ASA 1E) presents with a severe closed mid-shaft tibial fracture following a motorcycle collision 12 hours ago. He has unremitting, severe calf pain out of proportion to the injury, passive stretch pain of the hallux, and tense swelling. The surgeons schedule an emergent four-compartment fasciotomy. Defend your anaesthetic technique, specifically addressing the safety and medicolegal implications of regional nerve blocks in acute compartment syndrome.
• SCENARIO 2: A 30-year-old female (ASA 1) is undergoing open reduction and internal fixation of a distal radius fracture under an axillary brachial plexus block. After injection of 25 mL of 0.5% bupivacaine, she complains of a metallic taste, perioral numbness, ringing in her ears, and suddenly experiences generalised tonic-clonic convulsions followed by bradycardia and widening QRS complexes. Detail your step-by-step resuscitation protocol for Local Anaesthetic Systemic Toxicity (LAST).
• SCENARIO 3: A 40-year-old male (ASA 1) is undergoing a complex ankle reconstruction under a pneumatic thigh tourniquet inflated to 300 mmHg. At 75 minutes of inflation under general anaesthesia, his systolic blood pressure gradually rises from 115 mmHg to 175 mmHg despite deepening volatile anaesthesia. Explain the pathophysiology of tourniquet pain and hypertension, tourniquet safety guidelines, and the physiological consequences of tourniquet deflation.
• SCENARIO 4: A 19-year-old male (ASA 1E) with a full stomach presents with an open compound fracture of the right humerus and extensive soft-tissue degloving of the forearm. You decide to perform an ultrasound-guided supraclavicular brachial plexus block. Describe the sonoanatomy, needle approach, local anaesthetic choice, and how you will avoid phrenic nerve palsy and pneumothorax.