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1. Blood test (25 hydroxy vitamin D test) - to rule out vitamin D deficiency.

2. X-ray - to detect pseudofractures and bone loss.

3. Increase sun exposure - to increase vitamin D intake.

4. Supplements - to increase vitamin D intake.

5. Improve diet - to increase nutrition.

6. Exercise - to increase bone strength.

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Kasun is complaining of back, hip and leg pain. He also lacks vitamin D intake. ? osteomalacia.

prolonged lack of vitamin D and possibly calcium from lack of nutritious diet --> results in abnormal osteoid mineralisation. Bone resorption as a result of increased osteoclast activity.

weakened bones cause partial fractures --> evident by his uncomfortable walking and complaints of pain.

lack of exercise also contributes to bone mass loss --> resulting in weakened musculoskeletal system.

tenderness in ribs is also an indicator of osteomalacia and that it could potentially be starting to affect other regions of the body.

background is Srilankan, (most likely darker skin) --> needing more vitamin D intake, however since lack of vitamin D, disease progressing at a faster rate.

increased weight --> puts more pressure on bones due to sedentary lifestyle, increases the progression of disease at a faster rate.

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Waist to hip ratio is 1.24 (High). BMI is 27.5 (considered overweight).

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Waist to hip ratio is 1.24 (High). BMI is 27.5 (considered overweight).

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Can walk ind. however appears to be uncomfortable. Chair is also too hard, uncomfortable.

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Can walk ind. however appears to be uncomfortable. Chair is also too hard, uncomfortable.

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Diet is unhealthy (doesn't eat milk and cheese) ?lack of vit D

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Diet is unhealthy (doesn't eat milk and cheese) ?lack of vit D

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Hardly goes out and work includes driving around (stays inside undercover from sunlight majority of time) ?lack vit D

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Hardly goes out and work includes driving around (stays inside undercover from sunlight majority of time) ?lack vit D

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Has not seen a doctor in at least 1.5 years

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Has not seen a doctor in at least 1.5 years

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x-ray

other scanning modalities: CT scan whole bodys can

Fluid resuscitation

Bloods: full blood and blood gases

oximetry

UEC (elevated sodium?)

Blood typing

wound debriding?

pain relief

(prophylaxis infection?

skin examination for trauma)

Neurological assessment and obs

Bracing if evidence of any bruising to head or neck

nil by mouth

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Vitus has expeienced trauma due to a MVA where he experienced a compound fracture: -bone broken through skin

This has lead to substantial loss: (blood soaked clothing)

compensation for blood loss is evident: increase in heart rate and increase in breathing rate

possible hypovolaemic shock=>"non-progressive"=>signs of compensation in the face of hypotension.

Heightened SNS: increased heart rate, pale (reduced peripheral circulation due to increase vasoconstriction) anxious (increase in stress response hormones).

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bruising and abrasion from contact with a road

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no reports of loss of consciousness

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need for oxygen=>

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body temperature normal

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motor vehicle accident

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?neurovacular problems: blood loss and open fracture of limb

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low blood pressure

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GCS on the lower side (max is 15)

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pale and anxious

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open fracture

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evidence of substantial blood loss

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elevated breathing

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young