P272 Role of central neuraxial techniques in emergency repair of fracture femur in patients with acute cocaine and polypharmacy use

<h3></h3> <b>Application for ESRA Abstract Prizes:</b> <h3>Background and Aims</h3> The impact of substance abuse on traumatic injuries is of serious concern in today’s world. Data from the Australian registry shares substance use in major trauma to be higher than in the general population Nearly 40% of deaths due to trauma had positive alcohol or toxicology screens. We share a case presenting with acute cocaine, marijuana, polypharmacy toxicity requiring emergency surgery for fracture femur. <h3>Methods</h3> A 60 yr old male, presented after a fall from a height. In discussion he shared use of Cocaine, Marijuana &amp; polypharmacy, prior to and after sustaining the injury. Plan was ORIF to fix the Left subtrochanteric femoral fracture. On anaesthetic review, the patient was noted to be extremely drowsy, unresponsive at times, slurring speech. His heart rate was 60b/min with a BP of 172/94 mmHg, normal QTc, apyrexial. CT brain revealed right caudate nucleus, corona radiata ischemic infarct. We debated the possibility of the CVA leading to the fall. On assessment as the pupils were pin point a trial of naloxone was performed eliciting reversal and GCS of 15/15 with normal neurology. <h3>Results</h3> Taking into account acute cocaine, marijuana and possible drug use, a spinal anaesthetic was determined to be appropriate. The patient had an ORIF with cerclage and TFNA nail which was uneventful and was discharged a week later. <h3>Conclusions</h3> Substance misuse is associated with higher odds of inpatient medical adverse events, prolonged hospital stay and non-routine discharge after orthopaedic trauma Emphasis on appropriate investigations, associated diagnosis, prompt recognition and proactive treatment measures may support effective trauma management.