Trauma - Case 1

Trauma Case 1

Module Author: Kevin Baumlin, MD
Web Author: Michael Bessette, MD

Situation

A 24 year old female, Charlene Honda, is BIBEMS post extrication from a motor vehicle accident (MVA). The car reportedly hit a truck head on. The patient is unconscious, intubated with BP80/50 HR110. The patient will withdraw to pain with flexion of upper extremities, and has MAST trousers on her lower extremities. Her pupils are equal round and reactive. She is in a collar and on a board.

1. What is a primary survey and what does it include?

2. What important historical element can be obtained from EMS?

Further history was obtained by your colleague while you stayed with the patient. The patient's airway was checked and no breath sounds were appreciated bilaterally. No chest wall movement was noted. The patient was reintubated with a 7.0 tube while c-spine traction was maintained. Breath sounds were equal bilaterally with good chest wall movement.

3. Should an x-ray of the patients C spine be taken before intubation?

4. What is this patients Glascow Coma scale? (Review GCS)

5. If this patient were wake and combative what medications would be indicated in order to intubate?

6. Why is this patient in MAST trousers?

After you have finished your primary survey a secondary survey is performed. During this time your colleague returns and informs you that there was significant steering wheel deformity as well as a wind shield spider. The patient was found unresponsive in her car after unknown period of time and it was cold, as in below freezing, outside.

7. How does this information alter your management?

The patients secondary survey reveals: large frontal hematoma, no apparent neck injuries, with a midline trachea, no JVD, equal breath sounds, hypoactive bowel sounds, no rigidity, MAST trousers are slowly let down and reveal an open femur fracture and evidence of an unstable pelvis, the patient is rolled with c spine traction and the back is clean and rectal reveals no tone, brown stool. The patient remains hypotensive and DPL is performed. The tap is positive.

8. What x rays should be obtained prior to the patient leaving for the OR?

The patient codes in CT and cannot be brought back despite being taken to the OR with CPR in progress.

	1.	What is a primary survey and what does it include?

	2.	What important historical element can be obtained from EMS?

	Further history was obtained by your colleague while you stayed with the patient. The patient's airway was checked and no breath sounds were appreciated bilaterally. No chest wall movement was noted. The patient was reintubated with a 7.0 tube while c-spine traction was maintained. Breath sounds were equal bilaterally with good chest wall movement.
	3.	Should an x-ray of the patients C spine be taken before intubation?

	4.	What is this patients Glascow Coma scale? (Review GCS)

	5.	If this patient were wake and combative what medications would be indicated in order to intubate?

	6.	Why is this patient in MAST trousers?

	After you have finished your primary survey a secondary survey is performed. During this time your colleague returns and informs you that there was significant steering wheel deformity as well as a wind shield spider. The patient was found unresponsive in her car after unknown period of time and it was cold, as in below freezing, outside.
	7.	How does this information alter your management?

	The patients secondary survey reveals: large frontal hematoma, no apparent neck injuries, with a midline trachea, no JVD, equal breath sounds, hypoactive bowel sounds, no rigidity, MAST trousers are slowly let down and reveal an open femur fracture and evidence of an unstable pelvis, the patient is rolled with c spine traction and the back is clean and rectal reveals no tone, brown stool. The patient remains hypotensive and DPL is performed. The tap is positive.
	8.	What x rays should be obtained prior to the patient leaving for the OR?

	The patient codes in CT and cannot be brought back despite being taken to the OR with CPR in progress.