Major Trauma [Case #1]

“An unknown male has been brought into the ED having been struck by a car whilst crossing the road.”

The handover from the paramedics is as follows:

A: Patent, some blood around the mouth. His C-spine is triple immobilised

B: Trachea central, RR 22, reduced air entry at the right base, Sats 92% on 15L

C: HR 120, Bp 87/64, no IV access.

D: GCS E3 V4 M5 (12), Pearl bilat, BM 5.2

E: No significant external blood loss, an obvious deformity of left ankle (Closed injury) which the paramedics have splinted.

Questions

Answer one question before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. The first part of teaching will be spent discussing this case:

1. What grade of shock does this man have?

2. You are unable to establish IV access and decide to try IO, describe the landmarks and technique for this.

3. You successfully get access, outline your approach to fluid resuscitation for this man.

4. He remains unstable despite fluid resuscitation, what are the five sites of significant blood loss in trauma.

5. Other than fluid (and blood products) what other measures can you take to try and correct his haemodynamic instability.

6. He remains too unstable to transfer for a CT, what adjuncts to your assessment can be performed in the ED?

7. A Chest X-ray reveals a right sided haemothorax and you wish to place a chest drain, what size drain would you choose and what are the landmarks for the placement of a drain?