Initial assessment correct method

Summary

This transcript details the intense and critical care process for an 18-year-old male involved in a high-speed motor vehicle collision. The patient, unrestrained during the crash, suffers from multiple severe injuries including a head injury, open femur fracture, pelvic fracture, and possible pulmonary contusion. Immediate medical interventions, such as intubation, blood transfusions, and airway management, are discussed as the team works to stabilize him for transfer to a trauma center. The summary also highlights a systematic approach to monitoring, reassessing, and ensuring proper transport arrangements for the patient's condition.

Takeaways

• 😀 The patient is an 18-year-old male with severe trauma from a high-speed motor vehicle crash involving a tree. He was unrestrained during the crash.
• 😀 The patient's vital signs are critical: a heart rate in the 120s, blood pressure at 90/40, and low oxygen saturation (82%).
• 😀 The patient has significant injuries, including a head injury, open femur fracture, possible pulmonary contusion, and pelvic fracture.
• 😀 Airway management is a priority, with intubation performed due to low oxygen saturation and poor responsiveness.
• 😀 The medical team stabilizes the patient's breathing using a ventilator after successful intubation.
• 😀 The team performs rapid interventions, including fluid resuscitation (normal saline and blood transfusions) to address signs of shock.
• 😀 Traction splint and pelvic sling are applied to manage the femur and pelvic fractures, respectively.
• 😀 A detailed secondary survey, including head-to-toe examination and imaging (X-rays), is carried out to assess further injuries.
• 😀 The patient's GCS score is about 8, indicating a significant head injury. The medical team is vigilant about his neurological status.
• 😀 Communication with the trauma center is established to arrange for air transport, ensuring timely transfer for further treatment.
• 😀 The medical team ensures the patient is adequately exposed, warmed, and prepared for transport while maintaining stabilization and managing ongoing bleeding.

Q & A

What was the initial condition of the patient, Garrett, when he was brought in?

Garrett was an 18-year-old male who had been involved in a high-speed motor vehicle accident. He was unrestrained, had a GCS of 8, a head injury, an open femur fracture, rib fractures, a pulmonary contusion, and a suspected pelvic fracture. His heart rate was in the 120s, and his blood pressure was 90/40.

What immediate interventions were performed to stabilize Garrett?

The medical team intubated Garrett to manage his airway, applied a spine collar, and provided oxygen. They also started an IV line, initiated fluids and blood products, and used a traction splint for his femur fracture. The team quickly addressed his breathing and blood pressure issues.

What complications were identified during Garrett's assessment?

Complications included bleeding from an open femur fracture, scalp wound, and potential bleeding from a pelvic fracture. The team also noted diminished breath sounds, indicating a possible pulmonary contusion and rib fractures.

How was Garrett’s airway managed?

Garrett’s airway was managed by intubating him after confirming he needed airway support. The team performed suctioning to clear blood and inserted an oral airway to facilitate ventilation. His oxygen saturation improved after intubation and being placed on a ventilator.

What did the team do to control Garrett’s bleeding?

The team controlled bleeding from his open femur fracture and scalp wound by applying pressure. They also noted the pelvic fracture and wrapped it with a sheet to minimize blood loss. Further blood products were arranged to address his hemorrhagic shock.

What diagnostic steps were taken during Garrett’s assessment?

The team conducted a full physical exam, checking his vital signs, GCS, and performing a secondary survey. They also ordered chest and pelvic x-rays, which revealed rib fractures, a pulmonary contusion, and an acetabular pelvic fracture.

What was the result of Garrett’s secondary survey and imaging?

The secondary survey revealed significant injuries, including a pulmonary contusion, rib fractures, and an acetabular pelvic fracture. The chest x-ray indicated haziness, and the pelvic x-ray confirmed the suspected fracture.

What steps were taken to prepare Garrett for transfer to the trauma center?

The medical team ensured Garrett was stabilized with intubation, IV fluids, and blood products. They wrapped his pelvis, completed a secondary survey, and prepared to transport him by air. X-ray images and blood products were sent along with him.

What was Garrett’s condition upon transfer to the trauma center?

At the time of transfer, Garrett was intubated, had good oxygen saturation (96%), stable blood pressure (110/64), and a heart rate of 110. His injuries included a head injury, pulmonary contusion, rib fractures, and a pelvic fracture.

Why was air transport considered necessary for Garrett?

Air transport was necessary due to Garrett’s critical condition, including his head injury, breathing issues, and blood loss. The medical team decided he needed to be transferred promptly to a trauma center for advanced care.