Trauma case Stephen Lo

The case 42 female presented after MVA, car vs van. She is the back seat passenger. How would you manage this patient?

Case: Vital obs A: Patent B: Sats 93% on 15L/min rebreather, RR 30/min. Reduced air entry on the left. C: HR: 120/min, BP 90/60 D: E2M4V2 Pupils sluggish, but reactive

Case What else do you want to do now? Chest drain insertion IV access, fluid managment Intubation

What’s your fluid management? 2-3L of crystalloid Blood products, MTP if massive haemorrhage What other things need to be considered in massive transfusion What blood pressure are you targeting for?

Physical exam Bruising over the chest Abdomen is soft Bruising around the perineum

History Background of hypertension Driver died, delayed extrication. GCS 10/15 at the scene.

FAST scan positive What is your plan?

CT vs OR Laparotomy vs Angio Angio vs fixation Brain vs bleeding

Patient had ex-fix of pelvis, angio, laparotomy Returns to ICU How would you assess the patient?

Intubated, on SIMV Vt 500ml, RR 12/min Sats 94% on FIO2 0.55, PEEP 5 BP 100/70, HR 50/min, Norad 0.5mg/hr Propofol 20mg/hr

During transfer to CT scanner, left pupil becomes dilated and fixed. What’s your management now?

Brain looked tight in OR ICP was inserted What is the evidence for ICP monitoring How would you manage this patient now

Head to toe AMPLE Tetanus Complete pan scan

How would you clear the C-spine?

What’s your management now?