Michelin man.

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Presentation transcript:

Michelin man

Prehospital Saturday 12th February 17:51 M: high speed MBA into fence I: sucking chest wound subcutaneous emphysema to neck and head S: HR118, strong radial pulse Sats 98% on NRB, GCS 15 T: 3 sided dressing pneumocath insertion IV access & 23mg morphine total

Arrival to ED 18:50 AIRWAY & BREATHING CIRCULATION DISABILITY Talking, refusing C collar ?larynx injury with change in voice & tender larynx ++ Obvious flail on R R sided open chest wound with subcutaneous emphysema to neck and face CIRCULATION HR 101, BP 140/82 and good cap refill DISABILITY Alert, moving all limbs

CXR

Pelvis Xray

First venous gas

Initial ED management FAST negative Bilateral ICC under ketamine sedation Cephazolin 1g ADT

CXR post ICC

Problem List/Injuries MBA Significant chest injury ? tracheal injury Needing CT scan for further Ix Decision for intubation by anaesthetics in OT with ENT standby for CT scanning subsequently Grade 1 view

CT result Bilateral decompressed PTX and pneumatoceles Bilateral contusions Undisplaced R occipital #

Progress D2 – extubated D4 – trauma HDU D6 – fevers D16 – discharged IV site infection MRSA RML pneumonia D16 – discharged