Motocross is stupid.

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Presentation transcript:

Motocross is stupid

Prehospital 8th January Saturday 11:43am Mechanism Injury Motocross accident – bike bucked Handle bars hit abdomen Difficult extrication ++ Injury LUQ pain

Prehospital Signs GCS 14, pale, clammy HR 120, SBP 60 (palpable), Sats 70% Arrested briefly enroute Grossly positive FAST

Prehospital Treatment (prehospital) C-collar & SAM splint 10mg metoclopramide Crystalloid 2 L bolus Packed cells 2 units RSI : 40mg ketamine & 100mg rocuronium Prehospital notification ETA 15 min

Arrival  Resusc 13:16 Airway Breathing Circulation Disability 9.0 ETT, 25cm at lips  ETCO2 wave  Breathing Bilateral AE, Sats 84% Circulation HR 147, weak pulse, grey ETCO2 22 Disability GCS 3, pupils 3mm & sluggish

CXR Pneumothorax Thoracostomy

Pelvis Xray

FAST (prehospital)

First venous gas

Problem List/Injuries Profound haemorrhagic shock Intra-abdominal source Hypoventilation compounding acidosis Cold? Coagulopathic?

ED management CIRCULATION BREATHING Further peripheral access Bloods for CXM Activate MTP (4 units warmed packed cells total) Repeat FAST positive Subxiphoid view remained negative BREATHING ICC placement through field thoracostomy hole

ED management Patient arrested in ED CPR 2 minutes Adrenaline 1mg volume

Disposition Urgent trauma laparotomy ED stay – 14 minutes

Quality Improvement Documentation Coag profile No temperature recorded No ED notes in the chart Coag profile No temperature recorded