1. Trauma case
Stephen Lo

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

3. 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

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

5. 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?

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

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

10. FAST scan positive
What is your plan?

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

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

15. 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

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

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

20. Head to toe
AMPLE
Tetanus
Complete pan scan

21. How would you clear the C-spine?

24. What’s your management now?