1. Michelin man

2. 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

3. 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

4. CXR

5. Pelvis Xray

6. First venous gas

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

8. CXR post ICC

9. 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

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

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