1. Motocross is stupid

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

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

4. 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

5. 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

6. CXR
Pneumothorax
Thoracostomy

7. Pelvis Xray

8. FAST (prehospital)

9. First venous gas

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

11. 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

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

13. Disposition
Urgent trauma laparotomy
ED stay – 14 minutes

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