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Outside of the box?


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One vehicle, One Patient?

Conscious, alert, and oriented?

Patent airway with sufficient breathing?

Heart rate, blood pressure, obvious trauma, BGL?

Who else is on the scene. Any clues as far as the road or the bike why he lost control?

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One vehicle and one patient involved. He lost control of the bike at a high rate of speed and was thrown around 30 feet to land on the pavement. The best guess as to why he lost control was, the patient was driving at a very high rate of speed and lost control.

You initial assessment:

Pt found on the pavement in a right lateral position. The patient does not appear to be wearing a helmet. He responds only to painful stimuli and a GCS of 6 is appreciated. You not obvious massive facial and head trauma. A massive profusely bleeding scalp avulsion over the right frontal and parietal area is noted. Multiple facial abrasions and contusions along with post auricular ecchymosis and periorbital ecchymosis is appreciated bilat. The eyes are swollen shut. He has gurgling respirations with a rate of about 6 per minute and irregular. He is pale and diaphoretic with a weak radial pulse of 130 that matches his carotid pulse. The rest of his physical assessment is unremarkable.

Where do we go from here?

Take care,

chbare.

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LOL that is pretty brief.

Helmet?

Road paved, dirt, gravel?

Is it an extreme incline or difficult location to access?

Other vehicles involved?

Age of patient?

(baseline vitals but that has been already asked)

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Pt found in the middle of a paved back road, no safety or access problems appreciated.

The other questions have been answered in the prior posts.

I am reluctant to give full signs and diagnostics such as BGL's because I think we may need to provide immediate interventions and perform addition assessments based on the primary assessment before moving on to more definitive therapies.

Take care,

chbare.

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The patient does not appear to be wearing a helmet.

I can't get past this statement.

Is he or is he not wearing a helmet? :?

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In-line spinal immobilization, intubate, expose, secure to long spine board, initiate emergency transport to nearest trauma facility, and establish two large-bore IVs during transport. The avulsion can be covered with a moist dressing. Notify the receiving facility to prepare for an organ harvest operation.

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As stated above C-Spine precautions. Intubation and BVM with 100% oxygen. Anyone with him? Who called this in? Rapid trauma assessment to include DCAP-BTLS of the entire body, lung sounds, full set of vitals all working toward full package on LSB with texas two-straps/spiders and head blocks. How about also a 12-lead to rule out tamponade/contusion while we're at it.

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I might check a CBG, but I really do not see the point of performing a 12-lead. There are more effective diagnostic tools at the hospital and they might actually be able to DO something about a tamponade.

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