Earlier MVA (Now Altered)

[AnthonyM83]

Call Type: Chest Pain.

On arrival, you find two women sitting in a parked SUV (in front of a shut-down ER). Driver tells you that her maid/nanny in passenger seat came home a couple hours ago after being in a car accident. She had refused transport at the time, but now has severe chest pain, not acting quite right, and seems scared to go to the hospital. She is mostly Spanish-speaking.

Your source of info from last accident is an EMT ride-along who hopped units (responded to current patient's earlier accident where she refused transport) and speaks decent Spanish.

[Kaisu]

age, vitals? where was she going/coming from when she was in the MVC? Details of the accident ? PQRST on the pain.

(The first, knee jerk thought that runs thru my mind - illegal activities involved? possibly drugs)

[jsadin]

Way too many possibilities to even begin to speculate. Here's my plan tho':

Get more details on previous accident from ride-along

Collar/LSB if deemed appropriate (EMT ride-along can 'splain to patient)

Get her in the ambulance

O2/line/vitals/detailed survey

Assuming transport time is short, get her to a trauma center ASAP

Have spanish speaking ride-along get as much history as possible

If I were a medic, I'd get a 12 lead (but since I'm not, I won't!)

[AnthonyM83]

Age: 63

HR: 78 (s/r)

BP: 200/100

RR: 16 (none-labored)

Skin: Normal color, temp, quality

Pupils: Equal, Round, Reactive

SPO2: 98%

At original accident, EMT student impression she was going to work from home. Kept asking for a phone to talk to her son who leaving country that day. He doesn't remember it was being that bad of an accident. What else do you want to know about it?

You board and collar her, though she seems nervous/scared and isn't very cooperative about it, only asking why she can't go home.

You convince her to tolerate O2 and keep still for IV line. You do a physical detailed survey and find red bruising to her left upper chest area and bilateral abrasions to the knee (left one being a bit worse, but both being minor).

Trauma center is 20 min away, closest receiving is 10. You're en-route to trauma. Your EMT student is willing to help you, but he's not sure what "as much history as possible" means. He's able to muddle through OPQRST though.

Onset - Mild pain right after accident, got progressively worse. Still getting worse.

Provocation/Palliation - Car accident, nothing makes it better

Quality - Unable to clearly determine due to language barrier. Just keeps saying it hurts bad.

Radiation - None

Severity - Not great at following your questions, but in reply to 0-10 questions says it hurts really really bad.

Time - 2 hours now

12-Lead shows NSR at 78, no ectopy.

[BushyFromOz]

Whats her chest uscultation like matey? Also, percussion test would be nice. Where was she positioned in the vehicle for the MVA?

Keep going to the trauma center and another set of Obs in 5min

[AnthonyM83]

Lung Sounds are clear, equal, bilateral

Heart Sounds were not taken (Medic was on-scene, so had to defer to him)

She was driver in the MVA.

[BushyFromOz]

cardiac tamponade or pulmonary contusion?

Long shot, might have a beer

[zzyzx]

Ok, I'll bite....

Obviously your main concern is that she may have injured her aorta and developed an aneurysm as a result. It's an unlikely possibility, but since that could kill her, it's your main concern. Cardiac tamponade is possible too, but very unlikely with blunt trauma. So, was she wearing her seatbelt? Hit the steering wheel with her chest? You'd want her to carefully describe the MOI.

There are many other things to consider, and not just trauma but medical too.

Taking her to a trauma center...they may be better equipped to deal with her there, but don't count on it. If she does have an aneurysm, it won't be the trauma surgeon who'll operate on her.

Again, there are many other things to consider, but why don't you tell us what you're getting at? Was this another call you ran with those medics who didn't know how to use their Zoll?!!!

[zzyzx]

Just reread your post...so, is she really altered, or is her friend just saying that she's "not acting right"?

[BushyFromOz]

Obviously your main concern is that she may have injured her aorta and developed an aneurysm as a result. It's an unlikely possibility, but since that could kill her, it's your main concern. Cardiac tamponade is possible too, but very unlikely with blunt trauma

Duh!!!!

Yeah, aneurysm far more likely. Dunno how i cam up with that blinding tamponade assessment :shock: