Earlier MVA (Now Altered)

[emt322632]

Was she wearing a seatbelt? Airbag deployment? How fast was she going and what did she hit?

Don't know if I would have been so keen to backboard her, accident happened prior and she's obviously agitated already.

Any LOC? Suspect rib/sternal fx, aneurysm...Any hx of hypertension with a BP that high?

[letmesleep]

with her having a language barrier and the fact that she is scared, also consider that her son is leaving the country.........

is it possible that the bruising to her left upper chest is a seat belt mark that burns, and is continuing to hurting her now? could her v/s be what they are due to her anxiety of not being able to communicate? there are a ton of questions that can't seem to get answered at this point in time.......calm your pt as best as you can by explaining all your actions, then beat her up with all the precautionary Tx until you can rule out anything else.

I am not disagreeing with the other guesses, and if i'm missing something i'll take the heat, but I just wonder if this is one of those cases that we need to slow down a bit and consider the pt's state of mind instead of focusing on the physical state.

[Flasurfbum]

Wouldn't there be changes in the EKG that would indicate a cardiac tamponade?

[Just Plain Ruff]

Hijacking the thread

1. just bust down the doors to the closed ER and start working her up. I'll bet theres still some items that can be used to take care of her in there.

Other than that, take her to the trauma center.

3. Maybe she's worried about the kids or the fact that she probably has to make dinner and papa bear isn't gonna be happy when his dinner isn't ready.

[jwraider]

I'd think you see a narrowed pulse pressure if it was tamponade...

Does palpation make it worse? (I'm not saying push on the bruise but anything else hurt in the area.. range of motion of arm??) I just see that nothing makes it better...

Can we get a SAMPLE? Anything interesting in history or meds taken? Is she at risk for PE? Cardiovascular disease? Maybe the MVA just made something that already existed worse.

Are the bruises in the knee from trauma for sure? Just a wild ass guess from if a AAA sent an emboli down... or up to the brain?

Does she pass the stroke test?

And finally pupils and blood sugar?

... also student question:

should she really be fully immobolized if she's "not acting right"? Can you clear cspine by communicating with her especially considering shes been moving around for 2 hours since the accident? I'm not saying I wouldn't do it but I like hearing the thought process behind these decisions.

[spenac]

preguntas por senorita.

Esta herido? Donde? Muestreme.

Uso su cituron de segridad?

Le pego el volante?

Perdio el conocimiento?

El dolor es agudo? palpitando? presion? apretado?

Just a few things you need to ask.

[BushyFromOz]

I'd think you see a narrowed pulse pressure if it was tamponade...

Yeah, but for some reason i thought that was a late sign.

[mobey]

Yeah, but for some reason i thought that was a late sign.

If we are thinking along the lines of tamponade, watch for a narrowing pulse pressure trend, you can also assess for JVD, and listen to heart sounds to see if they are "Distant".

All of these signs are pretty late signs (not as late as PEA).