chbare Posted June 28, 2006 Author Share Posted June 28, 2006 The patient is exposed and spinal immobilization is maintained. If we follow PRPGfirerescuetech's airway management techniques then; an oral airway is in proper position and your partner reports he is able to bag the patient and a firefighter helps maintain the mask seal. You note chest rise and fall with ventilations. The patient remains unresponsive. You are able to palpate a regular radial pulse at about 100. The patient appears less pale with bagging. If we used the combitube; your partner states he is able to bag the patient through tube number 1 and placement is verified with ETCo2 monitoring and the patient appears less pale. The patient still remains unresponsive. A quick back exam is unremarkable as you rapidly move the patient on to the board. Your secondary survey reveals: HEENT; several small abrasions and lacerations to the face and scalp with minimal bleeding, no crepitus noted, airway is patent, pupils are about 4 and sluggish bilat, no drainage from the nose or ears noted, trachea is midline and slight JVD is noted, bilat carotid pulses at about 100 and regular are palpated, and no c-spine step offs are palpated. CX; a few small abrasions are noted over the left upper chest wall with the beginning of what looks like developing contusions, this looks consistent with hitting the steering wheel or the wheel hitting him, and he was trapped in part by the wheel, no crepitus is palpated, lung sounds are clear on the right upper and lower, and diminished on the left. ABD; atraumatic in appearance and soft to palp in all quads, and no surgical scars are noted. GU/Pelvic; atraumatic in appearance and stable to palpate, no GU abnormalities noted, and no rectal bleeding or blood at the meatus noted. EXT; atraumatic appearing lower ext with palpated distal pulses and no crepitus noted, several small abrasions to both elbows and forearms, no crepitus or deformity noted, and bilat distal pulses are noted. Take care, chbare. Link to comment Share on other sites More sharing options...
PRPGfirerescuetech Posted June 28, 2006 Share Posted June 28, 2006 Pale skin color indicated poor perfusion. This may be because of inadequate oxygenation, or due to decreased blood volume in the circulatory system. Pupils are constricted. I cant shake the feeling this is trauma 2ndary to a medical issue. CO poisoning if im right. Or...im reading too far into it. Expose, intubate, bag, IV large bore, monitor Otherwise, normal trauma care. ...im missing something here. Link to comment Share on other sites More sharing options...
TechMedic05 Posted June 28, 2006 Share Posted June 28, 2006 Before we jump much further into guessing/ diagnosing, etc...Vital signs. HR 100, RR = ventilated, BGL = 130 - BP = ? Link to comment Share on other sites More sharing options...
chbare Posted June 28, 2006 Author Share Posted June 28, 2006 PRPGfirerescuetech, pupils are 4 bilat and sluggish to react. You get the patient loaded and intubate him with an 8.0 ETT placement is verified with ETCO2, the lung sounds on the left side remain diminished however. You continue bagging him. You have a vent and can set the vent values for whatever you fancy. A large bore IV is established with blood tubing attached and 0.9 % saline as your fluid. You put him on the monitor and note a sinus rhythm of 95 without ectopy. You begin transport to the hospital and notice that the sun is out, the birds are singing, and the land scape takes on a surreal appearance. It must be the land of OZ and you now have a very progressive ambulance service. What would you like? Take care, chbare. Link to comment Share on other sites More sharing options...
chbare Posted June 28, 2006 Author Share Posted June 28, 2006 TechMedic05, good catch, need to finish up our base line vitals. The B/P is 160/090. Take care, chbare. Link to comment Share on other sites More sharing options...
TechMedic05 Posted June 28, 2006 Share Posted June 28, 2006 And also I forgot to throw in: Lung sounds? SpO2 readings? And just on visual assessment [i don't believe it's been mentioned yet] any seizure activity or posturing...Or any muslce movement at all? I can only assume no trismus with the ease of intubation. Any vomiting present? Link to comment Share on other sites More sharing options...
chbare Posted June 28, 2006 Author Share Posted June 28, 2006 TechMedic05, lung sounds per prior posts. O2 sat is 99-100% while bagging the patient on 100% FIO2. No seizure activity noted, no vomitus, and no trismus noted. The patient appears to be flaccid. Take care, chbare. Link to comment Share on other sites More sharing options...
ERDoc Posted June 28, 2006 Share Posted June 28, 2006 Decreased sounds on the left with good sats, let's pull the tube back a little, and shoot a cxr. How 'bout digital intubation in the truck prior to extrication? Let's pan scan him and find out what's broke so that the surgeons can fix it. Link to comment Share on other sites More sharing options...
MrSpykes Posted June 28, 2006 Share Posted June 28, 2006 Could we also put him on capnography to see his ETCO2 wave form and value? Is he easy to bag? What about his cap refill? I agree with Doc pull back on the tube and see if that fixes the lung sounds and if they remain the same lets decompress the left chest. Link to comment Share on other sites More sharing options...
chbare Posted June 28, 2006 Author Share Posted June 28, 2006 ETCO2 shows a good wave form with values around 36-38. CXR shows good tube placement, normal mediastinum and cardiac outline, you note a pneumothorax to the left approx 30-40%, diaphragm appears intact. Trauma C-spine and pelvis X rays are negative. Take care, chbare. Link to comment Share on other sites More sharing options...
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