30 yr old male driver - head on crash into concrete wall at ?30mph.
Hit face and upper chest on steering wheel causing major bend in steering
wheel and ?maxillary fracture - GCS 7 - trapped with poor access for
40min. IV access and Oxygen in the car and oral airway on release. Rapid
assessment showed bilateral reasonable air entry and no gross skeletal or
abdominal injury, warm pink fingers and a radial pulse of 112.
Transit time to hospital was 5min and my intubation skills are a bit out of
date so I made no attempt to intubate on scene - SaO2 in transit 80-85%.
Hospital alerted of need for trauma team.
At hospital IVI lost when transferring patient to trolley. Now GCS 8 and
trashing about. 30min then spent by trauma team establishing IV access -
arms tried 3-4 times, femorals 2-3 each side, interoseous once, ankle cut
down twice - second successful. During this time SaO2 running at 65 - 75%.
Once IV established he was sedated (?propafol) and intubated - Sa02 went up
to 92%.
I don't feel we served this man well between us - any thoughts?
Martin Hargreaves
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