First thanks to all for your thoughts.
Second the GCS was - E1 M4 V2 Starting to localise pain as time went on.
Andrew - It wasn't too cold round here on Saturday night, thank goodness. I
think the hypoxia was mostly an airway problem, he had a very bruised and
probably broken maxilla, a badly flattened nose and clenched teeth. During
the entrapment there was only just room to get an O2 mask in between his
face and the brow of the windscreen. On release the airway was managed with
oral airway, suction and jaw thrust which produced a gradual improvement in
sats. up to about 85% by the time we got to A&E.
Fingers were pink and he had quite a good radial pulse so we only gave him
about 500ml of Ringer's. Pulse rate came down in transit to hosp.
Outcome - no serious skeletal injury, last heard was that he was with the
neurosurgeons in London but they had not done any operations.
If this story is any value to anyone for teaching etc. - feel free to use
it. The only photograph is from the local paper and just shows a very badly
bent car under a lamp post and so is of little clinical interest.
Martin Hargreaves
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