1. Went for head CT
2. BP responded to fluid, went for arteriogram
3. Needed RSI, chest drains (left tension PTX), limb splintage so imaging
not immediate priority. Went later for head/chest/abdo CT (& arch aortogram)
4. Plain radiographs only
5. Stable. Analgesed and transferred by paed retrieval team to children's
hospital (no paed surgery on site). Further imaging done there (no follow up
info yet).
So only 2 patients needed CT, and the order was easy. This was facilitated
by negative FASTs on all patients done on arrival at the bedside after
primary survey by the trauma fellow. Made my decision making as team leader
(read 'Incident Officer'!) much simpler. Anyone else doing this routinely in
their EDs? I'm now convinced this is a skill we can't afford to be without.
(I'll put the can opener back in the drawer now the wiggly things are out)
Cliff
>We had 5 virtually simultaneous (few minutes apart) sick multitrauma
>patients last night from the same head on collision. One of the interesting
>challenges was imaging priorities.
>
>1. 30 yr M, open head injury, combative, GCS E3V4M5, compound right knee
>injury. Large heart on CXR ++
>2. 65 yr G, Abdo pain, hypotensive on scene then sys ~ 90 in ED, wobbly
>humeral fracture with cold hand and absent radial pulse
>3. 62 yr F, flail chest, resps 40, shocked sys BP 75, pelvic butterfly #,
>bilateral distal femoral shaft #s, one compound, conscious but non-english
>speaking, sternotomy scar
>4. 55 yr F, ABC okay, compound left knee injury, closed right ankle #
>5. 12 yr F, vitals okay, pain on inspiration, extensive seatbelt bruising
>to
>chest, severe seatbelt abrasions over her (tender) pelvis, tingling in
>fingers (no neck pain). some ? pulm contusion on CXR.
>
>CXR/PXR okay unless otherwise stated. No adequate lateral c spines achieved
>despite arm pulls (local policy to take them, not my preference).
>
>Any thoughts? - you've got one CT scanner running. There's an USS machine
>available if you know how to use it. One radiology reg on his way in ......
>and Vikki hasn't finished her sonography training (anyway it's Sunday
>night!)
>
>Cliff (wishing he hadn't remarked how quiet things were for a Sunday)
_________________________________________________________________
Send and receive Hotmail on your mobile device: http://mobile.msn.com
|