44 tonne articulated left hand drive truck from Holland goes out of control on sweeping series of
bends, rolling onto left side. As it does so, it knocks down an wooden electricity pole, and the cable
is now tightly stretched across the right side of the cab and trailer, which is now uppermost. No bare
cable ends are visible and no sparking can be seen or heard. The passenger has been ejected through
the windscreen, and is conscious on the grass complaining of a painful right arm. An ambulance crew
are assessing and packaging him.
The driver, who is about 60 years old, is trapped in a semi-upright position by his left thigh. He has
an obvious # dislocation of the left thumb, but nothing of the left leg can be seen or felt below upper
thigh. Airway, chest are normal and he has no apparent neck injury.
He is tachycardic, 120bpm, tachypnoeic at 36 breaths/minute and in pain from his left leg. Fire service
report that entrapment of the left leg is severe and may take some time to release. There are now
approximately 3 hours of daylight left. The patient tells the paramedic that he knows he is going to
lose the leg.
How would you manage this patient?
Best wishes,
Rowley Cottingham
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http://www.emergencyunit.com
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