More ketamine. You have only just waved the bottle under his nose. This
is precisely the patient who soaks up ketamine. AND DON'T WORRY ABOUT
THE HEAD INJURY!
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Vic Calland
Sent: 30 April 2003 10:54
To: [log in to unmask]
Subject: Ideas please....
Attended a MVC last night. Driver doing a 100mph plus put his car under
the end of an HGV only doing 50mph. Dragged 200-300 yards down the road
as the driver of the lorry regained control and came to a halt.
Driver was late twenties, physically fit but on the heavier end of
normal weight range. Trapped upright until the fire crew did a dash
roll. Had 8cm transverse laceration of forehead with bit of skull in
wound but amazingly had GCS of 12-13. Had bilateral bracing fractures;
left elbow was a posterior dislocation, radius & ulna a comminuted
compound fracture as crunchy as a bag of crisps; his right was a more
classical Monteggia apart from the fact it was compound and the bone was
protruding. He also has a fractured pelvis with a dislocation of the
He had breath sounds bilaterally so we didn't realise he had a ruptured
left hemidiaphragm until the CXR came back. At the time he wasn't too
shut down, so we splinted the arms, gave him 50mg Ketamine im and free
flow Entonox for the extrication (long board to the rear). We were only
5 minutes from the hospital so we ran with him rather than established
an i.v. on scene. There they ended up with a right femoral vein access
with a "security guard" watching it.
I'd be interested to know if anyone has clever ideas for dealing with
this kind of situation because his pain relief was not ideal by any