It is a cold, blustery winter night in the ED. You are the on-duty flight physician as well as ED physician for your particular patient care area, and you get toned out for a scene in a nearby county. Having arrived on scene, you enter the ambulance to find a middle aged man belted to the backboard with cervical collar on, verbally and physically struggling with the paramedics who are trying to restrain him.
By report, he was found at the bottom of a deer stand, presumably having fallen out. Initial GCS was 11 (3- 3-5) with a R parietal cephalohematoma and abrasions to his arms and face.
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