Flights - One Road too Far

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Welcome to the first case in our Air Care and Mobile Care Flight Orientation Curriculum! 

Every few weeks throughout the spring and early summer, there will be a series of posts and cases published to help spur some thought and discussion on the management of the critically ill patients we take care of in the pre-hospital environment.  These virtual flights will be used to highlight some key considerations in the management of blunt trauma, penetrating trauma, STEMI, and several other common disease processes seen on Air Care.

Comments will be open for 2 weeks after which time, a post containing expert commentary and curated commentary from the community will be published to reinforce the key learning points brought up in discussion.

Your First Flight - One Road too Far

You are working as the UH-doc.  Driving into your shift with the windows down and music playing, you figured the first warm day of the year would result in a busy day for you and the rest of the Air Care 1 crew.  You arrive for your shift, grabbing the radio from the Pod doc when the tones go off for your first flight of the day.  You grab the blood cooler head to helipad, checking your pager you find you’ll be responding to Southeastern Indiana for a “MVC rollover, entraped.”

You strap into the helicopter and fly over the city and to the rolling hills of Southeastern Indiana.  Landing on the 4 lane divided state road, you unstrap and head to your patient who is waiting with the BLS squad.

You open the side door of the EMS truck and head to the head of the bed to assess your patient...

Your patient is a 35 year-old male with no known medical history who was the driver in a single vehicle MVC in rural Indiana.  Per EMS, patient was seen driving at ~60mph when he hit a tree and rolled his vehicle two times into a ditch.  Patient was found entrapped in the vehicle upon arrival of EMS. After approximately 15 minutes they were able to extricate the patient from the wrecked car.   

Physical Exam

  • Vitals: P: 115, BP: 80/40, RR: 28, O2 Sat: 89% on BVM

  • General: in acute distress, multiple abrasions and contusions, in back of ambulance, smells of EtOH

  • Cardiovascular: tachycardic

  • Pulmonary: Decreased BS on the right, crepitus over right chest wall

  • Abdomen: +Seatbelt sign, tenderness to palpation diffusely

  • Musculoskeletal: deformity to right femur, no other obvious deformities, pelvis without obvious instability

  • Neurologic: moaning incomprehensibly, opens eyes to painful stimuli, withdraws to pain

Interventions PTA

  • Patient extricated

  • Being bagged

  • C-Collar and backboard

Questions*

Walk through your initial assessment of this patient.  What are the critical aspects of the assessment of this patient?

Do any procedures need to be performed on this patient?  If so, who performs the procedures? In what order should they be done? Where do you do these procedures (squad/in flight/receiving hospital)?

What medications should be used in the care of this patient?  Should this patient receive blood products? If so, what type and in what order?

Shortly after your arrival, during your primary assessment, the patient loses a pulse.  What do you do for the patient now?  What do you do if he does not have a return of spontaneous circulation after your efforts?  What if he does have a return of spontaneous circulation?

*To help facilitate discussion, when commenting please precede your answer to a particular question with Q1, Q2, etc.