CASE 10
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Incident
An 8-year-old male cyclist has been struck by a bus. He was not wearing a helmet. Although initially ‘unconscious’, he is now reported to be ‘confused’.
Relevant information
▪ Aircraft: Rotary wing
▪ Ground resources: One road ambulance and crew’. Police and Fire & Rescue Services
▪ Retrieval options: General hospital (no neurosurgery) 5 minutes by road. Major trauma hospital 30 minutes by air
▪ Other: Flight time to scene less than 15 minutes
Questions
10.1 Using the information so far available, outline your pre-hospital plan prior to arrival on scene?
10.2 Comment on the picture of the above scene.
On arrival, the patient’s GCS is 11 (E3, V4, M4). A ‘large’ forehead laceration has been dressed by the paramedic on scene. Clinical information at handover:
10.3 Outline your initial management.
In preparing the patient for transport, you remove the loosely placed head bandage to reveal an extensive de-gloving soft tissue injury over the right side of the face and scalp. A post-RSI review reveals the following:
• P 133.
• BP 78/59 mmHg.
• SaO2 90% with hand ventilation via a self-inflating bag valve mask device.
• ETCO2 22 mmHg (3 kPa).
• Right pupil fixed and dilated.
• Left pupil small and reactive.
10.4 Outline your response to this situation.
Discussion
10.1 In this scenario, the key aspect of the pre-hospital plan is the age of the patient. The PHR team should utilise the response time to prepare adequately. The mechanism sounds significant and severe injuries are likely. As a team, calculations should be made and recorded regarding potential drug, fluid and equipment requirements. Age-based formulae are best employed in the absence of length-based assessment. Particular attention should be given to preparing for potential pre-hospital anaesthesia. If not already done so, drugs should be drawn and labelled clearly. Early triage possibilities given the patient’s age and potential injuries should also be considered.
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