You are dispatched for an MVC at 06:33. The location is on a rural road approximately six miles from your station. A fire officer arrives, establishes command, and tells you that you have an elderly male, unresponsive, and entrapped in the vehicle. Command notifies the dispatch center to “put a bird in the air”.You arrive to find an approximate 65 year old male in the driver seat. Damage is as noted in the picture. There is no passenger compartment intrusion and the patient appears to have his seat belt on. The inside of the vehicle is covered with newspapers (dozens and dozens of them) and many more are on the ground around the vehicle.
First look at the patient- GCS 1-1-1, RR 12 shallow and snoring, pale looking skin.
There is a large, dead deer lying along the roadway near the crash.
It is early morning, the sun is rising, it is cloudy, 34° F, 54% humidity, and the wind is at 15 mph out of the SW. Traffic is light. You have an EMT for a partner. You have a QRV-based supervisor within 15 minutes; your next nearest ambulance is 20+ minutes away.What are you going to do?
The first vital signs after you get in the vehicle-
BP 94/58HR 40 weak and irregular
RR 10 shallow and snoring
Pupils equal and reactive
Finger stick gets an ‘error’ reading
Tympanic temperature 84°F
SPO2 is 62%
Skin is pale and dry without cyanosis
The first ECG-
|courtesy of Dr. Smith's ECG Blog|
Ground travel time to Level I trauma center is 15-18 minutes. Travel time to community hospital is 15-20 minutes.
The fire department has the patient free within 10 minutes. The helicopter is “five minutes out”.
Patient is exposed- no obvious deformities to any extremities. Chest expansion is equal bilaterally and lung sounds, while faint, seem to be clear. Carotids are faint- radials and pedals are absent. Upon extrication patient GCS is rated at 3-4-5.
You find three pill bottles in the vehicle (you DO take a quick look for such things, don't you?)- levothyroxine sodium, morphine sulfate, and paroxetine hydrochloride.
I have one response so far (Thanks, Cathy!). C'mon folks...
What do you think? What special things (if any) are you going to do? Is there anything different that you might do? Let's hear it.
Note: If you need a bigger copy of the ECG, email me at the address to the right.