CASE STUDYMVA TRAUMA

Code 3 Trauma Team Activation

• December 12, 2006, around 11 a.m.• MVA rollover with three teenage females

involved. • The teens were reported to be driving around on

their lunch break from high school. Later investigation discovered that the three girls were “Huffing” or “Dusting” which is when someone inhales gas from a compressed can of air that is usually used to clean computer keyboards.

• The car left the road at a high rat or speed, traveled greater than 300 feet, with multiple rollovers, finally impacting a telephone pole.

Patient Medical History/ Physical Examination:

• No known drug allergies.

• On arrival into the ER the patient had a:

• pulse rate of 121

• blood pressure of 125/61

• respiratory rate 20-22

• O2 saturation of 96% on a nonrebreather.

ON THE SCENE PICTURE OF THE PATIENTS VEHICLE

Chest x-ray: film critique

• Two flat plate AP Chests were obtained pre and post-intubation by placing a 14x17 film lengthwise underneath the backboard of the patient.

• The findings from this were:a normal heart, the mediastinum is not widelungs are normally aerated without diseaseno fractures are demonstrated chest x-rays have adequate density and contrast

• The lungs include the required anatomy, which includes the apices of the lungs to both costophrenic angles.

• Since the patient is on a backboard and the spine has not been cleared the patient is not in the upright positioned for both chests.

C-Spine Film Critique

• Two cross-table lateral cervical spine x-rays were performed. (the first view was not low enough to demonstrate all seven cervical vertebra.)

• In the second radiograph you can see that the patient was intubated. There is reversal of the cervical lordosis without evidence of subluxation or fracture.

• The pre-intubation view reveals no evidence of soft tissue swelling.

Femur Critique

• The articulation with the hips are normal.

• There is a comminuted, butterfly type, fracture of the middle one-third

• The backboard strap obscures the proximal knee joint.

• The distal joint is cut off.

• Film is acceptable for trauma

Pelvis Critique

• demonstrated normal articulation of the hips.

• The backboard obscured some areas in detail.

• There is a left pubic fracture with slight comminuted (small particles of bone). The break involves the body of the pubis and likely the rami.

Glasgow Coma Scale

• is a neurological scale which seems to give a reliable, objective way of recording the conscious state of a person, for initial as well as continuing assessment.

• A patient is assessed against the criteria of the scale, and the resulting points give the Glasgow Coma Score (or GCS). It has value in predicting ultimate outcome of the patient.

• The scale comprises three tests: eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible GCS (the sum) is 3 (deep coma or death), and the highest is 15 (fully awake person). (http://.en.wikipedia.org/wiki/Glasgow_Coma_Scale)

The Patients rating on the GCS

• Initially the patient could open her eyes in response to voice, giving her a 3. The patient had inappropriate but comprehensible words, giving her a 3. The patient had localization of painful stimulus, giving her a 5, for a total initial score of 11.

• Aproximately 90 seconds later the patient didn’t open up her eyes giving her a 1. No verbalizations, giving her a 1, and she did not obey commands, giving her a 1.

CT SCAN FINDINGS

• Right Femur Fracture

• fracture of the left pubic bone at the symphysis pubis

• Significant closed head injury

• Right lung pulmonary contusions

• transverse fracture of the posterior aspect of the right 10th rib

CT technical factors

• A 21 cm FOV (field of View) and a window width of 3077 was used for the head scans.

• The cervical spine was scanned helically without contrast. Axial, sagittal, and coronal 3-D constructions were created for review. A 12 cm FOV was used for this scan with a window width of 3077.

• The chest, abdomen and pelvis scans used a FOV of 36 cm with a window width of 545.

Ultrasound Findings

• A limited abdominal ultrasound and lower extremity Doppler venous ultrasound was ordered.

• The limited abdominal ultrasound study was ordered to evaluate free fluid in the abdomen.

• A very minimal amount of free fluid was demonstrated in the pelvis, which is not an abnormal finding in a young female.

• The radiologist reported no evidence of a DVT in the right lower extremity or the left thigh.

Emergency Room Decision:

• The patients were transport the patient to Emmanuel Hospital for further care. The latest update on the patient was that she was moved to fair condition at Emmanuel on December 11, 2006.