Patient Open R ankle injury. Open L knee injury. Back pain. Right leg pain. Abdominal pain. Denied chest pain. Denied headache. Denied arm pain.
EMS Extricated. IV in R arm. Splint Immobilized –C-collar –Long board –CID EMS requested MF due to mechanism of injury and open Fxs. Normal BP. Tachycardia. Breathing normal.
Med Flight Patient awake & alert. Confused. No gross head trauma. Mental status waxes and wanes. Moves all fours. Hypotension noted. Pulses all fours. Fluid bolus. Behavior suggests CHI. C/C having to urinate and lying on long board.
ED Airbags deployed but slid underseatbelt? Not remember event. Must urinate. Pulses all fours. Open Fxs both legs.
Trauma Multiple rib Fxs. Open R ankle Fx. Open L knee dislocation. Pelvic dislocation/Fx. Burst Fx 4 th lumbar. Free air/fluid in Abd. To the OR with: Orthopedic Surgery. Vascular Surgery. Trauma Surgery
OR Exploratory laparotomy. –Splenectomy. –Repair –Bowel perforation –Mesenteric tears –Colonic tear Bradycardia with hypotension. Angiography of aorta: normal. Thoracotomy: normal cardiac function. Retroperitoneal hematoma. Developed irreversible coagulopathy.
Outcome Remained hypotensive. On many pressors. Returned to ICU for resuscitation. Pressors and blood products withdrawn. Patient died at 1455. Autopsy refused.
EMS Prolonged extrication. Immobilized. Open and deformed right femur fracture. Left closed femur fracture. IV started. IV meds. –Fentanyl. –Versed. Reduced right tibia- fibula fracture and pillow splint. Left femur in Hare traction splint.
Med Flight Patient still pinned by legs. When extricated; was slid onto a longboard. Immobilized. IV established. Placed on monitor. Mid hypotension. During flight received 1800cc. Heart rate slowed. Systolic BP 117. To ED for Trauma.
Med Flight As rotors stopped; patient was being wheeled to us. Brief exam on EMS cot in roadway. Complaints of chest pain and extremity pain. Load and go. IV deferred for 3- minute flight. Placed on our monitor. Stable VS.
ED Right forehead abrasion. Parietal scalp hematoma. Right distal fibula fx. A non-traumatic thoracic aortic aneurysm. Trauma service. Orthopedic Team.
Outcome Admit for observation. Ortho placed the fibular fracture in a Bledsoe boot. Thoracic aortic aneurysm. Discharged home after two days. F/U ortho clinic. F/U Thoracic surgery clinic.