Term 4 week 5 (w/c 01/10/2012)
Thanks to everyone who contributed to last weeks discussion. We had a large number of views on our case discussion page and it was great to see that these were coming from right across the globe. It was particularly nice to see a joint discussion between quite different specialities (anaesthesia and general practice) and hopefully this is something we can do more often.
For this weeks case we will be looking at some of the difficult decisions that need to be made as part of prehospital anaesthesia. As always we will kick off with a fairly open ended question so that everyone can participate and hopefully learn something.
What factors make the administration of prehospital anaesthesia particularly hazardous?
Some good suggestions regarding the hazards of prehospital anaesthesia so far. We will develop the case further now…
You are called as part of a HEMS team to an accident on a building site. You are told that whilst working on the roof of a building a male has been struck by a moving steel beam. The site personnel tell you there is a lot of blood coming from his head
What other information do you need to enable you to form a plan?
Thanks for the contributions so far. It was interesting to see the divide between those that wanted more clinical information and those that wanted more information about the scene, specifically scene safety
As we have mentioned on twitter earlier today, you have spoken with the site manager. The worker was working on a roof approximately 2 stories high. The access is via a crane (cherry picker type). You have radio communications with his work mates who are still with him. He was knocked off his feet by the steel beam and has bled a lot from a head wound. They are able to tell you that he is breathing but he is not very responsive and he is clenching his teeth excessively.
The site manager can confirm that the roof is load certified and he has offered use of fall arrest harnesses and the cherry picker. The HART team are on their way but at present you are the only medical response. The workers are able to confirm that the patient is in a safely accessible location on the roof (no weak floors, not close to the edge etc). You make a risk assessment and based on the information you have you deem it is safe enough to attend the patient on the roof. It takes 4 mins to reach him using the crane and the basket is big enough for 4 people (Can only fit spinal board / scoop plus escort)
Obvious head injury with large Scalp wound.
HR 130 min. BP 155/89. He is having a generalised seizure.
There are no other obvious injuries on your brief primary survey and you brief his co workers about your plan to move him on the board.
What would you do now? Feel free to add any comments to the twitter conversation
Please only Tweet one point and wait until someone else has tweeted.
There are no trick questions in #gasclass. It is an educational tool only. Everyone’s opinion is as valid as the next person. Follow the conversation by using (or searching for) the hashtag #gasclass on twitter. We welcome input from all specialties and you can send us a direct message if you would prefer to remain anonymous.