Home > Acute medicine, Anaesthesia, Emergency Medicine, Gasclass, Neuro, Trauma, Vascular Surgery > June case: (week 8 day3): okay, back to Resus then!!

June case: (week 8 day3): okay, back to Resus then!!

June 12, 2014

Hi All!

Thank you for everyone’s participation. Remember tag tour tweets with #gasclass so everyone can see it.

So, where were we? Oh yes, ultimate nightmare: The polytrauma patient from the car crash has suddenly deteriorated in the radiology Department, afterhours on a Saturday afternoon in a small intercity hospital. You, as anaesthetic doctor are called by the porter to go and help out. When you arrive the patient is incredibly restless, doesn’t want to lie flat.

Most people on twitter suggested the plan of action should be to rush the patient immediately back to resus.

So, that’s what you do. Radiology in this hospital is quite remote and there is barely an oxygen cylinder about to speak off, so you and the porter rush the patient back to the Emergency Department.  All the way down the corridor you keep on thinking : “What dit I miss, WHAT DID I MISS? What is going on!!??¥$%#

In resus you reunite with your ER colleague and go through another primary survey:

A: Patent, talking but not coherent. C-spine still in collar. Bruising and slight swelling over neck from seatbelt

B: Sats 99% on highflow O2. Bilateral air entry. No pneumothorax on U/S. Small bit of fluid right chest and visible seatbelt sign

C: BP: 160/88mmHg. pulse 108. No blood in abdomen on re FAST. Pelvis still appears intact on examination

D: GCS: E4V3M5  pupils unequal with one pinpoint. Patient not moving his left side. Patient remains restless and uncooperative.

E: Glucose level normal. Minimal bleeding from open elbow fracture right.

Questions:

What’s going on?

What is your course of action?

okay, everyone would probably want to do a CT head right? What if I tell you the plain head CT appears normal…well, to you and your ER colleague at least.

 

happy tweeting.

conclusion and ideas around management of his diagnosis and anaesthetic involvement further to follows.

 

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