Post on 12-Jul-2015
MIST M:
75 yr old male brought to by helicopter after getting head trapped between tractor hydraulic mechanism and hay bale lifting apparatus (approx. 4 inch gap)
Previously fit and well
I: Ü Lateral and anterior neck injuries Ü Head injury Ü Facial bone injuries
Approx Injury Time: 10.40 Dispatched: 10.53 Arrive scene: 11.40 Depart: 12.08 ED: 13.04
MIST S:
Ü BP= 140/75 HR= 63 Ü GCS = 15 Ü RR 25 Sats 96%
T: Ü Fentanyl Ü Ondansetron Ü Sandbags and tap (not tolerating cervical neck
collar)
Approx Injury Time: 10.40 Dispatched: 10.53 Arrive scene: 11.40 Depart: 12.08 ED: 13.04
Primary Survey
Approx Injury Time: 10.40 Dispatched: 10.53 Arrive scene: 11.40 Depart: 12.08 ED: 13.04
A
Ü Patent; no stridor
Ü Neck - sandbags and tape in situ
Ü Expectorating blood
B
Ü SpO2 96%
Ü RR = 25
Ü Trachea midline
Ü No chest wall tenderness
Ü Equal breath sounds bilaterally
•
Primary Survey
C
Ü Well perfused; CRT < 2sec
Ü PR 63 bpm BP 140/75
Ü Pelvis stable Abdo SNT
D
Ü GCS 15 PEARL
E
Ü Logroll NAD
•
Immediate management
Ü IV access: - Bloods taken
Ü Immobilisation
Ü O2
Ü Warming: - Warmed IV Fluids - Warming blanket
Ü ADT given
•
Secondary survey
Ü HEAD:
- Loose teeth, bleeding from mouth
Ü NECK:
- No central C-spine tenderness
- Sandbags and tape
- Bilateral swelling and ecchymoses of the lateral neck
Ü CHEST: NAD
•
Secondary survey
Ü ABDO:
- SNT; normal FAST
Ü PELVIS:
- stable; plain X-ray normal
Ü LIMBS:
- NAD
Ü BACK:
- NAD
•
Radiology department
Ü CT BRAIN (14:50):
- no acute intracranial abnormality
Approx Injury Time: 10.40 Dispatched: 10.53 Arrive scene: 11.40 Depart: 12.08 ED: 13.04
Radiology department
Ü CT CAROTID ANGIO:
Approx Injury Time: 10.40 Dispatched: 10.53 Arrive scene: 11.40 Depart: 12.08 ED: 13.04
Radiology department
Ü C-spine:
- non-displaced fracture through right C2 lateral mass traversing the transverse foramen laterally
- non-displaced fracture of the base of spinous process and a displaced fracture of transverse process of C3 on the right side
- non-displaced fracture of the transverse process of C4 bilaterally traversing the transverse foramina
- fracture through the transverse foramen of C5 on the left
Radiology department
Ü C-spine MRI (17:19):
- oedema in the posterior spinal soft tissues of the mid to upper cervical spine
- raises possibility of ligamentous injury
Progress Ü Admitted to surgical ward
Ü Vascular surgery and interventional radiology review:
- observation
- not for anti-coagulation
Ü PCA fentanyl
Ü Fax / max for mandibular fractures
Ü Neurosurgical review:
- cervical collar for six weeks
Screening criteria CTA Neck (blunt CVI)
Ü Injury Mechanism:
Severe cervical hyper-extension, rotation or hyperflexion associated with:
- displaced midface or complex mandibular fracture
- closed head injury consistent with diffuse axonal injury
- near hanging resulting in hypoxic brain injury
Screening criteria CTA Neck (blunt CVI)
Ü Physical signs:
- seat belt abrasion
- other soft injury of anterior neck resulting in significant swelling or altered mental status
- fracture in proximity to ICA or vertebral artery
- basilar skull fracture involving carotid canal
- cervical vertebral body fracture Ü