March 2016 Trauma Case Study

You are working for a rural county service and dispatched to local interstate for a motor vehicle accident with unknown injuries.  Roadways are slick and hazardous due to a recent snow storm that has passed through the area. While en route, dispatch advises that a state plow is on scene advising that this is a head-on semi vs semi accident with one confirmed severely pinned occupant in one of the semis.  While en route you request air- medical transport to come up on stand-by due to the prolonged extrication and time to closest trauma center (approximately 45-60 minutes, however it could be longer depending on roadway conditions).

You are the first arriving unit on scene. You find two semis involved in a collision. One semi (semi A) was traveling westbound on the interstate and crossed the center median striking the other semi (semi B) head on. Semi A was on top of Semi B. Significant front-end and significant intrusion noted to the cab of semi B. No patient was found in semi A. Bystanders reported that the driver of semi A walked down the roadway for help. Driver of semi B was found to be heavily entrapped in the semi. Significant intrusion noted to the drivers side door as well as cabin room. The dashboard was crushed onto patient’s lap and the steering wheel was broken and bent upwards.

The patient, a mid-40s male, was alert and oriented  upon contact and has slight facial swelling and dried blood to the face.  He complained of no head, neck, or back pain, and denied any loss of consciousness as the result of the accident. The crew placed patient in a C-collar as precaution and noted a deformity to the left forearm. The patient also complained of lower leg pain, however due to the crushed dashboard, assessment could not be performed at this time. The patient had blood on his pants and what looked like a possible impalement from dashboard plastic, but advised that he was able to still move both his feet. Due to limited access to the patient, interventions could not be performed at this time. Patient was kept warm with warm blankets. Fire Rescue arrived on scene and started extrication on the semi. Air-medical transport requested at this time with ETA of 15mins. Landing zone was established on the interstate by fire personnel.  Due to poor access to the patient, wrecker was requested to pull Semi A from on top of Semi B to allow for better access. Dashboard was able to be “rolled” off the patients lap, and relief cuts made to the “A post” to allow for pt to be freed. Patient was not impaled at present time, however significant amounts of blood could be noted on patient’s pants. He was placed on a spine board while inside the semi and removed out of the passenger’s side.

Patient carried to ambulance for assessment and treatment by flight team. Clothing was removed revealing bilateral femur fractures and a blow out of the right knee. Patient had an open tib/fib fracture on left leg with significant bleeding. Bleeding controlled with use of tourniquet. IV access was obtained and crystalloid fluids administered with a 1G bolus of Tranexamic Acid with all extremity injuries splinted.  BP remained around 90 systolic and sinus tach on the monitor with a rate in the 110s. The patient was transported by flight from scene to a local Level II trauma center.

The patient is now recovering in a rehab facility, and was found to have mandibular fracture, nasal fracture, C7 fracture, pelvis fracture, radius/ulnar fracture, bilateral femur fractures, and left tib-fib fracture. Patient had a grade III liver lac and received several blood transfusions due to low blood count, and is expected to make a full recovery.

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