Sudden deterioration in an elderly trauma patient

Abstract

Dr. Ron Walls: Today’s case is that of a 75-yr-old woman who presented to the emergency department (ED) by helicopter after a rollover motor vehicle crash. She was an unrestrained front seat passenger and was ejected, landing approximately 20 feet from the vehicle. Upon arrival at the scene, the patient was found awake and alert, following commands. It was unclear whether the patient had suffered loss of consciousness. The initial vital signs in the field were: blood pressure (BP) 90 by palpation, pulse 110 beats/min, and respirations 20 breaths/min. The patient’s neck was immobilized in a cervical collar and a peripheral intravenous (IV) line was inserted. As she was being loaded onto the helicopter, her level of responsiveness deteriorated, and her systolic BP decreased to 80 mmHg. She was intubated by using rapid sequence intubation with lidocaine, fentanyl, and succinylcholine. A second intravenous line was placed, and she was transported to our hospital. Her husband, the unrestrained driver, had remained in the car and was taken to a local hospital with minor injuries. Are there any questions about prehospital management? Dr. Adler: There does not appear to be evidence that a MAST suit controls hemorrhage, but it may stabilize an unstable pelvic fracture by limiting soft tissue and vascular damage and by reducing the degree of hemorrhage.