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Case Review By James J. Augustine, MD Belly Full of Trouble A driver’s condition following an accident may be worse than it appears It’s a warm, sunny afternoon when Attack One responds to a mutual aid call for assistance in a neighboring jurisdiction. The crew rolls Initial Assessment up on a severe head-on collision between a sports car and a small pickup truck. Crews from the neighboring EMS agency are working A 24-year-old male, restrained driver in a head-on on the driver of the sports car, whose head is protruding through his collision. No air bag. Profuse bleeding from large windshield. Attack One is directed by Command to care for the single laceration on forehead. victim in the pickup truck. Airway: Intact and uncompromised. The driver is alone, still belted in. He’s a healthy man in his 20s. A Breathing: No distress. single member of the other EMS agency has placed a cervical collar Circulation: Normal capillary refill, pink skin, neck and is attempting to control the bleeding from a large laceration on veins flat. the man’s forehead. The patient is helping himself by placing direct Disability: No neurologic deficits. Awake and alert, pressure. He is awake, alert, oriented and expressing concern about complaining only of forehead pain. the other car’s driver. He remembers rounding the curve, ﬁnding the Exposure of Other Major Problems: Significant blood other driver in his lane and being unable to turn away. He saw the other loss from forehead laceration; bleeding is difficult to driver come through his windshield, and fears for the man’s life. control even with direct pressure. The Attack One paramedic does a rapid trauma assessment and ﬁnds the doors on the truck won’t open. They will require a quick extri- Vital Signs cation, but nothing as time-consuming as will be required to remove Time HR BP RR Pulse Ox. the other driver. He places a pulse oximeter on the man’s ﬁnger and 1410 96 110/palp. 20 98% “The patient ﬁnds oxygen saturation in the high 90% range, the pulse rate regular. There’s a lot of blood down the man’s face, chest and in his lap, but he has no obvious chest, abdominal or extremity trauma. The laceration on his forehead is the site of all the bleeding, and it continues, rapidly. 1415 1421 1428 110 130 130 100/palp. 100/palp. 96/palp. 24 24 28 95% 94% 92% AMPLE Assessment may be Only ﬁrm pressure directly on the wound edges slows it.
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