Belly Full of Trouble

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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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