Picking bits of vegetable and who knows what else off your shirt, you go in search of your next patient. Mr. George Stephenson is a 45 year old train driver who was apparently driving like a rocket down the freeway (letting off some steam?) and crashed into a bridge. Judging by the smell on your shirt he is lucky to be unconscious.

He had a Glasgow Coma Score of 7 when the paramedics got to him and has been intubated and ventilated. He is well oxygenated and has been haemodynamically stable throughout. Pupils are equal and reactive to light. He is on a spinal board with rigid cervical collar. He appears to have a fractured right wrist.