scenario015
34 year old woman loses control of her car while putting her make-up on. She is not wearing her seatbelt (interferes with mascara application) and has bullseyed the windshield. There is significant damage to the steering column.

Primary Survey

Airway: Obstructed initially. Subsequently is intubated and ventilated. Breathing: Multiple right sided rib fractures and extensive subcutaneous emphysema. O2sats 92%. RR 14. Trachea central. Decreased breath sounds and multiple crackles right chest.

A right chest tube is placed which drains a small amount of air and around 200mls of blood.

Circulation: Pulse 90, BP 160/95. No external haemorrhage. Pelvic X-ray normal.
Dysfunction: GCS 5(E2V1M2) . Pupils equal & reactive.

She is transferred to the CT scanner for a head and abdominal CT scan. While in the scanner her oxygen saturations fall to 85% and airway pressures rise to 40cmH2O. Blood pressure falls to 80/60 and pulse rate rises to 110. Central venous pressure is 28cmH2O.