scenario020
22 year old drunk driver loses control of his car and has lateral impact with tree which apparently 'jumped out in front of him'.

Primary Survey

Airway: Clear Breathing: Right sided bruising & rib fractures. Decreased air entry & crackles on right. O2sats 92% on 100% oxygen. Circulation: Pulse 130/min, BP 80/40. Cool peripheries.

Dysfunction:
GCS 14/15 (E4V5M6). Pupils equal & reactive to light.

A right chest tube is placed which drains 200mls blood. Pelvis X-ray is normal. His abdomen is distended and there is a significant amount of free fluid on FAST.

Pre-op his clotting reveals a Prothrombin Time of 20s, Partial Thromboplastin Time of 80s, Fibrinogen of 1.2g/l and Platelet count of 80.