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The Trauma Victim

Leaders:

William Taylor, MD, FRCPC
Ian Zunder, MD, FRCPC

Scenario 1

45 year old female, unbelted front seat passenger was involved in a head on collision. According to the paramedics, impact was at about 50 kph. There was no airbag deployment and the windshield was cracked. There was a brief loss of consciousness at the scene.



On arrival to the Emergency Room (elapsed time-30 minutes), the patient was semiconscious. Her neck was immobilized
by a hard collar and taped to the back board. She was breathing oxygen by face mask. Vital signs were stable. Lacerations
to the face and forehead were noted. The primary survey revealed an isolated closed head injury. Within a short
period of time, her level of consciousness progressively decreased and a decision was made to secure the airway.




The patient was given fentanyl, lidocaine, pentothal and rocuronium. Initial attempts at intubation were not
successful.




Learning Objectives:



    
	
  1. ATLS Primary Survey
	
  2. ASA Failed Airway Algorithm and alternative intubation devices/techniques









Scenario 2




25 year old male, motor vehicle accident earlier in the day resulting in a fractured femur. The patient arrives
in the Operating Room at 20:00 for IM Rod insertion. It is noted that he was the driver of the vehicle and that
the car was hit on the driver's side. He is complaining of a sore neck. At the foot of the bed is the patient's
chart and an x-ray envelope containing a single lateral C-spine film of poor quality.




Learning Objectives:



    
	
  1. Clearing the C-spine









Scenario 3




A 13 kg., 2 year old boy was involved in a head on MVA. He was an unbelted passenger in the back seat at the
time of the collision. He was transported to a peripheral hospital where it was noted that he had suffered a compound
skull fracture, a large forehead laceration and several facial lacerations. He was unconscious and apneic at the
time of presentation in the ER and he was immediately intubated by the emergency physician. Hyperventilation was
begun. He was transferred to the treating hospital whereupon a CT Scan was performed revealing diffuse cerebral
edema, a dural tear and frontal compound skull fracture as well as small epidural hematoma. He was brought to the
OR immediately after the CT Scan for emergency ventriculostomy, repair of compound skull fracture and suture of
scalp lacerations. On arrival to the OR, he demonstrated decorticate posturing, BP-65/40, P-155. The surgeon is
adamant that he needs to proceed right away!! How do you proceed?




Learning Objectives:



    
	
  1. Fluid resuscitation in the pediatric patient
	
  2. Head injuries in the pediatric patient