Pre-Hospital:
An 18-year-old male is the sole occupant, driver, of a utility vehicle and has rolled his vehicle several times while texting.
The rollover has happened on a sealed (Bitumen) country road in the Wheat- belt of Western Australia.
A truck driver has reported that the vehicle suddenly lost control, and rolled over about three times before coming to rest on its wheels with the roof on the driver’s side crushed but not trapping the driver.
Estimated speed was approximately 110 km/h.
The caller states the driver is still in the vehicle, not responding, but is breathing, with a large laceration on the forehead and bruising around the right eye.
No hazards observed on scene.
Relevant Information:
Aircraft option: Rotary Wing: landing site less than 30m away.
Ground resources: One Volunteer Services Ambulance and local Police Service.
Retrieval options: Royal Perth Hospital (Trauma Centre) 120 minutes by road or 35 minutes by air
Environmental factors: Tuesday Morning 09:00, clear conditions
Questions:
1: Using the information so far available, outline your clinical plan prior to arrival on scene.
Clinical Information:
• P: 120/min
• BP: 150/90 mmHg
• GCS 6 (E1 V2 M3)
• No Allergies
• No Previous medical history
• No current medications.
2: Briefly describe Patient selection criteria for RSI (Rapid Sequence Intubation), paying particular attention to the airway examination component and predictors of a difficult intubation.
3: Describe the key steps required in the performance of a Pre- Hospital RSI.
4: What are the risks and benefits associated with RSI in the trauma patient? Provide a critical assessment of your decision to RSI or not?