A 22-year-old female working at a dairy farm in a country town has been kicked in the chest and abdomen by a large bull.
She is complaining of dyspnea and abdominal pain, but remains alert.
The paramedic crew arrives about 15 minutes prior to your arrival, and reports the following:
• GCS 15
• No Loss of Consciousness
• Cold & Clammy
• Flail segment on right lateral chest wall with dyspnea.
• Rigid abdomen in all quadrants with visible hoof mark over umbilicus.
• NIBP: 90/60 (Usually 120/75)
• Pulse: 120 beats/min
• Spo2: 93 %, High Concentration Oxygen Mask
Relevant Information:
Aircraft option: Rotary wing with a flight time of 30 min.
Ground resources: 1 Paramedic Ambulance (Not critical care/MICA/ICP).
Retrieval Options: Trauma center 30 min by air.
Other: No reported hazards on scene with a wide, flat paddock 30m away; time of incident to your arrival is less than one hour.
Questions:
1) Describe the clinical picture you could possibly derive from the given information and what instructions would you give the attending paramedic crew prior to your arrival, if any?
2) What is your clinical plan and initial management? also briefly highlight any potential clinical deterioration that may be encountered ?
3) Describe how you will notify the receiving hospital of your planned arrival and how they might prepare for your arrival.