A 58 year old man presents to your department by ambulance from a construction site after being hit in the chest and face by a large concrete block swinging from a pulley. He has sustained no other injuries.
His vital signs on arrival are:
HR 115 /min
BP 99/66 mmHg
RR 28 /min
O2 sats 95% 6L via mask
Give 3 signs in the primary survey that would indicate the possibility of a pneumothorax. (3 marks)
The patient’s chest xray is taken just after arrival and is shown. Give 2 major abnormalities from the film and the diagnosis. (3 marks)
After the patient’s xray returns the suffers increasing respiratory distress, desaturates and has a cardiac arrest. Give 2 actions you will immediately undertake. (2 marks)
Describe the differences and advantages of each of finger thoracostomy and needle thoracostomy (2 marks)
A 35 year old motor bike rider presents to your department with the ambulance after a collision with a car. The ambulance report multiple injuries on scene. The accident occurred 500m from the entry to the hospital, so the ambulance have applied a c-collar, inserted an IVC and brought the patient to your department with no other interventions undertaken.
The patient’s vital signs on arrival are:
HR 145 /min
BP 90/72 mmHg
RR 29 /min
O2 sats 98% 6L via mask
What drugs will you use to intubate this patient? Justify your choices. (2 marks)
What volume resuscitation will you administer to this patient? (1 mark)
Give a further method of haemorrhage control which should be immediately applied to this patient? (1 mark)
What are the treatment elements that are part of the massive transfusion protocol? (3marks)
Give 6 endpoints you would use to judge the efficacy of your transfusion (3 marks)
A 68 year old woman presents after (?injury) with acute neck pain and difficulty moving her arms and legs. She has severe respiratory distress and is being bagged by the ambulance.
A decision is made to perform a rapid sequence intubation. After induction the patient’s airway obstructs and she becomes unable to be bagged. A view of the cords is unobtainable on laryngoscopy due to upper airway haematoma and a blind pass ETT fails.
The patient has desaturated to 82%. Describe your next actions including any techniques you will use. (4 marks)
A CT scan of the patient’s c-spine is taken and an image is shown below. Give the major abnormality and list 3 clinically important complications of this injury. (4 marks)
The patient’s vital signs are:
HR 41 /min
BP 72/42 mmHg
RR 16 /min (ventilated)
O2 sats 100% FiO2 tube 40%
Give 2 interventions you will apply to treat this issue. (2 marks)