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Michelin man

Michelin man. Prehospital. Saturday 12 th February 17:51 M : high speed MBA into fence I : sucking chest wound subcutaneous emphysema to neck and head S : HR118, strong radial pulse Sats 98% on NRB, GCS 15

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Michelin man

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  1. Michelin man

  2. Prehospital Saturday 12th February 17:51 • M: high speed MBA into fence • I: sucking chest wound subcutaneous emphysema to neck and head • S: HR118, strong radial pulse Sats 98% on NRB, GCS 15 • T: 3 sided dressing pneumocath insertion IV access & 23mg morphine total

  3. Arrival to ED 18:50 • AIRWAY & BREATHING • Talking, refusing C collar • ?larynx injury with change in voice & tender larynx ++ • Obvious flail on R • R sided open chest wound with subcutaneous emphysema to neck and face • CIRCULATION • HR 101, BP 140/82 and good cap refill • DISABILITY • Alert, moving all limbs

  4. CXR

  5. Pelvis Xray

  6. First venous gas

  7. Initial ED management • FAST negative • Bilateral ICC under ketamine sedation • Cephazolin 1g • ADT

  8. CXR post ICC

  9. Problem List/Injuries • MBA • Significant chest injury • ? tracheal injury • Needing CT scan for further Ix Decision for intubation by anaesthetics in OT with ENT standby for CT scanning subsequently Grade 1 view

  10. CT result • Bilateral decompressed PTX and pneumatoceles • Bilateral contusions • Undisplaced R occipital #

  11. Progress • D2 – extubated • D4 – trauma HDU • D6 – fevers • IV site infection MRSA • RML pneumonia • D16 – discharged

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