Jake Carwin, a 24 year old man, was riding his motorbike when a car turned in front of him; he hit the car and was thrown through the air, landing on his chest, then striking his head on a curb with significant force.
His helmet was severely damaged.
Bystanders called an ambulance.
Paramedics arrived within 6 minutes.
He was found to be tachypnoeic (RR30), hypoxic (initial oxygen saturations 89%), hypotensive (BP 89/50 mmHg) and tachycardic (HR 115).
He would not open his eyes to a painful stimulus, was extending his arms to painful stimuli and was not making any verbal response to pain.
His pupils are currently both 4 mm and reactive to light.
What’s his GCS?
Right now it is:
E1 V1 M2
(See the GCS lesson for some nuances on doing this)
It should be noted that this is an un-resuscitated GCS.
He’s hypoxic and hypotensive at this stage which will confound the neurological assessment.
What are the initial priorities?
Cervical spine immobilisation
Provide oxygen for sats > 90%
Protect airway
Resuscitate to achieve SBP > 110 mmHg
Quick transport to the closest appropriate trauma center
If there’s clinical suspicion of a haemo/pneumothorax, a finger thoracostomy is warranted
The extensor posturing suggests EICP so consider:
Mild hyperventilation aiming ETCO2 30-35 mmHg
Bolus of hyperosmolar agent e.g. 3 ml/kg 3% hypertonic saline
