Pre-Hospital
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:
2.1: 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?
2.2: What is your clinical plan and initial management? also briefly highlight any potential clinical deterioration that may be encountered ?
2.3: Describe how you will notify the receiving hospital of your planned arrival and how they might prepare for your arrival.
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