You are working as a double Technician crew on an EA when you are called to a local farm. Reports are that the farmer has hired a small digger/excavator and was doing some work when he took it onto uneven terrain and it has toppled over. The farmer is in an unconscious state and the caller reports that the digger had rolled onto him.
You arrive at the farm within 15 minutes and are directed to a field nearby. Control notifies you that Helimed is on route and there is a Paramedic on an RRV 10 minutes away. You look into the field, and can see the uphill section the digger has toppled over and rolled from. The patient is lying on his side a few meters away from the digger with other bystanders. The scene is safe to approach.
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You note the patient is still unconscious with a large contusion on his forehead. A bystander states they saw everything and saw the farmer inside the digger as it toppled 3 to 4 times down the hill. The farmer was thrown from the digger but it rolled over him before coming to a stop. There seems to be clear/straw coloured fluid leaking from his left ear with some blood staining. There isn’t any obvious major bleeding. He is breathing but is making snoring noises. Your colleague informs you that he has a radial pulse around 120 BPM.
What is your first priority
In relation to Airway, what must you also be mindful of in dealing with a trauma patient
Your colleague starts getting observations while you gently suction the airway. You remove some secretions but it is still noisy, what can you also do to help the airway in this scenario
You jaw thrust the patient and this somewhat helps but there still seems to be some difficulty with the airway management. What can you do next in the stepwise airway approach
Can you consider a Nasopharyngeal Airway in this scenario given the potential injuries
Placing the OPA helps manage the airway. A first responder has arrived on scene and is offering help so you ask them to maintain head position and C-spine. You move onto your next assessment, what pneumonic can you use to assist with a Breathing assessment
Your assessment of the chest currently shows bilateral air entry, but there is paradoxical movement of the chest wall on the left mid-axillary area. What does this indicate
Are you able to splint or immobilise the flail segment
The patients’ breathing rate is currently 16 breaths per minute. There seems to be good air entry despite the flail section, and saturations are maintaining around 97%. Is there any other intervention before moving onto your next assessment
You place 100% O2 on as you feel the patient is a critical trauma patient. Moving onto Circulation, you expose the patient, you assess the patient for potential internal haemorrhage. You note that the patients’ pelvis seems to be unusually splayed. Would you consider placing a pelvic binder now
You place the pelvic binder as your colleague reports observations to you; Saturations of 100% on O2, BP 104/68, HR 115, RR 16, Temp 35.4⁰C, Blood sugars 6.8, GCS 3. Pupils are size 4 and equal. What do you need to manage given the Disability and Environment assessment stage and from the observations
As you are wrapping the patient up you can see the helicopter landing in the field next to you and the RRV Paramedic has arrived. You give your handover. What pneumonic can you use to give a handover