You quickly look at the patient and can see they are a pale and waxy in complexion. There is a large pool of blood around the patient with more seeming to be spurting from what looks two stab wounds to his lower thigh. They seem to be tachypnoeic with a reduced GCS, and are making a grunting/snoring sound with each respiration.

What is your first priority

On the limb injury, what device should you utilise first to try and stem the haemorrhage

You instruct the two officers to continue applying pressure to the wound site as you get out the tourniquet. Where are you looking to place the tourniquet

You apply the tourniquet and start tightening. After the third turn the patient starts to groan loudly in pain and reaches down with his hand to try and remove it. One of the Police Officers says to you he thinks it’s too tight and is hurting the patient. Blood continues to flow from the wounds, what do you do

You explain to the Officer the importance of the device and its’ correct application. The Officer understands and tries to calm the patient. With the tourniquet applied the bleeding has now stopped, the Officers remove their hands and you can see two large stab wounds in the lower thigh. Now that all visible haemorrhage is controlled, what is your next assessment

You note the patient is making a grunting/snoring sound on inspiration. You ask the Police if they have any more information on the incident. All they know is that there was calling for help and when they came down the alley, the patient was leaning against the wall saying “He’s stabbed me.” The Police then laid him on the floor and started to apply pressure to the obvious wounds. A quick look around the head and neck shows no damage, with all this information you feel that the patient hasn’t sustained any C-Spine damage or injury. A look into the mouth shows no obstructions or fluids. With that in mind and a stepwise approach, what can you do to help manage the snoring/grunting

You perform the manoeuvre on the patient and the snoring sound goes. You move onto breathing and apply a finger O2 saturation probe. O2 levels return at 97%. Would you still apply O2 with levels of 97%

You feel that the patient is in a critical trauma situation and apply 100% O2. You continue with the breathing assessment. The patient is wearing a puffy jacket and top. You ask the officers to cut the jacket off so you can fully assess the patient. They cut off the jacket, what mnemonic can you use to assess the patients’ breathing

You work your way through FLAPS TWELVE, you note there is some reduced air entry on the left lower lobe area. As you come to the search part of the mnemonic, placing your hand around his back, you feel a lot of blood. The Officers also note to you that the back of his puffy jacket is saturated with blood. You turn the patient very carefully and expose an additional stab wound on the left side of his mid-back. There is blood flowing from the wound steadily. You get an Officer to place pressure on the wound to stem the bleeding. What in a stepwise haemorrhage control approach can you do to further treat

The dressing and pressure stop the bleeding from the wound. The Ambulance has turned up by the road and the crew are making their way to you. Following your intervention what should you do