Standing over the patient, you can see his bike helmet is cracked in half with blood on his head and a large bullseye on the bus windscreen. The patient seems semi-conscious, groaning in pain, holding at his side and leg. His right leg looks significantly deformed. The scene is safe to approach.

Looking at the patient’s injuries, what action should you look to start with

You start your primary survey of the patient, there is no obvious catastrophic haemorrhage that you can see. You move onto airway, the patient continues to groan and shout. As he does so, you look into the airway and can’t see any obstructions or fluids. Given the scenario, what level of mechanism of injury would you give

Given the mechanism and high suspicion for potential C-spine injury, you ask the patient to try and stay still, and a Firefighter offers to support C-spine control of the patient. As the patient is maintaining his airway and no obstruction is present, do you require further stepwise airway management

Given that the patient has a significant head injury and is agitated, you omit placing a collar due to potential raised ICP. You move onto breathing and cut off his shirt, exposing his chest. You note his respirations are 22 per minute. He continues to hold the right side of his chest and is very reluctant to move his hand due to the pain. At this stage, what can be given to help reverse the potential build up of acidosis in the blood

You get one of the Firefighters to apply 100% O2 as you do your breathing assessment. What mnemonic can you use

You feel and look at the rise and fall of the chest and it is bilateral and equal. You go to auscultate, any touching of the right side of the chest causes the patient to scream out. You are able to hear bilateral air entry, with it being slightly diminished on the right side. You attempt percussion but it is difficult to make out the sound. Both sides seem normal resonance. You search the back and sides trying best not to move the patient or cause further pain. Under his right arm and hand, you can see a lot of redness and marks. This seems to be the side the bus hit him. There are no obvious wounds. You complete your TWELVE assessment and there are no deficits. Do you need to do any interventions on Breathing

You move onto assessing circulation. You feel for pulses and have a radial pulse around 130 beats per minute. The patients’ pallor seems to be normal with no obvious paleness or clamminess. You assess for potential internal haemorrhage. You’ve already assessed the chest, you assess the abdomen but there are no obvious deficits. You cautiously expose the pelvis, on the right hand side there seems to be redness and possible deformity as it seems to be unequal to the left side. The right leg is also grossly deformed and causing a lot of pain. What management would you look to implement for these injuries

With assistance from the Fire Service, you accomplish all of the actions. While doing so you also instruct the Firefighters around you to start doing basic observations with your equipment. Your observations come back; 99% O2 saturations, Pulse rate 128, Respiration rate 23, BP 117/74, GCS 15, 36.8 Temp, Blood sugar 5.4. As you finish your primary, what further actions must you consider in the trauma scenario

As you look to further manage the patient under the trauma triad considerations, the patient starts becoming quiet and his respirations start increasing. His O2 saturations start dropping although being on 100% O2. What should you do

You quickly reassess the patient, there are no signs of Catastrophic haemorrhage, looking into his Airway it is still patent and clear, on Breathing, assessing FLAPS TWELVE, you note no rise and fall of the right side of the chest, there is no air entry auscultated on the right, and the trachea is deviated to the left. What does this indicate

You recognise the developing tension pneumothorax and get your needle decompression kit out. You identify the landmarks and decompress the chest. There is a positive hiss sound and you note movement on the right side of the chest. His breathing begins to ease and O2 sats return to normal. A specialist Doctor and Ambulance have now turned up on scene and are heading over to you. Following the needle decompression what should you do