Chest Trauma

It is summer time in the Peak district. X has fallen approximately 5m from Stanage Edge in the Peak District. He was climbing and his partner wasn’t belaying him correctly.

D – safe, no chance of rockfall.

R – casualty is responding to  voice but slightly confused, complaining of ankle and neck pain.

C – no catastrophic haemorrhage, C-spine needs to be immobilised due to mechanism.

A – airway is patent as casualty is talking, tracheal deviation to the right if checked.

B – RR is 32, O2 sats 85%, patient complains of SOB, asymmetric chest expansion, absent breath sounds on the L on auscultation due to Left sided tension pneumothorax, hyperresonant chest percussion, needs needle decompression. 

C – BP is 98/63mmHg, HR is 125bpm, internal bleeding - query chest, abdo clear, pelvis clear, long bones clear, PCR is > 2 sec, signs of peripheral cyanosis.

D – casualty is slightly disorientated, BM is 4.5, pupils equal and reactive to light, temperature 37C

E – obviously deformed right ankle, Battle sign visible behind ears if checked.

If team has done a needle decompression:

Patient becomes more confused, unsure of where they are.

R – very confused.

C – C-spine still needs to be immobilised.

A – airway is patent.

B – RR is 25, O2 sats, 94%, asymmetric chest expansion, auscultation adequate bilateral air entry.

C – 107/75mmHg, HR is 100bpm

D – confusion, disorientation, blown pupil, temperature fine if team has insulated casualty, dropping if not.

Patient becomes unconscious, team must use airway adjunct.

If no needle decompression:

Patient’s blood pressure drops to 65/40mmHg, patient loses consciousness. If rapid needle decompression return to above section of ‘if team has done a needle decompression’. 

If not:

Patient stops breathing, cardiac arrest.

Priorities: CPR, update emergency services, bag-valve mask and ventilate, consider 4Hs and 4Ts and treat accordingly with needle decompression.