Trauma Case Study by

The Traumatic Incident

RandeeWeeks — 2024-06-05 18:30:38 UTC

Airport workers were trying to hang a large glass sign and something went wrong causing it to break. Large shards of glass fell onto a young boy.

Apparent Injuries

RandeeWeeks — 2024-06-05 18:32:45 UTC

The patient has obvious bleeding from their right jugular vein, a left-sided pneumothorax, several lacerations, and penetrating glass injuries.

Environment

RandeeWeeks — 2024-06-05 18:34:41 UTC

The injury occurred in an airport. It is a crowded area with many bystanders and few available resources.

Geographical Location and Nearby Hospitals

RandeeWeeks — 2024-06-05 18:41:06 UTC

Regional Medical Center of San Jose: level ll trauma center located 12 minutes away.

Santa Clara Valley Medical Center: level l trauma center located 11 minutes away.

Media Clip

RandeeWeeks — 2024-06-05 18:41:42 UTC

Scene Size up

RandeeWeeks — 2024-06-17 15:39:55 UTC

Making sure the scene is safe by having security clear the bystanders and make sure the glass shards are cleared away

1 patient, approximately 10 year old male who looks to be distressed, consider c-spine stabilization

Life threats: cut to the jugular, put direct pressure on it

Rapid transport

Primary Assessment

RandeeWeeks — 2024-06-17 15:40:56 UTC

o Airway: the airway could be impeded by the injuries and the cut to the neck. Make sure the airway is clear and patent. The pt is talking to me so the airway is open.

o Breathing: there is a tension pneumothorax to the left side which I would do a needle decompression, listen to lung sounds and put pt on 02, spo2 90%

o Circulation: make sure that bleeding is stopped with direct pressure, consider packing the wound with hemostatic dressings

o Rapid body scan

Laceration to jugular
Tension pneumothorax on L side
Shard of glass impaling abdomen
Small lacerations all over the body

Secondary Assessment

RandeeWeeks — 2024-06-17 15:42:43 UTC

o Vitals: HR 126, RR 28, SPO2 94% after that needle decompression and 02, ETCO2 35, BP 108/70, lung sounds clear and equal - still slightly diminished on that left side but improving, BGL 100, pupils are PERRLA, PMS is good in all extremities

o Full body assessment showed nothing of note that wasnot seen in the rapid body scan

o NKDA, no medications, no medical hx

o GCS 15, pt can remember everything about the event, his name, and where he is

Interventions

RandeeWeeks — 2024-06-17 15:43:31 UTC

o 10 liters of 02 by NRB
o Bilateral 18 gauge IVs started, 27 mcg fentanyl

o Shock treatment - 02, warm, fluids

o Left sided needle decompression

o Controlled bleeding on neck

o Stabilized impalement to the abdomen

Transport

RandeeWeeks — 2024-06-17 15:44:05 UTC

Transport by ground to the level 1 trauma center that is
11 min awav

Report

RandeeWeeks — 2024-06-17 15:46:09 UTC

Arrived on scene to an approximate 10 y/o male who had been hit by shards of glass. Pt was found laying on the ground in the airport. I saw significant bleeding coming from his jugular vein in his neck, respiratory distress and a shard of glass impaled into his abdomen.
Pt is GCS 15 with PERRLA pupils and the pt did not lose consciousness. I corrected all visible life threats - stopped the bleeding from the neck, decompressed the left sided tension pneumothorax and stabilized the impaled glass. Upon further assessment, no other injuries were of note except for the small lacerations covering his body. Pt rated his pain a 10/10. I started bilateral 18 gauge IVs and administered 27 mcg of fentanyl to manage his pain based on his approximate weight. After fentanyl his pain is now a 4/10. Pt is at

10 Ipm of 02. Most recent set of vitals are as follows

HR 126, RR 28, SPO2 94% after that needle decompression and 02, ETCO2 35, BP 108/70, lung sounds clear and equal - still slightly diminished on that left side but improving, BGL 100, pupils are PERRLA, PMS is good in all extremities.

Supplies, Equipment, and Personnel

RandeeWeeks — 2024-06-17 16:14:00 UTC

On arrival Pt will send to a Trauma Bay with the following requirements:

Fully stocked with airway management equipment

Chest tube insertion kit for potential ongoing management of pneumothorax

Wound care supplies including sterile dressings, suture materials, and hemostatic agents

Pediatric-specific equipment such as appropriate-sized IV catheters, blood pressure cuffs, and monitoring devices

Warming devices

Equipment for diagnostic imaging.

Necessary personnel:

trauma surgical team

Pediatric emergency physician

Pediatric nurses trained in trauma care

Respiratory therapist

Anesthesiologist or anesthetist for potential procedural sedation or intubation.

Radiology technologist for imaging needs.

Questions for Paramedics

RandeeWeeks — 2024-06-17 16:19:07 UTC

How is the patient tolerating 18 gauge IV lines?

Mechanism of Injury

RandeeWeeks — 2024-06-19 17:00:53 UTC

Blunt force trauma resulting in laceration to the jugular, tension pneumothorax, and penetrating injury to the abdomen.

Taking Over Care

RandeeWeeks — 2024-06-19 17:01:49 UTC

Thank you for your report.

mitchellstanding — 2024-06-19 18:03:17 UTC

Does the 11 minute away trauma 1 center have a pediatric E.R.? Would changing plans to go to a pediatric E.R. farther away be worth the risk.
How do we secure the glass impaled in the abdomen for transport and management in the E.R.?
This kid looks longer than a Braslow tape. In the absence of a scale, what's the best way to get a good estimate of this kid's weight for medication administration?