After discovering the news that Darth Vader was his father, the patient expressed having no choice but to jump to escape the confrontation. This resulted in the patient tumbling head over heels through an air vent for 10-15 feet and sustaining trauma to his head. The patient fell to the end of the air vent where it exited out of the building a few feet from a cliff's edge. The patient was able to hold onto some pipes on the building’s exterior to steady himself and avoid a fall, but is unable to climb up the rocky slope around the perimeter of the building to safety due to the nature of his injuries. Battle’s sign is present and fluid is leaking from the patient’s nose. The patient is in and out of consciousness. The patient remains at the bottom of a steep slope covered in loose rocks behind the building overlooking a cliff.

The patient is in the City in the Clouds. Intergalactic Medical Center is a Level I Trauma center and is 43 miles away. Bespin Community Hospital is a Level 3 Trauma center and is 18 miles away. The building where the patient is located may be accessed via dirt road 3 miles off of the main highway.

🔹 Scene Size-Up:

• BSI/Scene Safety: Scene secured, no apparent presence of any sith lord. Area includes unstable footing (loose rock/cliffside), potential fall hazard. Coordinate with rescue personnel to access slope safely.

• MOI: High-energy trauma: amputation (via lightsaber), followed by a fall from height (~10–15 ft) with blunt head trauma.

• Number of Patients: One confirmed.

• Additional Resources: Request technical rescue team, rope rescue if needed for extrication. Request ALS transport and possible air medical evac.

• C-Spine: Manual stabilization initiated immediately due to mechanism and altered LOC.

🔹 Primary Assessment:

• General Impression: Adolescent male with partial limb amputation, head trauma, and altered LOC. High priority.

• AVPU: In and out of consciousness – Responsive to Pain (GCS trending 10–12).

• Airway: Patent but not guaranteed. Fluid from nose may indicate basilar skull fracture. Prepare for advanced airway if LOC declines.

• Breathing: Adequate but shallow. Monitor for increasing respiratory rate or decline in tidal volume. Oxygen via NRB at 15 L/min.

• Circulation:

  • Severe uncontrolled bleeding from below-elbow amputation

  • Immediate application of tourniquet proximal joint above stump

  • Skin pale, cool; radial pulse weak or absent

  • Signs of hypovolemic shock present

• Priority: Critical trauma – Rapid extrication and transport necessary to trauma center

🔹 Secondary Assessment:

Head:

• Signs of blunt force trauma (Battle’s sign)

• CSF leak from nose → high suspicion for basilar skull fracture

• Altered mental status, may worsen over time → frequent neuro checks

Neck:

• C-collar applied for spinal motion restriction

Chest:

• Clear breath sounds bilaterally, symmetrical chest rise noted

Abdomen/Pelvis:

• Soft, non-tender

• Pelvis stable

Extremities:

• Right below-elbow amputation

• Bleeding controlled via tourniquet

• PMS intact in remaining extremities

Back/Posterior:

• Palpated during log roll; minor abrasions

🔹 Vitals (Initial):

• BP: 84/50 (hypotensive)

• HR: 132 bpm (tachycardic)

• RR: 28 shallow

• SpO₂: 92% on room air → improved with O₂

• GCS: 10 (E3 V3 M4)

• Skin: Pale, cool, diaphoretic

🔹 Treatment & Transport Plan:

• Tourniquet placed and bleeding controlled

• High-flow oxygen

• Maintain C-spine throughout movement and extrication

• Secure airway equipment nearby (BVM, suction, intubation setup)

• IV access x2, (possible IO if IV is not possible in leg) initiate fluid resuscitation with NS

• Monitor for increased ICP: elevate head if no spinal contraindications

• Rapid extrication using scoop stretcher and rope-assisted rescue if needed

• Prepare for air medical transport if ground evacuation is delayed or LOC worsens

🔹 Hospital Decision:

• Intergalactic Medical Center – Level I Trauma Center (43 miles) selected due to:

  • Need for neurosurgical intervention

  • Amputation management

  • Higher-level critical care resources

• Will bypass Bespin Community Hospital unless patient becomes unresponsive or deteriorates en route

🔹 Additional Notes:

• Consider early notification to receiving trauma center of dual trauma (TBI + amputation)

• Possible ICP elevation → monitor for Cushing’s triad

• Pain management with caution due to altered LOC

• Amputated limb not available (severed and unrecoverable via lightsaber)

Mechanisms of Injury as identified by EMS: High energy trauma- Amputation via lightsaber and subsequent fall from a height of 10-15 feet with blunt head trauma.

The following supplies should be placed in the room: 

• Room ambient temperature should be warmed to maintain normothermia in patient

• Intubation equipment and other advanced airway supplies for possible inadequate ventilation from TBI. No nasal intubation due to CSF leak.

• Rapid infuser for blood transfusion + ready to acquire O- upon arrival

• Fluids for fluid resuscitation

• O2 monitor, EKG leads, BP cuff, thermometer 

• ART line equipment for hemodynamic monitoring

• Saline/Irrigation solution for irrigation of amputation site

• Sterile dressing to cover amputation site

• Prepare to administer Tranexamic acid Abx, Tetanus booster, pain management as ordered with caution for decreased level of consciousness

Personnel:

• Trauma surgeon to evaluate and perform surgical intervention if necessary

• Neurology team to evaluate possible basilar skull fracture and intervene as necessary

• ER Nursing staff to assist with neuro checks, additional IV access, medication administration, blood administration, wound management

• Respiratory therapist as airway management and ventilatory support are needed

• Blood Bank notified of incoming trauma and need for rapid transfusion

• CT notified to scan for TBI, visualize C-Spine

• ICU notified of incoming admission