Send the link below via email or IMCopy
Present to your audienceStart remote presentation
- Invited audience members will follow you as you navigate and present
- People invited to a presentation do not need a Prezi account
- This link expires 10 minutes after you close the presentation
- A maximum of 30 users can follow your presentation
- Learn more about this feature in our knowledge base article
Do you really want to delete this prezi?
Neither you, nor the coeditors you shared it with will be able to recover it again.
Make your likes visible on Facebook?
You can change this under Settings & Account at any time.
Case Study #2: MVC
Transcript of Case Study #2: MVC
Your patient and her husband are on the way back from the airport after renewing their wedding vows in the "Taco Bell Wedding Chapel" in Las Vegas. You are working an evening shift when you hear the EMS radio report that EMS is on scene at a MVC. The patient's husband was wearing his seatbelt and is uninjured. However, your patient, a 33 year old female, was not restrained and is brought into the ED by EMS.
Diabetes Type II
Iron deficiency anemia
No surgical history
No traumatic history
"The Case of the Irresistible Force vs. the Immovable Object"
Liver Function Tests
Total Bili: 1.1
Troponin I: 0.11
Urine Tox: neg
Segmented neutrophils: 82%
Band forms: 1
Red Blood Cells:
White Blood Cells:
BHCG Quantitative: 1100 IU/mL
Cervical spine fracture
Cervical spine subluxation
Cervical spine strain
Herniated cervical disc
? Epidural hematoma
Repeat serial Head CTs
q6 hours (or so)
Reversal of anticoagulation
Surgical evacuation if deteriorating
Not needed in this case...
Normal heart, no cardiomegaly, no infiltrates, pneumothorax, or free air.
Left anterior rib fractures of 7th and 8th ribs
Abnormal positioning of some of the facet joints due to distraction but no dislocation
Additional fracture of the body of C4
The vertical orientation of the fractures of the bodies of C4 and C5 indicate that there was severe axial loading.
(In fact these vertebral bodies kind of 'exploded' with propulsion of a bone fragment anteriorly (teardrop) and the larger part posteriorly against the spinal cord.)
Spinal surgery consultation
Closed reduction under fluoroscopy
Halo vest immobilization
Possible surgical immobilization
Flexion teardrop fracture of C5
Oriented to person, place time
Arrives via EMS, collared and boarded
: EOMI, PERRLA, sclera non-icteric
Ecchymoses to midline, anterior forehead, No deformity to calvarium
Pharynx and nares are normal
: tender in midline posteriorly over C4-C6
Tender over bilateral trapezium muscles, no deformity. Range of Motion (?)
: No deformity, normal excursion, midline ecchymoses,
tender to midline sternum without crepitus
: regular rhythm, tachycardic, S1S2 without gallop, rub, or murmur, tender
to left anterior chest about 5th-9th ICS
: soft, tender diffusely, worse in RUQ and epigastric regions, no
ecchymoses or abrasions, normal BS
good tone, light brown, soft stool, trace heme +
: no deformities or tenderness or ecchymoses, Pulses 2+ throughout
: nontender in midline and to paraspinous muscles
: No facial asymmetry, CN 2-12 intact,
Motor and sensory intact throughout, non-focal exam
Your patient was not wearing her seat belt when her car struck a telephone pole 30 minutes ago. She states she had been driving all night and fell asleep at the wheel. She doesn't really remember the collision, and the first thing she can recall afterward is waking up with a sore neck while the paramedics were knocking on the window. She quickly regained consciousness and unlocked the door. The neck pain is described as sharp. She has no prior neck problems. She does complain of a diffuse headache and achiness in the center of her chest and abdomen, but she denies problems with her extremities.
Fracture of the body of C5 with a small fragment anteriorly
Fracture of the spinous processus of C4
Acute angulation at the level of C5C6 with displacement of C5 in posterior direction
Scalp contusion/soft tissue
Possible Epidural Hematoma
Drinks alcohol socially
Denies any non-prescription drug use
Sexually active with husband only Monogamous for 4 years. No condom use
Job: Works at State Street
Temp: 37.0 C (98.6 F)
BP: 102/62 mmHg
HR: 110/min, irregular
O2 Sat: 97% on RA
Hollow viscous injury
Reading: Soft tissue swelling to left frontal forehead. No fracture of skull. Faint hyperlucency to left frontal lobe may be suggestive of epidural/subdural hematoma. Clinical correlation suggested.
To bind or not to bind?
Grading of injury
1. Few fluid-filled loops of small bowel are present but are nonpecific.
2. Liver with 2.5cm laceration to lateral aspect.
3. Gall bladder present
4. Fat containing umbilical hernia.
5. No abdominal free air of intraperitoneal fluid
1. No evidence of diverticulitis or acute inflammatory process in the pelvis.
No evidence if pelvic or retroperitoneal free air or fluid
Unstable airway/unsecure airway
Patients with severe maxillofacial injuries
Patients requiring immediate airway intervention
Facial burns or burns with significant suspicion of inhalation injury
Moderate-severe respiratory distress; sub-Q emphysema of the face, neck or chest
Systolic BP < 90mmHg or HR > 120
Witnessed cardiac arrest from trauma
Spinal Shock (Hypotension & normal HR with neuro deficits)
GCS ≤ 8
Head injury with LOC > 5 min with one or more other physiologic derangements
Known spinal cord injury
Neurologic deficits with suspected spinal cord injury (any level)
Diagnosed abdominal or pelvic injury with shock Major pelvic injury with shock
Major chest wall injury such as flail chest/sucking chest wound
Multiple long bone fractures with shock
Amputation of proximal extremity (not digits)
Pulseless extremity with evidence of trauma
Mechanism of Injury
Penetrating trauma to the head, face, torso (chest, abd, buttocks, back)
Ejection or thrown from any vehicle with presence of other criteria for Level I activation
Fall from height > 10 feet are Level II unless meeting Level I criteria
High voltage electrical injury
Burns > 20% BSA or burns combined with any other injury
Massive crush injury
Trauma Criteria #1
Trauma Criteria #2
Trauma Criteria #3