"16 year old male, fallen off a Lion"
The cab filled with screams of laughter. We see a lot of funny things show up on the MDT but this was one of the more amusing! Especially as that was the only details we had initially. Not even an address! Fallen off a Lion! What do you say to that?! Would this be a Lion tamer? Would it be a job for the Hazardous Area Response Team (HART)? Would be need the RSPCA or such like? Highly unlikely. If someone has fallen off a Lion it is likely to be a statue and in this case it was. But still, it put us in a good mood so off we went.

We jumped to work, I secured his airway and gave him o2 while my crew mate grabbed collars, a board, straps, blocks and splints. I started to get as much history as I could from his friends. He had landed head first onto the concrete, as they said that my eyes wondered to the small pool of blood and vomit about 3 feet away. He had got up and within about 30 seconds had vomited. After about 2 minutes he was complaining of a headache and began to stagger around. That's when his friends wisely called 999. About a minute before we arrived he lost consciousness. This was serious. I requested HEMS or a BASICS doctor. I was told HEMS were now on route and would be 8 minutes. This was going to be a long 8 minutes!
I assessed the back of his head and it was what we call a 'boggy mess'. No further description is necessary. I applied a large dressing to keep it clean and stop the bleeding. I suspected he had a fractured skull. Between the 2 of us we decided to forget the spinal board until help arrived and concentrate on stabilising and monitoring him as much as we could. A quick pulse check and alarm bells started ringing. It was 36 which in 16 year old with a head injury is a great concern. I did his blood pressure while my crew mate gained IV access and the bells continued to ring. 198/110. For his age he was severely hypertensive. Put those two observations with his head injury and development of irregular respirations and we had what's called Cushing's triad. That told us he had a raised Intracranial Pressure (ICP) which meant he was big big sick. I think his friends started to realise the gravity of the situation but despite this, they were fantastic. They phoned his parents, they got all his details, his allergies and passed us everything we asked for. I lost count of how many times they ran back and forward to the ambulance. We started bagging him as he began having prolonged periods of apnea. I looked up and saw 3 orange jumpsuits walking towards me! And breathe!
I assessed the back of his head and it was what we call a 'boggy mess'. No further description is necessary. I applied a large dressing to keep it clean and stop the bleeding. I suspected he had a fractured skull. Between the 2 of us we decided to forget the spinal board until help arrived and concentrate on stabilising and monitoring him as much as we could. A quick pulse check and alarm bells started ringing. It was 36 which in 16 year old with a head injury is a great concern. I did his blood pressure while my crew mate gained IV access and the bells continued to ring. 198/110. For his age he was severely hypertensive. Put those two observations with his head injury and development of irregular respirations and we had what's called Cushing's triad. That told us he had a raised Intracranial Pressure (ICP) which meant he was big big sick. I think his friends started to realise the gravity of the situation but despite this, they were fantastic. They phoned his parents, they got all his details, his allergies and passed us everything we asked for. I lost count of how many times they ran back and forward to the ambulance. We started bagging him as he began having prolonged periods of apnea. I looked up and saw 3 orange jumpsuits walking towards me! And breathe!

Good save! Hope he continues to improve...
ReplyDeleteE
Well done , and thank you . ( aka riiibbit )
ReplyDeleteI can hear my mum now- 'get down off there. There'll be tears before bedtime...' good save.
ReplyDeleteHe was intubated and immobilised and then hems decided not to RSI him? Am I missing something?
ReplyDeleteJ
Because of the head injury they felt that the RSI would risk raising the ICP to much. They discussed for what seemed an age and as he wasn't combative and tolerating a tube the decided to leave the RSI until at hospital under the monitoring of further specialists.
DeleteBut surely the raising of the icp is the passing of the tube not the drugs? Or have I got that base about apex?
ReplyDeleteJ
To be honest, I don't know! All I know is they didn't and that was the rationale I heard! Way above my paygrade!!
Delete