som
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UW que:
36 old female jumped frm 2nd floor is brought to the ER had a tibial fracture. she is unconscious with blood coming frm nose, eyes closed, PERRL. makes muffled sounds, responds to pain by opening eyes n moving all limbs. after initial resucitation, next step of Mx:
CT head
X ray left leg
Xray head
Xray spine
LP
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| drk1980
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CT head if i rmber correctly. Coz of bloody rhinorrhea.....skull base fracture shd be r/o.
,.....on second thots...it just might be xray spine to r/o cervical spine injury!!
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| som
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drk1980, ur second thoughts r right here. initially i thought of CT head but UW says it's imp to r/o cervical spine injury...so, do a xray spine then CT head unless the option gives CT head n spine combi.
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| achilles
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and just to add...the pt here is not stable and we dont usually sent a pt for CT unless the pt has been stabilised.
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| achilles
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and i just have a query here...what if this pt was also tachyapneic but anyways she is unconcious so we also need to protect her airway...so which should be the preferred method of establishing the airway in this pt with head injury considering that she must be having a Cx spine injury also.
even if she is not tachyapneic should'nt we establish the airway first just because she is unconcious(but obviously if establishing the airway was in the choices, then would that be the next step and in that case how would we establish the airway). just trying to hypothesize a situation for better understanding.
we cant do an orotracheal intubation in an unconcious pt with head injury. nasotracheal ? or is it cricothyroidectomy ?
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| msyamp
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http://www.madsci.com/manu/trau_air.htm
Hi achillis here is an excellent explanation of the situation. no controversy
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| som
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kaplan says the emerg CT can be done as fast in 7 mins..any comments?
that's a nice link msyamp...thanks
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| achilles
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thanks msyamp for clearing the confusion. that was a useful link.
som, i think however fast yu can do the CT, it still will not be an option for an unstable patient. what if something happens to the pt on the way to CT. not until there is a CT scan right there in the ER like sonography is nowdays. maybe others will add more to this. lets wait.
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" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
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