Multicasualty Drunk Driving MVC | Figure 1

thewildrn

Registered Nurse

Multicasualty Drunk Driving MVC

Two ER nurses driving home witness head on collision of SUVs each travelling ~35mph. Nurses pull over and identify 4 wounded.

• One male crawls out and runs.
• One female sits buckled in passenger seat with airbag deployed is AAOx4, texting.
• One male crawls and sits in curb, covered in blood and giving okay sign.
• One male witnessed to fall out passenger window is crumpled with bloody shirt over head and unresponsive.

Nurse A removes shirt from head and begins primary and secondary trauma assessment. Man begins to mumble and respond to pain, eventually stating his name, though slurred and with strong scent of alcohol. The only other remarkable finding is that his thumb cannot be located.

Nurse B helps with crowd control (~100 on busy street, friday night) and tasks someone with calling EMS, checks on other victims and returns to assist with translation/LOC assessment.

Police arrive ~10 minutes in and tape off area begin identifying witnesses.

EMS arrives ~20 minutes in for transport to trauma center 40 minutes away.

Care transferred to paramedic. Nurses continue home wondering how this story ends.

Questions

• What do you keep in your car for roadside emergencies?
• What would your next step be in managing this patient's care?

More about this case

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A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?