Head-on 30mph impact, not restrained, airbag deployed. Steering wheel bent.
A: Clear
B: Rapid, weak, shallow, BS clear
C: Rapid, weak radial pulse; 3 second cap refill; no visible bleeds
D: Response V, anxious, confused, PEARL
E: No findings; patient cold and shivering
Cause: internal bleeding, shock, chest trauma
Changes: circulatory shutdown, u/c unless O2 given quickly
Side-on impact on his side, restrained, no airbag. Legs trapped under dashboard.
A: Clear
B: Rapid, normal, BS clear
C: Rapid, normal radial pulse, cap refill OK. Serious venous
bleeding from left leg.
D: Response A, anxious, in considerable pain.
E: Open fracture of left tib/fib, deformations around kneecaps.
Cause: fractures to lower limbs, emotional shock
Changes: pain increases, shock develops unless bleeding stops
Head-on 40 mph impact, not restrained. Went through windscreen, lying face-down on car hood.
A: Noisy, blood and teeth
B: Slow, deep, BS clear
C: Pale face, warm dry arm skin, no external bleeds
D: Response U
E: No muscle tone from abdomen downwards
Cause: low C-spine fracture from contra-coup against windscrren
Changes: if moved, respirations stop; if airway not cleared, resp and circulatory arrest
Picked fight with rugby player in drunken stupidity. Got beaten around head and lost.
A: Clear, a few teeth gone, bleeding nose
B: Rapid, normal depth, BS clear
C: Rapid strong pulse, slowing
D: A but sometimes talks nonsense, dizzy
E: Strong smell of alcohol, bruising all around head
Cause: alcohol, concussion and a subdural haematoma
Changes: lowering LOC, goes u/c immaterial of treatment, postures and pupils go wide
Argument about possession of a boyfriend. Opponent wielded kitchen knife and plunged into left upper chest. Knife still in there.
A: Clear
B: Rapid, shallow, frothy blood on lips. Left lung
very noisy.
C: Pulse 100+, weak, cap refil 3s, sweaty pale skin
D: Numbness in left side below waist
E: No other wound visible, casualty cold and shivering
Cause: Knife penetrated lung and damaged spinal cord
Changes: Tension pneumo / haemothorax in left lung develops
Argument at a hunt meeting; shotgun (small shot) discharged accidentally at range of 5m into abdomen and legs of saboteur
A: Clear
B: Hyperventilating, breath sounds clear
C: Pulse 120+, normal. Cap refil 2 seconds
D: Can't move due to pain in abdomen and legs.
E: Lots of small wounds with shot all over abdomen and
upper legs. Substantial capillary blood loss.
Cause: Obvious
Changes: None, no threatening injuries
Lift power accidentally restored while workman in shaft. Both legs trapped between car and wall; been there 15 minutes.
A: Clear
B: Rapid, normal, BS normal
C: Rapid normal pulse, no external bleeding,
CR normal
D: Response A, in severe pain, legs deformed
E: No circulation or motor control past pelvis
Cause: Multiple bilateral fracture, pressure on blood vessels
Changes: Rapid collapse if released (crush syndrome)
Oxy-acetylene cylinder detonated in lab. Worker blown halfway across lab and burned.
A: Noisy, burns around face and mouth
B: Rapid, wheezing, BS noisy left, silent right
C: Rapid normal pulse, no external bleeding,
CR hard to get due to burns
D: Response P
E: Partial thickness burns on head, front torso and
front of arms
Cause: Airway burns, surface burns, right lung blown out from blast
Changes: Pulse speeds up and weakens as shock sets in, breathing speeds up and becomes shallower as airway swells
Worker falls through roof 30 foot to concrete floor, landing on back.
A: Clear
B: Very rapid (40+) and shallow, BS noisy
C: Pulse 110 and weak, skin cold and clammy, CR 3s
D: Response V, unable to move below arms, PEARL
E: Pelvis clearly misshapen
Cause: "Paper bag" lungs, pelvic fracture
Changes: will resp arrest unless breathing assisted and O2 given
Lost control of direction and hit a tree at bottom of trail. Was travelling very quickly.
A: Noisy, blood and teeth
B: Resp rate 38 shallow, breathing painful, BS clear
C: Weak radial pulse of 120
D: Response P
E: Deformed right knee, helmet damage
Cause: Flail chest
Changes: Pulse slows and stops unless respiration assisted
Linebacker blocked hard, does not get up again. Wearing helmet with faceguard.
A: Snoring respiration
B: Rapid, laboured breathing
C: Strong, rapid radial pulse
D: Response U
E: No obvious trauma
Cause: Concussion causing u/c and partial blocked airway
Changes: Stops breathing unless airway cleared.
Patient was knocked u/c by banging head on back wall while reaching for a shot. Recovered after a minute u/c
A: Clear
B: Normal, clear BS
C: Normal
D: Response A, PEARL
E: Pulse 90, resp rate 16, BP 120/70
Cause: Concussion
Changes: None, but remember possibility of slow haemorrage in brain
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