Case Discussion #3: Fall With Lung injury

Carl sustains a Blunt LUNG injury from a fall from height. He complains of rib pain, but no obvious fractures. Other than tachycardia, his initial vital signs are within normal parameters.  Four hours into the situation, he has an obvious decrease in his pulmonary status (i.e. increasing RR, decreasing SpO2, increase work of breathing, etc.). 

Beside the rules we have already been using you will have Carl as your patient for 48 hours including an 8 hour evac flight on a “slick” C-130. Just you and Carl…

Will the medic opt to put in a chest tube? 

When the chest tube does not help, what are his next actions?

If he does put in a chest tube, is he prepared to put one in properly with clean technique? 

Does he know how to troubleshoot the tube? 

Is he prepared to intubate?

Cric?

What medications will he use? 

Is he ready to Bag the patient for 48 hours with PEEP?

What will his report sound like if he calls for help?

Will he use a Telemed Script Cheat Sheet?