MVC with Pelvic Trauma: PFC Case Discussion 4

A U.S. service member sustains pelvic trauma secondary to a vehicle rollover in the middle of nowhere.  The patient complains of severe pain and you initially opt to control his pain with

morphine, and now you are unaware of the decrease in mental status.  Later, as you try to check on your sleeping patient, he has a decreased LOC, and does not answer questions. 

The scenario and following questions are meant to make medics rethink what we think we know.  No patches or right answers this time.  Perhaps some will spark a debate or discussion.  Maybe there will be issues that haven’t been considered or planned for. Talk through them now.  Put the time in to find the gaps in your knowledge, to find the answers.  If not the answers at least know where to turn when you need them. 

Would you treat pelvic trauma as a pelvic bleed until proven otherwise?

What is the plan for long term analgesia and sedation?

What could a slight increases in diastolic BP and changes in pulse rate? 

When was the last time an eFAST was trained?

Was the ultrasound signed out and taken?  How far forward?

Will you trend vital signs?

When would you do a repeat eFAST?

If a Foley were inserted, his UOP would have shown less than 30ccs for the last few hours. Are you clear on the indications to initiate FWB?

When would you stop?

At what point would you give TXA? 

Your larger, truck bag was on this truck and now destroyed what do you have in your smaller bag?

Will you put on an abdominal junctional tourniquet?

For how long will you leave it on?

Would you attempt to take it off?

Why or why not?

Would you call anyone for help?

What would you ask?

What is your plan for transport in your open back truck?