Clinical Case 135: Tackling Trauma in the Bush
October 24, 2016
This vodcast is a version of the talk I gave last week at the ACEM Annual Scientific meeting in Perth.
We were asked to present a “challenging case” – I decided to present a trauma case that I think represents the maturation of my trauma practice.
The case is pretty straightforward. However, there are a few concepts thrown in that you may not have heard before. Airway management, massive transfusion, head injury… it is a tough case.
Let me know what you think or if you have any comments.
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About The Author
Casey Parker
I am a GP working in Broome, NW of Western Australia. I work as a hospital DMO (District Med Officer) doing Emergency, Anaesthestics, some Obstetrics and a lot of miscellaneous primary care. Also on the web as @broomedocs | + Casey Parker | Contact
5 Comments
Hi Casey, That was great thanks. Can I just ask you a couple of things – I just wanted to ask about c-spine. How did you know he didn’t have a c-spine injury? Did you check and know that he was unlikely to have a neck injury from your first assessment and would your management have changed if you thought he did?
2. Are cell savers used and useful where you are for haemorrhage?
Hi ROBYN
In major trauma we assume c-spine injury until cleared- maintain position with manual in- line stabilisation then sandbags etc once intubated
It is basically impossible to clear the C-spine in rural areas in the context of massive injuries and urgent intubation/ sedation. ICU do this later
We do not use cell savers anywhere rural in WA. I’m not sure about city centres but they are used in tertiary obstetrics
Casey
Is the 2.6x number ISS-matched?
Here’s the audit paper
https://www.flyingdoctor.org.au/assets/files/Comparison_of_Metropolitan_vs_Rural_Major_Trauma_in_WA_Fatovich_et_al_1.pdf
I spoke to Prof Fatovich at the conference. The data does not include people who died prehospital or in the rural hospital- so probably underestimates true rural case fatality rates given the larger proportion of MVAs in rural setting
C