Clinical Case 135: Tackling Trauma in the Bush

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.



  1. 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

  2. Is the 2.6x number ISS-matched?


  1. […] a brain injury, we need a CT.  He needs a tube…  so we do a brain-sparing intubation (see Clinical Case 135).  He passes through the doughnut of death unharmed (aside from a few milliSeverts). […]

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