Patient is a soldier wounded by a staircase collapse and fall while exploring a building in a urban warzone. Participant is part of a unit exploring an abandoned building, and patient from participant’s unit has fallen ~12 feet onto a concrete surface due to the collapse of a staircase. Patient’s helmet was torn off during the fall. Participant starts case at patient’s side, with patient initially awake, but confused, GCS 14. After initial evaluation, including having an NPC soldier hold Cspine and having another NPC solder perform the log roll, which shows a benign CTL exam but possible depressed skull fx in the occiput, then patient rapidly deteriorates. Reevaluation shows a blown R pupil, and if ocular US is used edematous optic nerve sheath is found bilaterally. If the patient is not intubated, they aspirate and go into hypoxic cardiac arrest. If intubated, the patient survives. If available, IV mannitol or hypertonic saline should be given and the patient should be slightly hyperventilated to a target etCO2 of 30 – 35 mmHg (or 20 breaths per minute).
Emergency medicine, Prehospital, Trauma
Not For Purchase