Case #1 Trauma Emergency Adult

You are called for a 19 year old man shot in the abdomen. You find him lying supine on the sidewalk. He
is conscious, alert and crying out "I cant move my legs". There is entrance wound just to the left of the
umbilicus and no where to find an exit wound. On examination, sensation is absent from toes up to the
bottom of the ribs. The patient cannot move either legs, flush in appearance but he has normal strength
in both hands.V.S are pulse 60 regular, RR 24 shallow, BP systolic 70, skin is warm and dry.

Scene size-up

-SCENE SAFETY - Establish scene safety confirm with policeman in charge of the scene and assess for
clues if the assailant is present

-BSI on

- MOI: gunshot wound

- NO. OF PATIENTS: check for other patients

-ASSESS FOR A NEED FOR ADDITIONAL RESOURCES: ALS for possible hypovolemic shock due to gunshot
wound, police

-CONSIDER C SPINE STABILIZARION (MANUAL): no need

Initial Assessment

LOC-AVPU: conscious, alert and crying out "I cant move my legs"

CABDE:

Problems

C-PR 60 normal (60-100),BP 70 -inadequate (normal up to 80)= candidate for load and go

A-No problem in airway - Patient shouted

B- RR 24 but Shallow (problem in ventilation)= manage ventilation using BVM or ATV; reassess after

Transport decisionpriority 1: Surgical intervention: Load and go, place vacmat on stretcher, utilize scoop
stretcher to place patient on vacmat.

Secondary assessment:

In ambulance

Rapid trauma assessment, DCAP BTLS PMS

Sample data: unknown (not given)

Baseline vs: (given)

Threats:

Circulation place patient on modified shock position, Possible spinal shock, possible Hypothermia keep
patient warm

Airway:Check SPO2, Manage shallow ventilations use BVM, Administer 02 if not managed by
ventilations.

Manage Bleeding, apply pressure on wound

Transport

No siren, keep ambulance in spinal speed.

Detailed PE Reassess VS

Contact medical control

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