Clinical scenario: A freeway crash
How would you stabilize a patient with neck and chest pain following a motor vehicle collision?
By Patrick Lickiss
While transporting a recently discharged patient from the ED to a skilled nursing facility, you notice that freeway traffic suddenly slows to a halt. You hear dispatch assign another unit to a motor vehicle collision approximately half a mile in front of your location. You ask your partner if the transfer patient is still stable. She is, and you advise dispatch that you can respond to the freeway location.
As you approach the scene you see that the state police have already closed the left-hand lane. You turn on your emergency lights and pull past the incident to a safe location along the center divider. Putting on your reflective vest, you walk up and introduce yourself to the officer on scene.
According to the officer, there is a single patient who was the restrained driver of a full-size SUV. The driver suffered a blowout of one of his tires and slid across three lanes before colliding with the concrete divider in the center of the freeway. The vehicle has moderate damage and the front axle appears to be broken. The driver got out of the vehicle and walked approximately 25 feet before leaning against the divider.
As you introduce yourself, he tracks you visually and appears to be oriented. He has full recall of the crash itself. When asked if he has any complaints of pain, he states that his neck is “sore” and that he has “some chest pain.” He indicates that the pain is on the left lateral side and is making it hard to breathe.
You ask the state police officer to maintain inline immobilization of the patient’s head and neck. A rapid trauma assessment reveals tenderness to the neck and chest with no other trauma. The patient has strong radial pulses and clear lung sounds when prompted to take a deep breath. He has positive sensation and motor findings in all four extremities.
You relay your findings to the responding unit via the radio and are advised that they have a 10-minute ETA.
- What other physical assessment would you perform?
- How would you treat and package this patient for transport? Why?
Let us know in the comments and stay tuned for the conclusion of the case next week.