Clinical scenario: 15-year-old female with traumatic injuries

You are asked to respond to the nurse’s office at a local high school

"Medic 2491, respond with Engine 2444 to the office at Central High School on Main St. There’s a report of a 15-year-old female there with a controlled hemorrhage."

You are met at the entrance to the school building by a woman who introduces herself as the school principal. She leads you back to the nurse’s office where the school resource officer introduces you to a student, Alicia. The teenager appears upset and has obviously been crying but appears conscious and alert and is not having any obvious trouble breathing.

As the engineer from your crew starts to take vital signs, he finds that both of Alicia’s forearms have a series of parallel lacerations in various stages of healing running from her wrists to her elbows. There is no active bleeding at this time though some of the cuts appear new. The school resource officer, who is a police officer assigned to the school, asks to speak with you outside the nurse’s office.

When you walk into the hallway, the officer advises you that Alicia is an excellent student and is not routinely in trouble at school. He tells you that Alicia told the school counselor that her parents are getting divorced and that she has been asked by each parent to live exclusively with them. The officer shakes his head and says, "I just can’t imagine a girl like her trying to kill herself."

You nod and walk back into the office where your crew has finished primary and secondary assessment. Alicia’s vital signs are:

  • BP – 112/66
  • HR – 92
  • RR – 20
  • SpO2 – 99% RA

Your crew only found the lacerations previously noted on Alicia’s forearms and state that the bleeding was controlled prior to your arrival. Both arms have been wrapped in sterile dressings. Your captain advises that the transport unit has been downgraded to Priority 2 and that they have a 12 minute ETA.

Think about these questions as you consider what to do next:

  • What are some potential concerns about Alicia’s presentation?
  • What other assessments would you perform?
  • What are some precautions you should advise the transport unit to take during the trip to the hospital?
  • What is your working diagnosis?

Post your answers below in the comments and view the clinical solution for this patient.

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