Motor Vehicle Accident with Acute Stroke and Trauma

You are part of the trauma team at a metropolitan hospital. You are notified that a 67-year-old woman is being brought in by road ambulance after a motor vehicle accident. She was the driver and sole occupant of a car that veered off a country road and down an embankment. The extraction was complicated, and it is now three hours since her initial injuries. On arrival, her airway is patent, and her cervical spine is immobilised. She has two 16G IV cannulas in situ. Paramedics hand over that she is confused and has weakness in her left arm and leg. Prehospital eFAST is positive, with free fluid in the pelvis. She has an open fractured right tibia and fibula. Vital signs: HR 105 bpm (atrial fibrillation) BP 220/110 mmHg RR 24 breaths/minute Sp02 98% (6 L/minute oxygen via mask)