You are the anaesthetist on call at a trauma centre and you are asked to assist with the management of a 72-year-old male pedestrian who has been involved in a motor vehicle accident (MVA). He was struck by an oncoming car travelling at 60 km/hour.
He has extensive pelvic and lower limb injuries and is conscious but confused, pulling his oxygen mask off. You notice he smells strongly of alcohol.
Observations
HR 128 bpm
BP 89/48 mmHg
RR 16 breaths per minute
SpO2 92% on room air
Estimated weight > 120 kg, estimated BMI >45 kg/m2
GCS 12 (E3 V4 M5)
Investigations
BSL 11.7 mmol/L
Point of care haemoglobin 87 g/L
Treatment pre-hospital
18G IV access in situ (difficult intravenous access on scene)
1000 mL normal saline given intravenously
Cervical collar and pelvic binder placed
Treatment on arrival
Primary survey underway
1 unit O negative packed red blood cells in progress
Sections covered in this viva
Section 1 – Initial assessment and stabilisation of a multiply injured, obese and intoxicated trauma patient with hypotension and altered consciousnessSection 2 – Airway management in a shocked, obese, and intoxicated trauma patientSection 3 – Ongoing haemodynamic management and decision-making regarding damage-control surgery