PHEM: A day as a Prehospital Emergency Medicine observer

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Question 1 of 3

1. Question
Your first patient has features of airway compromise and requires immediate intervention.

Which of the following patients has the strongest predictor of a difficult airway, when considering the decision to perform a drug-assisted intubation?
- A 45-year-old male with acute severe asthma. He's had two previous intensive care admissions and currently in impending respiratory failure.
- A 23-year-old female patient with hanging and ligature marks on their neck
- A 32-year-old male had an opioid overdose, he has a long neck and mouth opening of three finger breadths
- A 40-year-old female with a history of a recent rapid sequence induction for an emergency appendectomy and required Sugammadex post-operatively
- A 27-year-old male with Down's syndrome and deep partial thickness burns to the left side of his face
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Question 2 of 3

2. Question
The next patient you encounter is a 35-year-old female, a cyclist involved in a road traffic collision. She has had a traumatic chest wall injury. You discover an open wound to her right lateral chest wall.

She has absent breath sounds on the right anterior chest and distended neck veins.

Her oxygen saturations are 84% on 15L high-flow oxygen, and she is hypotensive and tachycardic.

Which of the following options should be the next immediate intervention for this patient?
- Apply a three-way occluded dressing on the affected side and continue the primary survey
- Insert an open chest drain immediately bilaterally
- Secure intravenous access followed by rapid infusion of intravenous crystalloids to correct hypovolemia
- Needle decompression at the second intercostal space, midclavicular line on the right side or finger thoracostomy at the fifth intercostal space, midaxillary line
- Secure the airway with a drug assisted or rapid sequence intubation
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Question 3 of 3

3. Question
Your next patient was drilling on a construction site and now is having catastrophic bleeding from a puncture wound accidentally sustained to his right mid-thigh. Despite haemostatic dressings and a tourniquet applied near the injured site, bleeding is profuse. This patient is known to take Apixaban for atrial fibrillation.

What is the next best course of action?
- Do a primary closure of the wound at the scene
- Transfuse blood products and prepare for transfer to a major trauma centre for surgical intervention
- Apply a second tourniquet to the limb more proximally
- Complete the primary survey to find another source of bleeding
- Avoid reversing Apixaban as it may increase the risk of stroke
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PHEM: A day as a Prehospital Emergency Medicine observer

PHEM: A day as a Prehospital Emergency Medicine observer

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