Author: David Leverton / Editor: Adrian Boyle / Reviewer: John Wilson, Ciaran Mackle / Codes: / Published: 16/10/2023
A 66-year-old male falls 6 feet from a step ladder on to concrete. On scene he is haemodynamically stable, his GCS is 15 and he is moving all 4 limbs.
On arrival to the local district general Emergency Department (ED) his primary survey is as follows:
A: patients own, triple immobilised C-spine
B: left sided chest wall bruising, sats: 95% on air, RR: 22, good a/e throughout
C: HR 98, regular. BP: 148/78
D: GCS 15/15, normal peripheral neurology all 4 limbs, right pupil: 3mm, sluggish to react to light left pupil: 2mm, brisk reaction to light BM: 4.8
E: Obvious lip and cheek lacerations, bruising and swelling over mid facial structures; no obvious long bone injuries; no actively bleeding wounds
Initial actions by ED team:
- 15L o2 applied via non rebreather
- Morphine analgesia titrated to pain
- Trauma CT arranged
