MVA (Blunt Trauma)

Question 1

A 33-year-old man is brought to the ED with marked shortness of breath and chest pain following a motor vehicle accident. How would you assess and manage him?

Impression/DDx/Goals

Answer 1

Impression
Concerned about ?tension pneumothorax/chest-wall fracture/flail segment in setting of MVA trauma

Important Ddx/RED FLAGS

• Cardio: AMI, Dissection, AAA, tamponade
• Resp: PE, pneumothorax, haemothorax
• MSK: Cervical spine injury, other fractures
• GIT: splenic rupture, perforated viscous
• Neuro: head trauma, TBI, bleeds

Goals:

• ABCDE approach and stabilise haemodynamic instability
• Primary survey, secondary survey
• Prior to patient arrival, assemble trauma team and allocate roles
• Identify injuries and manage accordingly, appropriately disposition the patient

Question 2

MVA - History

Answer 2

In the setting of trauma, would implement a MIST AMPLE style of history:
M - mechanism
I - injuries sustained
S - signs/symptoms/severity
T - Treatments already administered
A - allergies
M - medications
P - past history
L - last meal
E - environment

Question 3

MVA - Examination

Answer 3

Assessment/Examination

• A to E assessment, would be conducting interventions concurrently
• Airway - obstruction, immobilize C-spine
• Breathing - sats, check equal air entry (exclude pneumothorax), RR
• Circulation - bleeding, BP, HR, large bore IV access, IO if unable on initial attempts
• Disability - GCS/AVPU, PEARL, weakness (SCI), glucose
• Exposure - examine for further injury, log roll

Question 4

MVA - Investigations

Answer 4

Investigations:

• Bedside: vitals, POC VBG (Hb, lactate, pH, glucose, electrolytes (Na/Ca/K), eFAST scan, ECG → Cardiac differentials
• Bloods: FBC, EUC, group and hold, coags
• Imaging: eFAST (pneumothorax, haemothorax), trauma series x-rays (CXR, abdo/pelvic, thoraco-lumbar), CTB/Spine

Question 5

MVA - Management

Answer 5

Management:
Dependent on
- Haemodynamic stability: fluids, MTP if needed
- If tension pneumothorax: needle thoracostomy/chest drain(s) (triangle of safety)
- Other life-threatening differentials as appropriate
- Call surgeons/ICU for additional support,

Consider
- may require retrieval to tertiary trauma centre following stabilisation depending on time of presentation/ availability trauma theatres staff/ extent of injuries