# 82 y/o Female involved in MVC



## emtchick171 (Nov 7, 2010)

Responded to a 2 vehicle MVC. Upon arrival, found 82 yr old female PT in her car. Her car had been t-boned on drivers side by an 18-wheeler, car was knocked approx 150-200 feet into a field, where it came to rest head-on into a light pole. 1-2 foot intrusion to passenger compartment from t-bone impact, complete dash deformity also, steering wheel deformity. Pt had positive LOC, on scene pt was awake but not responsive (eye opening). Placed pt in full c-spine immobilization & loaded onto ambulance. As I cut her clothes off, she began guarding left lower side of chest/abdomen. You could feel deformity from ribs and abdomen was not rigid (still soft to touch). PT only medical history, is HTN. 


Vitals Initially: B/P: 184/94  Pulse: 100   Respirations: 18   O2sat: 95% RA  BGL:12

Vitals 2nd: B/P: 124/76   Pulse: 84    Respirations: 18    O2sat: 100% 15lpm 

Vitals 3rd:  B/P: 136/80   Pulse: 82    Respirations: 18    O2sat: 100% 15lpm

Vitals 4th:  B/P: 144/88   Pulse: 82    Respirations: 18   O2sat: 100% 15lpm

Vitals 5th:  B/P: 178/98   Pulse: 82    Respirations: 18   O2sat: 100% 15lpm


Had 2 IVs established, 1 of normal saline, 1 ringers 18gauge. Secured possible flail chest with 5x9 ABD pad. 

Rapid Transport to hospital. At hospital, Doctor inserted chest tube, and placed pt on ventilator after pt was sedated. 


questions on what you would have done for pt???


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## gicts (Nov 7, 2010)

how were her breath sounds, pupils, and what was the transport time? Was her BGL really 12, or is that supposed to be her GCL? 

With a pressure like that and possible head trauma, how were the fluids running?


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## emtchick171 (Nov 7, 2010)

gicts said:


> how were her breath sounds, pupils, and what was the transport time? Was her BGL really 12, or is that supposed to be her GCL?
> 
> With a pressure like that and possible head trauma, how were the fluids running?





Breath sounds were clear and equal, no sea-saw breathing. Fluids were at a TKO rate, sorry typo. BGL was 112. Pupils were equal and reactive.


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## Veneficus (Nov 7, 2010)

it really helps to have the GCS.

individually


a lot.


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## emtchick171 (Nov 7, 2010)

veneficus said:


> it really helps to have the gcs.
> 
> Individually
> 
> ...





gcs: 11


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## Veneficus (Nov 7, 2010)

Veneficus said:


> it really helps to have the GCS.
> 
> *individually*
> 
> a lot.



so how does the 11 break down?


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## emtchick171 (Nov 7, 2010)

Veneficus said:


> so how does the 11 break down?



Eyes: 4 (spontaneous)

Motor Response: 5 (localizes painful stimulus) 

Verbal: 2 (incomprehensible sounds)   (grunting mainly)


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