CASE STUDY

MVA TRAUMA

Code 3 Trauma Team Activation

December 12, 2006, around 11 a.m.
MVA rollover with three teenage females
involved.
The teens were reported to be driving around on
their lunch break from high school. Later
investigation discovered that the three girls were
Huffing or Dusting which is when someone
inhales gas from a compressed can of air that is
usually used to clean computer keyboards.
The car left the road at a high rat or speed,
traveled greater than 300 feet, with multiple
rollovers, finally impacting a telephone pole.

Patient Medical History/ Physical

Examination:

No known drug allergies.

On arrival into the ER the patient had a:
pulse rate of 121
blood pressure of 125/61
respiratory rate 20-22
O2 saturation of 96% on a nonrebreather.

ON THE SCENE PICTURE OF

THE PATIENTS VEHICLE

Chest x-ray:
film critique
Two flat plate AP Chests were obtained pre and postintubation by placing a 14x17 film lengthwise underneath
the backboard of the patient.
The findings from this were:
a normal heart, the mediastinum is not wide
lungs are normally aerated without disease
no fractures are demonstrated
chest x-rays have adequate density and contrast
The lungs include the required anatomy, which includes
the apices of the lungs to both costophrenic angles.
Since the patient is on a backboard and the spine has
not been cleared the patient is not in the upright
positioned for both chests.

C-Spine Film Critique

Two cross-table lateral cervical spine x-rays
were performed. (the first view was not low
enough to demonstrate all seven cervical
vertebra.)
In the second radiograph you can see that the
patient was intubated. There is reversal of the
cervical lordosis without evidence of subluxation
or fracture.
The pre-intubation view reveals no evidence of
soft tissue swelling.

Femur Critique
The articulation with the hips are normal.
There is a comminuted, butterfly type,
fracture of the middle one-third
The backboard strap obscures the
proximal knee joint.
The distal joint is cut off.
Film is acceptable for trauma

Pelvis Critique
demonstrated normal articulation of the
hips.
The backboard obscured some areas in
detail.
There is a left pubic fracture with slight
comminuted (small particles of bone). The
break involves the body of the pubis and
likely the rami.

Glasgow Coma Scale

is a neurological scale which seems to give a reliable,
objective way of recording the conscious state of a
person, for initial as well as continuing assessment.
A patient is assessed against the criteria of the scale, and
the resulting points give the Glasgow Coma Score (or
GCS). It has value in predicting ultimate outcome of the
patient.
The scale comprises three tests: eye, verbal and motor
responses. The three values separately as well as their
sum are considered. The lowest possible GCS (the sum)
is 3 (deep coma or death), and the highest is 15 (fully
awake person).
(http://.en.wikipedia.org/wiki/Glasgow_Coma_Scale)

The Patients rating on the GCS

Initially the patient could open her eyes in
response to voice, giving her a 3. The patient
had inappropriate but comprehensible words,
giving her a 3. The patient had localization of
painful stimulus, giving her a 5, for a total initial
score of 11.
Aproximately 90 seconds later the patient didnt
open up her eyes giving her a 1. No
verbalizations, giving her a 1, and she did not
obey commands, giving her a 1.

CT SCAN FINDINGS
Right Femur Fracture
fracture of the left pubic bone at the
symphysis pubis
Significant closed head injury
Right lung pulmonary contusions
transverse fracture of the posterior aspect
of the right 10th rib

CT technical factors
A 21 cm FOV (field of View) and a window width
of 3077 was used for the head scans.
The cervical spine was scanned helically without
contrast. Axial, sagittal, and coronal 3-D
constructions were created for review. A 12 cm
FOV was used for this scan with a window width
of 3077.
The chest, abdomen and pelvis scans used a
FOV of 36 cm with a window width of 545.

Ultrasound Findings
A limited abdominal ultrasound and lower
extremity Doppler venous ultrasound was
ordered.
The limited abdominal ultrasound study was
ordered to evaluate free fluid in the abdomen.
A very minimal amount of free fluid was
demonstrated in the pelvis, which is not an
abnormal finding in a young female.
The radiologist reported no evidence of a DVT in
the right lower extremity or the left thigh.

Emergency Room Decision:

The patients were transport the patient to
Emmanuel Hospital for further care. The
latest update on the patient was that she
was moved to fair condition at Emmanuel
on December 11, 2006.