Invasive venous catheterization of criticly ill patient - 2019
As an ambulance doctor you arrive at a car accident where the car crashed to a tree sideways. The only person involved, young driver, is injured but conscious, suffers from dyspnea, pain in the lower abdominal region and a left lower extremity. You track patient's status using a vital sign monitor. What´s your next step?
The patient is in danger of shock, due to both bleeding and a suspected pneumothorax, therefore early central venous line securement is in order. After the central line is secured we provide a cervical collar and stabilize the fractures.
First, we provide an oxygen mask, cervical collar, pelvic sling and a femoral splint to immobilize the left femur, second we secure 2 peripheral venous lines for the analgesic and crystaloid infusions.
We provide an oxygen mask, cervical collar is not indicated, since the patient shows no signs of spinal trauma. Next we stabilize the fractures and secure a peripheral venous line.
man
RR
30 /min
HR
102 /min
SpO2
93 %
BP
99/55 (70) mmHg
Examination
The patient is conscious, confused, with no signs of memory loss, has not been unconscious, head and neck show no signs of trauma. Crepitations and decreased lung sounds detected rightwards and distally. Also, very significant deformity of left femur and pelvic crepitations are observed.