As you start work, you wonder where your end-of shift colleague is. The question is answered when the curtain for bay 2 is pulled back and you see her intubating a young man. She tells you he arrived by ambulance for ?burn care.? He fell 12 feet to the ground after his mop pole touched a power line above the semi-trailer he was cleaning. There are minor burns to his hands and chest wall, but more worrisome is the pink fluid draining from his ears and nose. As you assess the patient, you wonder how best to prioritize the patient’s workup…
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Where would you begin?
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Last Updated on January 26, 2023
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Head Injury…..base of skull fracture with CSF leak. quick neuro exam, Intubate for airway safety, CT head,
CT scan head and neck
the patient’s airway needed to be secured while protecting C-spine. After that, the ABCs suggest evaluation of his breathing with auscultation, inspection and pulse oximetry/capnography. Next would be a quick review of his vital signs while checking for end-organ perfusion to ensure circulation. depending on the evaluation for shock, the patient may need a FASTexam. the next priority would be neurologic evaluation: pupils, GCS, and looking for signs of laterality. Some of this might be gleaned from how the patient looked after the fall and whatever capacity he might have prior to intubation. Next would be complete exposure, evaluation of the back. Identification of burn points and burn size. At this point, neurosurgery should be informed there is a patient with evidence of basilar skull fracture. If he was hemodynamically normal at this point, I would plan for a CT of the head and neck.
I woul dispose a neurological Evaluator and, of positive, I world Asia a brain CI to rule out a subdural Hematoma
Agree with Dan Field. Follow ATLS algorithms prioritizing ABCs. Then D and E to further assess for other possible injuries. Certainly basilar skull fracture is the concern with drainage of pink fluid from his ears and nose. Even if CTH does not show a fracture, Neurosurgery should be involve due to concern for for occult fracture.