Traumatic haemothorax
candidate brief
You receive a pre-alert for a 20yo stabbed in the chest, hypoxic and tachycardic, ETA 5 minutes.
actor brief
You are 20yo Jake. You got in a fight today in your workshop with your friend, who as a result stabbed you once in the chest with an awl. He ran away when he saw the blood but your girlfriend, who was also present, called an ambulance.
examiner brief
Patient stabbed in chest 1x with awl (= narrow wound).
Ambulance interventions: 15L high flow oxygen, Russell chest seal over wound on left side of chest, 1L normal saline
Not conveyed to MTC as this was the nearest trauma unit.
Initial obs:
SpO2 90% on 15L, RR 30
HR 130, BP 100/70
GCS 15/15 though agitated due to pain - if analgesia is offered, he calms down
O/E:
Decreased air entry, decreased chest rise on left side
Heart sounds - difficult to appreciate in noisy resus
No distended neck veins
Wound is around the 3rd intercostal space, not actively bleeding
If drain is not sited, patient becomes more breathless and hypoxic ?deteriorating to arrest
If drain is sited, it immediately drains just under 1L of blood
At minute 7, the surgical registrar appears and asks for a handover
- Wash hands, introduce self to patient and nurse
- Confirm patient identity
- Confirms team competencies
- Takes handover and appropriate history
- Puts out trauma call
- Facilitates primary survey
- Appropriate interventions:
- Prepares for surgical chest drain insertion
- Prepares for transfusion
- TXA
- Considers other sites of bleeding
- Recognises potential need for cardiothoracic intervention depending on hourly output
- Requests appropriate investigations
- Hands over to surgical reg
- Leads team well
- Global mark from examiner