A 68-year-old male presents to ambulance crew

A 68-year-old male presents to ambulance crew through emergency call after falling from his bicycle at an unknown speed. Patient was cycling on quiet country road when he fell from his bicycle. He was not wearing a helmet at the time. His friend found him semi-conscious on the road. He was placed sitting in a car that stopped to help where he was still sitting on arrival of ambulance crew. Initial Clinical Findings Airway – partially obstructed, large amounts of vomit evident. C Spine – suspected (MOI: fall, altered LOC) Breathing – regular Circulation – Pulse present, regular, skin color pale, cap refill delayed (>2 sec) Disability – LOC before ambulance arrival; patient experiencing periods of lucidity, alternating with responding to voice Clinical Impression Head injury secondary to fall AMPLE History A No known allergies M Currently taking ant-hypertensive medications P History of hypertension, investigated for right sided weakness 2/52 previous to event L Last oral intake lunch earlier that day E Found semi-conscious on road after fall from bike, no evidence of collision with vehicle Observations: HR 58, regular RR 20 per minute, normal, regular SaO2% 99% on 15lpm via NRB Cap Refill >2secs BP 136/101 Pupils Left size 3, reactive. Right unreactive, (damaged in surgery) GCS 15/15 (E4, V5, M6) BGL 250 What is your clinical impression? What are your treatment priorities and what treatments would you initiate for this patient? Discuss prehospital treatment priorities for traumatic brain injury. Discuss the risks and benefits of advanced airway management, including endotracheal intubation in prehospital patients with TBI.

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