W/F 40 ish in hospital SP MVA. pt unresponsive, gray bp 54/35 HR 56, O2 sat 60% on 10L with cervical collar. Injuries FX femur, lacerated Kidney, ruptured spleen, lacerated liver.
2 18 G IV for access. GOOD MORNING!!!
In or monitors on induction 250mg ketamine 150 fentanyl with 50 mg rocuronium, Intubate with collor on using bougie end tidal, 20 mg ephedrine bag to 100% as tell surgeon to cut. in 30 min get 4L LR with 4 Units type PRBC. surgeon removes speen packs kidney and liver, pt to ICU extubated and then transferred to local trauma center in the evening. Rural hospitals get their share.