MVA with chest pain

[EPmedic]

Hello everyone been practicing some scenarios while I sit at an airport awaiting a flight back overseas to work.... its been a long time since I have been in a classroom.

Here it goes, also all the medics here are at least EMT-I, with a few military medics thrown in...

You arrive to the scene of an Humvee accident. A female Command Sergeant Major has lost control of her vehicle and driven into a ravine at a slow rate of speed. She is complaining of chest pain, and skin is cool, moist, and pale. She is having difficulty breathing. Your first assessment, you find a seat belt imprint on her chest.

Her vital signs are B/P 178-90, HR 104, R 22, and pulse oximetry is 95%.

She has numbness and tingling down her left arm

Age: 55 years old

Prior history: she tells you she hurt her back a week ago

How do you treat this patient?

[EPmedic]

hmm, im going with spinal proticals, o2, pulse ox, IV TKO, GCS and vitals.. a lot of times though overseas i dont have nitro.

[Arctickat]

Just wondering, why does it matter that she's a Command Sergeant Major? Does that modify your assessment or treatment in any way?

I think she has pericarditis.

Edited December 14, 2012 by Arctickat

[EPmedic]

no it does not matter at all, its just the way it was written. guess because its miltiary

[ERDoc]

Why are you participating in your own scenario? Which came first the chest pain or the MVA?

[island emt]

Kat is always looking for the elusive pericarditis case. :-}

How big of a ravine? 10 feet or 100 feet? steering wheel bent or deformed?windshield intact? LOC?

Rib cage intact. lung sounds equal?quick set of vitals.

What does her presentation show as to history. recent problems beside back pain, co-morbitities, Medications prescribed?

[DFIB]

Welcome to EMT city EPmedic. Good on you for starting a scenario with your first post!

So tell us about our soldier patient,

When did her chest pain begin?

Has her chest pain been evaluated before?

What was the nature of her back injury and the MOI that caused it?

At what level was her back injury?

Is the Command Sargent Major an overachieving hard charger that may have ignored that might have neglected to report a injury?

Was her back injury evaluated?

Did she have tingling in her arm before the accident?

Did she have difficulty breathing before the accident?

Why did she loose control of her vehicle? Was the loss of control of the vehicle provoked by an existing medical condition?

Edited December 15, 2012 by DFIB

[EPmedic]

Chest pain began just before the accident causing her to loose control of vehicle, and drive off road down ravine 50 feet, hitting small bumbs and holes on the way down. until coming to rest. steering wheel is not best, and seat belt is still on, when seat belt marks on chest.

no prior history of cardiac problems.

She started noticing the tingling and breathing problems after she stopped.

Prior back injury, seems to be from lifting something to heavy she says, and she did not go to medics to have it checked out, only taking OTC meds for the pain.

[ERDoc]

Ask the the typical chest pain questions since this is more likely to be something medical since it started before the trauma. Can she tell us a little more about the back pain? What was she doing when it started? Is she still having it now? What did it feel like? Is it worse after this accident? What is her general overall appearance? How about pulses, lung souns and heart sounds?

[Resqmedic]

Treat her as a trauma PT with an eye to her possible cardiac symptoms. I personally wouldn't give NTG or ASA due to the possible chest trauma, but would consider Morphine if her LOC is good. I would also focus the assessment on possible chest trauma, LS, physical exam, and 12 lead. Then work out cardiac as much as I could.