A 30s M is struck by a car. EMS reports that bystanders say the car rolled over the patient. The patient states he has right chest pain and upper back pain. On arrival, his HR is 110, RR 20, BP 120 / 72, and his room air oxygen sat is 83-93. On exam, his airway is clear; he has good breath sounds bilaterally; the abdomen is non-tender. Other than small abrasions on his knees, there is no visible injury; and he moves all four extremities easily. How do we proceed?
Would put on non-rebreather. Then do an EFAST to check for hemo/pneumo while we wait for portable CXR.
Significant mechanism puts this patient at high risk for intra-abdominal or intra-thoracic injury. Though he has bilateral breath sounds, we need more definitive assessment for hypoxia; consider PTX vs. pulm contusion vs. anemia from internal bleeding. eFAST, place on NRB, 2 large bore IVs, make sure type and screens are sent in case we need to transfuse, and pan-scan.
EFAST is crucial but he is clinically telling you he has broken lungs. Need to find out extent of injuries. Hard to believe he would not need at least one chest tube. Maybe one for the airway if he is unstable for CT. Somebody goes with him to CT. Surgeons ready.