This “case” is about a personal opinion of resident training.
The same resident / team should take both patients. Have one senior resident run both traumas so that one learns how to manage sick patients simultaneously. In the real world, it’s often just one doc in the ED. Learning to prioritize patients is an important skill for an ED doc.
We took both patients. K.M. was the pretending, M.S. was the chief. They did well on their own with little assistance; the minor assistance was a reminder to talk to each other. When there are multiple traumas, the critical decision is often “who goes to the CT first?” or “who goes to the OR first?” Priorities had to be shifted as patients were reassessed and we find injuries. Surgery was busy with a trauma on the other side, so K.M. and M.S. ran the show. As it turned out, the case was a good real-life sim. The sick patient turned out to be not-so-sick, and the not-so-sick patient turned out to be sick. The residents switched back and forth and managed each new issue smoothly.
The injuries reported by EMS are often misleading, and such was the case with these patients. The major injuries to “broken femur” were a complicated, open dislocation of the foot-ankle, distal femur fracture, and a stable retroperitoneal hematoma. “Facial injuries” had a big lac to her forehead that was not bleeding, but her major injuries were fractured pelvis, maybe-active pelvic bleeding, multiple broken ribs, and left hemothorax-small pneumothorax. She dropped her BP and required resuscitation. Her pelvic angio was negative.
After initial assessment, both patients underwent the “pan-scan”. Pan-scans are designed for patients like these- major mechanisms, obvious injuries, high likelihood of undiagnosed injuries. Patients should not have pan-scans for minor injuries, but many surgeons and ER docs have become so ingrained with the pan-scan that they would pan-scan someone for falling out of a chair. There is an argument that the pan-scan is unnecessary because we find inconsequential injuries, and that was true in these patients. The only injury found on the pan-scan that required intervention was the maybe-active pelvic bleeding, but that only resulted in a negative angio.
I’m a big fan of Jerome Hoffman, if it’s possible to be a fan of an EM doc. (We are similarly grumpy).
https://www.ncbi.nlm.nih.gov/pubmed/21890237