66 y.o. otherwise healthy female presented to the emergency room in full spinal precautions after being involved in a high speed MVA. Patient was a restrained driver with a prolonged extrication. On arrival to the ED, patient was anxious, but conscious and complained of right-side chest pain, right lower extremity, and left wrist pain. Key findings on EXAM: GCS: 14/15, VS: 102/54, 110, 18, 96% on non-rebreather. HEENT: Negative except dried blood right forehead with small abrasion and surrounding 5 cm hematoma. PERRL EOMI. Neck: in collar, no tracheal deviation, no crepitus, neck tender along right paraspinal region. HEART: RRR No murmurs, rubs, gallops, no carotid bruits, no JVD; radial, dorsal pedal, post tibialis pulses 1+ bilaterally. Lung: Shallow rapid breath, no wheezes, no crackles Chest: Bruising over right upper chest. No crepitus. No deformity. ABD: bruising over lower abd consistent with a seat beat sign. Diffusely tender. Non distended. Back: No step offs, no focal tenderness T/L spine. No bruising Pelvis: stable, no pubic or iliac spine tenderness. UE: obvious closed left wrist fracture. LE: Bruised swollen right anterior lateral thigh; tender to palpation midshaft Neuro: GCS: 14/15 secondary to confusion, sensation intact both distal UE/LE Psych: confused anxious Skin: pale, no rashes, cap refill at 2 seconds. ORDERS: Non contrast CT: Head, c-spine, and abdomen/pelvis; left wrist XR, right femur XR, Chest XR, CBC, CMP, PT, PTT, Urinalysis, ETOH, UTOX, Lactic Acid. Cardiac Monitor, two large bore peripheral IVs and lactated ringers. Initial findings: Right Femoral shaft fracture, Left Colles fracture, Scalp hematoma right frontal bone, right anterior rib fractures (6 & 7th), HCT 31, Lactic Acid 3.2, UA 10 RBC HPF. CT abd/pelvis did not identify a cause for patients’ abdominal pain and provider called the transfer center to discuss the case with the surgeon on call…
