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Proposed answers

Your answers may differ from those proposed here. As always, follow your Clinical Guidelines and utilise your own clinical judgement.

1)  Outline your clinical approach to this patient:

Standard Clinical Approach should include:

- Assessment of scene safety and utilisation of dynamic risk assessment

- Response: Is the patient responsive?

- Airway: Is it patent? Is intervention required immediately?

- Cervical Spine: Consider potential injury, modify airway manoeuvres and maintain spinal alignment.

- Breathing: Is the patient breathing? Is ventilatory support required?

- Circulation: Is there a palpable pulse? Carotid vs Radial. Any major external haemorrhage?

- Disability: To what degree is the patient responsive? Alert, Voice, Pain, Unresponsive.

- Exposure: Is the patient adequately exposed? Are there any environment concerns to account for?

2) What are your initial actions / priorities?

 You should recognise that this patient is critical and requires immediate intervention. This patient has ineffective breathing, however still has sufficient circulation to maintain a radial pulse. Therefore, the priority should be airway management and ventilation.

Care for c-spine should be initiated - careful but rapid removal of the helmet should be facilitated to allow for management of the airway. Modified airway techniques (jaw thrust) should be utilised to open the airway, suction any secretions, application of a bag-valve mask and assisted ventilations at a rate of 12/min (with a tidal volume of approximately 6-7mL/kg), maintaining ETCO2 between 30-35mmHg and an SPO2 of >95%. Airway adjuncts may be used if required, however caution should be applied. High flow oxygen should be initiated and maintained where possible in the initial phases.

Bonus: Requesting Intensive Care Paramedic support is also crucial to patient care.

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