Scenario Simulations

You are called to a scene — high-speed MVC, unrestrained driver vs. guardrail. ETA 8 minutes.

Male, ~35yo. High-speed frontal impact. Airbag deployed. Significant intrusion into the passenger compartment. Patient found in seat, seatbelt not worn. Windshield starred.

1. 1High-flow O₂ via NRB 15L/min → SpO₂ improves to 93%
2. 2Needle decompression left 2nd ICS MCL → breath sounds return, SpO₂ 96%
3. 3RSI for airway protection (GCS 9, trajectory worsening): Ketamine 1.5mg/kg + Succinylcholine 1.5mg/kg → successful intubation, confirmed bilateral breath sounds, ETCO₂ 38mmHg
4. 4Two large-bore IVs, initiate 1:1 pRBC:FFP resuscitation (O-neg until type/screen)
5. 5Pelvis binder applied — pelvic instability on compression
6. 6Transport decision: Level I trauma center, 12-minute flight

Patient arrives intubated, hemodynamically improving. OR team standing by. Bilateral chest tubes placed in trauma bay. Pelvic fracture confirmed on CT. Splenolaceration Grade III. Patient survives following damage control laparotomy.

• Tension pneumothorax is a reversible cause of shock — treat before addressing hemorrhage
• RSI thresholds in flight: GCS ≤ 9 with trajectory concerns warrants early airway control
• Permissive hypotension and balanced resuscitation reduce coagulopathy