Emergency Trauma Assessment

32M BIBA following high-speed motorcycle vs car collision with suspected R femur fracture and blunt chest trauma.

Pre-Arrival

• Personal Protective Equipment (PPE): Lead apron, gown, gloves, eye protection
• EMS Notification: ETA 14:15. 32M rider ejected 5 m at 70 km/h. Scene vitals: HR 115, BP 105/70, GCS 15, SpO2 96 % RA. 18G IV R ACF, fentanyl 100 mcg IV, C-spine collar and vacuum splint to R leg applied at scene.
• Mechanism of Injury: High-speed blunt trauma; motorcycle T-boned turning sedan at approx 70 km/h. Significant front-end bike damage, helmet intact with visor scrapes, nil other fatalities.
• Trauma Activation Criteria: Level II activation due to high-speed motorcycle crash > 60 km/h and suspected proximal long-bone fracture.

Arrival

• Time of Patient Arrival: 14:18
• Trauma Team Activation Time: 14:10
• Team Members Present: Dr S. Chen (ED Consultant), J. Miller (Trauma NP), RN K. Patel (Airway), RN L. Nguyen (Circulation), RN T. Brooks (Scribe)

EMS Hand-off

• Time of Handoff Completion: 14:21
• Key Findings from EMS Report: Pt alert, c/o severe R thigh and R-sided pleuritic chest pain. Haemodynamically stable en route following 250 mL 0.9% NaCl IV bolus and methoxyflurane (Penthrox®) 3 mL INH.
• Immediate Life Threats Noted: Nil immediate life threats on handoff; patent airway, speaking in full sentences.

Primary Survey (ABCDE Assessment)

Vital Signs

• RR: 22, **SpO2:**97 %, HR: 112, BP: 118/74 (MAP: 89 ), T: 36.4 C, GCS: 15 (E: 4, V: 5, M: 6)
• Central Capillary Refill Time: < 2 s

Airway

• Patent: Patent, nil blood, vomit, or foreign body obstruction.
• Verbal Response: Clear speech, nil stridor, hoarseness, or gurgling.
• Airway Interventions: Nil required; maintaining own airway.

Breathing

• Chest Wall Examination: Superficial abrasions R lateral chest wall, tender to palpation over R 5th–7th ribs, nil flail segment or surgical emphysema.
• Trachea Position & JVD: Trachea midline, nil JVD.
• Breath Sounds: Present and equal bilat, slightly reduced air entry R base secondary to pain.
• Oxygenation/Ventilation: SpO2 97 % on RA, EtCO2 not indicated.

Circulation

• External Bleeding: Minor grazing to R forearm, nil major external haemorrhage.
• Internal Bleeding Suspicion: E-FAST negative at 14:25 (nil pericardial or free intraperitoneal fluid, lung sliding present bilat).
• Blood Pressure & Pulses: BP 118/74 mmHg. Radial pulses 2+ equal bilat; DP pulse 2+ L, 1+ R (diminished distal to R femur deformity).
• Pelvic Stability & Intervention: Pelvis clinically stable, non-tender; pelvic binder not indicated.

Disability (Neurologic Status & Cervical Spine Status)

• Pupil Examination: 3 mm PEARL bilat
• Extremity Movement: Moving UL and L LL with 5/5 power; R LL movement limited by mid-shaft femur deformity, sensation intact distally, able to dorsiflex R great toe.
• Cervical Spine (Status and precautions taken): In Cx Spine precautions; midline C-spine non-tender but distracting injury present.
• Collar: Yes, Stifneck rigid collar in situ, initiated by QAS at 13:55.

Exposure

• Complete Undressing: Clothing removed completely at 14:24.
• Hypothermia Prevention: Forced-air warming blanket (Bair Hugger) applied at 14:26, warmed IV fluids running.
• Log Roll for Back Assessment: Log-rolled at 14:30 with inline C-spine immobilisation: nil thoracic or lumbar step/tenderness, nil flank bruising, normal perianal sensation, nil saddle anaesthesia. R thigh traction splint (CT-6) applied at 14:35 following morphine 5 mg IV; distal R DP pulse improved to 2+.