26-year-old man brought in via bystanders after being found down outside of the ED. He has a penetrating wound to the abdominal left upper quadrant and the left flank. Free fluid is not initially seen on US. Has a shock index >1 at arrival. He has an altered LOC, is agitated, tachycardic, and requires imaging to determine extent of his injuries. He requires airway management prior to CT scan. If airway is not controlled he will arrest in the CT scanner. He also requires management of his penetrating trauma. If the penetrating trauma and shock is not identified and treated he will have a PEA arrest.

Goals and Objectives

Educational Goal:

1. Decision to intubate prior to CT scan in a patient who could become unstable
2. Bedside US to diagnose patient in shock
3. Proper primary and secondary survey to identify wounds
4. Management of the agitated trauma patient

CRM Objectives:

1. Recognize an unstable patient with a penetrating trauma requiring airway management prior to imaging
2. Good primary and secondary survey
3. Management of a penetrating abdominal and retroperitoneal wound
4. Shared mental model

Medical Objectives:

1. Identification of an unstable patient – Shock Index
2. When to intubate prior to imaging
3. Airway management
4. Management and recognition of a penetrating trauma

Related Link: Specialist Trauma Advisory Network (STAN) Clinical Practice Guidelines – Trauma Care BC