Simulation, Training and Research (STaR) shifts have recommenced at Bankstown this week with registrars putting each other through their paces with daily simulation.

Scenario – Road team attending a 70 year old male who has fallen 4-5m from his roof landing on his right side. He has sustained an obvious head injury with reduced consciousness and brisk scalp bleeding.

Scene – Male patient in right lateral position at base of wall. First-responder team arrived 5 mins earlier and applied a collar, placed an IV and have given IV ondansetron for “vomiting on several occasions”. They are struggling to control bleeding from a scalp laceration. Wife has just told paramedics he “only takes warfarin for AF”.

Patient – Obtunded with partial airway obstruction and a briskly bleeding right scalp laceration. Extensive right chest wall contusions with subcutaneous emphysema and reduced air entry. RR 28, SaO2 93%, P 105 (AF), BP 148/90, GCS 6. Pupils equal 4mm.

Learning points from debrief:

• Obtain observations as early as possible. This only helps to prioritise care and interventions.
• Optimise the environment to optimise your resuscitation. Move the patient to a safe location to make your care easier.
• Adopt neuroprotective measures post-RSI for all patients with traumatic brain injury. Don’t forget to reassess the pupils.
• Control brisk scalp bleeders if possible. Employ others to apply direct pressure & don’t forget that we carry staples !!
• If possible notify the receiving ED for potential need for early warfarin reversal (PCCs & FFP).

Thanks to Dan (Doc), Laurie (Para), Alex (SRC), Jimmy (trusty assistant #1), Keith (trusty assistant #2) & Chris (STaR).