Case 16: Motorcycle Crash
This case involves a 55-year-old man, Mr. W, whose motorcycle collided with an oncoming vehicle. The ambulance run sheet describes the accident:
He was hypotensive for EMS personnel but this improved en route to the hospital.
At 12:42pm the patient arrived to the emergency department where Dr. B, an emergency physician, was working.
The hospital has 36 ED beds but does not carry a trauma designation.
The following is pieced together from available nursing notes, defense and plaintiff expert witness disclosures and depositions, as well as from Dr. B’s note.
He was additionally noted in the ED chart to be taking Aspirin, hydrochlorothiazide, and Diclofenac.
Dr. B ordered 2 liters of IV fluids at 12:45pm, after the patient’s initial vital signs demonstrated that the patient became hypotensive again. One liter of IV fluid was started. He had two peripheral IVs.
Per nursing documentation, the first liter was infused over approximately the next hour. Shortly after the IV fluids were started, vasopressors are initiated.
The patient became very drowsy on arrival to the ED.
Dr. B’s note documents “Immediately after the patient arrived in the emergency department was transported from the ambulance gurney to the hospital bed, the patient’s mental status abruptly changed. … No further history could be taken from the patient because he was almost immediately intubated following arrival.”
The first part of Dr. B’s note is shown here:
Dr. B consulted the general surgeon Dr. R, who came to the patient’s bedside. The decision was made to CT panscan the patient.
Per the MDM, if the patient’s abdomen is full of blood, he would go to the operating room.
Continue to the next page to see what happens next.