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Exactly correct. Airway before breathing and then circulation as this is not a military type of injury requiring "C" first.
Now, as we went to intubate, the clot in the pharynx that was on the inside of the neck broke lose and the patient started hemorrhaging from the neck's mucosa internally and externally as had been reported by the ground crews before the neck wound stopped hemorrhaging by itself. The EM physicians were surprised and started yelling for a surgical cric as they repeated an ETT airway attempt while suctioning blood quickly. That is when I went to head of the bed and applied pressure to the wound with a stack of 4 x 4's. They had paraylzed the patient with Etomidate and SUX (short acting) IV. As the bleeding slowed to a stop, they were able to intubate (sigh of relief). The nurses got two more IV's in peripherally (another in the right upper extremity and one in the left upper extremity) with all of the comotion at the head of the bed. I cautioned the nurses and the physicians about not using the one on the left (any guess as to why?). So, we have three functioning IV's. We did draw a trauma panel (everything under the sun) but the key draw was the T and C.
Now we are intubated . . . bleeding from the neck without pressure and now with a large air leak from the right chest after the ETT is in. Last BP was 60/palp in the right arm.
Now what???
Dutch
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