How to evaluate a patient who is a victim of a motor vehicle collision (MVC) and is awake, alert, and talking?

From the Guidelines

To evaluate an MVC victim who is awake, alert, and talking, begin with a primary survey following the ABCDE approach, and consider a whole-body CT scan if the mechanism of injury suggests a high risk of internal injuries, as indicated by studies such as 1 and 1. The primary survey should include:

• Airway: ensuring the airway remains patent while maintaining cervical spine immobilization with a cervical collar if mechanism suggests spinal injury
• Breathing: assessing respiratory rate, effort, and oxygen saturation, providing supplemental oxygen if saturation falls below 94%
• Circulation: checking pulse rate, blood pressure, and assessing for external bleeding or signs of shock
• Disability: performing a quick neurological assessment using the Glasgow Coma Scale and checking pupillary responses, as recommended by 1
• Exposure: exposing the patient appropriately to identify any hidden injuries while maintaining dignity and preventing hypothermia

After the primary survey, conduct a thorough secondary survey including a detailed head-to-toe examination looking for injuries, deformities, and tenderness. Obtain vital signs including temperature, and gather a SAMPLE history (Signs/Symptoms, Allergies, Medications, Past medical history, Last meal, Events leading to injury). Considerations for whole-body CT scans include high-velocity MVC, MVC resulting in rollover or passenger ejection, motorcycle trauma, bicycle injury, MVC-pedestrian collision, and a fall from a height of >15 feet, as indicated by 1 and 1. CT of the chest, abdomen, and pelvis with IV contrast has greater sensitivity for detecting visceral organ and vascular injury compared with noncontrast CT, and contrast-enhanced CT of these areas should be primarily considered unless absolutely contraindicated, as stated in 1 and 1. This systematic approach ensures no critical injuries are missed despite the patient appearing stable, as internal injuries may not immediately manifest with obvious symptoms.

Some key points to consider in the evaluation of an MVC victim include:

• The mechanism of injury, as certain mechanisms are associated with a higher risk of internal injuries
• The patient's age and functional status, as older adults may be at higher risk for injury or death, as noted in 1
• The patient's hemodynamic stability, as unstable patients may require more urgent evaluation and treatment
• The results of initial imaging, such as portable radiographs of the chest and pelvis, and/or FAST, as these can help identify potential injuries and guide further evaluation and treatment.

Overall, the evaluation of an MVC victim who is awake, alert, and talking requires a systematic approach that takes into account the mechanism of injury, the patient's overall condition, and the results of initial imaging, as indicated by studies such as 1, 1, and 1.

From the Research

Evaluation of MVC Victim Patient

To evaluate an MVC (Motor Vehicle Collision) victim patient who is awake, alert, and talking, the following steps can be taken:

• Assess the patient's vital signs, including heart rate, respiratory rate, and oxygen saturation, using wearable or contactless devices, as studied in 2
• Consider the use of intravenous contrast material for CT and MRI scans, as outlined in 3, to aid in diagnosis
• Be aware of the potential use of drugs in CT and MR cardiac imaging, as discussed in 4, to improve image quality and assessment of the coronary arteries

Vital Sign Assessment

The assessment of vital signs, such as heart rate, respiratory rate, and oxygen saturation, is crucial in evaluating the patient's condition. According to 2, wearable devices have been shown to be statistically equivalent in accuracy and precision to contactless devices, but with less measurement bias and more precision at extreme vital signs.

Imaging and Diagnostic Considerations

The use of intravenous contrast material for CT and MRI scans can be essential in making critical diagnoses in ED patients, as noted in 3. However, precautions and preparations should be taken to avoid adverse reactions. Additionally, the use of drugs in CT and MR cardiac imaging, as discussed in 4, can improve image quality and assessment of the coronary arteries, but requires careful consideration of indications, contraindications, efficacy, and safety.