What is the initial care plan for a patient ejected from a vehicle in a trauma accident?

Initial Care Plan for Patients Ejected from Vehicles in Trauma Accidents

Patients ejected from vehicles in trauma accidents should be immediately transported to a trauma center, as ejection is associated with a 27.4% risk of severe injury (ISS >15) and requires comprehensive trauma evaluation and management. 1

Initial Assessment and Transport Decisions

• Ejection from a vehicle is a significant mechanism of injury that warrants immediate transport to a trauma center, even if the patient appears stable initially 1
• Assess for physiologic and anatomic criteria (Step One and Step Two) to determine the appropriate level of trauma center needed 1
• Complete ejection is associated with higher mortality and morbidity compared to partial ejection 1
• Transport should be expedited with minimal on-scene time to reduce time between injury and definitive care 1, 2

Pre-Hospital Management

Airway and Breathing

• Secure airway if GCS <13, oxygen saturation <90%, or respiratory distress 1
• Avoid hyperventilation in patients with suspected traumatic brain injury unless signs of herniation are present 1
• If intubation is required, maintain PaO2 ≥13 kPa and PaCO2 of 4.5-5.0 kPa 1

Circulation

• Apply external pelvic compression immediately if pelvic trauma is suspected 1
• Use pelvic binders placed around the great trochanters (not sheet wrapping) for suspected pelvic injuries 1
• Establish large-bore IV access and begin fluid resuscitation if systolic BP <90 mmHg 1, 3
• Target systolic BP of 80-100 mmHg until major bleeding is controlled (if no traumatic brain injury) 1

Spinal Precautions

• Maintain full spinal immobilization due to high risk of spinal injuries in ejected patients 1
• Position patient with 20-30° head-up tilt if possible while maintaining spinal immobilization 1

Hospital Management

Initial Trauma Bay Assessment

• Perform E-FAST (Extended Focused Assessment with Sonography for Trauma) to identify free fluid in the abdomen, chest, and pericardium 1
• Obtain pelvic X-ray for hemodynamically unstable patients 1
• For stable patients, proceed directly to whole-body CT scan with IV contrast 1

Bleeding Control

• Patients with ongoing hemorrhage should undergo immediate surgical control of bleeding 1
• The time between injury and operation should be minimized for patients requiring urgent surgical bleeding control 1
• For pelvic injuries with hemodynamic instability despite stabilization, consider early angiographic embolization or surgical packing 1

Monitoring

• Monitor serum lactate and base deficit to estimate and track the extent of bleeding and shock 1
• Single hematocrit measurements should not be used as an isolated marker for bleeding 1
• Continuous monitoring of vital signs and neurological status is essential 1

Special Considerations

Traumatic Brain Injury

• Maintain cerebral perfusion pressure by avoiding hypotension 1
• Position head-up 20-30° to reduce intracranial pressure 1
• Consider mannitol (0.5 g/kg) or hypertonic saline (2 ml/kg of 3% solution) for signs of increased intracranial pressure 1

Psychological Aspects

• Implement trauma-informed care principles, recognizing that physical trauma often accompanies psychological trauma 4
• Avoid retraumatization through clear communication about procedures and maintaining patient dignity 4

Common Pitfalls to Avoid

• Delaying transport for unnecessary field interventions - prioritize rapid transport over extensive field stabilization 2
• Failing to recognize the high likelihood of multiple injuries in ejected patients 1
• Underestimating the severity of injuries due to lack of external signs of trauma 1
• Neglecting to apply pelvic binders early when pelvic trauma is suspected 1
• Focusing on obvious injuries while missing less apparent but potentially life-threatening conditions 5