EMT Challenge Cases


S: Doug is 28 years old. He was riding with his friend in his 1968 VW beetle. They had been drinking considerable amounts of beer and smoked several joints of pot mixed with "angel dust". They ran a stop sign and crashed into the side of another car passing through the intersection. He was not wearing his seat belt and was thrown forward through the front windshield. He was prevented from ejecting completely from the vehicle when he hit both legs into the metal flat dashboard causing both femurs to shatter. He suffered numerous lacerations and injuries to his head  and chest, and was knocked unconscious. He is awake but semiconscious when you arrive at the scene.

O: He is unable to move either leg and it is obvious that both femurs are shattered severely. He opens eyes to painful stimulation but not verbal commands. His speech is very soft, mumbling, and makes no sense.  Blood pressure 80/38. Pulse 160. Breathing is very shallow. Pupils are dilated, unequal, and are non-reactive. Skin is pale and moist. Capillary refill is very delayed. Lips are bluish.

How would you handle this patient?