Walking dead – An accurate triage is a must

Abstract text (incl. references and figure legends)

In pre-hospital units, there is a need to examine and identify injured patients as quickly and as accurately as possible to resolve potentially fatal conditions. We are prepared for the worst possible scenario every time right from the dispatch call. But what about when the patient comes to the medical unit on foot? Triage is an extremely important part of patient treatment, which can be quickly forgotten when the patient is talkative and mobile.

A 56-year-old male came on foot, alone, to the entrance of the Litija Primary care health. Because of bleeding, he was sent to the ER department. At first assessment, we noticed massive bleeding from the mouth and a wound on his lower lip.

When taking an anamnesis, the patient was evasive and claimed that he had fallen off a ladder. On arrival, his BP was 102/50 mmHg, HR 110/min, SpO2 90%. Given the condition, the suspicious circumstances of an accident (which later turned out to be fabricated), we acted quickly. A more detailed examination showed a suspicion injury of mandibula, right hemithorax and the lumbar spine. His front teeth were avulsed.

After spinal immobilisation, he became responsive only to pain. His BP dropped to 70/45 mmHg, saturation was still 90%, he was breathing sufficiently. Two IV lines were applied, 1000 mL NaCl 0.9% and 100% oxygen through a high flow oxygen mask were administered. Immediately after the initial care HEMS was activated for transport to the trauma centre. From the moment the patient entered the ER to the arrival of HEMS, lasted 45 minutes. Since the patient was a middle-aged man, without associated diseases and in good physical condition, his body was able to compensate for a longer period of time, which could mislead us. An accurate triage with efficient and fast treatment played a significant role in the further care of the patient.

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