Author: Celestine Weegenaar / Editor: Sarah Edwards / Codes: CC5, SLO3, SLO4, SLO6, TP3, XC2 / Published: 27/09/2021

You are working as part of a pre-hospital critical care team on an evening shift. You are responding in a rapid response vehicle (RRV) with blood products on board. Your team is dispatched to a 21-year-old male who has allegedly been assaulted outside of a night club.

You have been called to support a double crew ambulance (DCA) who have approached the scene after it was made safe by the police. They request back up after an initial examination has revealed that this male has multiple injuries including a puncture wound to the left anterior chest.

When you arrive, the male is lying on the pavement outside the night club. The paramedic and emergency care assistant (ECA) have been on scene for 10 minutes.

On initial assessment you find:

There is a bleeding head wound but nil external catastrophic haemorrhage.

C-spine: manual in-line stabilisation to restrict movement

A- patent, own with no airway swelling.

B- RR 35, SaO2 94%, there is a 2cm stab wound left anterior chest mid-clavicular line just below the nipple, there is no exit wound, trachea is central, reduced air entry left base to midzone with dullness to percussion.

C- radial pulses are palpable but weak, HR 110, BP 96/63, the patient is cold peripherally with a central capillary refill time of 4 seconds.

D- GCS 14 (E4V4M6), BM 6.7, moving all 4 limbs, the patient is very agitated, PEARL size 3 bilaterally

E- T 35.2, on fully exposing the patient and rolling him to check his back, you find no other penetrating injuries.