A police officer held her head in alignment against the back of the seat; an improvised airway temporarily inserted using a plastic breathalyser stick. Blood covered her ungloved hands, staining them bright red.
"Spine board?" I queried.
A nod of agreement by Amy.
No time for proper spinal precautions, no time for a KED. 30 seconds later and we were out of the driver's seat and into the back of the ambulance.
She didn't look good.
Small arterial bleed above the eye and some visible brain matter, gurgled respirations exiting with bubbling around the mouth, significant flow of blood from the mouth, massive head and facial trauma, deformed thigh. GCS 6, HR 132, RR 28, SpO2 79% RA, BP 70/40.
Backup in the form of a Critical Care Paramedic and Operational Manager arrived fairly soon after, despite the peak hour traffic.
A laryngoscope was inserted but with significant facial fractures and an ongoing stream of blood in the oral cavity even with suctioning, it was near impossible to lift the palate let alone visualise the trachea.
"Let's go!" we all concluded.
It was pretty useless inserting an LMA as that would just pool the blood and offered limited protection into the trachea so instead a size 3 OPA was inserted with supportive ventilation and suctioning. 16g cannula and 1.5L of fluids helped to increase the BP to 100 systolic, but it was a fine line between increasing blood pressure and increasing the facial / cranial bleeding which we couldn't control.
The 20 minutes to hospital seemed like an eternity.
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Further investigations at the hospital found she had a Le Fort III fracture, which probably explained the difficulties we had with field intubation, a depressed fracture of the skull and significant head injuries. She passed away in ICU 3 days later.
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