[MUSIC PLAYING]
LAURA: Hi, I'm Laura. I'll be taking care of you today.
TORI: This is Mr. Gregory. He's a 41-year-old gentleman who just arrived via ambulance after having been ejected from his snowmobile. All vital signs have been stable en route.
LAURA: Mr. Gregory, can you tell me what happened?
MR. GREGORY: I was riding my snowmobile, hit a bump, and got ejected.
LAURA: Do you know how fast you were going?
MR. GREGORY: Probably 30, 35.
LAURA: OK, were you wearing a helmet?
MR. GREGORY: Yes.
LAURA: Wonderful. Did you lose consciousness?
MR. GREGORY: No.
LAURA: Are you in any pain?
MR. GREGORY: My left wrist.
LAURA: OK, OK. Can you give me a number, 1 to 10, to mean the most pain you can imagine?
MR. GREGORY: Seven.
LAURA: OK, OK. Well, a couple of things are going to be happening. We're taking your vital signs right now. And then we'll get you something for your pain, OK?
MR. GREGORY: OK.
LAURA: Has your family been notified?
MR. GREGORY: No.
LAURA: OK, we'll get a phone in here. That way we can do that for you.
MR. GREGORY: OK.
LAURA: OK. Wonderful, your vital signs look good. He does meet level yellow trauma criteria. Do you mind paging the overhead activation and bringing in the ultrasound?
TORI: OK.
LAURA: And do you mind bringing in the telemedicine cart, and connect it with emergency medicine in Rochester?
LISA: I'll do that.
LAURA: Thank you
LISA: Hi, Melanie. I'm calling from the emergency department in Cannon Falls. We have a yellow trauma patient that we need a video emergency medicine consult.
MELANIE : All right, I'm just going to confirm your location, that you're in Cannon Falls?
LISA: Correct.
MELANIE : All right, I'm going to connect you up with a tele-emergency medicine physician. Hold, please.
LISA: OK.
DR. SANGHA: Hello, this is Dr. Sangha.
MELANIE : Dr. Sangha, it's Melanie from the ATC. I have the tele-emergency need for Tori from Cannon Falls.
DR. SANGHA: Hi, this is Dr. Sangha. I'm emergency medicine in Rochester. How can I help you?
LISA: Hi, Doctor Sangha. I'm calling, we have a 41-year-old male, yellow trauma, in the emergency department in Cannon Falls, and we could really use your help.
DR. SANGHA: I'll connect via telemedicine right now. Do you have the device in the room?
LISA: We do.
DR. SANGHA: Great, I can see you now.
LISA: OK, thank you.
DR. SANGHA : Hello, I'm Doctor Sangha, emergency medicine in Rochester. Would you please introduce your team?
LAURA: Hi, Dr. Sangha. I'm Laura, and I have nurses, Tori and Lisa, here with me. Mr. Gregory is our patient. He's a 41-year-old male brought in by EMS after being ejected from his snowmobile, traveling roughly 30, 35 miles per hour. We have him leveled as a yellow, and his vitals are stable. We were about to start our primary assessment.
DR. SANGHA : OK, please continue.
LAURA: Open your mouth for me. All right, airway is intact. He has bilateral breath sounds. Left radial pulse is strong. Squeeze my fingers. Wiggle your toes. Wonderful. GCS is 15. Primary assessment's complete and negative. Head is atraumatic. Pupils are equal, round, and reactive to light. Any pain here?
MR. GREGORY: No.
LAURA: How about over here?
MR. GREGORY: On the left side.
LAURA: On the left side, OK. So chest and abdomen is free from abrasion and laceration. He does have some left-sided chest tenderness. Any belly pain?
MR. GREGORY: No.
LAURA: And your pelvis?
MR. GREGORY: No.
LAURA: And pelvis is stable to rock. Any pain here?
MR. GREGORY: Just in the wrist.
LAURA: In your wrist, OK. Can you move your left arm for me? Wonderful, left upper extremity does not have any gross deformity, laceration, or abrasion. Full range of motion, but he does have tenderness in the left wrist. We'll do the same thing on this other side.
DR. SANGHA : So to summarize, we have a 41-year-old male, level yellow four for ejection from a snowmobile. Stable vital signs, primary survey has been unremarkable. Secondary survey only notable for left wrist and left chest wall tenderness. Is that correct?
LAURA: Correct.
DR. SANGHA : OK, can you do a FAST exam?
LAURA: I can, and I have the ultrasound right here.
DR. SANGHA : If you plug it into the telemedicine device, I could see your images directly on my screen. All right, there's the kidney.
LAURA: I'm not seeing any free fluid.
DR. SANGHA : OK, looks good.
LAURA: Same thing on this side. There's kidney. Suprapubic view. Negative.
DR. SANGHA : Good.
LAURA: And then subxiphoid. This might be a little uncomfortable, OK.
MR. GREGORY: OK. Are you satisfied with that view?
DR. SANGHA : Maybe if you just increase the depth just a bit.
LAURA: There we go.
MR. GREGORY: Great.
LAURA: Also negative.
DR. SANGHA : I agree. So that's a negative FAST. What's his vitals looking like right now?
TORI: We have 113 over 73, heart rate of 56, 16 are his respirations, and he is 94% on room air.
DR. SANGHA : Since the FAST is negative, and his vitals have been stable, his exam is good, I think you can keep him there for imaging.
LAURA: We'll do so. We'll call you if anything changes?
DR. SANGHA : Excellent. Thank you.
LAURA: Thank you.
[MUSIC PLAYING]
