Splenic Laceration & C-Collar
High-acuity trauma logic involving cervical spine instability, full-stomach Rapid Sequence Induction (RSI), and massive transfusion priorities.
"A 53 y.o. woman is brought to the OR for exploratory laparotomy after a car crash. BP 110/70, HR 115. EXAM: Soft cervical collar in place (not cleared). Mallampati 2. CT shows splenic laceration and active internal bleeding."
Management of the unstable patient with a potential difficult airway and C-spine instability. Massive Transfusion Protocol (MTP) logic.
Defend your intubation plan: Fiberoptic vs. Video-Laryngoscopy vs. Direct with MLI. Examiners look for your ability to protect the spinal cord while securing a life-threatening airway.
How a Board-Certified Consultant answers this scenario.
This patient is hemodynamically unstable with a presumed full stomach and a potential C-spine injury. My goal is to secure the airway while maintaining Manual In-Line Stabilization (MILS). I will perform a Rapid Sequence Induction using etomidate to preserve its cardiovascular stability and succinylcholine for its rapid onset and favorable conditions.
I will use a Video-Laryngoscope as my primary device to minimize cervical neck movement during intubation. I'll have the Level-1 Rapid Infuser ready with O-negative blood as her tachycardia and soft blood pressure suggest significant internal bleeding. I will prioritize volume resuscitation over vasopressors in this trauma setting, aiming for a MAP that balances organ perfusion with the risk of 'popping the clot' from her splenic injury.