A 58-year-old man was riding his bicycle and was struck by a car. He was ejected and landed on his back on the pavement of the roadway. He complained of severe pain in his lower back and sacral area. Ground emergency medical services (EMS) arrived to find a pale, diaphoretic man who was alert but in distress. His medical history was negative, and he was taking no medications. The initial heart rate was 130 beats/minute, and the blood pressure was 70 mmHg by palpation. A helicopter air ambulance was requested from the rural scene location to transport the patient to a trauma center.
The physical examination by the flight crew demonstrated the patient had not changed from the original EMS assessment, despite the administration of 1 L normal saline intravenously. There were no apparent injuries to his head, neck, chest, or extremities.
Authors' Note: For a variety of reasons, this article marks our final contribution to the Case Review Series in Air Medical Journal. We would like to thank the authors who have contributed cases for this series, as well as the readers we have received comments from, during the 4 years it has been published. We hope that this series and its format have been beneficial.
1David W. Ross, DO, FACEP, is a former flight medical director and the current medical director of numerous ground EMS agencies in the Colorado Springs area. An emergency physician at Penrose Hospital.
2Carol Wichman, BSN, MSN, a former flight nurse, has been a site reviewer for the Commission on Accreditation for Medical Transport Systems (CAMTS) and has authored a number or articles and textbook chapters.
3Mike MacKinnon, BSN, CEN, CCRN, CCFRN, is a flight nurse and a former paramedic trained in Nova Scotia, Canada. He created and maintains an interactive case review series atwww.flightweb.com.
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