Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

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Section IV: Trauma

Case Study 9: Sail Training Offshore Scene Sail training and research vessel in the Gulf Stream approximately 300 m SE of Cape Cod. The weather was mild but was expected to deteriorate over the next 24 hours. S: A 23-year-old student was struck on the head by a swinging davit when a cable lowering instruments

parted. He was found sitting on deck with a large and freely bleeding laceration across the top of his head. He remembered everything about the event. He denied neck pain, and he had no other complaints. He denied allergies, was taking no medications, was well-fed and warm, had no significant medical history, and was up to date on his tetanus vaccination. O: Awake, oriented, and cooperative man holding a blood-soaked kerchief on his head. Blood covered his left shoulder and chest, and there was a large pool if it on the deck. He had no neck deformity or tenderness, had

full range of motion, and had normal sensation of extremities with no numbness or tingling. The scalp had a 4-cm laceration, clean and straight, through the skin and subcutaneous tissue to the skull. No depression or bone fragments could be seen or felt. Vital signs at 1805: BP: 112/78, P: 88, R: 16, C: awake and oriented, T: normal, Skin: normal color and temperature. A: 1. Scalp wound. A’: Wound infection (unlikely) P:

1. Direct pressure to stop bleeding. 2. Wound irrigation and dressing. 3. Monitor for infection, change dressings daily. 4. Follow-up in Bermuda on planned port call in three days. Discussion:

The scalp did just what it was designed to do by absorbing enough of the force of the impact to protect the skull and brain. There was no traumatic brain injury, just a scalp wound. As is common with the scalp, bleeding was profuse but easily controlled with direct pressure. Although it looked like a lot of blood, vital signs showed that not enough was lost toproduce shock. Because of the rich blood supply in the scalp, even deep scalp wounds usually heal well with a very low incidence of infection. There was no emergency here.