Unidentified white female/single vehicle MVA. "Driving erratically" according to witness. Hit tree at high speed. Extricated at scene. Incoherent and combative according to paramedics.

PMHx - not available

O/E -

• H+N: Pupils equal and reactive to light, laceration/contusion right brow, maintaining airway but increased respiratory rate, trachea deviated to left
• Chest: Decreased breath sounds on right
• CVS: Tachycardic, normal heart sounds, no murmur
• Abdomen: Superficial abrasions, ?tender to light palpation, some distension.
• MSK:
  • C-spine collar in place/spine board
  • No step or bruising T/L spine
  • Left arm and leg in yellow transport splints, obvious deformity/crepitus forearm and knee
  • Puncture wound radial/volar aspect left forearm
  • Right leg shortened (?) - irritable with logrolling
• Vascular: Radial, Dorsalis pedis, Posterior tibial pulses present bilaterally. Good colour and capillary refill both hands and feet
• Neuro:
  • Thrashing about, slurred speech, disoriented to place/person/time. Smells of EtOH.
  • Spontaneous motion both hands and feet; unable to do full exam.
  • Normal rectal tone.