Case Study - Eaten by the Boat!-Handout: Eaten by the Boat!

Handout: Eaten by the Boat!

Pdf Summary

This presentation reviewed a real trauma case involving a 24-year-old man injured by a boat propeller near Lake Moultrie, South Carolina. The patient was found in the water with massive right arm hemorrhage, a mangled extremity, chest lacerations, and near-drowning. Prehospital crews applied a tourniquet, intubated the patient, gave TXA, blood products, fluids, and vasopressors, and transported him rapidly to a Level 1 trauma center. Total time from dispatch to trauma bay was 77 minutes. The case highlighted the importance of scene safety, early hemorrhage control, rapid transport, and high-quality pre-arrival communication, especially the MIST report.<br /><br />The talk then reviewed management of mangled extremities: rapid assessment using XABCDE, immediate control of exsanguinating hemorrhage, use of tourniquets and wound packing, splinting, and minimizing scene time. It emphasized documentation of tourniquet times, interventions, and serial vital signs to guide definitive care and limb salvage decisions.<br /><br />A major focus was the “Diamond of Death,” the trauma cycle of hypothermia, acidosis, coagulopathy, and hypocalcemia. The presentation explained how these four problems worsen one another and increase mortality. It described damage control resuscitation principles: permissive hypotension when appropriate, balanced blood product transfusion or whole blood, early TXA within 3 hours, calcium replacement, and active rewarming. Massive transfusion protocol activation, lab targets, and nursing responsibilities were also reviewed.<br /><br />Key takeaways: stop bleeding immediately, avoid hypothermia, give TXA early, replace calcium proactively, activate MTP early, and communicate clearly. The overall message was that prehospital actions strongly shape in-hospital outcomes and can save both life and limb.

Keywords

trauma case

boat propeller injury

massive hemorrhage

tourniquet

prehospital care

MIST report

mangled extremity

damage control resuscitation

massive transfusion protocol

hypothermia coagulopathy