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e-CASES: Polytrauma due to a fall of a few meters following a loop while paragliding

Fall of a few meters following a loop while paragliding:

Glasgow 15 at start of care, hemoglobin 14.4g/dl, blood pressure 11/6, pulse 104, saturation 92%.

Auscultation normal, abdomen soft. No audible heart murmur. Medical transport to university hospital.

 

On arrival at the university hospital, onset of left anisocoria in spite of Glasgow of 15, decision to intubate after induction and sedation, placement of a left subclavian central venous line followed by hemodynamic instability requiring intravenous fluid therapy with 1 l of saline and introduction of Norepinephrine 1 mg/hr, infusion of Mannitol due to mydriasis. Onset of a cogwheel holosystolic murmur at all foci that can be auscultated. Cardiac ultrasonography revealed interventricular communication with systolic pulmonary arterial pressures measured at 50 mmHg, with no right cavity dilation and no paradoxical septum.

 

Full body scan performed.