You are a member of a retrieval team tasked by helicopter to retrieve a 25-year-old from a small peripheral country hospital to the major trauma centre. The pilot estimates a flight time of 1.5 hours. The patient was involved in an MBA with bruising/abrasions to the right chest, RUQ pain/bruising, and an open left femoral fracture. Observations: RR 22, sats 96% on 2L/min nasal cannula, HR 100, BP 100/50, GCS 14/15. On arrival, eFAST shows loss of lung sliding on the right.

1. State (5) methods to reduce the risk of ongoing blood loss in this patient. 5 marks

On your arrival, you perform an eFAST examination during which you find a loss of lung sliding on the right side of the chest.

2. List (2) absolute indications for chest drain insertion prior to transfer for this patient. 2 marks

3. List (5) other factors you would consider when deciding whether to insert a chest drain. 5 marks