MVA With Injuries

[Shrimpfriedrice]

:rofl: :rofl: :rofl:

You really, really need to lay off whatever Kool-aid you've gotten into. MOI is intended to be an ADJUNCT to assessment, not THE assessment. Relying on "Major Trauma Criteria" is outdated at best and negligent at worst. Make your decisions based of patient condition, not the condition of the scene. Occult injuries are really fairly rare.

So lets flip it around and say you force an uninjured patient to go by HEMS because they meet "criteria" and the helicopter crashes enroute to the hospital. Now who's negligent? Good luck using the magical protocol shield...

I work in the city, at best my trauma hospitals are 15mins from each other i wont be using any helicopter and EXACTLy i mever said otherwise; u probably need to read on how this whole conversation went

 

[usalsfyre]

I work in the city, at best my trauma hospitals are 15mins from each other i wont be using any helicopter and EXACTLy i mever said otherwise; u probably need to read on how this whole conversation went

I really don't think you grasp what was said.....

Strike "helicopter" insert "transport code 3". You can't justify doing either one. The just following orders excuse doesn't work well.

 

[Shrimpfriedrice]

I really don't think you grasp what was said.....

Lol i did i was just tryna lighten the mood..relax everyone we made our points..

 

[Veneficus]

I have to agree with this. You might say it's outdated, but Passenger 1 still has signs of shock. She also has an MOI that makes it very likely she has internal bleeding.

I'll bite.

Bleeding from where?

What class of shock is she in? (hint: 1,2,3,or 4)

How would you be able to tell?

Does she have mechanism for an aortic tear? How long after insult are those usually repaired? DO they have to be repaired surgically?

What other organs might she be bleeding from? What artery? How would you assess for it?

Perhpas her bleeding is from her longbone injury? Is it life threatening? LImb threatening? What would be the finding that would tell you?

What else do you think is important to check for in her?

 

[STXmedic]

I work in the city, at best my trauma hospitals are 15mins from each other i wont be using any helicopter and EXACTLy i mever said otherwise; u probably need to read on how this whole conversation went

Well assuming you're like 90% of the city medics I know, with similar mindsets, and you're transporting this patient to a Lv 1 as a trauma alert based off of MOI, you will be transporting with lights and sirens. Now, I don't recall the exact numbers on increased likelihood of getting in a wreck while driving emergent, but 23 times more likely rings a bell. Could be wrong on the exact number, but it's in the ball-park So lets change the scenario from HEMS getting in a wreck, to you getting in a wreck. Better now?

 

[Veneficus]

Well assuming you're like 90% of the city medics I know, with similar mindsets, and you're transporting this patient to a Lv 1 as a trauma alert based off of MOI, you will be transporting with lights and sirens. Now, I don't recall the exact numbers on increased likelihood of getting in a wreck while driving emergent, but 23 times more likely rings a bell.

In 2003 the Insurance Institute of America said it was 300x more likely to be in an accident and they didn't have numbers on wake effect accidents caused.

I know the number because I was researching whether or not code 3 driving should be discontinued by the service.

The conclusion then was it certanly should be, but because of public expectation it would continue.

I doubt it is much different if not increased today.

 

[Shrimpfriedrice]

Well assuming you're like 90% of the city medics I know, with similar mindsets, and you're transporting this patient to a Lv 1 as a trauma alert based off of MOI, you will be transporting with lights and sirens. Now, I don't recall the exact numbers on increased likelihood of getting in a wreck while driving emergent, but 23 times more likely rings a bell. Could be wrong on the exact number, but it's in the ball-park So lets change the scenario from HEMS getting in a wreck, to you getting in a wreck. Better now?

<moderator snip>..I wasnt the one going off an MOI i said along with a patient assessment that need to be included..like Protocols sts! Read the entire convo before u comment and this whole thing was done 30mins ago.

 

[STXmedic]

<moderator edit>

You*

I wasnt the one going off an MOI i said along with a patient assessment that need to be included..like Protocols sts!

I know what you said. That's not what you said.

MOI is not supposed to be based on patient assessment, thats why its a MOI. She meets criteria period! Had the 2 other ppl died and she only sustained a minor sti with no complaints would u rma her?!

This, to me, is saying that her assessment doesn't matter. This is saying that even if she is completely without injury or complaint, she needs to be transported to a trauma center, based SOLELY off of MOI. F*** the patient assessment. This is saying you're going off an MOI. That is what this is saying.

Either take the time to post what you mean in coherent, thought out posts, or don't cry when people take your post as it is and call you out on it.

 

[Veneficus]

and now...

back to our regularly scheduled program...

Cmon guys, there is sort of a good discussion here.

 

[Gastudent]

I'll bite.

Bleeding from where?

What class of shock is she in? (hint: 1,2,3,or 4)

How would you be able to tell?

Does she have mechanism for an aortic tear? How long after insult are those usually repaired? DO they have to be repaired surgically?

What other organs might she be bleeding from? What artery? How would you assess for it?

Perhpas her bleeding is from her longbone injury? Is it life threatening? LImb threatening? What would be the finding that would tell you?

What else do you think is important to check for in her?

I am just a student so I wont be able to get into as advance as you do, but the point I was making is that internal bleeding is a possible cause of the signs of shock, because of her MOI. As from where she was bleeding cant really say. It is going to be hard for anyone to tell for sure in the field, and I don't know if the limb has distal circulation so I cant really say if it is in danger. Like I say am just a student not trying to say I know more than anyone because I don't. Just giving my opinion on the scenario.

 

[Shrimpfriedrice]

You*

I know what you said. That's not what you said.


This, to me, is saying that her assessment doesn't matter. This is saying that even if she is completely without injury or complaint, she needs to be transported to a trauma center, based SOLELY off of MOI. F*** the patient assessment. This is saying you're going off an MOI. That is what this is saying.

Either take the time to post what you mean in coherent, thought out posts, or don't cry when people take your post as it is and call you out on it.

At the end of the day a MOI is a MOi and a patient assessment is just that. Earlier it was stated that this pt did not meet major trauma criteria. That was incorrect due to death in same compartment thats all. Follow protocol or dont treat asthma with glucose if u like ur perrogative

An assessment allows us to make a decision whether trauma or not just like MOI

 

[STXmedic]

At the end of the day a MOI is a MOi and a patient assessment is just that. Earlier it was stated that this pt did not meet major trauma criteria. That was incorrect due to death in same compartment thats all.

That, I'll buy. As flawed as MOI injury predictability is, that patient could meet trauma criteria if you were hell-bent on taking that patient to a trauma center.

Follow protocol or dont treat asthma with glucose if u like ur perrogative

How is that relative or comparable in any way to the current discussion. Not following protocol =/= incorrect treatments. I'm not even sure how I was able to discern what you were trying to get across... :unsure: Oh, and prerogative*.

An assessment allows us to make a decision whether trauma or not just like MOI

Uhh... What? Again with being incoherent. Please try and make some form of sense on your next reply. It's really difficult to form an adequate rebuttal when I can't understand what the hell you're trying to say.

 

[Chimpie]

Keep it polite and on topic please.

 

[usalsfyre]

..I wasnt the one going off an MOI i said along with a patient assessment that need to be included..like Protocols sts! Read the entire convo before u comment and this whole thing was done 30mins ago.

Lol wut?

 

[Veneficus]

I'll bite.

Bleeding from where? Most likely her long bone injury.

What class of shock is she in? (hint: 1,2,3,or 4)

How would you be able to tell?

If we give a fluid bolus and she responds favorably, class I.

If she responds transiently (gets better then goes back, class II)

She does not respond she is in class III, (possibly IV, but IV is asclose to
dead as you can get without being dead and she is too well for that.)

Does she have mechanism for an aortic tear? No, neither the speed nor angle is suggestive of that. The seatbelt also reduces that possibility.


How long after insult are those usually repaired? DO they have to be repaired surgically? Hours to days, no, they can be treated without surgery in some cases.

What other organs might she be bleeding from? What artery? How would you assess for it?

Solid organs, in particular the liver (which has multiple stages of laceration as well as surgical, medical, and intravascular treatment modalities) as well as potential injury to the kidneys.

There are several arteries possible, but most likely nutrient arteries to the deformed bone.

While not perfect, abd palpation, and if she is of small frame, deep abd palpation. You could also look for bruising on both the abd and flanks.

Splint the arm. observe for changes is size and color of abd, and any injured areas like the arm.

Perhaps her bleeding is from her longbone injury? Is it life threatening? LImb threatening? What would be the finding that would tell you?

Pain out of proportion. In compartment syndrome severe pain is the primary clinical finding. You can still have a distal pulse and have compartment syndrome. It is the most time sensitive and one of the only life threatening ortho injuries.

What else do you think is important to check for in her?

Her lungs, sounds, rate rhythm, quality. You will need to check over time, as if she inhaled during the collision she risks a pneumo, which develops over time.

Normally I charge about $200 for an hour of lecture...

 

[Veneficus]

That, I'll buy. As flawed as MOI injury predictability is, that patient could meet trauma criteria if you were hell-bent on taking that patient to a trauma center.

Only if your outdated EMS system still has that in the protocols.

But it definately will not win you any friends on the trauma team.

 

[Melclin]

That was incorrect due to death in same compartment thats all. Follow protocol or dont treat asthma with glucose if u like ur perrogative

I just finished posting some thoughts directed at you in another thread, but I respectfully suggest that the same idea may apply here.

I assume that the reason you came to a forum like this was to expand your knowledge beyond your protocols say.

One thing that is a constant theme in these discussions are the differences in guidelines and protocols. There are some extensive regional differences in accepted practice even when the practice is based on the same evidence. That you might do something in a particular way doesn't mean that everybody else in the world does or should do it that way. In the same vein, "Death in the vehicle" is no longer accepted as an MOI predictive of serious occult injury by many providers. While this may be different to you practice, education or protocols, that doesn't necessarily make it wrong.