# Avulsions!!!



## GeorroEMT (Apr 16, 2016)

I need help here is a persons leg is barely hanging by skin and tissue. And arriving on scene after asking for permission and treating it and performing your rapid ***. Would you clean the spot of the wound with saline water at the scene or en route???


----------



## STXmedic (Apr 16, 2016)

Well considering you'd probably want to bandage the wound before leaving, and if you were going to irrigate it, you'd want to do that before bandaging, then probably before. It also kind of depends on if the patient is crashing or not.


----------



## CANMAN (Apr 16, 2016)

GeorroEMT said:


> I need help here is a persons leg is barely hanging by skin and tissue. And arriving on scene after asking for permission and treating it and performing your rapid ***. Would you clean the spot of the wound with saline water at the scene or en route???



If their leg is barely hanging on by skin and tissue I would hope that:
1. Consent is implied and you don't have to ask them if they want help
2. You treat the massive hemorrhage that is likely and going to be a primary concern, and leave the irrigation to the folks at the hospital......


----------



## GeorroEMT (Apr 16, 2016)

CANMAN said:


> If their leg is barely hanging on by skin and tissue I would hope that:
> 1. Consent is implied and you don't have to ask them if they want help
> 2. You treat the massive hemorrhage that is likely and going to be a primary concern, and leave the irrigation to the folks at the hospital......


I'm saying that obviously once you ask consent,call for als backup, checked the airway breathing, applied the tourniquet, and finish the rest of the rapid assessment, ex..  I just had that question


----------



## GeorroEMT (Apr 16, 2016)

STXmedic said:


> Well considering you'd probably want to bandage the wound before leaving, and if you were going to irrigate it, you'd want to do that before bandaging, then probably before. It also kind of depends on if the patient is crashing or not.


Cause my I thought that for a trauma call your suppose to treat all life threatening situations at the scene evrything else would be done en route. But some friends tell me that I should do it at the scene. That's why I was asking


----------



## CANMAN (Apr 16, 2016)

GeorroEMT said:


> Cause my I thought that for a trauma call your suppose to treat all life threatening situations at the scene evrything else would be done en route. But some friends tell me that I should do it at the scene. That's why I was asking



That's fine, I wasn't being smart. You are correct in you need to identify and treat life threats immediately. However if the injury is severe, like you are describing, I wouldn't worry about irrigating it. You are likely to have other issues to worry about, and if it's a borderline amputation then they will get a complete washout in the O.R. at the trauma center anyway. When ALS arrives they may need your help to address things like hypotension, or pain management, and irrigating a serious injury like that is just going to make a bloody mess. Irrigation for smaller stuff like lacerations, abrasions, etc with contaminates is perfectly fine.


----------



## Carlos Danger (Apr 16, 2016)

GeorroEMT said:


> I need help here is a persons leg is barely hanging by skin and tissue. And arriving on scene after asking for permission and treating it and performing your rapid ***. *Would you clean the spot of the wound with saline water at the scene or en route???*



Neither. I would focus on the real problems (airway status, hypovolemia, hypothermia, just to name a few) and getting to a hospital as soon as is safely possible.


----------



## GeorroEMT (Apr 16, 2016)

CANMAN said:


> That's fine, I wasn't being smart. You are correct in you need to identify and treat life threats immediately. However if the injury is severe, like you are describing, I wouldn't worry about irrigating it. You are likely to have other issues to worry about, and if it's a borderline amputation then they will get a complete washout in the O.R. at the trauma center anyway. When ALS arrives they may need your help to address things like hypotension, or pain management, and irrigating a serious injury like that is just going to make a bloody mess. Irrigation for smaller stuff like lacerations, abrasions, etc with contaminates is perfectly fine.


Thanks, your right that it's not that important to irrigate it at the moment. The main priority would be just to treat the injury asap and transport immediately and make sure the patient doesn't go into hemorrhagic shock


----------



## redundantbassist (Apr 17, 2016)

No way I'd clean that on the spot. TQ and diesel.


----------



## StCEMT (Apr 21, 2016)

I'd just leave it for the folks at the hospital. I had a finger tip avulsion the other day (not so friendly pooch) and I didn't mess with it. Gave him some morphine and transported. I'll let the docs play with his finger.


----------



## ERDoc (Apr 22, 2016)

This isn't really an avulsion, it's just an amputation with a little tissue left.  This guy is going to the OR for a washout, so other than controlling bleeding in the field, there isn't much else to do.


----------



## shelvpower (Apr 22, 2016)

Train vs person, was working on my University's response vehicles. Waited an hour and half with the pt before the first ambo arrived.

*Moderator's edit. Picture removed because of this rule:*


> EMTLife.com is a forum that is dedicated to EMS. As such, there may be material (such as photos and videos) that are of a graphic nature and may offend some members or readers. Our policy is that all graphic images must be hosted off-site, and a link will be placed in the post. The post MUST have a graphic image warning so that participants may decide if they want to view the material. The Community Leaders will edit any post that does not meet this requirement by removing the picture AND the link to the picture from the post. The common sense rule of thumb that you can use is the PG-13 rating. If it exceeds PG-13 then it needs the warning.


----------



## shelvpower (Apr 22, 2016)

*Moderator's edit. Picture removed because of this rule:*


> EMTLife.com is a forum that is dedicated to EMS. As such, there may be material (such as photos and videos) that are of a graphic nature and may offend some members or readers. Our policy is that all graphic images must be hosted off-site, and a link will be placed in the post. The post MUST have a graphic image warning so that participants may decide if they want to view the material. The Community Leaders will edit any post that does not meet this requirement by removing the picture AND the link to the picture from the post. The common sense rule of thumb that you can use is the PG-13 rating. If it exceeds PG-13 then it needs the warning.


----------



## shelvpower (Apr 22, 2016)

*Moderator's edit. Picture removed because of this rule:*


> EMTLife.com is a forum that is dedicated to EMS. As such, there may be material (such as photos and videos) that are of a graphic nature and may offend some members or readers. Our policy is that all graphic images must be hosted off-site, and a link will be placed in the post. The post MUST have a graphic image warning so that participants may decide if they want to view the material. The Community Leaders will edit any post that does not meet this requirement by removing the picture AND the link to the picture from the post. The common sense rule of thumb that you can use is the PG-13 rating. If it exceeds PG-13 then it needs the warning.


----------



## shelvpower (Apr 22, 2016)

*Moderator's edit. Picture removed because of this rule:*


> EMTLife.com is a forum that is dedicated to EMS. As such, there may be material (such as photos and videos) that are of a graphic nature and may offend some members or readers. Our policy is that all graphic images must be hosted off-site, and a link will be placed in the post. The post MUST have a graphic image warning so that participants may decide if they want to view the material. The Community Leaders will edit any post that does not meet this requirement by removing the picture AND the link to the picture from the post. The common sense rule of thumb that you can use is the PG-13 rating. If it exceeds PG-13 then it needs the warning.


----------



## Ewok Jerky (Apr 22, 2016)

Dude that is knarly. Nice splint and dressing job.


----------



## Gurby (Apr 22, 2016)

shelvpower said:


> Train vs person, was working on my University's response vehicles. Waited an hour and half with the pt before the first ambo arrived.
> Sent from my SM-G920F using Tapatalk



For this guy.... If hemodynamically unstable, pretty much scoop and screw after addressing any obvious major bleeding?

Assuming he is stable and just in a lot of pain... Expose, assess pulse/motor/sensory function of both feet.  Squirt of IN Fentanyl.  If pulse/sensory/motor function is normal just bandage and splint in place.  If absent, try to realign in anatomical position if possible/easy to do so, reasses, then splint?

I guess one nice thing about that avulsion is it's easy to find the pedal pulse....


----------



## shelvpower (Apr 22, 2016)

For the amount of blood that this patient lost he was actually very stable. 
Unfortunately we had to wait for an ambulance to transport because we cannot transport in our response vehicle. 

Sent from my SM-G920F using Tapatalk


----------



## Martyn (Apr 22, 2016)

shelvpower said:


> For the amount of blood that this patient lost he was actually very stable.
> Unfortunately we had to wait for an ambulance to transport because we cannot transport in our response vehicle.
> 
> Sent from my SM-G920F using Tapatalk


Bit like having a fire truck turn up first...innit? I rest my case!!!!


----------



## Jim37F (Apr 22, 2016)

An hour and a half for an ambulance? Weather too bad for a HEMS unit?


----------



## STXmedic (Apr 23, 2016)

Martyn said:


> Bit like having a fire truck turn up first...innit? I rest my case!!!!


What is your case? Genuinely curious just because the post was kind of vague.


----------



## Chimpie (Apr 23, 2016)

Hey everyone. I've removed the images in the posts because it violates our rules.


> EMTLife.com is a forum that is dedicated to EMS. As such, there may be material (such as photos and videos) that are of a graphic nature and may offend some members or readers. Our policy is that all graphic images must be hosted off-site, and a link will be placed in the post. The post MUST have a graphic image warning so that participants may decide if they want to view the material. The Community Leaders will edit any post that does not meet this requirement by removing the picture AND the link to the picture from the post. The common sense rule of thumb that you can use is the PG-13 rating. If it exceeds PG-13 then it needs the warning.



I've allowed the thumbnails to remain, as my comments are the warning.


----------



## phideux (Apr 25, 2016)

My first go round as a medic I worked the city and went on quite a few subway calls, I was the skinny new guy so guess who got sent to crawl under the trains???? Luckily though, in the city we didn't have an hour and a half wait for help. Plus we loved it when the fire guys showed up, they had all the cribbing and airbags and stuff. 

To the OP, don't worry about cleaning it, control the bleeding, splint and wrap it the best you can, morphine, zofran, fluid and transport, let the ortho and vascular guys worry about the rest.


----------



## Daniel G (Jul 19, 2016)

GeorroEMT said:


> I need help here is a persons leg is barely hanging by skin and tissue. And arriving on scene after asking for permission and treating it and performing your rapid ***. Would you clean the spot of the wound with saline water at the scene or en route???



-Tourny
-assess
-transport
-pressure dressing/large bore IV/o2/Vitals
-reasses/get HX
-transfer to ER facility


----------



## Tigger (Jul 19, 2016)

Daniel G said:


> -Tourny
> -assess
> -transport
> -pressure dressing/large bore IV/o2/Vitals
> ...


How hard is it to just write tourniquet? Civilian EMS: not that high speed.



Martyn said:


> Bit like having a fire truck turn up first...innit? I rest my case!!!!


Well no. There is a time and a place for transport first response, life threatening hemorrhage would be one of those times.


----------



## TransportJockey (Jul 19, 2016)

Tigger said:


> How hard is it to just write tourniquet? Civilian EMS: not that high speed.
> 
> 
> Well no. There is a time and a place for transport first response, life threatening hemorrhage would be one of those times.


And TQ is the appropriate abbreviation anyway


----------



## redundantbassist (Jul 19, 2016)

TransportJockey said:


> And TQ is the appropriate abbreviation anyway


I've seen a lot of people use TK. Which has always confused me because there is no "K" in "Tourniquet"


----------

