# ATV Scenario



## AZFF/EMT (Feb 17, 2008)

Dispatch

962 (MVA) Motorcycle.

57 yr old Male
Unconscious, snoring resperations.

Approx 8.7 miles away, a man on a dirtbike will guide you in. 

You are on the first arriving unit an ambo with 1 emt and 1 medic.
The next arriving units are 5-10 miles behind you and will most likely have access issues. You take a dirt gas-line road approx 4 miles where you find the patient. You will be alone for around 20 minutes. Helicopter has a 20 min eta if launched.


Patient upon arrival. Approx 75 yards from ambo, up and down a 20 foot hill.

Supine with helmet still on, flailing his body around and fighting with his son.

A&O X 1. Awake, non alert, unable to communicate with.
AVPU= Pain
Airway=clear, open
Breathing= 16 resp/min, saying the ABC's and counting over and over again.
Pulses= Tachy, no count yet.
Pupils= Fixed and dialated at 5mm.

Rapid assement.
No obvious deformities, inimal blood from nose already drying. C-spine has already been comprimised, patient is fighting hard and flaining around as you try to asses. 

It's you, your medic and the mans son. 


How do you treat this patient?


This happened yesterday, right after 2 hours of 3 on 3 b-ball!


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## james (Feb 17, 2008)

first I would call medcontrol and ask to restrain and or sedate pt


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## firecoins (Feb 17, 2008)

AZFF/EMT said:


> It's you, your medic and the mans son.



Is that the man's son or Manson?  :huh:

Very simple.  Backboard the man anyway. C-spine being compromised already means nothing.  You have a head injury and possibly spinal injuries.  What would you say his GCS was?  a/o X 1 is not specific enough.

Sedation has been mentioned.  This may be a standing order where you live. If not, cal medical control and get it.  

Chopper should been called prior to arriving at the patient since we have a prolonged extrication.


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## AZFF/EMT (Feb 17, 2008)

-GCS=8 eyes open to pain, inappropriate words and flexion and withdrawl to stimuli.
-Sedation with versed allowed online 1-5 titrate. IV or IM.
-Restraints can be used in order to properly treat the patient without med direction.

We did C-spine, we had to in order to carry the patient, a basket stretcher would have been ideal, but wasn't available. Left his helmet on, his was still thrashing his body around and trying to fight us. 

It was the man's son, forgot puncuation, sorry.h34r:

Helicopter was launched when we met the dirtbike rider who was leading us to the scene.


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## certguy (Feb 17, 2008)

Ah ! point of order , this is the BLS discussion site . Sedation isn't an option .  How are the respirations again ? First you mentioned snoring resp. , then you said he didn't have them . You will have to restrain this pt. to treat him . Copter should've been launched on the initial response given the circumstances . Have the first in FD unit locate and set up your LZ . Others to assist with pt. . Do I have good airway acess with helmet on , if not , it needs to come off . If the helmet stays on , horseshoe collar around it .  The tachy pulse with a combative head injury doesn't sound right . We may have a bleeder we don't know about . What are chest and abd. findings ? I'd say c - spine with restraints , NPA contraindicted due to head injury . Have an OPA and suction handy . Non - rebreather at 15 lpm . Full vitals evry 5 min. when you can get them . Control obvious bleeds . splint as necessary . SAMPLE hx. from son ( as much as you can get ) . Monitor LOC , vitals , and neuros closely . Treat for shock .


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## certguy (Feb 17, 2008)

Sorry , missed one , be ready to assist ventilations if needed .


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## certguy (Feb 18, 2008)

I goofed , I forgot you have a mixed crew , sorry . I'm curious , what was the MOI ? Did he hit the handlebars ? Did he go over the bars or lay it down ? Is the helmet damaged ? What surface did he fall on ? ( dirt vs. rock or gravel ) Was he wearing leathers ?


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## NRNCEMT (Feb 18, 2008)

What certguy said was good, but one of the 1st things I would have done was to check BGL.


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## firecoins (Feb 18, 2008)

certguy said:


> Ah ! point of order , this is the BLS discussion site . Sedation isn't an option .  .



You have a medic with you.  ALS section would be more appropriate than.  Sedate him.


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## AZFF/EMT (Feb 18, 2008)

Blood sugar was 117
Minor helmet damge, helmet was not obstucting his airway so we kept in on and secured him o the board. Our first main concern was getting him into the rescue asap, and sedating him.

Flight crew called us after getting the patient to th trauma center.
He had a right temporal bleed and swelling. Doc wanted to thank us for getting him in as fast as possible. He had no other major injuries jus some bumps and bruises. They said he should recover fine after surgery and some rehab.


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## MEDIC213 (Mar 5, 2008)

Definitely want spinal precautions. How bout RSI capabilities? Do you have them in your area? Due to his altered mental status (combativeness) a probability of head injury, I would definitely consider it as an option. Then wait on the bird.


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## emtwacker710 (Mar 14, 2008)

we get these calls quite a bit in our area, the adirondacks of NYS, most fire companies have 6-wheelers and we just send the emt's in on it and they stabilize the pt. then we transport him out and if necessary we will land a chopper on the closest road and go from there..


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