# What would you do in this scenerio?



## Judeau (Feb 12, 2012)

If someone is bleeding severely from his femur, found prone, and is unconscious. 

I would like to give my answer first. 


I would proceed to the scene making sure everything is safe and secure. Then i would check if the patient is conscious(by verbally communicating and try to stimulate their pain sensors). If he doesn't respond at all to any of these i would quickly try to stabilize his condition. First i would check his vitals and then i would carry out with stabilizing and securing his wound(first), spine and neck(because i would assume hes been hit by a profound impact), followed by inserting a Tracheal intubation, trying to prevent hypoperfusion. I would place him on a spine board then onto a wheeled stretcher keeping him supine, On our way to the hospital i would check his vitals and give medicine if needed?

Sorry, i'm new to EMT-B and new to this forum. I started class at least 3 weeks ago. I'm don't think EMT-B would be on this type of call, but i'm just wondering if i got any of this right? Please explain what would you do in this situation.


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## DrankTheKoolaid (Feb 12, 2012)

3 ways to approach this depending on your situation

Airway Breathing Circulation is the gold standard medically trained approach until changed to

Circulation Airway Breathing which would be the AHA guidelines

Bleeding Airway Circulation Breathing would be used in the military and tactical worlds in austere environments


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## Shishkabob (Feb 12, 2012)

Judeau said:


> First i would check his vitals


  I'd be correcting that "severely bleeding femur" before checking vitals.



> followed by inserting a Tracheal intubation, trying to prevent hypoperfusion.



I don't know if you have trouble with English or if you really think intubating will really do anything to prevent hypoperfusion???


On top of that, you're an EMT, with several rare exceptions in just a couple of different locations, you wont have access to ETI, and just from the info you gave, there is no way to tell if ETI is indicated quite yet.


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## DrankTheKoolaid (Feb 12, 2012)

Linuss said:


> I'd be correcting that "severely bleeding femur" before checking vitals.



Agreed.   AHA dropped the ball not following TCCC this time around.


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## Cup of Joe (Feb 12, 2012)

Forgot BSI (a critical fail), get in the habit of just saying "BSI, Scene Safety.  Is the scene safe?" at the beginning of every scenario.

Treat life threats as you find them. Airway, breathing, circulation.  What was the reasoning for intubation (which I don't believe is a basic skill in any state, except under medical director approval)?  Was the patient's airway at risk?  Was his breathing inadequate?  Lets make sure this guy is not a candidate for CPR.

Spinal immobilization should be considered en-route, and applied at the very beginning if determined necessary.  

What medicine would you give this guy?

You are correct in suspecting hypoperfusion, but think of what you can do about it.

And (because I always got this question at the end of my scenarios): How often would you check this guy's vitals?

Good luck!


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## Anjel (Feb 12, 2012)

Ok first thing you gotta do is click "spell check". 

Then you start patient care....

You get on scene.

BSI/Scene Safety.

Call for ALS.

You take C-spine precautions if you think it is necessary, and if the guy is laying prone you need to roll him over. Check AVPU

Check his breathing if that is good and is airway is good that you are good. If not then start breathing for him with a BVM, check pulse if that's not there do CPR. If it is continue on.

Then you need to control the bleeding from his leg. Direct Pressure, more pressure, if that doesn't work than a tourniquet. 

Do a quick head to toe assessment. Correct any other life threatening issues at that time.

Get him on a back board, and load and go. Get vitals in the truck. That's about all you can do as a basic.


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## JPINFV (Feb 12, 2012)

Turn the patient over, tourniquet, RSI, turf to ortho.


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## RocketMedic (Feb 12, 2012)

Anjel1030 said:


> Ok first thing you gotta do is click "spell check".
> 
> Then you start patient care....
> 
> ...



Sorry, but not quite.

1. Why is he bleeding (Scene/BSI/prep).
2. Tourniquet and/or pack the wound if inguinal, high and very tight, until bleeding is controlled. Why? Because a known femoral bleed will kill very quickly. If you have a partner, this is a perfect job for him.
3. Expose and assess patient.
4. Package, treat secondary injuries, initiate transport. IVs, warming, etc can be done en route. RSI PRN, but you need to assess the patient and figure out why he's unconscious and how he responds to treatment.


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## TheGodfather (Feb 12, 2012)

*A*irway 
*B*reathing
*C*irculation
*D*eformity 
*E*nvironment
---> Transport + secondary survey (if time/condition allows)
Know it, live it, love it.


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## abckidsmom (Feb 12, 2012)

JPINFV said:


> Turn the patient over, tourniquet, RSI, turf to ortho.



Figures that the most correct answer has the fewest words.


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## Shishkabob (Feb 12, 2012)

Severe hemorrhage will kill before lack of an airway.  You can't breathe without an airway.

Fix in that order.  C-A-B.



Ironic part?  I failed CPR/AED in EMT class the first time I did it because I followed that logic... the very logic that one year later, the AHA adopted as their own.


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## Handsome Robb (Feb 13, 2012)

If he's actively bleeding I'm gonna go out on a limb and say he still has a pulse 

Tourniquet the leg, strip and flip him onto a board, control the airway if indicated (if he's truly unresponsive I'd say it's indicated in some way shape or form), transport him, anything else can be done en route.


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## Judeau (Feb 13, 2012)

Linuss said:


> I'd be correcting that "severely bleeding femur" before checking vitals.
> 
> 
> 
> ...




Sorry, i don't understand all those acronyms... I haven't gotten that far in the book yet. It was just a guess; I'm trying to see if i was right. What is up with all the criticism? What did i spell wrong?


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## Handsome Robb (Feb 13, 2012)

Judeau said:


> Sorry, i don't understand all those acronyms... I haven't gotten that far in the book yet. It was just a guess; I'm trying to see if i was right. What is up with all the criticism? What did i spell wrong?



From the way you structured your sentence in the original post it appeared as though you were trying to say endotracheal intubation would correct hypoperfusion. 

As an EMT-B, intubation isn't in your scope in most places so you shouldn't be worrying yourself about it. Focus on learning the basics before you start on the fun stuff.


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## Judeau (Feb 13, 2012)

Cup of Joe said:


> Forgot BSI (a critical fail), get in the habit of just saying "BSI, Scene Safety.  Is the scene safe?" at the beginning of every scenario.
> 
> Treat life threats as you find them. Airway, breathing, circulation.  What was the reasoning for intubation (which I don't believe is a basic skill in any state, except under medical director approval)?  Was the patient's airway at risk?  Was his breathing inadequate?  Lets make sure this guy is not a candidate for CPR.
> 
> ...



I would assume he would need oxygen. The lack of blood could interrupt perfusion? That could potentially lead to shock? And i don't know, i'm just guessing if the medic would give medicine. I wanted you guys to correct me not criticize me. Also you would check the guys vitals every so often? I mostly read about the scope of practice, lifting, how to carry someone, what stretchers are used, and my class just started last week how to take vital signs. I haven't gotten my CPR certification yet...


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## Shishkabob (Feb 13, 2012)

Judeau said:


> Sorry, i don't understand all those acronyms...



I used literally 1 more acronym than you did. :unsure:


ETI-- Endotracheal Intubation.


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## Judeau (Feb 13, 2012)

NVRob said:


> From the way you structured your sentence in the original post it appeared as though you were trying to say endotracheal intubation would correct hypoperfusion.
> 
> As an EMT-B, intubation isn't in your scope in most places so you shouldn't be worrying yourself about it. Focus on learning the basics before you start on the fun stuff.



you're right lol. I have been trying to cram all this stuff in my head. I'm not even going to be doing this stuff yet lol. I just want to become a paramedic so baddddddd!!!


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## TheGodfather (Feb 13, 2012)

direct pressure BEFORE tourniquet... Not really sure why everyone has been jumping the gun on that one here..

and GCS < 9 = advanced airway. (for those others who questioned it)


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## Judeau (Feb 13, 2012)

Linuss said:


> I used literally 1 more acronym than you did. :unsure:
> 
> 
> ETI-- Endotracheal Intubation.



So every time i enter a scene, including CPR scenerios. I have to say BSI, scene is safe? Is there anything else i have to say? Also do you have to learn all the street addresses? I want to work in a city i don't even know or go to. Wouldn't it be hard to remember all those streets? The concept of that is pretty hard.


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## Shishkabob (Feb 13, 2012)

TheGodfather said:


> direct pressure BEFORE tourniquet... Not really sure why everyone has been jumping the gun on that one here..



Because there are times that it's not necessarily jumping the gun.  If I have a critical patient with multiple things going on, and I see massive external bleeding, I'm slapping a TQ on, then moving on to other stuff.  You have several hours after application of a TQ before any real damage sets in.  Plenty of time to get them to a hospital.  Plus, there is also nothing wrong with putting a TQ on, doing other stuff, then coming back and re-evaluating the TQ and its necessity.





> and GCS < 9 = advanced airway. (for those others who questioned it)



GCS < 9 = sleepy patient.  

I get patients with a GCS of 3 all the time that I don't do an advanced airway on... I call them diabetics and epileptics.


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## Handsome Robb (Feb 13, 2012)

TheGodfather said:


> direct pressure BEFORE tourniquet... Not really sure why everyone has been jumping the gun on that one here..
> 
> and GCS < 9 = advanced airway. (for those others who questioned it)



True but in the good bleeds I've seen it has always been pretty obvious that pressure wont cut it. Also if he's unresponsive with a mechanism great enough to wreck his femur I'm betting there are some other things happening beyond what we see right off the bat, neurological being my main thought, so I'm not going to waste  a bunch of time ****ing around with direct pressure. Although that'd be a great job for a student or fire. 

Also, once he's on a lsb it's gonna be a pain in the *** to apply a tourniquet.


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## Judeau (Feb 13, 2012)

NVRob said:


> From the way you structured your sentence in the original post it appeared as though you were trying to say endotracheal intubation would correct hypoperfusion.
> 
> As an EMT-B, intubation isn't in your scope in most places so you shouldn't be worrying yourself about it. Focus on learning the basics before you start on the fun stuff.



What will i do as a EMT-B?


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## Handsome Robb (Feb 13, 2012)

Judeau said:


> What will i do as a EMT-B?



I bet a quick google search will answer that for you 

Basic airway adjuncts.
Splinting
Patient assessment
a very limited selection of meds.


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## Judeau (Feb 13, 2012)

NVRob said:


> True but in the good bleeds I've seen it has always been pretty obvious that pressure wont cut it. Also if he's unresponsive with a mechanism great enough to wreck his femur I'm betting there are some other things happening beyond what we see right off the bat, neurological being my main thought, so I'm not going to waste  a bunch of time ****ing around with direct pressure. Although that'd be a great job for a student or fire.
> 
> Also, once he's on a lsb it's gonna be a pain in the *** to apply a tourniquet.



When would you apply direct pressure? The book mention a lot about being sued? i.e, If a patient refuses to be taken care of, later on if he collapse and his injuries get worse, he could come back and sue you.... Why would anyone do that? I know you would have to try and convince him, but if he denies and doesn't want to... why would he sue you?


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## Shishkabob (Feb 13, 2012)

What book are you reading that mentions being sued even once, let alone "a lot" about it?  

Whatever it is, throw it away, as if they're saying, 'a lot', about you being sued by a patient after they refuse care, I'd call in to question, well, everything they write.  I cant even recall a single time it was mentioned in my EMT book.



I'm calling shens...


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## DrankTheKoolaid (Feb 13, 2012)

You would put direct pressure on it the second you find it


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## Handsome Robb (Feb 13, 2012)

Judeau said:


> When would you apply direct pressure? The book mention a lot about being sued? i.e, If a patient refuses to be taken care of, later on if he collapse and his injuries get worse, he could come back and sue you.... Why would anyone do that? I know you would have to try and convince him, but if he denies and doesn't want to... why would he sue you?



I'm going to guess that you are pretty young...not saying that's a bad thing....

This is all stuff you will learn about in class.


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## TheGodfather (Feb 13, 2012)

Linuss said:


> Because there are times that it's not necessarily jumping the gun.  If I have a critical patient with multiple things going on, and I see massive external bleeding, I'm slapping a TQ on, then moving on to other stuff.  You have several hours after application of a TQ before any real damage sets in.  Plenty of time to get them to a hospital.  Plus, there is also nothing wrong with putting a TQ on, doing other stuff, then coming back and re-evaluating the TQ and its necessity.
> 
> 
> 
> ...



GCS is scored after any correctable intervention takes place (IE; glucose), and is rated to the greatest score producible (IE; if a hemiparesis patient is only responsive to pain on one arm) ----- with that said, per American College of Surgeons ATLS guidelines ----> every patient with a GCS < 9 in the trauma scenario REQUIRES intubation.... period.

Also, sure an amputation or an obvious injury we know will require a TQ will automatically get one, but why not have your partner hold pressure, or even apply a pressure bandage to the extremity before TQ application? In a pinch, ok, I agree, but if we have the extra hands, why not apply pressure?


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## Judeau (Feb 13, 2012)

NVRob said:


> I bet a quick google search will answer that for you
> 
> Basic airway adjuncts.
> Splinting
> ...



Sorry for the 101 questions i have a few more bud.

My teachers in the class(I have a lot, they are all firemen/paramedic) said they don't follow everything in the book, because they have more efficient ways. Will i learn them? and when i start to work will my partner be experienced and teach me how to do things properly? My teacher said he spelled one word incorrect in 5 different rapports and he went to court. Can you spell check medical terms? I have a hard time with some of them.


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## TheGodfather (Feb 13, 2012)

NVRob said:


> Also, once he's on a lsb it's gonna be a pain in the *** to apply a tourniquet.



actually, it's really quite easy to do.


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## Judeau (Feb 13, 2012)

NVRob said:


> I'm going to guess that you are pretty young...not saying that's a bad thing....
> 
> This is all stuff you will learn about in class.



I'm 18


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## Handsome Robb (Feb 13, 2012)

TheGodfather said:


> GCS is scored after any correctable intervention takes place (IE; glucose), and is rated to the greatest score producible (IE; if a hemiparesis patient is only responsive to pain on one arm) ----- with that said, per American College of Surgeons ATLS guidelines ----> every patient with a GCS < 9 in the trauma scenario REQUIRES intubation.... period.
> 
> Also, sure an amputation or an obvious injury we know will require a TQ will automatically get one, but why not have your partner hold pressure, or even apply a pressure bandage to the extremity before TQ application? In a pinch, ok, I agree, but if we have the extra hands, why not apply pressure?



I was always taught it was GCS<8 = intubate, but hey 9 works too 

I cited why I would jump straight to a TQ in this situation. I do agree with you about using available hands though.


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## Shishkabob (Feb 13, 2012)

TheGodfather said:


> with that said, per American College of Surgeons ATLS guidelines ----> every patient with a GCS < 9 in the trauma scenario REQUIRES intubation.... period.



Then  I'm going to go out on a limb and say they're wrong and stupid.


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## TheGodfather (Feb 13, 2012)

NVRob said:


> I was always taught it was GCS<8 = intubate, but hey 9 works too
> 
> I cited why I would jump straight to a TQ in this situation. I do agree with you about using available hands though.



GCS less than or equal to 8 = intubate... i dont know how to produce that symbol so < 9 had to suffice lol


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## Judeau (Feb 13, 2012)

Linuss said:


> What book are you reading that mentions being sued even once, let alone "a lot" about it?
> 
> Whatever it is, throw it away, as if they're saying, 'a lot', about you being sued by a patient after they refuse care, I'd call in to question, well, everything they write.  I cant even recall a single time it was mentioned in my EMT book.
> 
> ...



Lol! It mentioned it quite a few times in the book. If you do this, blah blah blah will happen. I think the book is new. At least it looks new


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## Handsome Robb (Feb 13, 2012)

TheGodfather said:


> actually, it's really quite easy to do.



Depends on what kind you use. 

CAT or something of the sort absolutely easy as pie. My service uses the SWAT-T. It gets a bit more difficult with a pt strapped to a board using the SWAT-T. Again this is just me talking about my situation.


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## TheGodfather (Feb 13, 2012)

Linuss said:


> Then  I'm going to go out on a limb and say they're wrong and stupid.


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## DesertMedic66 (Feb 13, 2012)

NVRob said:


> Depends on what kind you use.
> 
> CAT or something of the sort absolutely easy as pie. My service uses the SWAT-T. It gets a bit more difficult with a pt strapped to a board using the SWAT-T. Again this is just me talking about my situation.



Those are all nice and fancy lol. We use triangle bandages and synch it down with a pen haha


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## Shishkabob (Feb 13, 2012)

TheGodfather said:


> every ... period.



Hey, if you want to work in a world of absolutes and cookbook medicine, by all means, but I'm standing by my "They're wrong" if that's what they truly say.


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## RocketMedic (Feb 13, 2012)

Linuss said:


> Because there are times that it's not necessarily jumping the gun.  If I have a critical patient with multiple things going on, and I see massive external bleeding, I'm slapping a TQ on, then moving on to other stuff.  You have several hours after application of a TQ before any real damage sets in.  Plenty of time to get them to a hospital.  Plus, there is also nothing wrong with putting a TQ on, doing other stuff, then coming back and re-evaluating the TQ and its necessity.



^^^
This, so this. With a femoral artery or even decent venous involvement, pressure isn't going to do much other than keep the blood from spurting or gushing. Actual hemorrhage control depends on getting above the injury and stopping flow. The only ways to do that are a lot of sustained pressure or tourniquets.


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## Cup of Joe (Feb 13, 2012)

Judeau said:


> I would assume he would need oxygen. The lack of blood could interrupt perfusion? That could potentially lead to shock? And i don't know, i'm just guessing if the medic would give medicine. I wanted you guys to correct me not criticize me. Also you would check the guys vitals every so often? I mostly read about the scope of practice, lifting, how to carry someone, what stretchers are used, and my class just started last week how to take vital signs. I haven't gotten my CPR certification yet...



I had assumed you were a little more advanced in the course.  We aren't trying to make you feel stupid, we want you to think.  If we hand you the answers, you will learn less than if you think about *why* you're doing something.


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## TheGodfather (Feb 13, 2012)

In the multiple trauma scenario, with my patient who is suffering from extensive internal/external injuries, who is unconscious (whether it be from blood loss, alcohol intoxication, neurological dysfunction, etc etc etc) -- I'd feel more comfortable breathing for my patient than having the risk of worsening airway issues arising later on during the time they are in my care -- they may physically not be able to control their own airway (and it is really not something I'd like to sit around and find out), so yes, I would intubate every patient with a GSC < 9 involved in multiple trauma.... if that is cookbook medicine, then so be it.


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## Shishkabob (Feb 13, 2012)

And please do the TQ right...


Had a call for a person with a lacerated AC... FD put on 3 TQs, a quicklot pack, and a crap load of abd pads and 4x4s and it was still bleeding out.  We put on a single BP cuff, pumped it up, and stopped the flow...



Though FD looked at us like retards when we took out the BP cuff.. "Why would want want a blood pressure at a time like this?!"


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## Shishkabob (Feb 13, 2012)

TheGodfather said:


> In the multiple trauma scenario... multiple trauma....





That wasn't what was said, though.  What was said was "Any trauma patient... PERIOD"


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## ffemt8978 (Feb 13, 2012)

Cup of Joe said:


> I had assumed you were a little more advanced in the course.  We aren't trying to make you feel stupid, we want you to think.  If we hand you the answers, you will learn less than if you think about *why* you're doing something.



Well said.


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## RocketMedic (Feb 13, 2012)

TheGodfather said:


> In the multiple trauma scenario, with my patient who is suffering from extensive internal/external injuries, who is unconscious (whether it be from blood loss, alcohol intoxication, neurological dysfunction, etc etc etc) -- I'd feel more comfortable breathing for my patient than having the risk of worsening airway issues arising later on during the time they are in my care -- they may physically not be able to control their own airway (and it is really not something I'd like to sit around and find out), so yes, I would intubate every patient with a GSC < 9 involved in multiple trauma.... if that is cookbook medicine, then so be it.



Depends on the trauma. Am I going to RSI a double-leg amputee after HEMCON and packaging? Yes. Am I going to RSI a non-tension penetrating chest wound with hemostasis and a patent airway? Probably not...

Extremity wounds don't always mean intubation. A lot of these patients are just fine breathing on their own.


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## TheGodfather (Feb 13, 2012)

Linuss said:


> That wasn't what was said, though.  What was said was "Any trauma patient... PERIOD"



I'll rephrase; if I have a patient with only a single bleeding femur fracture who has a true GCS of 8, I would still intubate due to high probability of TBI.

(this is after a good history taking and scene size up of course) -- im sure there are loopholes here, and different types of patient population that may generate this from an underlying pathology


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## TheGodfather (Feb 13, 2012)

Rocketmedic40 said:


> Depends on the trauma. Am I going to RSI a double-leg amputee after HEMCON and packaging? Yes. Am I going to RSI a non-tension penetrating chest wound with hemostasis and a patent airway? Probably not...
> 
> Extremity wounds don't always mean intubation. A lot of these patients are just fine breathing on their own.



I agree, given the GCS is at an acceptable level and they are able to maintain their own airway.


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## ffemt8978 (Feb 13, 2012)

Let's all take a moment and remember that this is for a Basic class, before we go off on the tangent of what advanced providers would do.


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## Shishkabob (Feb 13, 2012)

ffemt8978 said:


> Let's all take a moment and remember that this is for a Basic class, before we go off on the tangent of what advanced providers would do.



To be fair, he DID ask about ETI.


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## TyBigz (Feb 13, 2012)

I think it would be worth mentioning a C-spine precaution. Id direct my partner to hold C-spine before addressing the femur, and then i would log roll my patient. At this time i would already know his level of consciousness as i would go through AVPU before letting him know my partner is going to hold his neck. Things can go a few ways from there depending on his level of consciousness but A-B-C no mater what. As a basic I would strongly consider ALS depending on where you are due to blood loss and as you will learn and ETI is the only indefinite airway but this is also dependent on how it plays out, a pt laying prone with an arterial bleed can go a few ways. And depending on if it is just you and your partner, vitals might take the back burner to Airway, Breathing, CPR, C-spine, Controlling bleeding.


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## JPINFV (Feb 13, 2012)

abckidsmom said:


> Figures that the most correct answer has the fewest words.




The sad part is that I was being a bit of a bung hole with that reply. I originally had "page surgery" in there.


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## Kevinf (Feb 13, 2012)

He is 3 weeks into a course, I'd say he's getting way ahead of himself and to concentrate on passing the course and getting certified first. The book has all he needs for now, and if his instructors are running a class that both discourages these sorts of questions during lectures and also not teaching the proper way to do things (shortcuts that work better? Super, but don't drop that on students, teach em the right way first and let them learn the tricks in the field) then he is being taught in a very poor manner. If the class is at all decent, they'll have practicals that will address such situations that will stick far better than a few forum posts will.

I'm all for outside learning, but this is exactly the kind of question that should be brought up in his class so that all can learn from the response. If he has questions about the material, so do others.


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## systemet (Feb 13, 2012)

* If there's an arterial bleed, it needs controlling before it stops bleeding.  The TQ is entirely appropriate, and should be a priority.

* An unconscious trauma patient with major trauma should have c-spine controlled.

* The patient needs to be rolled over in order to be assessed properly.  It would be good to quickly check the back now.

* Real life, multiple things happen simultaneously.  Scenarioland, you have to have a standardised and methodical approach and move in a linear manner.

* Intubation depends on transport time, need or lack or need for RSI, anticipated difficulty, and anticipated clinical course.


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## Anjel (Feb 13, 2012)

Rocketmedic40 said:


> Sorry, but not quite.
> 
> 1. Why is he bleeding (Scene/BSI/prep).
> 2. Tourniquet and/or pack the wound if inguinal, high and very tight, until bleeding is controlled. Why? Because a known femoral bleed will kill very quickly. If you have a partner, this is a perfect job for him.
> ...



Sorry didn't know RSI, IVs and wound packing were in a basics scope of practice. And who said it was a femoral bleed. They said the femur was bleeding badly. Not spurting. 

And I covered checking out the scene with BSI/scene safety. 

Thats where you check out the surroundings and see whats going on.


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## systemet (Feb 13, 2012)

Anjel1030 said:


> Sorry didn't know RSI, IVs and wound packing were in a basics scope of practice. And who said it was a femoral bleed. They said the femur was bleeding badly. Not spurting.



This varies a little with location.  In some areas IVs are BLS.


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## Jon (Feb 13, 2012)

Linuss said:


> To be fair, he DID ask about ETI.





systemet said:


> This varies a little with location.  In some areas IVs are BLS.



In some areas, one or both of these skills are within the scope of an Emergency Medical Technician - perhaps with additional training/certs, perhaps without. 



JPINFV said:


> The sad part is that I was being a bit of a bung hole with that reply. I originally had "page surgery" in there.


Turf works so much better.


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## Jon (Feb 13, 2012)

Judeau said:


> Sorry for the 101 questions i have a few more bud.
> 
> My teachers in the class(I have a lot, they are all firemen/paramedic) said they don't follow everything in the book, because they have more efficient ways. Will i learn them? and when i start to work will my partner be experienced and teach me how to do things properly? My teacher said he spelled one word incorrect in 5 different rapports and he went to court. Can you spell check medical terms? I have a hard time with some of them.



Alright, I'll bite.

Yes, you can spell-check medical terms. Charting programs often have a variety of common medical terms within their spell check database.

That said, spell check only gets you so far. You've got to use the RIGHT word, too - Best example in the above?
Rapport: http://en.wiktionary.org/wiki/rapport
Report: http://en.wiktionary.org/wiki/report

Grammar is important, too. "I" should be capitalized. And "firemen/paramedic" isn't correct because the single and plural don't agree with each other. Further, in today's politically-correct world, the word "firefighter" is considered more appropriate because it is gender neutral. So the correct way to write that would be firefighter/paramedic, or the plural firefighter/paramedics.



As for the question about court - Appropriate spelling/grammar will NOT keep you from going to court. Documenting well won't keep you from going to court, either. Only way to avoid court is to not work in this field. That said, proper spelling/grammar and good documentation skills WILL help WHEN you get called to court to testify. It is likely that the opposing side will attempt to discredit you based on your poor documentation.


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## Veneficus (Feb 13, 2012)

Is hacking off the leg, replacing it with a peg, giving the guy a parrot and teaching him to say "aye" and "argh" an option?


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## systemet (Feb 13, 2012)

Veneficus said:


> Is hacking off the leg, replacing it with a peg, giving the guy a parrot and teaching him to say "aye" and "argh" an option?



That would solve the whole tourniquet issue.


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## JPINFV (Feb 13, 2012)

Veneficus said:


> Is hacking off the leg, replacing it with a peg, giving the guy a parrot and teaching him to say "aye" and "argh" an option?




Only if you want him to find himself in a ditch on the side of the road when people want to find out how tough he really is.


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## Veneficus (Feb 13, 2012)

JPINFV said:


> Only if you want him to find himself in a ditch on the side of the road when people want to find out how tough he really is.



just get him a friend, nobody messes with the 2 dudes and comes out the better.


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## Melclin (Feb 13, 2012)

I'm confused. Did I miss the post that explained whether this was trolling/english as a second language/typing on a iphone keypad? Whats happening here?


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## JPINFV (Feb 13, 2012)

Veneficus said:


> just get him a friend, nobody messes with the 2 dudes and comes out the better.




Emergency Medicine:

Worst disease: Two Dudes.
Worst location: Sitting on the front porch, minding your own business.


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## Veneficus (Feb 13, 2012)

JPINFV said:


> Emergency Medicine:
> 
> Worst disease: Two Dudes.
> Worst location: Sitting on the front porch, minding your own business.



I thought the worst location was minding your own business taking your library books back at 3am so you could be a responsible citizen and not return them past due?


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## JPINFV (Feb 13, 2012)

I haven't heard the taking library books back at 3am bit yet.


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## Veneficus (Feb 13, 2012)

JPINFV said:


> I haven't heard the taking library books back at 3am bit yet.



That is original Veneficus.

The 2 dudes and I go way back and they travel easily as much as I do.


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## hippocratical (Feb 13, 2012)

I'll bite. I have an interview next week which involves a scenario, so this will be good for me:

_(The following is Scenarioland for my province. Real life is waaaaay faster, but I think the OP was talking about a scenario which is a different beast. Your state/province/planet may have different protocols but I'm very confident that the below is correct for where I work)_

Anyway. 

* BSI precautions and check the time
* Scene survey - any fire, wire, water, gas or glass?
* Broad mechanism of injury? Ask bystanders what happened.
* Is this my only patient? Confirm with bystanders.
* Do I need any specialised equipment? Call for backup. Scenarioland is Fire, police, ALS, BLS and 24,000 of each 
* Get closer and look at you patient:
* Are their eyes open and tracking?
* What's their skin colour and condition like?
* Do they seem to be in any respiratory distress?
* Do they seem to have any obvious fractures, dislocations, or deadly bleeds?
* Partner goes over and holds C-spine for manual spinal motion restriction
* available EMS goes over and deals with the deadly bleed. They do this in the following order: 
Direct pressure, if that fails:
Pressure point, if that fails:
Pressure dressing, if that fails:
Elevation, if that fails:
Tourniquet (preferably after calling medical director at EMR level) and write on the pt.s forehead "T _time_"
* Now me again, I check LOC, finding Unresponsive
* Available EMS brings over a backboard and places it next to the patient 
* Check posterior for DCAPBTLS and palpate for TIC _(we're only allowed to roll the patient once in Scenarioland)_
* Using appropriate number of people, roll the pt. onto the backboard
* Airway: Dude holding the head does a modified jaw thrust and I check for blockages. If clear, size and fit for and OPA adjunct (after having checked the eyelashes for a flicker indicating a gag reflex - if gag reflex found fit and NPA assuming no signs of skull fractures)
* Breathing: O2 provided by available EMS using appropriate method (BVM, NRB whatever) at appropriate flowrate (15lpm in my world)
* Circulation: what's their pulse?
* rapid wet check
* check skin colour, condition and temperature with back of ungloved hand
* critical intervention check
* continue...

There we go. My interview is in the bag


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## Judeau (Feb 13, 2012)

hippocratical said:


> I'll bite. I have an interview next week which involves a scenario, so this will be good for me:
> 
> _(The following is Scenarioland for my province. Real life is waaaaay faster, but I think the OP was talking about a scenario which is a different beast. Your state/province/planet may have different protocols but I'm very confident that the below is correct for where I work)_
> 
> ...




 awesome! What are you? Paramedic? Also how would you put this on a rapport? Please write it based on the procedures you listed


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## tssemt2010 (Feb 13, 2012)

not sure why people are so quick to RSI, whats the patients rate, quality etc? o2 sat? and as a basic you will not get to intubate anyways.


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## JPINFV (Feb 13, 2012)

tssemt2010 said:


> not sure why people are so quick to RSI, whats the patients rate, quality etc? o2 sat? and as a basic you will not get to intubate anyways.




Anything to still a tube from a gas passer.


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## Judeau (Feb 13, 2012)

Jon said:


> Alright, I'll bite.
> 
> Yes, you can spell-check medical terms. Charting programs often have a variety of common medical terms within their spell check database.
> 
> ...



I know lol, i won't spell 100 percent correct on the internet, its a start though. Also, how much money can you be sued for? Were you sued before, please state why if you were sued(if its personal i understand).


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## Judeau (Feb 13, 2012)

Melclin said:


> I'm confused. Did I miss the post that explained whether this was trolling/english as a second language/typing on a iphone keypad? Whats happening here?



English is my native language. How am i spelling incorrectly? Maybe a few typos, but it isn't atrocious. Maybe i formatted it wrong???


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## Judeau (Feb 13, 2012)

ffemt8978 said:


> Let's all take a moment and remember that this is for a Basic class, before we go off on the tangent of what advanced providers would do.



lol


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## usalsfyre (Feb 13, 2012)

tssemt2010 said:


> not sure why people are so quick to RSI, whats the patients rate, quality etc? o2 sat? and as a basic you will not get to intubate anyways.



The rate, rhythm and quality can be fine but if they aspirate secondary to ICP induced vomiting you've set them up for a bad outcome down the road.


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## Judeau (Feb 13, 2012)

Cup of Joe said:


> I had assumed you were a little more advanced in the course.  We aren't trying to make you feel stupid, we want you to think.  If we hand you the answers, you will learn less than if you think about *why* you're doing something.



Thank you for the good gesture. ^_^ I don't even know what half of you are talking about, but i just want to get a feel of what it will be like as a paramedic. I'm still filling out papers for my class. I originally studied computer science and networking for 3 years. As you can guess this is very new to me. The whole concept and blah blah blah. I was pretty good at computers, i was one of the three kids in class who got an email and certification from CISCO. My mom is almost an RN, and she talks me about medical things 24/7; i actually like to talk about it and very interested in the medical field. I am trying to as lucid as possible. It was a notion i had to explore. I'm still young(18) and i don't know what i want to do with my life... If all else fails I might want to join the marines or be a field medic in the army. My mom told me to keep on looking for something i really enjoy even though she wasted well over 1k on this class. She said she wouldn't be disappointed if i failed.


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## hippocratical (Feb 13, 2012)

_> What are you? Paramedic? _

My wife says I'm special

_> Also how would you put this on a rapport? _

My rapport is smooth

_> Please write it based on the procedures you listed _



What i wrote is the first 5 minutes of a 20 minute spiel that one does in a scenario in my part of the world. Real life, and potentially where you are, is different. I'm assuming your class will have it's own flavour of a scenario sheet. 
Get that -> Memorize it -> Profit.


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## Judeau (Feb 13, 2012)

hippocratical said:


> _> What are you? Paramedic? _
> 
> My wife says I'm special
> 
> ...



thanks bra lol ill try my hardest!


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## Judeau (Feb 13, 2012)

Judeau said:


> Thank you for the good gesture. ^_^ I don't even know what half of you are talking about, but i just want to get a feel of what it will be like as a paramedic. I'm still filling out papers for my class. I originally studied computer science and networking for 3 years. As you can guess this is very new to me. The whole concept and blah blah blah. I was pretty good at computers, i was one of the three kids in class who got an email and certification from CISCO. My mom is almost an RN, and she talks me about medical things 24/7; i actually like to talk about it and very interested in the medical field. I am trying to as lucid as possible. It was a notion i had to explore. I'm still young(18) and i don't know what i want to do with my life... If all else fails I might want to join the marines or be a field medic in the army. My mom told me to keep on looking for something i really enjoy even though she wasted well over 1k on this class. She said she wouldn't be disappointed if i failed.



Before anyone corrects me, yes i forgot to add in some words between my sentences. I do that occasionally because i type fast and don't review it. Its easy to spell incorrectly on the internet, but in real life its not the same. I generally don't care how i type on the internet and that is the general consensus on the net. I do realize that i have spell correctly and use lucidity on this forum though, so i can get my point across.


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## Shishkabob (Feb 13, 2012)

tssemt2010 said:


> not sure why people are so quick to RSI, whats the patients rate, quality etc? o2 sat? and as a basic you will not get to intubate anyways.



It's not just rate/quality/o2sat etc.  It's also expected clinical course, preventive, and protective.


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## hippocratical (Feb 13, 2012)

Judeau said:


> *thanks bra* lol ill try my hardest!


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## Judeau (Feb 13, 2012)

hippocratical said:


>



Giggity!


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## systemet (Feb 14, 2012)

hippocratical said:


> ** Is this my only patient? Confirm with bystanders.*



This is gold, both for scenarioland and real-life.  It is way too easy to show up to a scene with an obviously critical patient, run them to the ER and find out you've missed other patients because you focused on the first one you found.  

It's amazing how people find their way underneath cars and into ditches in MVCs, just like stab wounds find themselves in axillae, or right in the umbilicus in someone obese, and small caliber rounds end up covered by hair.



> Direct pressure, if that fails:
> Pressure point, if that fails:
> Pressure dressing, if that fails:
> Elevation, if that fails:
> Tourniquet (preferably after calling medical director at EMR level) and write on the pt.s forehead "T _time_"



This may be how they're teaching it still.  For real life, understand that direct pressure is what you're doing while you're making a pressure dressing.  Pressure points aren't generally used any more, and you should have a low threshold for using a tourniquet if a pressure dressing isn't adequate, or if arterial hemorrhage is present.



> There we go. My interview is in the bag



Good luck!


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## Jon (Feb 14, 2012)

Judeau said:


> I know lol, i won't spell 100 percent correct on the internet, its a start though. Also, how much money can you be sued for? Were you sued before, please state why if you were sued(if its personal i understand).



So... You pick and choose when you want to use proper grammar and spelling?

My iPhone has a built-in spellcheck and autocorrect. Yes, it's sometimes hilariously wrong, but it also works most of the time. My browser also has a spellcheck.

Ever heard the phrase: practice makes permanent? The more times you do something wrong, the more likely you are to keep doing it. If you always practice using proper spelling and grammar, it comes easier when it's needed - like the EMS charting software with a crappy spellcheck.

On top of that, what you post online is forever. I'm pretty confident that any employer doing a bit of google-fu investigation prior to hiring me will likely find this site and all my posts. Therefore I try to be courteous and professional in my dealings here.

Oh, and one more thing. It's much easier to understand what you are saying and respond with well-articulated answers if we don't need to try to understand what you wrote that is hidden behind spelling and grammar errors.

Jon


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## Melclin (Feb 14, 2012)

Judeau said:


> Before anyone corrects me, yes i forgot to add in some words between my sentences. I do that occasionally because i type fast and don't review it. Its easy to spell incorrectly on the internet, but in real life its not the same. I generally don't care how i type on the internet and that is the general consensus on the net. I do realize that i have spell correctly and use lucidity on this forum though, so i can get my point across.



But it is real life. We are having an actual conversation. Yeah sure when you're on /b/ and you're launching the ROFLcopters at n00bs you can be as illiterate as you want. 

But these types of forums are a bit different. Like I said we're having a real discussion and there are two reasons why you're style of posting causes issues.

1) If a group of people are sitting around quietly in the library seriously discussing intubation in the moribund haemorrhaging trauma pt, and some jackarse in a slipknot hoody runs up, stands on the table and shouts, "t00b em or loose em muthfockers!!!!", you will find that the people involved in that conversation get frustrated. Its the same here. He's not adding anything useful to the discussion and a comment that might have gone down fine in a less formal chat in a bar, in fact ends up making him a d_ck in the eyes of the people involved and future interactions don't go well as a result. In short, if your posts make you out to be an idiot, then you'll get treated like one and you won't get as much out of the forum as you could have. 

2) MOST IMPORTANTLY: While the finer points of grammar aren't that important to getting a message across, *if you completely disregard the basic rules and structure of the language, nobody can understand what you're saying*. Firstly it makes you look like and idiot (see above). Most importantly though, I actually struggled to understand your posts to such an extent as to assume you were trolling. Its hard enough to communicate the finer points of patient condition and management in text over the internet even when grammar and syntax are your friend. You seem to legitimately want to get something out of this forum and I welcome that, but you can't really get involved in conversation if nobody has any idea what you're saying. 

My own rule of thumb (mean though you might think it) is that if its that much of a struggle for someone to form coherent sentences with >90% success rate in regards to spelling, then that person it too stupid to warrant my talking to them. It would be a shame if we all disregarded you, a potentially intelligent contributor, because you couldn't see fit to spend 3 seconds proof reading your own posts.


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## Handsome Robb (Feb 15, 2012)

Judeau said:


> awesome! What are you? Paramedic? Also how would you put this on a rapport? Please write it based on the procedures you listed



That was all BLS level stuff.


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## jgmedic (Feb 15, 2012)

NVRob said:


> That was all BLS level stuff.



Sorry, I think I quoted the wrong post, but right after someone very nicely explains to you the importance of spelling and grammar, you misspell report as rapport again! Not to mention, the title of your thread, it's spelled scenario! Now, as a paramedic preceptor, I hammer home the importance of proper spelling in our PCR's as they are legal documents, and any lawyer worth his salt could use spelling as a possible reason why you are incompetent. Dude, I realize this is an internet forum, but(and I'm generalizing here) younger people such as yourself seem to have no regard for the English language. These are your future co-workers, bosses, instructors, etc. It's like I tell my intern "mistakes are fine, just not the same one twice", sorry if I came off like an ***, but this is a big pet peeve of mine. Good luck to you.


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## the_negro_puppy (Feb 15, 2012)

I would intubate with a NRB @ 15 l/M then helicopter evacuate on a long spine board :rofl:


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## hippocratical (Feb 16, 2012)

jgmedic said:


> Now, as a paramedic preceptor, I hammer home the importance of proper spelling in our PCR's...



Part of the process for an interview I'm seeking at the moment was to write (not type... _*write*_) a 2 page essay on why I'm teh awesomestest EMT. I haven't written that much in 10 years! It sucked, but I'm positive it was to check for A) spelling, and B) legibility of handwriting for PCRs. Probably a good move on their part I guess, and I did manage to write it out in one go without any errors, which shocked me.


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## Aidey (Feb 16, 2012)

Jon said:


> Alright, I'll bite.
> 
> Yes, you can spell-check medical terms. Charting programs often have a variety of common medical terms within their spell check database.
> 
> ...





Judeau said:


> awesome! What are you? Paramedic? *Also how would you put this on a rapport?* Please write it based on the procedures you listed



I'll make this easy. REPORT! 




Judeau said:


> thanks bra lol ill try my hardest!



:glare: Things like this make me sad for my generation.


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## Aidey (Feb 16, 2012)

And to respond to the OP: 

I'm pretty sure immediate life threats comes above all else in the initial assessment, but it has been a while since I've actually looked at one of those skill sheets. That may mean controlling bleeding before you do anything else. If the guy is truly unconscious deal with the bleeding first, not c-spine. He is unconscious, it's not like he is going to be moving much. 

Also, why does everyone seem to be assuming he is the victim of some massive trauma? He could have been hit in the leg with a baseball bat and be unconscious due to hypovolemia.


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## hippocratical (Feb 16, 2012)

Aidey said:


> And to respond to the OP:
> Also, why does everyone seem to be assuming he is the victim of some massive trauma? He could have been hit in the leg with a baseball bat and be unconscious due to hypovolemia.



Protocol-wise, an unconscious unknown pt is a candidate for c-spine control. Especially if they have a deadly bleed - that's a sure sign that they met '_some guy_' and were attacked '_for no reason_' ^_^

Getting you partner to hold his head while you check stuff out isn't the biggest hassle really.


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## Aidey (Feb 16, 2012)

I didn't say don't hold c-spine, just that stopping the bleeding is the priority. If the pt is already holding still what good is your partner serving holding their head still?


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## TheGodfather (Feb 16, 2012)

Aidey said:


> I didn't say don't hold c-spine, just that stopping the bleeding is the priority. If the pt is already holding still what good is your partner serving holding their head still?



if the patient is responsive to painful stimuli (which is likely with a possible open femur fracture) and he/she jumps.....hellooooo compromised c-spine!

(more than likely the patient, as you said, will be out completely, however in the rarer event they are not, that issue could have been easily avoided)


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## JPINFV (Feb 16, 2012)

TheGodfather said:


> if the patient is responsive to painful stimuli (which is likely with a possible open femur fracture) and he/she jumps.....hellooooo compromised c-spine!



If a patient jumps, do you really think manual c-spine is going to stop cervical movement?


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## TheGodfather (Feb 16, 2012)

JPINFV said:


> If a patient jumps, do you really think manual c-spine is going to stop cervical movement?



i agree. i was, more-or-less, trying to word it towards less of a "jump" and more of a "twitch" or "jerk" i guess... i wouldn't expect this patient (the true neuro/multiple trauma patient with significant enough injuries to cause obtundedness) to have the strength to "jump up", but im sure they would be able to grudge their shoulders, twitch, or respond in any of those more subtle/controllable ways....


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