# Got Truama Scenario



## james (Mar 21, 2008)

I really suck at running these things but I will try. 

Try not to be to hard on me I dont remember all the details to this because it happend to me I was the PT. I dont have a run sheet to look at because it happend in Iraq so go easy on me please. But I am in contact with the medic that treated me so I can get the answers you need.

28y/o male
Involved in a IED Road side bombing
Multiple puncture wounds to the right thigh, arm, and neck with a lacerated carotid artery. 

Unresponsive 
r/r 30 shallow
pulse 110
bp 140/100
skin moist worm red

You have a fully stocked medic bag and all meds and equipment that you will need. what would you do.
Questions will be answered as there asked.


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## certguy (Mar 21, 2008)

I'm only a basic , so I'll treat as such . Is the scene reasonably safe ? If not , slap a quick occlusive dressing on the neck wound and evac to a safer location . Then ; 

  ABC's
  Due to the possibility of a head injury , I'd drop an OPA , not an NPA . 
  Resp. shallow , but hard to tell if ineffective by the scenerio . At min, , 15 lpm by non - rebreather , assist if needed . Suction ready if you have it .
  Control obvious bleeds . 
  Full c - spine using a horseshoe instead of a stiffneck so the wound can still be accessed .
  Left lat. recumbent trendelenburg positioning . 
  Treat for shock and splint any possible fx.
   Medivac ASAP . 

I'm curious about the b/p . Why was it so high with a major bleed ?


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## james (Mar 21, 2008)

bp was so high because i was scared half to death. I was just blown up by a road side bomb, not a good day for me. lol


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## akflightmedic (Mar 21, 2008)

Sorry mate, check with your buddies on the BP or was your CAROTID ARTERY really lacerated?

Being scared is not going to elevate your BP to that level with those kinds of injuries. Besides, you were UNRESPONSIVE, so level of fear is irrelevant.

I need your lung sounds, with all those puncture wounds have to make sure none entered the chest or abdominal cavity.

The rest of what I do will be after the scene is relatively safe for me.

Cover the major bleeders, apply reasonable pressure.

I am going to see if you have a gag reflex, possibly RSI you and secure your airway.

Cspine if its available.

Monitor shows what?

IV placement, 2 large bores since that is all we typically carry in the field here.

Medevac, further treatment would be determined on what other info you make available as others ask questions.

Other questions I want to know is what vehicle you were in and what seat?

Having been to a few of these incidents, it is very relevant information.


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## TheAfterAffect (Mar 21, 2008)

From the scenario hes Explaining ill take it as hes in the Armed Forces, at which, I doubt the Military Medics care about a scene being safe such as the one described as above. Sounds like it was most likely on a convoy and they got hit with a roadside bomb. Medics probably went straight to work as described by the two gentleman above me.


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## akflightmedic (Mar 21, 2008)

Scene safety noted and commented on, as I said "relatively safe".

This means when my life is not in imminent danger, I will tend to the wounded. 

The threat has to be minimized or negated before a medic can tend to the wounded typically. Otherwise, they are sitting ducks and only create more patients for which there would be no medics left to assist.

This is one of the reasons that almost all combat personnel are now being CLS (combat life saver) qualified. This course is basically a very short, intense first aid course that includes how to start IVs.


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## james (Mar 21, 2008)

He don’t remember the exact bp sorry

Lung sounds Clear bilat

I was wearing body armor

Scene is as safe as two 50 cal guns can make it

You have a c-collar don’t have a monitor

I was in a 18 wheeler  semi truck

Normal gag reflex 

Medevac 20 minutes ETA 

I start to become responsive about 10 minutes before medevac arrives


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## akflightmedic (Mar 21, 2008)

Ok well, it sounds as if we all said what was proper to do and you are fixed now.

Congrats!


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## Ops Paramedic (Apr 10, 2008)

If you are posting here, it implies that the outcome was positive!!  I'm glad for your sake.

In the tactical setting, a lot of the focus is on Self-Rescue, however seeing you were unresponsive, it is not an option.  I don't think the BP of 140/100 can be correct for a severed caritoid artery, as you would not even have minutes (Almost seconds) to survive??

As the medic, i would apply direct pressure, then get you to safe zone and then apply Quick Clot (or equivilent).  Following of that would be two large bore IVs (Unilateral or Bilateral), and then evac with haste.  May be some analgesia should time and circumstances permit...


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## AZFF/EMT (Apr 13, 2008)

ABC's, try to rapidly move you to to cover. IV's use quick clot on extremity injuries if needed. secure your airway via combi-tube or King LT whatever I had on me. Plug your holes with vasoline guaze, dope you up a lot and get the fake blood flowing into you. 

If no advanced airway was needed and you were breathing on you own after becoming responsive I would give you a nice little fentanyl sucker to keep you doped up. Decompress as needed.


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## NREMT08 (Apr 13, 2008)

Well, I am an EMT-B so I will just say how I would handle it, 

First..I would make sure the scene is safe (as much as it can be considering the circumstances) then I would immediately place a gloved hand over the neck wound to try and prevent an air embolism, after that I would dress the neck wound with an occlusive dressing and reasonable amount of pressure to stop the bleeding, 

If there were enough hands there I would ask that someone hold c-spine, if not, I would do my best to hold c-spine and dress the neck wound, assessing breathing all the while...and controlling any life threatening bleeding would be the two largest priorities,

 c-collar and backboard then transport, I would place him in the trendelenberg position and constantly reassess ABC's. if necessary, I would assist breathing with a BVM and supplemental O2 upon his inspiration to increase volume and slow resp rate, 

ohh, and I would probably insert an OPA if he would tolerate it, also once in transport I would reassess all injuries and I would take a closer look at that thigh,

 one time during my EMT clinicals I was told about something called a fat embolism that can happen from a femur fracture especially in males of this age because of the fatty tissue in their bones, we were told that it's just like an air embolism but with the fat from the bone. 

I am fairly new and have not had my first trauma call as an EMT-B so please feel free to critique me and tell me what any of you guys would do differently or any mistakes I would have made, I appreciate the feedback, I know alot of you are ALS, Paramedics and doctors and nurses and stuff, so this is a great place to gain knowledge and sharpen my thinking for when I actually have use my skills, thanks guys.


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## Topher38 (Apr 13, 2008)

IS THE SCENE SAFE??!?!?!

AVPU - Unresponsive

Collar and backboard

A Assist ventilations with BVM & 15L 02
B 
C Pressure over bleeding on neck, Oclussive dressing, Heavy gauze.
   -Same for thigh and arm if bleeding is significant

Rapid trauma assassment reveals the same injuries?

Transport immediatly (Helicopter available?)
ALS (For the airway, and Some fluids, loss of blood may be great)

-While enroute-

Focused physical exam reveals?
Cyanosis of any extremties?
DCAP-BTLS? 
Is patient still unresponsive?

Still ventilating with 02 15L/m
   -NPA or OPA placement (unless ALS has intubated)

Occlusive dressing with gauze still in place.
  -Thigh and arm (gauze) still in place

Lung sounds?

Have the vitals changed?

Is there any SAMPLE history on the patient? Tags or cards for DNR or diabetic?

*High priority patient*


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## SCFD8REZ (Jul 30, 2008)

This to me sounds like a load and go scenario, arrive on scene, try to make sure the scene is safe chances are its not if your in friggin IRAQ. Control bleading as best as you can, administer oxygen, chances are if you dont get this guy out of there and to the hospital he will die, we can only do so much as emt-b's if your are a emt-p start an iv and give this guy some freaking pain relief, get him well packaged and get him the hell to the hospital.


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## mikeylikesit (Jul 31, 2008)

assess your airway, with that type of shrapnel i would be worry that what ever cut your carotid also punctured your trach. i would apply distal pressure to the artery and wrap what i can on the leg and arm but unless they are gushing they are not my concern at the time. i would start you on an IV of NaCl to help ward off the insuring hypovolemic shock and give you some O2 on transport. My first objective would have been C-spine above all else due to your circumstances.

Now, for a 68W point of view. i would do all of the same except for c-spine. i wouldn't have cared about your legs or arms unless like said they were falling off or gushing blood. I'm glad to see you made it though.


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