# Single veh. MVA 1 PT.



## C.T.E.M.R. (Nov 22, 2010)

this was an actual call i got the other day, im going to give you the basic details but ill wait to tell you how we handles it, i want to know how you guys might have handled it.

Called to an MVA 5:30 AM. One car One PT. chief complaint of chest  pain. upon arrival PT. was ambulatory, very intoxicated/combative, did not want the help. she had crashed the vehicle 15 miles away and continued to drive until she stopped where we got her, she hit a guard rail first, car was missing left rear tire, had airbags deployed. cracked windshield not from PTS head. PT had obvious abrasions because of the seat belt. and only complained of chest pain. So lets hear how you would handle it and ill soon tell hoe we took care of it. Thanks. if there is any important detail i left out met men know


----------



## uhbt420 (Nov 22, 2010)

First try to talk the patient down and get her calm so she can be treated.  if that doesnt work ALS may need to sedate.  i would not try to fight her or force her on to a LSB or anything, this will only aggravate current injuries, or cause new ones.

c-collar and backboard to protect the spine.  chest pain protocol, transport to the hospital.


----------



## Veneficus (Nov 22, 2010)

uhbt420 said:


> First try to talk the patient down and get her calm so she can be treated.  if that doesnt work ALS may need to sedate.  i would not try to fight her or force her on to a LSB or anything, this will only aggravate current injuries, or cause new ones.
> 
> c-collar and backboard to protect the spine.  chest pain protocol, transport to the hospital.



Chest pain protocol?


----------



## TransportJockey (Nov 22, 2010)

IS the chest pain traumatic chest pain or cardiac in origin? is it reproduceable on palpation? Any crepitus on palpation of chest? 
Yay drunks.


----------



## C.T.E.M.R. (Nov 22, 2010)

All she said was that it was a pain in the middle of chest. we didnt know to many details as P.D. had her in custody for nearly 45 Min. BTW we did pick up a medic so i guess it could be interpreted as ALS, ill wait for a few more responses and tell how we handled it


----------



## Akulahawk (Nov 22, 2010)

Run down possible traumatic causes of the chest pain first... What might be interesting would be to find out how many times she hit something head-on hard enough to set off the airbags. Once? Twice? ???


----------



## C.T.E.M.R. (Nov 22, 2010)

all we knew was she hit one guard rail, when we got on scene the vehicle was in the middle of the road, my guess is that the CP was caused by the seat belt. 

Here's how we handled it, she was walking when we arrived no complaint of neck pain back pain etc. she walked into the rig, where we collared and back boarded her, still only complaining, took vitals, all within normal limits, pulse was good, medic tries a four lead but she kept trying to rip off the pads. couldn't get a good reading she wouldn't really stop moving so the IV almost caused damage. 

It wasnt my choice to backboard her in the rig, some might say it was a good or bad idea, so let me know what you think.


----------



## Veneficus (Nov 22, 2010)

C.T.E.M.R. said:


> all we knew was she hit one guard rail, when we got on scene the vehicle was in the middle of the road, my guess is that the CP was caused by the seat belt.
> 
> Here's how we handled it, she was walking when we arrived no complaint of neck pain back pain etc. she walked into the rig, where we collared and back boarded her, still only complaining, took vitals, all within normal limits, pulse was good, medic tries a four lead but she kept trying to rip off the pads. couldn't get a good reading she wouldn't really stop moving so the IV almost caused damage.
> 
> It wasnt my choice to backboard her in the rig, some might say it was a good or bad idea, so let me know what you think.



I think if she walked to and climbed in the rig, that would have defeated any purpose the backboard was supposed to have. 
(Not that it actually does have any)

I hope nobody gave any ACS medications for the "chest pain."


----------



## C.T.E.M.R. (Nov 22, 2010)

Yeah i dont now why my partners decided to backboard, and no meds were given other than 02 and saline to flush the line


----------



## nakenyon (Nov 22, 2010)

C.T.E.M.R. said:


> all we knew was she hit one guard rail, when we got on scene the vehicle was in the middle of the road, my guess is that the CP was caused by the seat belt.
> 
> Here's how we handled it, she was walking when we arrived no complaint of neck pain back pain etc. she walked into the rig, where we collared and back boarded her, still only complaining, took vitals, all within normal limits, pulse was good, medic tries a four lead but she kept trying to rip off the pads. couldn't get a good reading she wouldn't really stop moving so the IV almost caused damage.
> 
> It wasnt my choice to backboard her in the rig, some might say it was a good or bad idea, so let me know what you think.



On more then one occasion, especially in the winter, I've walked a patient who by protocol required c-spine precautions. This occurs for various reasons, patient expresses desire to refuse, patient is uncooperative, etc. If it benefits the patient in the long run, I feel that providers should do what is necessary to get a patient into the rig. I don't know what protocols are like in you area, but in my company, everyone gets a backboard if the have possible c-spine injury -- regardless of whether or not they were ambulatory. 

In situations like this, provided the patient appears stable, I won't force interventions upon the patient -- providing I've touched base with medical command and they are ok with the decision. 

Ultimately, every provider handles things a little differently. If you disagree with how it was handled, have an conversation with your partner about why they did it the way they did. Don't be aggressive, just ask politely.


----------



## Akulahawk (Nov 22, 2010)

Veneficus said:


> I think if she walked to and climbed in the rig, that would have defeated any purpose the backboard was supposed to have.
> (Not that it actually does have any)
> *
> I hope nobody gave any ACS medications for the "chest pain.*"


I wouldn't have without any indications to do so. But then I'm just a medic and don't know any better.


----------



## uhbt420 (Nov 23, 2010)

Veneficus said:


> Chest pain protocol?



well yea, what if the pt had a heart attack which led to the accident.  its probably a result of the trauma but u can't assume in this field


----------



## usalsfyre (Nov 23, 2010)

uhbt420 said:


> well yea, what if the pt had a heart attack which led to the accident.  its probably a result of the trauma but u can't assume in this field



Two words....horse puckey....

How do you think MIs were diagnosed before the ready availability of easy and fast labratory testing for cardiac specific enzymes? History and physical exam. She gets a monitor and 12 lead, but I seriously doubt we jump into ACS protocols.


----------



## C.T.E.M.R. (Nov 23, 2010)

The PT was on a four lead with normal rythym, we gave 02 first by NRB which she did not like and then by cannula. IMHO The CP was caused by a seat belt injury, I'm not saying for sure that's the fact. all of her vitals were normal, the medic did a full trauma assessment, and the only thing she still complained of was the pain, which was basically at the bottom of her ribcage right in the middle.


----------



## TransportJockey (Nov 23, 2010)

Just out of curiosity what was her sat on room air, the nrb, and the canula?


----------



## C.T.E.M.R. (Nov 23, 2010)

that i dont know JT, i really didnt think to check those myself. the medic took her off 02 so i would assume it was fine.


----------



## Veneficus (Nov 24, 2010)

How old was she?


----------



## 18G (Nov 24, 2010)

I was just thinking the same thing... "how old was she"?.

I highly doubt the chest pain caused the accident.. she was drunk! lol. Usually, people can drive well with chest pain up until they arrest ne way. 

Most drunks don't wear their seatbelts... and she was out of the vehicle when you got there... how do you know for sure she had a seatbelt on and the patient is not what cracked the windshield?

If her perfusion parameters were all good with normal SpO2 I wouldn't even fight with the O2. 
---------

One thing that bugs me to death is people who have patients walk to the ambulance to immobilize or they have the patient lay down on the backboard which is already placed on the stretcher. If your taking the time to backboard because of a suspected spinal cord injury or as precaution, then why are you causing further manipulation?!? Makes no sense to me. 

If someone is walking around an incident scene post-MVC and I feel they really should be backboarded then I will stop them, have c-spine held, and then do a standing take down.... or I'll explain to them the "protocol indications" and some risks and ask them if they want to be boarded.

Backboarding is an overrated and over used modality that causes more discomfort than anything. I wish we had a c-spine clearance protocol.


----------



## C.T.E.M.R. (Nov 25, 2010)

she was mid 20's. The windshield just had a few cracks, and no evidence of an object coming into contact, the reason i believe she was wearing a seat belt was that she had abrasions that would make sense that she had a seat belt on, and she did tell us that she had it on, I know you cant believe an intoxicated person, but to me it all fit together.


----------



## boingo (Nov 25, 2010)

18G said:


> I was just thinking the same thing... "how old was she"?.
> 
> I highly doubt the chest pain caused the accident.. she was drunk! lol. Usually, people can drive well with chest pain up until they arrest ne way.
> 
> ...



I would be careful about clearing the c spine of an intoxicated individual, both Canadian and NEXUS c spine rules don't include those under the influence.


----------



## Veneficus (Nov 25, 2010)

boingo said:


> I would be careful about clearing the c spine of an intoxicated individual, both Canadian and NEXUS c spine rules don't include those under the influence.



I imagine, the "clearing" the cspine was just a poor choice of words for not using a backboard. 

I have seen several studies over the years, and with a bit more understanding about anatomy and physiology than was known in the 1970s, I really think the backboard is jst another one of those flawed EMS treatments that are not going quietly into the night.

In other news:

a 20 y/o female isn't exactly in the high risk category for ACS.


----------



## Akulahawk (Nov 25, 2010)

Did she, by chance, have a somewhat solid object in her lap that might have been shoved into her chest by the airbag? How close to the airbag was she sitting?


----------



## C.T.E.M.R. (Nov 25, 2010)

As far as i know she didn't have anything in her lap, as for the airbag i don't know about either, When we arrived she was ambulatory.


----------

