# Basic Life Support Scenario of the Day



## Medic27 (Aug 14, 2017)

First of all, I want to know if this is something any EMTs would be interested in at the basic level, possibly advanced too EMT-A's?

All credit goes to @bakertaylor28 for starting this idea in the critical care / air medical section.

Would anyone follow this or be interested?


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## Old Tracker (Aug 16, 2017)

Isn't is supposed to be BLS before ALS, so yes definitely interested in a topic like this.


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## CALEMT (Aug 16, 2017)

Medic27 said:


> First of all, I want to know if this is something any EMTs would be interested in at the basic level, possibly advanced too EMT-A's?
> 
> All credit goes to @bakertaylor28 for starting this idea in the critical care / air medical section.
> 
> Would anyone follow this or be interested?



Ok dude I gotta ask... are you and baker the same dude or do you just have a serious affinity for one another. Just to be honest the bromance between you two is getting annoying.


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## RocketMedic (Aug 17, 2017)

Here's one for y'all...

Middle age woman lacerated her left radial artery accidentally. Lost about a quart of blood, hand and forearm are wrapped in a blood soaked towel on arrival. Vitals are tachycardic but otherwise normal. The hand is hanging limp and you see spurting blood of an indeterminate bloody color. Laceration is deep and wide, messy.

What do you do?


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## VentMonkey (Aug 17, 2017)

RocketMedic said:


> The hand is hanging limp and you see spurting blood of an indeterminate bloody color. Laceration is deep and wide, messy.
> 
> What do you do?


Call it a time-sensitive injury with neurovascular compromise, control bleeding, and get going to the closest, most-appropriate receiving with willing, and able neurosurgical capabilities.


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## SpecialK (Aug 17, 2017)

I'd put on a CAT and ring the Clinical Support Desk to have a word with the Vascular Reg to see about taking her directly to wherever he may be.

If she's only lost a quart of blood then I don't see utility in IV fluid administration.

Pain relief - in this case, I'd also see if we could do a nerve block since it's confined to just her hand rather than hopping her up on opiates; oh and a bit of MOF to begin with as always.


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## Akulahawk (Aug 17, 2017)

RocketMedic said:


> Here's one for y'all...
> 
> Middle age woman lacerated her left radial artery accidentally. Lost about a quart of blood, hand and forearm are wrapped in a blood soaked towel on arrival. Vitals are tachycardic but otherwise normal. The hand is hanging limp and you see spurting blood of an indeterminate bloody color. Laceration is deep and wide, messy.
> 
> What do you do?


From a _purely_ BLS standpoint, this one is easy. Continue having someone hold direct pressure until you've got your own hemorrhage control stuff ready to go. In this case, I'd apply fairly heavy direct pressure _and_ a tourniquet because I'm pretty certain direct pressure isn't going to do it on its own. Once the TK is in place and doing its job, I can then change the dressing out for my own dressing and bandaging and this will also ensure that I get a good look at the wound. If I don't take a look at it, there's no way I can describe it to the receiving facility. I note a limp hand and the spurting blood from earlier so I would expect that this isn't just a laceration to an artery, the wrist flexors are involved so that just bumps things up a notch in terms of complexity. This patient is going to need vascular surgery, possibly neurosurgery, and trauma surgery consults and to start reperfusion of the limb within a few hours or she'll certainly lose it. That means she's going to a trauma center, a level II or level I. If the "right" services are immediately available at a level III, I would consider transport there. 

From an ALS standpoint, all I'd add to it is starting a saline lock or two, one of which should be an 18g, and attempt to provide pain control. Otherwise she's almost purely BLS. This is also a code-2 (non-RLS) transport. While she's at risk of losing a limb, that's several hours off. I would only upgrade transport to RLS or flight pickup only if the destination facility is too distant in terms of time that there might be benefit in a more rapid transport. Where I used to work, I'd hope the ambulance crew would fly her from the scene. Arranging even a priority 1 IFT can take an hour or more and ground transport can take upwards of 90 minutes, so with initial workups and the like, I'd much rather attempt to get a flight from the scene as I'd be shaving at least an hour, maybe as many as 3 hours from injury to arrival at a trauma center. We sometimes got lucky and managed to fly people out from the hospital within 30 minutes of arrival at the door...

Where I am now, there's nowhere in the County that I'd fly this patient from... RLS ground from some places, but no flights for her here. Why? There are 4 Trauma Centers that I can get her to any one of them within 30-40 minutes from anywhere in the county by ground. In certain places, I have a choice of 3, all within 30 minutes...


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## VFlutter (Aug 17, 2017)

You may want to consider going to a facility with Microvascular surgery, not every level one has it.


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## Akulahawk (Aug 17, 2017)

Chase said:


> You may want to consider going to a facility with Microvascular surgery, not every level one has it.


Agreed. That's best option and the service I was thinking mostly of but it's late for me and my tired mind didn't want to work that hard.


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## EpiEMS (Aug 17, 2017)

RocketMedic said:


> Here's one for y'all...
> 
> Middle age woman lacerated her left radial artery accidentally. Lost about a quart of blood, hand and forearm are wrapped in a blood soaked towel on arrival. Vitals are tachycardic but otherwise normal. The hand is hanging limp and you see spurting blood of an indeterminate bloody color. Laceration is deep and wide, messy.
> 
> What do you do?


Trauma is easy 
Tourniquet, O2, blanket, diesel, trauma center.


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## Medic27 (Aug 17, 2017)

CALEMT said:


> Ok dude I gotta ask... are you and baker the same dude or do you just have a serious affinity for one another. Just to be honest the bromance between you two is getting annoying.


Lmfao... I wasn't aware I was annoying anyone with it, we've just been talking on the forum.


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## E tank (Aug 17, 2017)

SpecialK said:


> Pain relief - in this case, I'd also see if we could do a nerve block since it's confined to just her hand rather than hopping her up on opiates; oh and a bit of MOF to begin with as always.



A nerve block with a neuro injury?


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## RocketMedic (Aug 17, 2017)

Question: where you do put the tourniquet, and why?


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## CALEMT (Aug 17, 2017)

RocketMedic said:


> Question: where you do put the tourniquet, and why?



The neck because why not.


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## MonkeyArrow (Aug 17, 2017)

RocketMedic said:


> Question: where you do put the tourniquet, and why?


It's got to go above the elbow, if I choose to go that route. Can put it below because the two bones (radius and ulna) of the forearm could prevent complete compression of the arteries.


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## EpiEMS (Aug 17, 2017)

RocketMedic said:


> Question: where you do put the tourniquet, and why?



Seems like you could apply below the elbow (in this case, close to the site of the wound, but still distal to the elbow) or on the thickest part of the extremity...or roughly around there. I'm going above the elbow, in this case, I think. I found no compelling evidence to pick either one over the other, I'm just going with the one that I think is easier to apply the tourniquet to.


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## RocketMedic (Aug 17, 2017)

Although tourniquets can be effective distally (where they're compressing bone onto arteries), remember your population: middle-aged women are not known for remarkably strong bones. A tourniquet doesn't need as much force and stands less of a chance of creating a fracture if it is placed proximally, above the elbow. In this case, a single CAT placed to the middle of the upper arm did a great job.


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## Medic27 (Aug 17, 2017)

Great thread so far you guys, I love the conversation and have already learned a lot from this community. If everyone is okay with it, the next scenario will come out here 8/18/2017 in the forum of a thread post to keep the thread open for other things. I've thoroughly enjoyed everyone commenting, any suggestions for scenarios please inbox me it helps me come up with material. Thank you everyone for participating.


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