What would you do in this scenerio?

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)
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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.
 
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.
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What will i do as a EMT-B?
 
Judeau said:
What will i do as a EMT-B?
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I bet a quick google search will answer that for you ;)

Basic airway adjuncts.
Splinting
Patient assessment
a very limited selection of meds.
 
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.
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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?
 
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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You would put direct pressure on it the second you find it
 
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?
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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.
 
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 < 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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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?
 
NVRob said:
I bet a quick google search will answer that for you ;)

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

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.
 
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?
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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.
 
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.
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Then I'm going to go out on a limb and say they're wrong and stupid.
 
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.
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GCS less than or equal to 8 = intubate... i dont know how to produce that symbol so < 9 had to suffice lol
 
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.



I'm calling shens...
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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 :)
 
TheGodfather said:
actually, it's really quite easy to do.
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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.
 
Linuss said:
Then I'm going to go out on a limb and say they're wrong and stupid.
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tumblr_lntyx34xxx1qf9kud.gif
 
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.
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Those are all nice and fancy lol. We use triangle bandages and synch it down with a pen haha
 
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.
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^^^
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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