Ambulance accident

[Grady_emt]

Male gets flown out in the first bird.

Red female should be extricated just as the second bird arrives, so she's going air also.

Yellow female, ALS transport upon her extrication.

All peds transported to a pedi trauma center, each in their own unit so that the carseat can be properly restrained to the stretcher. (if the trauma center (adult) has no pedi coverage)

You and your partner (should:excl go get checked out, and for the mandatory drug testing since you were involved in a vehicle contact

 

[wolfwyndd]

I found it . I wanted to make sure I was putting out good info soooooo , According to www.emedicine.com , in an article last updated june 2006 , priapism can be caused by pelvic trauma , which is what I've been taught for years .

Wow. That's interesting. I have actually never heard that before. I'd always been taught that priapism, while can be cause by medical illnesses, that's clearly not the case here, so we should suspect either spinal cord injury or head trauma. I've actually never heard pelvic injury as a cause for that, HOWEVER, given the MOI, I would not be surprised to see pelvic injuries.

At this point though it doesn't matter. He's flying first (if he's extricated first, I've lost track).
If we do have a second bird, the woman with the bilateral femur fractures would be next (note: In our area, getting two birds at the same time isn't always possible, getting THREE at the same time, forget it.), if not, send her by ground to Miami Valley Hospital (only level 1 trauma hospital in our area) by ground, L/S all the way.
The yellow tag female also needs to go to Miami Valley Hospital too. (Any idea what her GCS is?) She's borderline on physical findings, but the MOI buys her a ticket there for sure(IE, high speed over 40 MPH, rolled, greater then 20 inches of intrusion).
As for the green tagged pedi's, they go to Children's Hospital. TECHNICALLY, they are only a level 2, but Miami Valley HATES it when we bring in kids, Both they and Childrens have agreed that we should take them there.

 

[certguy]

I'm really surprised that people aren't being taught about priapism and pelvic injuries nowadays . I was taught that way back when I was first certified . Thought I was getting early onset alzheimer's there for a minute .


Wofwyndd , how would you treat the female red tag ?

 

[Grady_emt]

But here is the million dollar question. Priapism in spinal injury occurs due to a neurological condition and bad/partial signals being sent from the brain to the...umm....male anatomy:unsure:

In the pelvic injury why does this occur. If an artery or vein is severed in the pelvic region, is it the now free-flowing blood just filling up the empty...male anatomy:unsure:... or is there another mechanism that causes priapism in the presence of a pelvic injury?

 

[certguy]

Hi Grady ,

I've never gotten into the physiology , but good question . I just checked on www.medscape.com . A lot of what I read was way over my head , but the jist of it , as I understand it , is that it's caused by cavernous nerve damage. It makes sense , damage the nerves , and things you don't want happening at that particular time happen , causing additional pain . Something else I didn't know is that pelvic fx. carries a 55% mortality rate , which is a lot higher than I ever thought .

 

[wolfwyndd]

Wofwyndd , how would you treat the female red tag ?

Well, since I'm only a basic, what I can do for her won't do a whole lot of good for very long. But there are a few things I can do. First, get an ALS provider over to help with the IV she's gonna need and the possible punctured lung / pnumothorax / hemo going on. Let's see. C-collar, backboard, bag her with O2, treat the open wounds on her knees as best we can, and I'm actually thinking that this might be a good time to break out the MAST pants that we carry and haven't used (other then training) in the 4 years I've been an EMT and either fly (IF a bird's available) or ALS her to Miami Valley, our level 1 trauma center L/S.

 

[wolfwyndd]

Something else I didn't know is that pelvic fx. carries a 55% mortality rate , which is a lot higher than I ever thought .

Yeah that percentage increases dramatically when you get over 65 too. Last time we did a geriatric training session I think they said pelvic fractures have about a 90 percent mortality rate and that's generally within the first year after the injury.

 

[certguy]

Wolfwynnd ,
Hi , not bad but there's a little more we can do as basics . We can stabilize the flail segment of the chest with a pillow or bulky dressing taped in place . In our area , we no longer use the MAST and barely cover it for NREMT testing purposes only . A Saeger splint may come in handy as it can be used bilaterally or double HARE traction splints . but keep in mind in this situation the MOI becomes very important . when the dash hits the knees , the force is transmitted from there up the legs into the hips , pelvis , and lower spine ( there's a name for this syndrome but I can't remember it right now ) , so you may have fx and/or dislocations along that whole area . If there are additional extremity or hip fx , you won't be able to use the traction splints . Plan B , rigid splints or anatomical .


Thanks for the info on geriatric pelvic fx.



Craig

 

[Ridryder911]

But here is the million dollar question. Priapism in spinal injury occurs due to a neurological condition and bad/partial signals being sent from the brain to the...umm....male anatomy:unsure:

In the pelvic injury why does this occur. If an artery or vein is severed in the pelvic region, is it the now free-flowing blood just filling up the empty...male anatomy:unsure:... or is there another mechanism that causes priapism in the presence of a pelvic injury?

Priaprism is caused by multiple things other than trauma. Black widow bites, sickle cell disease, leukemia, adverse effects of medications, tumors located in the spinal cord, strokes, and of course trauma.


Technically, priapism is an abnormal erection for > 4 hours (hence the a/e of Viagra, etc). It is usually categorized into two major types: low-flow priapism or ischemic, which means that little or no blood flow is getting to the penis and this lack can cause damage; or high-flow priapism, which is the result of trauma to the penis.

When discussing priapism in spinal cord trauma, this is usually seen in the acute phase and why we teach EMT's to assess for it. Since it is only a short duration of occurrence, per sympathetic response of the neural chain causes a perfusion of blood and thus causes erection (temporary). With this can be an ominous sign of potential cord or high cerebral injury to the stem/cord.

I agree it is not taught well enough, as also very few if never assessed by majority of EMT's. When was the last time you seen someone assess for it?

The usual giggle response is obtained in class, only to know when in the field that this patient truly has a severe injury. A very high possibility that is the last erection ever to occur due to cord injury, as well potential other lethal injuries does take away the humorous side.

R/r 911

 

[certguy]

Hey Rid ,
2 questions ,
Why aren't they teaching assessing for priapism in pelvic fx. in class anymore ?

Do you know the name of the impact syndrome caused by pt's knees striking the dashboard and the force transmitting through the legs into the hips , pelvis , and lower spine ? I know there's a name for it , but for the life of me , I can't remember it .

 

[wolfwyndd]

We can stabilize the flail segment of the chest with a pillow or bulky dressing taped in place . In our area , we no longer use the MAST and barely cover it for NREMT testing purposes only . A Saeger splint may come in handy as it can be used bilaterally or double HARE traction splints .

You know, I did consider the pillow / bulky dressing for the flail segment but I figured in the time it would take a paramedic to start treatment it MIGHT be in the way. I also considered the hare traction splints too, but I figured it would take more time to get them in place then it would to get the MAST pants on and I was going down the road of 'load and go' and 'life over limb.' Also for us, Careflight (air medical transport) will not fly a victim with traction splints, their helicopter isn't big enough for them to fit. And if we've got a bird available for this patient I'd rather NOT have to put a couple of traction splints on and then HAVE to drive them because I can't take them off.

 

[certguy]

Always have a plan B in mind . Don't always expect the medics to be right there , because Murphy's an optimist with a sense of humor . Be prepared to go ahead and treat to your level of training till they get there , you meet them enroute , or you get to the facility you're transporting to . Anything can ( and does ) happen out there , high call volume , other large incidents going on at the same time , rig breakdowns , etc . can cost both you and your pt.

As for traction splints , another advantage of the Saeger over the Hare is that it doesn't take as much room as the Hare . I wish we would've carried them on our rigs . We always had Hares . I've trained with the Saeger and boy , do I like it better . 1 man application , can be used bilaterally , and less space taken are all plusses . Check with your copter service , they may be able to transport with Saeger's , and would help justify the cost of getting some . I hope this helps with helo transports .

 

[wolfwyndd]

You know, I actually have a 'ride along' scheduled with CareFlight this Saturday evening so I'll ask them.

I'm also going to have to check the ambulance next time I'm at the squadhouse. I'm not even sure if we have sager's onboard. I know we've got traction and I know we've got vacuum because I've used them both. I honestly don't know if we've got sagers or not.

 

[certguy]

Hey Wolfwyndd ,

I've heard about vaccum splints but I've never used them . How are they ?

 

[Jon]

I'm not Wolfwyndd... but I'll take a stab at the question. I tried explaining them in the bar last Friday night... but that didn't work too well

Vacuum splints are heavy-duty rubberized/nylon packs that are filled with foam/plastic pellets. When the air is removed, the pellets form up next to one another and become immobile, held in the thick outer casing. This forms a splint that adapts to ANY injury site or limb positioning, filling all voids, and holding the limb in a position of comfort.

They are VERY solid.

 

[certguy]

Sounds cool Jon , I'd like to play with them some day and try them out .


Craig

 

[BossyCow]

We use them regularly. When fully deflated, they are almost as solid as a cast. They are light and easy to use. The only trick is making sure the pellets are equally distributed in the cast before deflating it. Otherwise you can end up with a lump in the wrong place or an area without support.

 

[wolfwyndd]

Jon, I couldn't have put it better myself. I LLLLLOOOOOOOVVVVVEEE the vacuum splints.

They are kinda the opposite of what I originally thought they were. I figured it'd be kinda like a baloon that you blow up to keep pressure on the appendage in question, but it's the opposite. You suck air OUT of the 'balloon' with the tiny balls in and it compresses itself around the appendage. IMO, however came up with it is a genius.

My only (minor) complaint is that when we bring a patient into the hospital with one of these vacuum splints we have to hang around till the patient gets looked at because no one in the ER seems to know how to get the thing off.

 

[certguy]

I watched a show on tv that showed british medics using an air matress sized vacum splint in lieu of a backboard . Looked wierd to me , but I'm a traditionalist on some gear .