BLS Support / Daily Scenario / #2 MVC

What is your primary concern?

  • Head Pain

    Votes: 0 0.0%
  • Patent Airway

    Votes: 6 66.7%
  • Chest Pain

    Votes: 3 33.3%
  • Abdominal Pain

    Votes: 0 0.0%

  • Total voters
    9

Medic27

Forum Lieutenant
134
23
18
"Medic 27 please respond to an MVC roll-over crash, complainant states two vehicles were involved, Medic 28 and Engine 35 are responding."

Medic 28 & Engine 35 are on scene, you are given the least critical patient. They expedite transport.

Your patient:
27 year old female / seat-belt
Chief Complaint: Major headache, and crushing chest pain. Chest pain radiates into the neck.

Observations:
Small bump on the head, patient isn't fully there, however, patient responds to verbal commands and reflexes to pain. Patient has been protected with full-spinal precautions and is ready for transport. ALS is 15 minutes out so you decide to transport to the nearest ED.

Trauma assessment complete, chest bruising is present, head pain reveals upon inspection as small bump. No other injuries at this time.

GCS Scale - 11

HR: 122
BP: 100/72
RR: 23
O2 Sat: 93% with 100% O2 via non-rebreather 15L


Shortness of Breath (difficult taking deep breaths) , Muffled Heart Sounds, Jugular Vein Distension, Double Vision, Clear Breath Sounds.

BLS & ALS

What are you treating for? Multiple things?
Why are you suspecting this?
Why did you elect with this line of treatment?

Good luck everybody, I tried to be more specific on this one.
 

EpiEMS

Forum Deputy Chief
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My primary concern is not getting run over!
.
 

GMCmedic

Forum Deputy Chief
1,155
620
113
My primary concern is not getting run over!
.
That's not a 5 point break away. What if the tow mirrors a diesel truck with smoke stacks catches your vest?


Oh and the patient has a head bleed and Cardiac tamponade.

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OP
Medic27

Medic27

Forum Lieutenant
134
23
18
That's not a 5 point break away. What if the tow mirrors a diesel truck with smoke stacks catches your vest?


Oh and the patient has a head bleed and Cardiac tamponade.

Sent from my SAMSUNG-SM-G920A using Tapatalk
Also correct, damn... Maybe I have to make these harder. ;) What is your treatment?
 

NysEms2117

ex-Parole officer/EMT
1,925
883
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Medic. Just so these threads don't take over the whole topic section you may want to make one thread and continue posting in there.
 

DesertMedic66

Forum Troll
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So we have an altered patient who possibly has a brain bleed and a cardiac tamponade. I hope that the closest facility you are transporting to is also a trauma center..
 

GMCmedic

Forum Deputy Chief
1,155
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Also correct, damn... Maybe I have to make these harder. ;) What is your treatment?
Mostly supportive. She gets a NRB and a smooth ride to the trauma centet with lights and sirens. Preferably fairly close to the speed limit.

I really wouldnt want to intubate unless I have too.

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VentMonkey

Family Guy
Premium Member
5,126
4,274
113
Medic. Just so these threads don't take over the whole topic section you may want to make one thread and continue posting in there.
Perhaps have the mods merge them, and put them in the scenarios section because they're, well, scenarios.
 

EpiEMS

Forum Deputy Chief
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I really wouldnt want to intubate unless I have too.
Indication for intubation primarily being a decline in mental status?
 

VentMonkey

Family Guy
Premium Member
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Indication for intubation primarily being a decline in mental status?
Not necessarily for me, Ep. Obviously it depends on several factors such as how rapid and drastic the GCS has declined, how far we are from said trauma center, how well they're able to maintain their own airway/ we're able to maintain it for them with adequate oxygenation and ventilation and without having to move to aggressively invasive airway management techniques.

Many times if the patient can still converse fairly logically, even in the presence of an obvious closed head injury, it is so much more practical to allow the trauma team to obtain as close to an accurate initial GCS as they can upon our arrival at the ED, and their own neurological assessment, then they can induce for surgical repair and airway protection. Again, many ED attendings are not exactly thrilled with long-acting paralytic inductions for these reasons listed, even though we all know they will eventually wear off.
 

EpiEMS

Forum Deputy Chief
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NysEms2117

ex-Parole officer/EMT
1,925
883
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Perhaps have the mods merge them, and put them in the scenarios section because they're, well, scenarios.
no can do. makes too much sense. not allowed ;)
 

VentMonkey

Family Guy
Premium Member
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Her right ventricular filling will already be compromised, i dont really want to add more pressure.
Right, so now which BLS provider on here can explain to us the physiological changes behind such catastrophes and why?
 
OP
Medic27

Medic27

Forum Lieutenant
134
23
18
I am going to respond to my own scenario just for the practice..

I am going to keep in mind the patient isn't entirely there with me, make sure to keep the patient with me (awake) due to the head injury. If the SPO2 drops any lower I will switch to a BVM w/ 100% O2 @ 15L. Monitor vitals closely, call ahead to ED. Lights and sirens smooth transport. M27 inbound with a 27 year old patient involved in a MVC, GCS Scale 11, Vitals, O2 via BVM treatment, likely cardiac tamponade, possible head bleed, ETA your facility 5.
 

EpiEMS

Forum Deputy Chief
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@VentMonkey Well, if there is a shift in the mediastinum due to a pneumothorax, the vena cava could be compressed, so there isn't sufficient venous return to the heart? Perhaps? Unless you're thinking this is tamponade - which I suppose would affect both sides.
 

E tank

Caution: Paralyzing Agent
973
774
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@VentMonkey Well, if there is a shift in the mediastinum due to a pneumothorax, the vena cava could be compressed, so there isn't sufficient venous return to the heart? Perhaps? Unless you're thinking this is tamponade - which I suppose would affect both sides.
Here's a monkey wrench...If your patient has cardiac tamponade, taking a breath causes a drop in his cardiac output...and we can demonstrate that by measuring a pulsus paradoxus....but, taking a breath causes the intrathoracic pressure to fall and venous return to rise...yet the cardiac output falls anyway....

Paralyze, intubate and mechanically intubate this person and you still have tamponade, but the pulsus paradoxus goes away...
 

Brandon O

Puzzled by facies
1,718
336
83
Paralyze, intubate and mechanically intubate this person and you still have tamponade, but the pulsus paradoxus goes away...
Or reverses!
 

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