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Continuous Facial Bleeding with CSpine

Discussion in 'BLS Discussion' started by ChewyEMS13, Feb 15, 2018.

  1. EpiEMS

    EpiEMS Forum Deputy Chief

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    Totally, just made me think of a fun video - it's so awesome :p

    Any idea what pharmaceuticals? Are they using a paralytic?
     
  2. VentMonkey

    VentMonkey calpuleque Premium Member

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    I was curious as well, so I looked at their protocols. It looks like Etomidate and Succs. There’s no alternative paralytics listed, and their backup sedative in-lieu of Etomidate is Versed.
     
  3. Jim37F

    Jim37F Forum Deputy Chief

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    This is a pic I took of their "cheat sheet" posted in the ambulance: 20180129_124947.jpg
    None of the crews I was with on my ride alongs did this, but a few other classmates said their medics did PATI a patient or two (the only intubation attempt on mine was for a cardiac arrest patient ...medic made 1, maybe 2 attempts ata tube befire letting his EMT partner drop a combitube instead)
     
    EpiEMS likes this.
  4. EpiEMS

    EpiEMS Forum Deputy Chief

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    Ahh, should've thought of that. I didn't see any BLS protocols for Hawaii's services when I looked, just ALS.

    You know, that reminds me, I heard somewhere that the EMTs in Hawaii were all actually AEMTs. Any truth to that?
     
  5. Jim37F

    Jim37F Forum Deputy Chief

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    I know their state scope is higher than National Model, and they start IVs, beyond that I'm honestly not 100% sure what the state EMT scope is lol....they did me tion AMR has EMTs, AEMTs, Paramedics, and CUT Nurses though, and will run BLS/ILS/ALS/CCT units (City&County EMS runs 1 and 1, EMT and Medic, though 2 medics can work together.....Fed Fire is the only other ambulance provider on the island, I think they're dual fire medics)
     
  6. RocketMedic

    RocketMedic Fancy Book Learnin'

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    Also, KED
     
  7. EpiEMS

    EpiEMS Forum Deputy Chief

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    @Jim37F gotcha - I’ll have to try and dig up some protocols on that!
     
  8. MSDeltaFlt

    MSDeltaFlt Forum Deputy Chief

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    Exactly. We're overlooking the BLS provider who is asking a BLS question on the BLS forum lobby here.

    Rocket hit the nail on the head. "Spinal restrictions" (there is no such thing as "spinal immobilization" unless a neurosurgeon uses a torque wrench to place a Cervical HALO on someone who has a significantly fracture cervical spine to prevent subluxation - believe me I know first hand) does NOT require all four limbs. In other words, you can use a KED or some other form of short spine board and sit them up.

    Now if your assessment reveals an obviously fractured pelvis, then you're stuck using the long spine board and you'll have to log roll them to one side.

    Now for those of us who have been doing this WAY before the invention of Spider Straps here is a best practice idea to TRULY secure them to a long spine board. This is way better than spiders or Kerlix(roll gauze). 3 inch tape.

    Wrap 3 inch tape all the way around the patient and the spine board. First at under the armpits because you will need a free arm for blood pressures. Then the pelvis. Then wrapping around the head and C-Collar. Then the lower extremeties. 3 inch silk tape is not likely to cause a skin tear. Definitely do not use duct tape.

    I say 3 inch silk tape because it is wide enough and wrapped around the entire patient is strong enough that even a morbidly obese patient can be flipped facing the ground and not move even an inch.
     
    Jim37F likes this.
  9. Emily Starton

    Emily Starton Forum Probie

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    I've watched the video and i also loved it.
     
  10. NPO

    NPO Forum Deputy Chief

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    My service specifically recommends having the patient lay prone with their head hanging off the end of the mattress (if they are conscious). It allows for natural draining of the airway. Good for people who shoot off their jaws with a gun or firework or something like that.
     
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  11. EpiEMS

    EpiEMS Forum Deputy Chief

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    Overlooking the practical Be-Lifting-Stuff* considerations here of "Aw, darn, now I have to clean up all that blood!"
    :eek:

    *Alternatively, Be Cleaning & Lifting Stuff (BCLS :) )
     
  12. NPO

    NPO Forum Deputy Chief

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    Subjectivity, it's easier to clean the floor than the gurney.
     
  13. EpiEMS

    EpiEMS Forum Deputy Chief

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    True that. And I can always put down a bucket!
     
  14. NPO

    NPO Forum Deputy Chief

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    Also, that little bit about having an open and patent airway is pretty cool too.
     
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  15. VFlutter

    VFlutter Flight Nurse

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    If a patient truely has massive nasopharyngeal hemorrhage to the point of getting intubated then put the largest tube you can get in. Place a bougie and go for a 8.0/8.5. They will be coughing up clots for days and getting multiple bronchs or tube exchanges for occluded ETT.
     
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  16. inthefield

    inthefield Forum Ride Along

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    What about putting on the collar, putting the patient on the backboard, and manually holding the patient while elevating one side of the backboard and suctioning? In theory you may be able to have the blood drain away from the mouth.
     
  17. Sipps

    Sipps Forum Ride Along

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    What about the lateral trauma position that we have been using in Norway? Can't post links since this is my first post :(
     
  18. Remi

    Remi Forum Deputy Chief Premium Member

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    An actual airway compromise always trumps a potential spinal insult.

    Turn them on their side or even completely prone. Put the stretcher in a little t-burg. If they are breathing well, that may be the only prehospital intervention they need.
     

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