Continuous Facial Bleeding with CSpine

[EpiEMS]

While that procedure is awesome, it doesn’t have bearing on this conversation.

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

The medics here can also "PATI" (Pharmaceutical Assisted Tracheal Intubation) and this case sounds like one they'd be quick to pull that trigger on.

Any idea what pharmaceuticals? Are they using a paralytic?

 

[VentMonkey]

Any idea what pharmaceuticals? Are they using a paralytic?

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.

 

[Jim37F]

Any idea what pharmaceuticals? Are they using a paralytic?

This is a pic I took of their "cheat sheet" posted in the ambulance:

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]

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.

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

.medic made 1, maybe 2 attempts ata tube befire letting his EMT partner drop a combitube instead

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

 

[Jim37F]

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)

 

[RocketMedic]

Also, KED

 

[EpiEMS]

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

 

[MSDeltaFlt]

Also, KED

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.

 

[Emily Starton]

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

 

[NPO]

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.

 

[EpiEMS]

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.

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


*Alternatively, Be Cleaning & Lifting Stuff (BCLS )

 

[NPO]

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

 

[EpiEMS]

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

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

 

[NPO]

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

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

 

[VFlutter]

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.

 

[inthefield]

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.

 

[Sipps]

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

 

[Carlos Danger]

Hey y'all. I've got a little scenario that came across my mind. I don't know how common it is (or we practical/possible) but humor me. Let's say there was serious trauma to the face or neck with the need for spinal immobilization. The bleeding keeps filling the upper airway and you continue to suction. My question is, what if a pt is on a backboard and needs spinal immobilization? Do you let them vomit/fill with blood and then suction? Do you roll the backboard so it is on its side? If they continue to vomit/bleed, do you transport with the backboard on its side? Just something that went through my mind. Thanks!

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.