Reviewing for the final, just read that 85-95% of trauma patients end up needing surgery. That info leads me to concur.
How much effort do spend on trauma?
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Reviewing for the final, just read that 85-95% of trauma patients end up needing surgery. That info leads me to concur.
How do you define a "trauma patient"?
could i just ask your source for this, it seems awefully high.
It's in Bledsoe's "Essentials of Paramedic Care," volume 2. It's a Canadian text. I don't have the book with me right now, so I can't look up a page for you.
mycrofft
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Ha! Great debates!
Lemme in.
1. Most trauma is ortho? I worked an ER, most trauma is not ortho, but non-orthos tend to come in via private car with a towel wrapped around something, or carrying something in a cup full of ice. Penetrating trauma tends not to be primarily ortho. Closed head, blunt abdomen: not ortho. Burns: not ortho. Then, there are bony injuries which are not ortho (craniomandibulofacial injuries), and cases with an ortho component (fx femur...) which are not primarily ortho (...driven into the peritonium from a great fall or unrestrained passenger MVA). We get trained to death in ortho because we can make a difference in our time frame and, unless it is open, debridement is not always necessary. Also, most traumas don't require professional intervention, unless they get infected.
2. Surgeons see opportunities to operate. Orthopod surgeons see everythig as bony, their oncologic colleagues see everything as neoplastic, and our holistic homeopathic cousins see everything as an opportunity to avoid aggressive or usually effective treatment for trauma.
Lemme in.
1. Most trauma is ortho? I worked an ER, most trauma is not ortho, but non-orthos tend to come in via private car with a towel wrapped around something, or carrying something in a cup full of ice. Penetrating trauma tends not to be primarily ortho. Closed head, blunt abdomen: not ortho. Burns: not ortho. Then, there are bony injuries which are not ortho (craniomandibulofacial injuries), and cases with an ortho component (fx femur...) which are not primarily ortho (...driven into the peritonium from a great fall or unrestrained passenger MVA). We get trained to death in ortho because we can make a difference in our time frame and, unless it is open, debridement is not always necessary. Also, most traumas don't require professional intervention, unless they get infected.
2. Surgeons see opportunities to operate. Orthopod surgeons see everythig as bony, their oncologic colleagues see everything as neoplastic, and our holistic homeopathic cousins see everything as an opportunity to avoid aggressive or usually effective treatment for trauma.
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How to you figure this is a Canadian textbook??
BLSBoy
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Some publishers will make texts specific to an area or school.
For example, I had a text book made exclusivly for my school when I went to Medic school in Fla.
I reckon it was a ploy so you HAD to buy the book through them, but that is just speculation on my part......
So believes ACS. But I am guessing they are counting the stuff that doesn't go to the ED like sports injuries, etc.
Paramedic care is my favorite text for medics, are you using the 5 volume series or the really thick one that has to compete in price category with mosby's?
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Some publishers will make texts specific to an area or school.
For example, I had a text book made exclusivly for my school when I went to Medic school in Fla.
I reckon it was a ploy so you HAD to buy the book through them, but that is just speculation on my part......
My query was a loaded question. I already knew that the publication was not Canadian since I shoot for the publisher. I was just curious why he thought it was a Canadian publication.
Ridryder911
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True NOT all trauma is a surgical case but overall true life threatning requires some form of surgical intervention.
I believe we screw up in the beginning of teaching trauma. We should start discussing shock syndromes in the basic EMT program. This should include cellular level effects of glucose, metabolism, to lactic acid by products. If we start at the first we can build upon that. The Basic EMT curriculum addressing this topic is ridiculous!
Of course as the level increases, more in-depth education should be taught. EMS personnel SHOULD HAVE THE MOST KNOWLEDGE OF SHOCK SYNDROMES!
It is quite shameful and in fact embarrassing to see Paramedic know very little of the path physiology of shock from capillary sphincters to ACTH levels. If you do not understand the process, you cannot understand what the presentation, the assessment and treatment that is associated.
I believe we screw up in the beginning of teaching trauma. We should start discussing shock syndromes in the basic EMT program. This should include cellular level effects of glucose, metabolism, to lactic acid by products. If we start at the first we can build upon that. The Basic EMT curriculum addressing this topic is ridiculous!
Of course as the level increases, more in-depth education should be taught. EMS personnel SHOULD HAVE THE MOST KNOWLEDGE OF SHOCK SYNDROMES!
It is quite shameful and in fact embarrassing to see Paramedic know very little of the path physiology of shock from capillary sphincters to ACTH levels. If you do not understand the process, you cannot understand what the presentation, the assessment and treatment that is associated.
EeyoreEMT
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Do to the best of your ability
Do what is best for the pt. Trauma in our area is our main volume. We get big seasoned city medics coming down to work part time-get a bad trauma-they scream for help and all you can say is we are 25 minutes out, what else do you want done before we are enroute? My partner had a tricky call about 5 years back, 2 car mva, moderate-severe damage to vehicles. Her pt. was male, 40's, unbelted driver. She and her partner attempted to backboard him and as they did he gasped and could not tollerate lying flat. Our protocols at the time, full c-spine was required for any trauma. What ended up happening was she KED boarded him w/c-collar, minor visible injuries, however ran hot due to breathing issue lying flat. Tollerated KED on cot at 45 degree or more angle. Upon arrival at Level II trauma center, she was reemed for no backboard, despite her explaination. She was upset, finishing her report in EMS room, doc came back in, he had a ruptured diaphram, if she would have backboarded him, lying him flat, he would have coded. He admitted she did the right thing.
In all, best advise, treat the PT, not the equipment, those are tools. If the monitor shows a-fib, they're stable, statting fine, no distress, no pain, relax, this might be pre-existing, keep on your toes. Machines can be wrong if you can't look at a pt and tell if they're not profusing well. Like the medic who looked at the monitor and saw v-fib, shocked the pt, and saved the day. What actually happened, the pt had a seizure, the medic panicked, saw the monitor, never checked the pt for a pulse, and shocked. Bad boo-boo.
And remember, you can do your best and they still die. When their time is up, nothiing you can do will stop it. Do your best, pray for the best and move on.
Do what is best for the pt. Trauma in our area is our main volume. We get big seasoned city medics coming down to work part time-get a bad trauma-they scream for help and all you can say is we are 25 minutes out, what else do you want done before we are enroute? My partner had a tricky call about 5 years back, 2 car mva, moderate-severe damage to vehicles. Her pt. was male, 40's, unbelted driver. She and her partner attempted to backboard him and as they did he gasped and could not tollerate lying flat. Our protocols at the time, full c-spine was required for any trauma. What ended up happening was she KED boarded him w/c-collar, minor visible injuries, however ran hot due to breathing issue lying flat. Tollerated KED on cot at 45 degree or more angle. Upon arrival at Level II trauma center, she was reemed for no backboard, despite her explaination. She was upset, finishing her report in EMS room, doc came back in, he had a ruptured diaphram, if she would have backboarded him, lying him flat, he would have coded. He admitted she did the right thing.
In all, best advise, treat the PT, not the equipment, those are tools. If the monitor shows a-fib, they're stable, statting fine, no distress, no pain, relax, this might be pre-existing, keep on your toes. Machines can be wrong if you can't look at a pt and tell if they're not profusing well. Like the medic who looked at the monitor and saw v-fib, shocked the pt, and saved the day. What actually happened, the pt had a seizure, the medic panicked, saw the monitor, never checked the pt for a pulse, and shocked. Bad boo-boo.
And remember, you can do your best and they still die. When their time is up, nothiing you can do will stop it. Do your best, pray for the best and move on.
BLSBoy
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EeyoreEMT
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What I'm saying, not clear enough, the medic say v-fib, when it was actually the pt seizing, not in v-fib, bad medic, stupid medic. Like the pulse ox, if the fingers are cold, it's not accurate. I'f the monitors look bad and pt looks find, check leads, low battery, human error, because the medic in that case never checked the pt before shocking, she didn't know the noise she was seing wasn't v-fib it was the body shaking from grand mal seizure. Do you not think that, with the exception of peds, that equipment can give you a false positive on something you might react to, giving unneeded medication, if you didn't confirm with how the pt looks, how the vitals are and what their complaints are?
I don't know if I didn't explain myself well or just confused people. Sorry if I did.
Which would you be more concerned over: 1. 70 yom pt pale, 180/100, diapheretic, regular sinus rhythem, hr 110, o2 stat 96%, resp 20, no cardiac history or 2. 70 yom pt. BP 180/90, no complaints, hr 80, o2 stat 96%, monitor shows occasional pvcs with a possible 1st degree heart block, resp 16, MI history 3 years ago.
I don't know if I didn't explain myself well or just confused people. Sorry if I did.
Which would you be more concerned over: 1. 70 yom pt pale, 180/100, diapheretic, regular sinus rhythem, hr 110, o2 stat 96%, resp 20, no cardiac history or 2. 70 yom pt. BP 180/90, no complaints, hr 80, o2 stat 96%, monitor shows occasional pvcs with a possible 1st degree heart block, resp 16, MI history 3 years ago.
BLSBoy
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Just throwin it out there....
http://www.healthline.com/channel/ventricular-fibrillation_complications
http://www.healthline.com/channel/ventricular-fibrillation_complications
EeyoreEMT
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Certainly you can't dispute the fact that there are people that can be that stupid??
BLSBoy
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Can it happen, sure.
I don't know for sure all the facts, and I would be remiss should I not play Devils Advocate.
I don't know for sure all the facts, and I would be remiss should I not play Devils Advocate.
EeyoreEMT
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Very true, I would also.
I find the most concerning patient is the one who is "so healthy they haven't been to the doctor in 40 years."
Mostly because you have no idea the train wreck you are walking into. At least you have some idea what could be wrong and therefore what to do when you patient has a history.
But I got what you were saying about the "v-fib" patient. Also about what you are saying about sick kids, how they don't always look sick.
Mostly because you have no idea the train wreck you are walking into. At least you have some idea what could be wrong and therefore what to do when you patient has a history.
But I got what you were saying about the "v-fib" patient. Also about what you are saying about sick kids, how they don't always look sick.
EeyoreEMT
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kids
We had a lightening strike at a soccer field two years ago. I got the call at home-get over here, get a squad. There's been a lightening strike, MCI
Oh your kidding, I was in dress clothes, it was pouring rain, I was getting ready to surprise my friend, work partner on a day off, with a 40th birthday surprise party. We both got on scene and grabbed arms, running down the hill, nothing but mudd. The kids playing I believe were around 8-10. It was the first strike of the incoming storm. The strike hit an adult male in the head then out his groin into his daughter, she was about 6, who was standing right in front of him then into the ground, which knocked anyone standing, down to the ground. I got on scene with my truck, jumped on the first open squad, which had three pts, 2 peds and 1 adults female. I had no info on anyone, who the kids were or what happened, all I knew was that lightening struck and people were hurt and everyone had a moniter on. The medic on that truck wanted to leave now, but the 2 of us shouldn't have 3 potentially critial pts, especially given two were seated and in seatbelts.
Well, that's how it ended up, an female adult who couldn't hear anything and had numbness in her arms and legs, was on the cot. A 4 year old F was buckled smiling at me, but refused to talk, and to my right was a 6 year old F, shy, had burnt hair on her head, she too was in good color, monitor on both was good.
The medic was focused on the adult, I had the two peds, vitals good, the younger didn't want to talk much but the older one was doing good. After checking all fingers, toes searching for any type of entrance and/or exit mark, I found out that none of the 3 were related. That explains why the girls were a little shy, then the older one got quiet and pale. I looked at the monitor and her P wave inverted. I checked the leads, making sure everything was on right, no human error, did recheck on vitals, vitals were ok, except for the inverted P wave and I have a pale, quiet 6 year old, who was just talking with me. I grabbed the medic by the arm and asked him to take a quick peek, I thought he should be with her, he said no, she's ok, No IV access was started on the peds and she wasn't looking so good. I said, no-look her P wave inverted. He said to check the leads, which I had already done. I had to grab him again, pulled him and said look at her! and printed a strip for him. He grabbed the strip looked up at her, his mouth dropped open and quickly switched with me and she went into the hospital first.
We found out later on, she was seizing on scene and took the hit from her father, who was being worked as a code. People on scene started CPR initially are responsible for saving this man. He was later stabilized and transfered to a burn center. The daughter was kept overnight for observation. The 4 year old, nothing was wrong, not a scratch.
We had a lightening strike at a soccer field two years ago. I got the call at home-get over here, get a squad. There's been a lightening strike, MCI
Oh your kidding, I was in dress clothes, it was pouring rain, I was getting ready to surprise my friend, work partner on a day off, with a 40th birthday surprise party. We both got on scene and grabbed arms, running down the hill, nothing but mudd. The kids playing I believe were around 8-10. It was the first strike of the incoming storm. The strike hit an adult male in the head then out his groin into his daughter, she was about 6, who was standing right in front of him then into the ground, which knocked anyone standing, down to the ground. I got on scene with my truck, jumped on the first open squad, which had three pts, 2 peds and 1 adults female. I had no info on anyone, who the kids were or what happened, all I knew was that lightening struck and people were hurt and everyone had a moniter on. The medic on that truck wanted to leave now, but the 2 of us shouldn't have 3 potentially critial pts, especially given two were seated and in seatbelts.
Well, that's how it ended up, an female adult who couldn't hear anything and had numbness in her arms and legs, was on the cot. A 4 year old F was buckled smiling at me, but refused to talk, and to my right was a 6 year old F, shy, had burnt hair on her head, she too was in good color, monitor on both was good.
The medic was focused on the adult, I had the two peds, vitals good, the younger didn't want to talk much but the older one was doing good. After checking all fingers, toes searching for any type of entrance and/or exit mark, I found out that none of the 3 were related. That explains why the girls were a little shy, then the older one got quiet and pale. I looked at the monitor and her P wave inverted. I checked the leads, making sure everything was on right, no human error, did recheck on vitals, vitals were ok, except for the inverted P wave and I have a pale, quiet 6 year old, who was just talking with me. I grabbed the medic by the arm and asked him to take a quick peek, I thought he should be with her, he said no, she's ok, No IV access was started on the peds and she wasn't looking so good. I said, no-look her P wave inverted. He said to check the leads, which I had already done. I had to grab him again, pulled him and said look at her! and printed a strip for him. He grabbed the strip looked up at her, his mouth dropped open and quickly switched with me and she went into the hospital first.
We found out later on, she was seizing on scene and took the hit from her father, who was being worked as a code. People on scene started CPR initially are responsible for saving this man. He was later stabilized and transfered to a burn center. The daughter was kept overnight for observation. The 4 year old, nothing was wrong, not a scratch.
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Ridryder911
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I think you answered that your self. Sorry, but any idiot that went to any half arse Cracker Jack Paramedic mill should know to always check the patient, the leads then re-check the monitor. Now, there is V-fib seizures in which the patient will go into seizures r/t the v-fib, which may have been the case.. how does one really know?
R/r 911