I hesitated. And this guy might've lost his life..

[usalsfyre]

ABCs take 3 minute?!? About 5 seconds from across the room via an experienced provider...

 

[JPINFV]

I check my ABCs before I do a rapid trauma.

That's nice, but when are you going to check the patients?

[I'll be here all night. Try the veal, remember to tip your waitress...]

 

[Hunter]

ABCs take 3 minute?!? About 5 seconds from across the room via an experienced provider...

Glad that you can check for a Patent airway, count the # of respirations/min, listen to lung sounds, check a pulse ox, check Blood Glucose, check pulse, check skin temp, and take a BP all from across the room... However a visual BP has been discouraged by most of my instructors and generally all other professionals I've encountered in the field...

 

[Sasha]

Glad that you can check for a Patent airway, count the # of respirations/min, listen to lung sounds, check a pulse ox, check Blood Glucose, check pulse, check skin temp, and take a BP all from across the room... However a visual BP has been discouraged by most of my instructors and generally all other professionals I've encountered in the field...

You dont need to count resps, you can.tell if theyre within normal too slow/too fast without going "1...2....3"

If your patient isnt breathing/in resp distress what the heck are you doing listeningto lung sounds and checking a bgl before cpr?

Also you can get an idea of how well thryre perfusing by skin color.

Sent from LuLu using Tapatalk

 

[Shishkabob]

Glad that you can check for a Patent airway, count the # of respirations/min, listen to lung sounds, check a pulse ox, check Blood Glucose, check pulse, check skin temp, and take a BP all from across the room... However a visual BP has been discouraged by most of my instructors and generally all other professionals I've encountered in the field...

No, but you should generally be able to do the ol' PEPP routine (Sick/Not Sick) and go "Oh sh**, something needs to be done and fast"


I can tell if a patient is having difficulty breathing from across a room, and I don't need to listen to their lungs/ check a pulse ox/ do anything else other than see them.

 

[JPINFV]

Glad that you can check for a Patent airway, count the # of respirations/min, listen to lung sounds, check a pulse ox, check Blood Glucose, check pulse, check skin temp, and take a BP all from across the room... However a visual BP has been discouraged by most of my instructors and generally all other professionals I've encountered in the field...

Out of all of those, airway and respiration rate are the only ones that are actually a part of checking ABC. Respiration rate, in terms of ABCs really can be characterized on sight by "none, too slow, normal, too fast" with tidal volume being "none, too slow, normal, too fast." Similarly, you should be able to get a good idea of a patient's airway by looking at them (are they gagging, are they breathing, do they have trouble talking?). Circulation is similarly just as simple. How are they acting? What's their skin color like.


ABC = "Is there anything obviously life threatening?" not "Do a full respiratory exam?"

 

[usalsfyre]

Hunter, experienced provider vs new provider. As noted above what you listed is patently unneeded for me to assess ABCs. My 5 second assessment goes something like...

A&B)Is he breathing? Are there any noises coming out? Are the upper airway or lower airway noises? How's his chest excursion. Is he sitting up in tripod position? Is he using accessory muscles? Is he breathing fast or slow?

C)Is he pink warm and dry or pale,cool and diaphoretic? (just as an aside, this tells me a hell of a lot more about perfusion status than an isolated BP, your instructors opinions not withstanding). Does he have a pulse? Is it too fast or too slow? Regular or irregular? Narrow or wide? Dies he have that peri/immediately post-arrest duskiness? Do I see mass amounts of blood pouring out, or that may have just finished pouring out?

We can even throw in D)Is he conscious? Did he turn and look at me when I walked in? Is he ambulatory, if so do I see ataxia? Sitting? Is he leaning to one side? If he speaks back to me is it clear? Are any limbs missing or bending the wrong way? Does he move both sides?

Except for taking a pulse, feeling skin temp I can do all this from the door. I assure you I am a professional. You sound like your early in your medical career. Understand that right now experinced practitioners can tell more about your patient from the door than you can after a three minute assessment. One day if you learn from what you see and experince you'll be there too. But calling them out as shortcutting assessment and not being professional is extremely arrogant and short-sighted on your part.

 

[usafmedic45]

I was driving home from work. I was about two blocks away, when I see a crowd in the middle of the street. It was a car vs. bicycle. I was 1st on scene. The victim was laying there, in somewhat of a recovery position, in his own blood, and a bunch of other stuff. It was my first time coming across something like that, without the help of a partner, and a fully-stocked rig. I spent about 5 minutes there, by myself. All I did was get some vitals. Not even that, I just took a pulse, since I didn't have any equipment with me. He had agonal respirations, at a rate of about 4. I should have flipped him over, and started CPR right away. But no. I just stayed there by him, not really doing anything, but monitoring his condition. PD and FD showed up with Care, and took over, flipping him over, and starting CPR, which I could've started a good while back. I keep thinking to myself that if he ends up dying, that I will be somewhat responsible.:sad: I think I just failed as an emt.

Nah. He was on his way out regardless of whether you did anything or not. If he needed CPR, then he was dead. Blunt trauma arrest = death.

 

[abckidsmom]

i assure you i am a professional. You sound like your early in your medical career. Understand that right now experinced practitioners can tell more about your patient from the door than you can after a three minute assessment. One day if you learn from what you see and experince you'll be there too. But calling them out as shortcutting assessment and not being professional is extremely arrogant and short-sighted on your part.

+1000

 

[usafmedic45]

I assure you I am a professional. You sound like your early in your medical career. Understand that right now experinced practitioners can tell more about your patient from the door than you can after a three minute assessment. One day if you learn from what you see and experince you'll be there too. But calling them out as shortcutting assessment and not being professional is extremely arrogant and short-sighted on your part.

+1000 again.

 

[clibb]

While you check his respirations and lung sounds he has severe internal bleeding from one of his femoral arteries, The rapid head to toe in an unconscious patient is like getting a chief complaint from a concious patient, since you can't ask them, "where does it hurt?" You gotta check for stuff, your ABCs take you about 3 minutes, head to toe takes you 1 if you're good.

Really? If he doesn't have a pulse and is not breathing, your rapid trauma doesn't really matter. It's CPR you'll be doing anyways depending on your protocols and extent of injuries.
Here's a question for you Hunter, how long are you supposed to spend on scene of a trauma patient? At the most 3 minutes. Extrication and other delays are considered.
After that, go ahead and do a rapid trauma if patient's airway is patent and you got a pulse while you instruct someone else to hold c-spine.

 

[Melclin]

Open thoracotomy and cardiac massage is the indicated treatment for
A blunt trauma arrest.

And in all likelihood, won't help anyway. The body wants to perfuse. When an gross traumatic injury is such as to immediately and continually force it not too, in most cases there is little we can do about it. I say decompress if you find a PEA of reasonable rate, with reasonable downtime, with no obvious injuries incompatible with life, otherwise, call it.

If I saw anyone wrist deep in a chest with a scalpel beside them on scene it'd be time for me to a)run far, far away off duty b)be on the phone with dispatch telling them to call my medical director ("no, not med control! I need the medical director himself...")

I think I'd be calling for a copper. That'd scare the :censored::censored::censored::censored: out of me.

Hunter, experienced provider vs new provider. As noted above what you listed is patently unneeded for me to assess ABCs. My 5 second assessment goes something like...

A&B)Is he breathing? Are there any noises coming out? Are the upper airway or lower airway noises? How's his chest excursion. Is he sitting up in tripod position? Is he using accessory muscles? Is he breathing fast or slow?

C)Is he pink warm and dry or pale,cool and diaphoretic? (just as an aside, this tells me a hell of a lot more about perfusion status than an isolated BP, your instructors opinions not withstanding). Does he have a pulse? Is it too fast or too slow? Regular or irregular? Narrow or wide? Dies he have that peri/immediately post-arrest duskiness? Do I see mass amounts of blood pouring out, or that may have just finished pouring out?

We can even throw in D)Is he conscious? Did he turn and look at me when I walked in? Is he ambulatory, if so do I see ataxia? Sitting? Is he leaning to one side? If he speaks back to me is it clear? Are any limbs missing or bending the wrong way? Does he move both sides?

Except for taking a pulse, feeling skin temp I can do all this from the door. I assure you I am a professional. You sound like your early in your medical career. Understand that right now experinced practitioners can tell more about your patient from the door than you can after a three minute assessment. One day if you learn from what you see and experince you'll be there too. But calling them out as shortcutting assessment and not being professional is extremely arrogant and short-sighted on your part.

This. ^^^.

 

[usafmedic45]

Open thoracotomy and cardiac massage is the indicated treatment for
A blunt trauma arrest.

E-mail Ken Mattox and ask him what he thinks about that.

 

[jjesusfreak01]

If I saw anyone wrist deep in a chest with a scalpel beside them on scene it'd be time for me to a)run far, far away off duty b)be on the phone with dispatch telling them to call my medical director ("no, not med control! I need the medical director himself...")

Our medics have the MDs cell number.

 

[Hunter]

Hunter, experienced provider vs new provider. As noted above what you listed is patently unneeded for me to assess ABCs. My 5 second assessment goes something like...

A&B)Is he breathing? Are there any noises coming out? Are the upper airway or lower airway noises? How's his chest excursion. Is he sitting up in tripod position? Is he using accessory muscles? Is he breathing fast or slow?

C)Is he pink warm and dry or pale,cool and diaphoretic? (just as an aside, this tells me a hell of a lot more about perfusion status than an isolated BP, your instructors opinions not withstanding). Does he have a pulse? Is it too fast or too slow? Regular or irregular? Narrow or wide? Dies he have that peri/immediately post-arrest duskiness? Do I see mass amounts of blood pouring out, or that may have just finished pouring out?

We can even throw in D)Is he conscious? Did he turn and look at me when I walked in? Is he ambulatory, if so do I see ataxia? Sitting? Is he leaning to one side? If he speaks back to me is it clear? Are any limbs missing or bending the wrong way? Does he move both sides?

Except for taking a pulse, feeling skin temp I can do all this from the door. I assure you I am a professional. You sound like your early in your medical career. Understand that right now experinced practitioners can tell more about your patient from the door than you can after a three minute assessment. One day if you learn from what you see and experince you'll be there too. But calling them out as shortcutting assessment and not being professional is extremely arrogant and short-sighted on your part.

When you say ABC's I think of assessing everything I listed in my earlier post. I understand that beginning CPR is something that's important. But taken from the scenario that the OP posted since the patient was laying in a pool of his own blood and "stuff". I think a rapid head to toe to find and stop the source of the pool of blood might be more important than CPR. Idealy in real life you would wanna do both at the same time if possible, but CPR on a hemorrhaging patient isn't gonna do a thing. I don't mean to come off as arrogant but I don't see how CPR on this case or any other trauma patient would do anything if they're bleeding out.

 

[Shishkabob]

When you say ABC's I think of assessing everything I listed in my earlier post.

What you listed earlier was an assessment. ABC are simple "Can they breath, are they breathing, and is the heart pumping?"

 

[Handsome Robb]

CPR on a hemorrhaging patient isn't gonna do a thing.

Stopping the bleeding on a pt who isn't circulating blood isn't going to do a thing either...

 

[Hunter]

Stopping the bleeding on a pt who isn't circulating blood isn't going to do a thing either...

Agreed, so let me correct your quoting

...I understand that beginning CPR is something that's important. But taken from the scenario that the OP posted since the patient was laying in a pool of his own blood and "stuff". I think a rapid head to toe to find and stop the source of the pool of blood might be more important than CPR. Idealy in real life you would wanna do both at the same time if possible, but CPR on a hemorrhaging patient isn't gonna do a thing. I don't mean to come off as arrogant but I don't see how CPR on this case or any other trauma patient would do anything if they're bleeding out.

"Idealy in real life you would wanna do both at the same time if possible"

Think this part that you left out is sort of saying what you said?

 

[usalsfyre]

When you say ABC's I think of assessing everything I listed in my earlier post. I understand that beginning CPR is something that's important. But taken from the scenario that the OP posted since the patient was laying in a pool of his own blood and "stuff". I think a rapid head to toe to find and stop the source of the pool of blood might be more important than CPR. Idealy in real life you would wanna do both at the same time if possible, but CPR on a hemorrhaging patient isn't gonna do a thing. I don't mean to come off as arrogant but I don't see how CPR on this case or any other trauma patient would do anything if they're bleeding out.

If they've exsanguinated to the point of cardiac arrest and you don't have blood handy, you might as well let them lay. They're not coming back.

 

[Hunter]

If they've exsanguinated to the point of cardiac arrest and you don't have blood handy, you might as well let them lay. They're not coming back.

As low of a chance as they have of coming back from that cardiac arrest, we're supposed to try no?