motorcylce accident

PS: OP cointosser, you took that BP manually on an exposed arm without a bunched up sleeve between the cuff and the heart, right?:cool:
 
Household6 said:
Fantastic article, this is absolutely something that I think we need to discuss and practice our skillzz class.. Great information, the collective knowledge around here is so helpful to me.

We haven't got to that part in our book yet, but the EMR class last semester did. As an EMR, we followed the guidelines in the book which said not to remove them. Of course EMTB/P will have completely different protocols.

DesertEMT66, did you practice helmet removal in skills?
Click to expand...

Yes, many different times with many different helmets.
 
To the OP, of you're relying on B/P to clue you in on shock you're way behind the 8 ball.
 
Ok maybe I was way too sensitive with the vitals signs. Maybe the motorcyclist was just fine.

All I wanted to do was ask if the vital signs meant anything. I remembered something in EMT class about High Blood pressure and low/irregular respirations. I could've given you all the information/vitals about the call but I really don't want to put all that information. I tend to forget about my calls after a day, so I don't know how reliable my information would be. I'm a new EMT, I have very little experience BUT I'm all about learning and getting experience. What I don't want are people insulting my level of experience. Remember guys (guys like usalsfyre<_<), you used to be a rookie, just like I am right now. Comments like "To the OP, of you're relying on B/P to clue you in on shock you're way behind the 8 ball". usalsfyre, I don't just rely on B/P, I know that I don't even have to take a B/P to know that my patient is in shock. Yes I know I'm behind. I'm working my way up, but like everything, it takes time.
 
Last edited by a moderator:
Whoa bud, I don't think that comment was made as a dig at your experience level. That's good you realize BP is a late sign of shock, and he was just trying to make sure you knew that.

For my two cents, good work on noticing an unexpected value in vital signs and attempting to make a clinical correlation. As far as being a sign of Cushing's, this probably isn't. Firstly, most people with increases in ICP causing Cushing's Triad will be either unconscious or highly altered. Just as BP is a late sign of hypovolemia, Cushings is a late sign of head injury. These VS changes are caused by an increased ICP that has progressed to the point of brain damage and imminent herniation of the brain stem itself. As was mentioned earlier in this thread, head injuries of that severity will typically be obvious long before you get to taking a BP. Noticing hypertension and bradycardia will most likely be secondary to the realization that "This patient has all of the badness, and I should be leaving here yesterday." This can also be profound hypertension, bradycardia, and changes in respirations. 160 systolic is obviously elevated, but not necessarily as high as you would expect in a closed head injury. A RR of 12, like you said, is completely normal. If you notice, many healthy adults have a RR closer to 10 anyway when relaxed.

Keep trying to further your education! Seriously, outstanding work on looking up more than the bare minimum and finding out more about why your patient presented the way she did.
 
Yes, raised BP and slowed atypical respirations (graduating to kussmaul and-then/or agonal breathing) plus (maybe) posturing indicate intracranial damage.

Yes, it is advanced by then, but unless you have protocols/drugs in the field it doesn't make much difference, just try to keep the head a little elevated, try not to fatally aggravate any other injuries, protect airway, and go.

OP, look up other signs of intracranial trauma.
 
Cointiosser, I think you'll find that most of the members here are VERY willing to help new EMTs learn. You're right, we were all rookies once. But, rather than us just giving you an answer, it's better for you to learn to search out answers and to make connections on your own. It's not that we don't want to help, but we want to help you learn it on your own. As I mentioned above, This is a good case for you to formulate a treatment plan and explain how you would manage this patient over the 10 or 12 minutes to the hospital. It's also a good scenario for you to develop a concise patient report for the receiving team. As a new EMT, depending on how much experience you have to 911, these scenarios can be very useful in helping to increase your skill set.
 
Last edited by a moderator:
Personally, I'd be thrilled with these vitals. I'd want to check the pupils etc. But the vitals look great.
However. Start trending. If they start to look funny, then you know there is a problem. Don't forget she had time to calm down.


As for helmet removal. I do it. Removing a helmet is extremely easy, I can get a better look at my patient and I prefer too . It needs to come off anyway eventually and I'm trained to do it.
 
Aprz said:
Leaving the helmet on could make it difficult to quickly safely assess and manage the patient's airway (ie insert an airway or suction). I believe that even if the patient was wearing a helmet, it's still important to assess their head too. If a paramedic needs to intubate the patient, he may have a difficult time opening the mouth and putting the patient in the sniffing position to view the cords and insert a endotracheal tube.

If you are concerned about c-spine, I believe most helmets will not allow the patient to lay supine with the helmet on while keeping the neck in the inline neutral position. If you remove the helmet by yourself, you may manipulate the neck too much. That's one reason you probably shouldn't backboard a patient with a motorcycle helmet on in regard to c-spine. Also I don't believe you can apply a c-collar on the patient's neck with the motorcycle on and the helmet doesn't help minimize movement with the neck, which is another reason you probably shouldn't backboard a patient with a motorcycle helmet on in regard to c-spine.
Click to expand...

I am of the belief that while we know that c-spine precautions are really not that helpful, if we are going to do them we need to actually do them correctly. As you mention, leaving the helmet on is pretty much guaranteed to prevent neutral positioning of the head and neck. It is for that reason that helmets should come off even if there is no airway compromise. I also think they amke assessing the head kind of difficult, and yes facial fractures are still very possible with a helmet on. While we don't really have much in the way for treatment of these fractures, I still want to know if my patient's face is crushed.

That said, helmet removal is a two person job and that is too often forgotten around here. When I worked for a hockey program we would use three people if the hands were available.

It is also difficult to immobilize a smooth and rounded helmet to a smooth backboard for what it's worth.

IslandTime said:
And that PT doesn't complain if you use plenty of tape on the helmet to immobilize the neck which is a lot easier than blocks and strips applied across the forehead.
Click to expand...

Again, there is no point of providing an intervention if you are not going to do it right. It's not that hard to tape someone's head and let them keep all their hair.
 
mycrofft said:
Always take of the helmet versus always leave the helmet on.

Because MVA's ALWAYS have the same degree and directions of force-moments, the victims ALWAYS experience the same degree and types of injury, and ALL helmets are made the same and ALWAYS have the same damage.

Same as NEVER use a long spineboard versus ALWAYS use a long spine board.

How about this one: NEVER do anything to the patient which will not yield a better level of care versus the risk inherent on THAT PARTICULAR CASE.

PS: airway airway airway.
Click to expand...

I am having hard time coming up with a scenario where a helmet would remain on except in the case obvious c-spine trauma (gross deformity) where I am so concerned that additional distraction caused by helmet removal would be devastating.

Beyond that though, it's awfully close to most always.
 
Tigger said:
Again, there is no point of providing an intervention if you are not going to do it right. It's not that hard to tape someone's head and let them keep all their hair.
Click to expand...

A very valid point. Thank you.
 
Here's another point to add about helmets and airways....and this is anecdotal (from experience).

With motorcycle TCs, riders will have already taken their helmets off. If a helmet is still on, it's likely that said rider got his or her bell rung (head hit/injury) enough to affect mental status...which means the helmet is coming off.

See where we're all going with this?
 
Jambi said:
Here's another point to add about helmets and airways....and this is anecdotal (from experience).

With motorcycle TCs, riders will have already taken their helmets off. If a helmet is still on, it's likely that said rider got his or her bell rung (head hit/injury) enough to affect mental status...which means the helmet is coming off.

See where we're all going with this?
Click to expand...

Excellent point.
 
The big picture versus the "me" picture

In the big picture, most spinal immobilization done in the field is unnecessary.

That can be restated as "not that helpful", if you are looking at the big picture. However, in cases where cervical or other spinal injury is suspected, it goes from "not that helpful" to "Stan, go get the long board and KED, now".

If it's me and my neck's likely busted, I give you permission to KED me at least.
 
Tigger said:
I am having hard time coming up with a scenario where a helmet would remain on except in the case obvious c-spine trauma (gross deformity) where I am so concerned that additional distraction caused by helmet removal would be devastating.

Beyond that though, it's awfully close to most always.
Click to expand...

Yes. Just need to have enough corporate knowledge and the proper tools to do it without causing more harm on those occasions where there is injury.
That may be rare, but if it's me being quadded out due to no one knowing how to do it or incautiously approaching me because of the always/never mindset, it means the world for me and my family and insurance company. And someone's going to pay.:ph34r:
 
mycrofft said:
That can be restated as "not that helpful", if you are looking at the big picture. However, in cases where cervical or other spinal injury is suspected, it goes from "not that helpful" to "Stan, go get the long board and KED, now".
Click to expand...

Except it's still probably not that important...
 
You must log in or register to reply here.
Back
Top