Priority intervention?

kirky kirk

kirky kirk

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During one training session, this scenario was given.

Patient arrived at the ER, gunshot wounds to the left chest, left abdomen. Patient is gasping, bleeding profusely and de-saturating fast. What is the priority intervention?
 
kirkyrabbit said:
During one training session, this scenario was given.

Patient arrived at the ER, gunshot wounds to the left chest, left abdomen. Patient is gasping, bleeding profusely and de-saturating fast. What is the priority intervention?
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Well, my first thought is to throw one of these:
latest


If that's not an option, I'm going to go with the ABC's and take care of B & C as quickly as I can. Patient is gasping so the airway is patent...
 
Akulahawk said:
ABC's and take care of B & C as quickly as I can.
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This. Maybe try to find some info on the gsw. Caliber? Entrance/exit wound? Approximate distance from shooter to victim?
 
What do you think the priority intervention is?
 
Akulahawk said:
Well, my first thought is to throw one of these:
latest


If that's not an option, I'm going to go with the ABC's and take care of B & C as quickly as I can. Patient is gasping so the airway is patent...
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Just make sure to count to three. Four is right out

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Bright lights, cold steel.

Just prior to that; chest tube, ETI and blood.

Have someone prophylacticly MFB. (Measure for box.)
 
Chase said:
100% NRB to oxygenate the non-existent hemoglobin
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EpiEMS said:
Somebody paid good attention to the NREMT's preferences ;)


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That's pretty much what I was hinting at with getting going with B and C... Flood patient with oxygen using an NRB or oxymask (because both can provide high percentage of inhaled oxygen) and then get going with stopping the leaks as much as possible. Ask about GSW info on the way to the ambulance, find way to trauma surgeon who can apply bright lights, cold steel. Maybe along the way, start a couple of medium-to-large bore IV lines and use just enough fluid to maintain a palpable carotid pulse because anything more unnecessarily dilutes what little kool-ade is left. Call hospital so they can bring blood to ED and have it available upon arrival.

Oh, and 4 really is right out...
 
Gurby said:
"patient is gasping"

Consider poking a needle in their chest.
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That's around step 4 or 5... and since I'm going go be moving rather quickly, that will be considered and perhaps done (if indicated) rather early on as well. It was one of the interventions I had in mind when I read the scenario. However the question was what's the priority intervention. Of course NONE of the answers were provided so we all get to add in our own priority interventions. :D
 
Chase said:
100% NRB to oxygenate the non-existent hemoglobin
Click to expand...

Lol!

In all seriousness, gasping indicates the patient is protecting the airway and breathing (although with difficulty) and also confirms presence of circulation. Check the mouth for blood; there's a high likelyhood with the left abdominal wound.

Now, I'm going with the ITLS 'find-it fix-it' approach. If you have the personnalle, get a gloved hand on that left chest wound to prevent tension pneumo. If the pt. was brought in by EMS I would expect they would have said if there was an exit wound on the back. If they were a walk-in, then finish the primary survey and check the back.

It goes without saying, getting the patient on a monitor, throw the pads on, multiple IV access, and prepping for intubation and chest tube is all happening at once, but my 'priority' would be figuring out what I'm dealing with and responding appropriately.
 
With the understanding I have never seen or treated a patient who has been shot, nor would 99.9% of ambulance personnel ever see it in their careers, nor would most hospital personnel (except maybe for somebody who has had a slug pellet accidently fired at them) hmm I would hazard a guess at the following:

1) Most importantly, a very early RT call to hospital to have an appropriate doctor who could open his chest in ED if required or at the least, an operating theatre ready upon arrival,
2) Go directly to theatre on arrival if possible and bypass ED all together,
3) Airway by whatever means works (laryngeal mask is fine for now)
4) Compress any external bleeding +/- CAT
5) Blood if available but not waiting at the scene for blood to arrive unless a very few minutes away

I can't say what else I'd do ...
 
SpecialK said:
With the understanding I have never seen or treated a patient who has been shot, nor would 99.9% of ambulance personnel ever see it in their careers, nor would most hospital personnel (except maybe for somebody who has had a slug pellet accidently fired at them)
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Ok I have to ask, @SpecialK what are the assault weapons of choice in New Zealand?
 
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