Scenerio

[certguy]

It's 3:00 a.m. , and you get a code 2 FD call for neck pain - post mva . On your arrival , you find a very intoxicated 25 y/o who weighs approx. 250 lbs. lying in bed on the top floor of a 3 story condo , c/o severe neck pain . As you approach him , you notice round wounds spaced evenly around his head . When you ask how he got those , he gives evasive answers till your partner lifts a blanket in the corner to reveal a HALO . He then states he rolled his pickup a couple days ago , breaking his neck in the process . He just got discharged today and couldn't stand to wear the HALO , soooooo , him and his buddy get drunk and he talks the buddy into using a pair of pliers to take the screws out and remove the HALO . His neck is now resting on a stack of pillows . Assessment findings are unremarkable . v/s within normal limits and neuros surprisingly intact . Thr pt. informs you as you notice his loc start to decrease that the pain was so bad , he washed an unknown # of pain pills down with a beer . Fire and medics are unavailable due to a multiple alarm fire downtown . How would you handle this ?

This was an actual call I responded on . It gives a whole new dimension to stupidity .

 

[medic001918]

On a BLS level, you're limited. It's a matter of proper spinal immobilization and packaging and transporting to the hospital. I'd bring the halo with you to the hospital so that they can see it and tell if it was damaged in the removal process. Monitor neuro's often and look for signs of compromise and document all of it thoroughly.

On an ALS level, it depends on what kinds of pain pills he took as to how it would be treated. But again, close monitoring is what's needed.

Immobilization in this case is of the utmost importance.

Shane
NREMT-P

 

[Flight-LP]

Ask him to move his neck to see if it hurts.......................


Definately one for the books.............

 

[BossyCow]

So, on the MIR, would you put R/O Stupidity?

 

[firetender]

If there was any way in the Universe for me to weasel out of the call (transporting), I would.

The guy's vitals are stable, he is positioned perfectly as he is and any moves toward immobilization could easily do more harm than good. Given his size and the 3rd storey scenario, I wouldn't budge him without adequate support.

THIS IS NOT AN EMERGENCY.

Duct tape and pillows galore to immobilize him as he is. I wouldn't even use my equipment.

The biggest question mark is about the drug/alcohol combination and to estimate the dosage would be of utmost importance, and, I'd guess, possible to do at the scene. My bet would be the sedation would be welcome, but not fatal. Be ready with suction, and pray the puke is not chunky.

He's got a Neurologist somewhere, let HIM come in and re-attach the HALO. I'd be happy to help. That may not be a fantasy because the Neuro has an investment to protect. It's also highly unusual circumstances and could be a bit of an interesting challenge.

I've put my Cert. on the line before refusing to transport if I felt it would cause more damage than not. In this case, I would not make the decision. That would have to come from someone much better qualified than myself, who is present on the scene to do the evaluation and willing to take responsibility for the numbnuts.

 

[certguy]

Firetender's take on this is definitely different . I definitely didn't go this route . The extrication was a major PITB ( pain in the butt ) . We had to stand him on end to get around each landing . As fire was unavailable , we called 2 additional crews for manpower . The possible OD was the wildcard . With decreasing LOC , I dropped an NPA , started 15 lpm non - rebreather , did the mega packaging job ( we didn't have spiders back then , so we used multiple straps and a sheet looped at the feet to prevent sliding ) , prepared for my worst case scenerio , taking an extra EMT in the process , and transported , closly monitering vitals . We did determine what he took , but couldn't be sure of how much as his buddy said he lost some of the pills when he dropped the bottle . We also took the HALO along . As luck would have it , his trauma doc was on duty and went completely ballistic when we brought him in . He told the pt. " You think you were uncomfortable before , you ain't seen nothing yet ! " Then he told us not to expect our board back soon . We left it at that and went back in service . Hopefully , the butt chewing he got from me , my fellow EMT's and the doc did some good .

 

[MSDeltaFlt]

This guys was wearing a halo because he BROKE HIS NECK! It takes approximately 12 weeks for the broken bone to heal... voice of experience talking here.

The ONLY C-Spine immobliloization there is, is a halo; which dipstick took off and is now feeling the effects of the self anesthesia. What a moron.

Yes, he wins the Darwin Award. He also wins another C-Collar with full C-Spine RESTRICTIONS - notice the difference. Along with another trip to the ER in full spinal precautions. You're not going to do more harm than good by packaging him AS LONG AS IN-LINE CERVICAL STABILIZATION IS MAINTAINED. Assess SMC's before and after and continually.

He is an aspiration risk due to the pills, ETOH, and decreasing LOC. Keep an eye on it. Drive slow and smooth.

 

[MSDeltaFlt]

Sorry, didn't fully read the previous post,

You did a good job.

 

[BossyCow]

Yes, he wins the Darwin Award.

Nope, you can only win a Darwin Award if you have taken your genes out of the gene pool. The victim of their own stupidity has to have either rendered themselves incapable of reproducing or died in order to qualify.

Scary to think these genes are still in the gene pool!

 

[MSDeltaFlt]

Nope, you can only win a Darwin Award if you have taken your genes out of the gene pool. The victim of their own stupidity has to have either rendered themselves incapable of reproducing or died in order to qualify.

Scary to think these genes are still in the gene pool!

Well, he's a runner up on the short list at least with what and how he took the halo off. Also, I'll bet you money that the wreck that caused the broken neck in the first place was not an accident.

Behavioral characteristics do not change overnight. I would not be surprised if genius ended up winning the award after all before too long.

 

[Jon]

I think that the first step is to keep him in his current position and call medical command. Explain the WHOLE situation to the doc, and let the doc decide if you should move the patient, or if someone needs to make a house call - the doc may well consult this guy's trauma doc or neurosurgeon for their ideas.

I'd also get FD there... and perhaps think about an alternate means of extrication - like out a window and down a rope / aerial ladder - it might be more stable. Probably best to get the cheif / technical rescue leader onscene ASAP to help you get a plan together... I'm not a big fan of standing up a board, as it isn't going to hold the patient as well as lying flat.

Additionally, you might need ALS and perhaps ALS with expanded scope (In PA, only flight medics/RN's and ground RN's can carry paralytics) this guy might need to be paralyzed and intubated to maintain his airway... as he is intoxicated and could become combative.

 

[AntonioEMT]

250 lbs....in kg?

I agree with Jon.....

 

[Jon]

250 lbs in Kg is close to 110 kg (I think)... it is a lot... even though I weigh a little more.

 

[certguy]

Hi Jon ,

There were a couple complications here . Fire and medics were unavailable due to a major incident and I was dealing with a possible OD with decreasing LOC . In the time it would've took to work things out , He could've been CTD ( circling the drain ) His vitals at that time weren't too bad , but I couldn't count on that . If I can't get ALS to the pt. , the only other option is to bring the pt. to ALS . The guy didn't crump on us , but the potential was there . It was a lot of work to get him down and a slow , smooth ride to the ER .

 

[mdtaylor]

Hopefully , the butt chewing he got from me , my fellow EMT's ...

Is that really part of your local protocols? I do hope you are joking.