here is a decent link
http://ajcc.aacnjournals.org/cgi/content/full/14/5/364
Thanks! It continues to surprise me how little study there is about some commonly used interventions, and how they're taught as gospel truth anyways.
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here is a decent link
http://ajcc.aacnjournals.org/cgi/content/full/14/5/364
Abdo pad on the shotgun wound, 02, 12-Lead, quickclot (R), Load & Go, I wouldn't want to keep her on scene any longer than necessary. Transport Code 4 CTAS 1 to the nearest hospital, MediVac if possible.
for the trandeleberg.... I was taught that by elevating the legs... your using gravity to help move the blood that is stored in your thighs towards the organs in the abdominal cavity. since theres about 2-4 Liters of blood in the legs, and Basics can't start IV's to restore the bodily fluid, its meant to be used in the field while transporting on a BLS rig.
As for the 12 lead... I know that most rigs (if not all) use the 5 lead... so I'd go a 5 lead.
Didn't this remind anyone else of the movie ALIEN?! I've got a mental image that is absolutely comical (in a Monty Python sort of way). I don't mean to make light of the scenario - this would be an unbelievably stressful one - but a little humor never hurts.You notice a baby hand moving from the hole created by the shotgun blast.
Like Smash said, I think you're missing the forest for the trees. Knowing her rhythm isn't going to do you a whole lot of good when she is very clearly a top-priority patient for far more obvious reasons. Don't even bother.As for the 12 lead... I know that most rigs (if not all) use the 5 lead... so I'd go a 5 lead.
Personally, with this patient, even running with an ALS crew I'd just do a pulseox. If somebody found time for the leads in-transit then great, but it'll take less time to slap the doohickey on her finger, toe, or earlobe and run with it. It'll also give you at least some indication of her oxygenation. Given the patient though, I would expect weak distal pulses - so I'd probably go for the earlobe with the pulseox.I would probably put a 3 lead monitor on if I had spare hands, as this allows a quick look at heart rate, which I can then correlate with other observations to get an idea of her hemodynamic status, and it doesn't take long to slap 3 leads on, especially as placement is not critical.
Real scenario, this came in via ambulance when I was doing clinicals last week.
Other than O2 and fluids, sounds like they needed a surgeon FAST!
Do you know what their outcome was?
What a nightmare call...
As smash said, some form of permissive hypotension is the go these days, but its not actually backed up by a great deal of evidence. It makes good intuitive sense, and I think there are some animal models kicking around, but I'm told by someone who knows better than I (Professor & Head of Trauma at the Alfred Hospital), that that's about the extent of it, and he's not keen on it. He's one of the doctors on the state service's medical advisory committee, and consequently, we are not allowed to give any fluids to a person with penetrating truncal trauma.
Some interesting work coming out of the various battlefields of Iraq and Afghanistan in the past few years though. Not exactly high levels of evidence involved, but the experience of military trauma docs makes for interesting reading on the matter anyhow. Here's a couple of papers from my reference list that I found very interesting when I was writing about it for uni:
48. Jansen JO, Thomas R, Loudon MA, et al. Damage control resuscitation for major trauma. BMJ. 2009;338:1778
49. Holcomb JB, Jenkins D, Rhee P, Johannigman J,Mahoney P, Mehta S, et al. Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma 2007;62:307-10.
50. Hodgetts TJ, Mahoney PF, Kirkman E. Damage control resuscitation. JR Army Med Corps 2007; 153: 299-300.
Maybe not THE deciding factor, but it is definitely of great importance. You could - especially if there's a long transport time - kill this patient (or her baby) with bad positioning.as for positioning of the patient? dunno but i dont think its the deciding factor here.
What's more imminently life threatening: the fact that she is hemorrhaging from her uterus, or the possibility of low-level spinal damage? One might give her some minor paralysis. The other will kill her within a few hours. I'm not saying it's an excuse not to backboard, but given the risk of her going into labor...spinal?
Anything to stop contractions? Haha, in a squad? Doubt it. Positioning is about all you're going to get, and that won't stop contractions - it'll just keep the baby from coming. This baby needs delivery in an OR. Asap.anyone here worried about uterine contraction and does anyone have anything in their kit for this?
When rules get skewed, responders get screwed. Doesn't matter who's on the phone. My former BLS instructor loved to tell us a story about two medics who were sued, found guilty, lost their certs, and were facing criminal charges because they did an emergency C-section on a deceased, full-term pregnant woman, via telephone with a surgeon. It's outside their practice to pronounce someone dead, and you can't operate outside the scope of practice just because a doctor is telling you what to do on the phone - even if there's a baby involved. This patient needs diesel.for bp/fluid admin, id assume your on the phone with the doc the whole way to the hospital and your under his licence doing things out of your scope, like drug admin for whatever reasons. when its prenatal/neonatal rules get skewed
Anything to stop contractions? Haha, in a squad? Doubt it. Positioning is about all you're going to get, and that won't stop contractions - it'll just keep the baby from coming. This baby needs delivery in an OR. Asap.
so somebaody said theyd be happy with a bp at around 80.this will starve the fetus yes?
Where was scene safety in all of this?
12-Lead
quickclot (R)
A thought: Where was scene safety in all of this?
You arrive on scene after police confirm scene is safe
When rules get skewed, responders get screwed. Doesn't matter who's on the phone. My former BLS instructor loved to tell us a story about two medics who were sued, found guilty, lost their certs, and were facing criminal charges because they did an emergency C-section on a deceased, full-term pregnant woman, via telephone with a surgeon. It's outside their practice to pronounce someone dead, and you can't operate outside the scope of practice just because a doctor is telling you what to do on the phone - even if there's a baby involved. This patient needs diesel.
Sedation of the patient, with narcs or barbituates allows the patient to rest.