WoW even in LA everybody doesn't get a back bord from a minor tc, if you have no neck and back pain we don't waste time with you. Hey if you have all the time in world to do it, more power to you.
soooo there we were.....
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WoW even in LA everybody doesn't get a back bord from a minor tc, if you have no neck and back pain we don't waste time with you. Hey if you have all the time in world to do it, more power to you.
Fox
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Actually, in EMT-B you are taught to give a bolus to trauma. No matter what. Even when you're doing the skills check offs. I had a MVA with trauma scenario and didn't run a bolus and they counted it against me. I said the IV was TKO. I used permissive hypotension as my example in argument, but was told to always give a bolus.
It was a paramedic that told me not to. So, I think there may be a difference in teaching there. EMT-B gives a bolus, Paramedic does not?
When I did my state practicals I had a trauma. You bet your butt I did an unnecessary bolus! And passed.
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Shishkabob
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Either I missed it, or it wasnt there, but I didnt see any mention of the pts bp so I cant judge if the bolus was good or not.
Granted more often then not a 250cc bolus wont help much if they DO need a bolus due to hypovolemia, but still.
EDIT: just saw it was later posted as 110/p in the post just above my first. Ha
Granted more often then not a 250cc bolus wont help much if they DO need a bolus due to hypovolemia, but still.
EDIT: just saw it was later posted as 110/p in the post just above my first. Ha
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LucidResq
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I am definitely not all about indiscriminate backboarding. If you dig up old posts of mine you'll find me arguing against it citing research that points to the detriments caused by unnecessary backboarding.
Although I wasn't there, I think I would have boarded this patient, though. This may be biased because I recently completed a clinical rotation in a renowned SCI/TBI rehab hospital and saw: a) how devastating SCI is, and b) how seemingly minor MOIs often leave people paralyzed.
We have guidelines for spinal immobilization decision making. Among the MOIs that one should CONSIDER immob, are equestrian accidents (this is similar) and falls >3 ft. That's not saying you board everyone who has these MOIs, but one should consider it.
Now if this kid got tossed pretty hard, but had no apparent or distracting injuries, was reliable (ie not drunk, altered or 8 months old), normal neuros, and no midline tenderness... I'm not boarding him.
I'd say a femur fx is a pretty significant distracting injury, and although spinal immob. is not without complications, I'd rather stay on the safe side with this kid and risk some time wasted and back discomfort or muscle spasms than risk aggravating and contributing to an absolutely devastating injury.
Although I wasn't there, I think I would have boarded this patient, though. This may be biased because I recently completed a clinical rotation in a renowned SCI/TBI rehab hospital and saw: a) how devastating SCI is, and b) how seemingly minor MOIs often leave people paralyzed.
We have guidelines for spinal immobilization decision making. Among the MOIs that one should CONSIDER immob, are equestrian accidents (this is similar) and falls >3 ft. That's not saying you board everyone who has these MOIs, but one should consider it.
Now if this kid got tossed pretty hard, but had no apparent or distracting injuries, was reliable (ie not drunk, altered or 8 months old), normal neuros, and no midline tenderness... I'm not boarding him.
I'd say a femur fx is a pretty significant distracting injury, and although spinal immob. is not without complications, I'd rather stay on the safe side with this kid and risk some time wasted and back discomfort or muscle spasms than risk aggravating and contributing to an absolutely devastating injury.
+1.
I had a similar call awhile ago at a horse show, with the patient also displaying symptoms of heat exhaustion. My crew treated pretty similarly, with the addition of pain control. I don't remember what fluids we gave. The receiving hospital didn't find fault with any of our interventions.
adamjh3
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Veneficus, first of all, thank you for taking the time to write that out, that was the most informative single post I have read today.
When using kling to apply traction, do you personally wrap around the ankle, the foot, or both? When tying off to the cot, what kind of knot do you use? Just a simple overhand or something different?
Thanks.
8jimi8
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My original question was why did you bolus and the reply came back, (paraphrased) because i can and because it won't hurt.
My primary problem with the fluid bolus was that, he gave no evidence that it was necessary, AND he gave an arbitrary bolus without taking into account the weight of the child (unless he's gonna argue that the pt was only 12.5kilos)
Why are you going to give a fluid bolus of an insignificant amount? If you are not actively treating hypovolemia, what are you treating with this intervention?
The bolus should have been a larger one, if[i/]i it was indicated. Of course that is assuming that the patient was at least 36 kilos ~ 90lbs.
here is how you do it. (though I admit it is much easier to show than type it)
You hold traction with your dominant hand. While at the patient's feet place your fingers on the dorsal tarsal surface. (you can grip if you want but you don't need to) apply pressure to bend the foot to a point, stopping when you meet resistance. (should look like a ballet dancer's pointed foot now) Anatomically it puts equal pressure on and extends all of the attached muscles in the leg. (including some proximal to the fx)
Next until you are skilled at this,(with a little practice you can do this one handed) have your partner wrap the cling a couple times around the ankle. (this is not the main support but helps keep the kling on) then wrap around the dorsal and plantar arch. The final and tightest loop should be from the dorsal side downward towards the cot or LSB. (don't wrap to the toes or you will not be able to check cap refil, though you should still be able to feel both the posterior tibial and dorsalis pedis pulses. (if they are there to begin with, which of course you remembered to check.)
When tying any patient for any medical purpose the the knot should be quick releasing. I use a simple slip knot. That way even the orthopod can figure out how to redo it
if you want to see how well the traction of this works, try it on a friend. If they are in a sitting position, they will actually have to try to keep their hips level and not raise up if you are doing it right.
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Distracting injury + mechanism = smrd
so what you're saying is: "if there is a femoral neck fx"
well basicially yeah
reaper
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I brought up the bolus because of lack of evidence that it is needed. Just because you CAN lose 1000-1500cc's does not mean that they are. Most femur Fx's have minimal bleeding. If the assessment showed it was needed, then do it! Everyone has the potential to be hypoglycemic, but we dont just bolus D50 without doing an assessment.
Lets push our new providers to assessment based medicine, not protocol based!
As far as traction splints. Sagers have always had problems with xrays. The Hares do not block the view, so they are a better design. Our trauma centers never remove the Hare, prior to xray. They always get clean shots.
MOI keeps getting thrown out there. Let me give you some Hx.
Rodeo injuries are a breed in themselves. For 30 years they had to deal with EMS providers going extreme on treatments, because they did not know or understand the potential. 15 years ago a couple of Ortho specialists and trauma surgeons start the Justin Sports Medicine Team. They are special teams of Dr's,PT's,surgeons,Rn's and Medics. They know the sport and specialize in the injuries that come from it. They are the primary emergency response at all Pro rodeos and bull ridings. They are working their way to the college and high school levels. They assess the Pt's and determine any treatments or procedures that are done on site. The local EMS is there for transport only. This is becoming the norm in all major sports. They went this route because of local EMS following protocols and not doing actual assessments.
As I stated before, why wasn't the ten other riders that were thrown off back boarded! They took the same forces? The Femur Fx was caused from being stepped on, not from the fall.
I applaud any local EMS that wants to do standby at a local sporting event. But research it and learn about it. There is a lot of different things to look at in Sports Medicine. That is why it is a specialty!
Lets push our new providers to assessment based medicine, not protocol based!
As far as traction splints. Sagers have always had problems with xrays. The Hares do not block the view, so they are a better design. Our trauma centers never remove the Hare, prior to xray. They always get clean shots.
MOI keeps getting thrown out there. Let me give you some Hx.
Rodeo injuries are a breed in themselves. For 30 years they had to deal with EMS providers going extreme on treatments, because they did not know or understand the potential. 15 years ago a couple of Ortho specialists and trauma surgeons start the Justin Sports Medicine Team. They are special teams of Dr's,PT's,surgeons,Rn's and Medics. They know the sport and specialize in the injuries that come from it. They are the primary emergency response at all Pro rodeos and bull ridings. They are working their way to the college and high school levels. They assess the Pt's and determine any treatments or procedures that are done on site. The local EMS is there for transport only. This is becoming the norm in all major sports. They went this route because of local EMS following protocols and not doing actual assessments.
As I stated before, why wasn't the ten other riders that were thrown off back boarded! They took the same forces? The Femur Fx was caused from being stepped on, not from the fall.
I applaud any local EMS that wants to do standby at a local sporting event. But research it and learn about it. There is a lot of different things to look at in Sports Medicine. That is why it is a specialty!
Shishkabob
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Ah got it 8jimi
My original response was just to his firsr post and your question stemming from it.
My original response was just to his firsr post and your question stemming from it.
I would bet that they were not backboarded because they got up and walked off.
reaper
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Really? Had a good friend that Fx'ed C6 and C7. He walked out of the arena and collapsed behind the chutes.
When I had my midshaft Femur Fx, I walked out on it, with slight limp. No one even knew till I cut my own pant leg and reveled it.
I have seen hundreds of guys knocked out cold and lay there for 5 minutes, then get up and walk out. This is what I am saying about a different breed and injuries from what the book taught you.
Adrenaline does wonderful things to the pain receptors.
When I had my midshaft Femur Fx, I walked out on it, with slight limp. No one even knew till I cut my own pant leg and reveled it.
I have seen hundreds of guys knocked out cold and lay there for 5 minutes, then get up and walk out. This is what I am saying about a different breed and injuries from what the book taught you.
Adrenaline does wonderful things to the pain receptors.
medic417
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First rule of rodeo is you will not carry me out unless I'm dead.
I understand that injuries can happen that are undetected until later. But in this specific case the pt had a distracting injury and mechanism for spinal injury, so even without back or neck pain, it would be appropriate to SMRD.
The reason that the 10 other riders you were talking about, along with yourself and and your friends wern't backboarded immediately, is because they got up, and walked off.
BTW: it seems to me like your trying to pick a fight.
foxfire
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Very well put. I agree, those kinds of sports take special training, why not specialty EMS response. Not to put down the local EMS that is on standby. Hat off the them.