Specific Question

[Patience]

Hi I am taking an online quiz for my EMT-B refresher. I am allowed to use books or whatever materials I want to answer questions. In the question below what consideration if any would I take for the fact there is likely some broken glass in this wound?

Any advice would be appreciated. Thanks. ~~Patience

Scenario #8
The emergency medical dispatcher sends your unit to an accident at a local baseball field. She reports, "A 12-year-old boy fell, and cut his leg on some broken glass."
When you arrive on the scene, the boy's mother is applying pressure to the wound with a handkerchief. Both the handkerchief and a patch of ground near the boy are blood soaked.
You observe that the boy looks pale. His heart and respiratory rates are rapid. The mother wants you to bandage the wound quickly so that she can take the boy to the family doctor. As you talk to the mother, the boy lies down on the ground. "I feel tired," he says. The boy closes his eyes and starts to shiver.
1. Does the boy have blunt or penetrating trauma?
Penetrating trauma.

2. What care steps will you take to control bleeding? Why?

3. Do you feel that the boy should be transported to the hospital? Why or why not?

Yes, His altered mental status. Shock.

4. How will you handle the parent's request to take the child to the family doctor?
I would tell them this is more serious than a family doctor visit because of the child’s altered mental status and it would waste valuable time taking him to the doctor who would order the child to the ER.

 

[1badassEMT-I]

I woud tell the family that the pt need to be seen in ER the loss of blood....however it is the family members choice of where they should be taken....all you can do is make your suggestion and tell them the seriousness of the call.....now if the child becomes unconiouss now that becomes your call....DIVERT to ER....

 

[Patience]

I woud tell the family that the pt need to be seen in ER the loss of blood....however it is the family members choice of where they should be taken....all you can do is make your suggestion and tell them the seriousness of the call.....now if the child becomes unconiouss now that becomes your call....DIVERT to ER....

My question is about what consideration to take about the likelihood of broken glass in this wound. I want to apply pressure but I don't want to cause further injury by grinding in broken glass, but he is bleeding too badly to take time to clean the wound. What do I do?

Thanks for the reply.
~~Patience

 

[NYBLS]

You cannot remove a penetrating object (ie glass). Call for ALS, bandage wound, treat with high flow diesel.

 

[1badassEMT-I]

My question is about what consideration to take about the likelihood of broken glass in this wound. I want to apply pressure but I don't want to cause further injury by grinding in broken glass, but he is bleeding too badly to take time to clean the wound. What do I do?

Thanks for the reply.
~~Patience

What are you taught? ABC's you got to control the bleeding.....the national standard being taught now is TK's is now the method of bleeding control so if your direct pressure is not working TK it and move on. But you got to get the bleeding stopped!

BLEEDING CONTROL/SHOCK MANAGEMENT
Start Time:
Stop Time:
Date:
Candidate's Name:
Evaluator's Name:
Points
Points
Possible
Awarded
Takes, or verbalizes, body substance isolation precautions
1
Applies direct pressure to the wound
1
Note: The examiner must now inform the candidate that the wound continues to bleed.
Applies tourniquet
1
Note: The examiner must now inform the candidate the patient is now showing signs
and symptoms indicative of hypoperfusion
Properly positions the patient
1
Administers high concentration oxygen
1
Initiates steps to prevent heat loss from the patient
1
Indicates the need for immediate transportation
1
Total:
7
Critical Criteria
Did not take, or verbalize, body substance isolation precautions
Did not apply high concentration oxygen
Did not control hemorrhage using correct procedures in a timely manner
Did not indicate a need for immediate transportation

 

[1badassEMT-I]

Also it is not your place to clean the wound....ie the glass....if there was any in there......

 

[1badassEMT-I]

You cannot remove a penetrating object (ie glass). Call for ALS, bandage wound, treat with high flow diesel.

Good answer HOT LIGHTS and COLD STEEL going to meet ALS or the ER....whichever comes first!

 

[Patience]

Thanks for the replies. This is how I'm going to answer.
~~Patience

Scenario #8
The emergency medical dispatcher sends your unit to an accident at a local baseball field. She reports, "A 12-year-old boy fell, and cut his leg on some broken glass."
When you arrive on the scene, the boy's mother is applying pressure to the wound with a handkerchief. Both the handkerchief and a patch of ground near the boy are blood soaked.
You observe that the boy looks pale. His heart and respiratory rates are rapid. The mother wants you to bandage the wound quickly so that she can take the boy to the family doctor. As you talk to the mother, the boy lies down on the ground. "I feel tired," he says. The boy closes his eyes and starts to shiver.
1. Does the boy have blunt or penetrating trauma?
Penetrating trauma.

2. What care steps will you take to control bleeding? Why? Apply pressure to the femoral artery with the heel of my gloved hand. Raise the leg if it’s not broken. Add dressings to the handkerchief the mother has on the wound. I would add to the dressings and not remove the blood-soaked ones so not to disturb any clotting that may happen. Leave cleaning the wound to ER.

3. Do you feel that the boy should be transported to the hospital? Why or why not?

Yes, His altered mental status. Shock.

4. How will you handle the parent's request to take the child to the family doctor?
I would tell them this is more serious than a family doctor visit because of the child’s altered mental status and it would waste valuable time taking him to the doctor who would order the child to the ER. The child is probably in decompensated shock; a trip to the family doctor would be a bad decision.

 

[1badassEMT-I]

Thanks for the replies. This is how I'm going to answer.
~~Patience

Scenario #8
The emergency medical dispatcher sends your unit to an accident at a local baseball field. She reports, "A 12-year-old boy fell, and cut his leg on some broken glass."
When you arrive on the scene, the boy's mother is applying pressure to the wound with a handkerchief. Both the handkerchief and a patch of ground near the boy are blood soaked.
You observe that the boy looks pale. His heart and respiratory rates are rapid. The mother wants you to bandage the wound quickly so that she can take the boy to the family doctor. As you talk to the mother, the boy lies down on the ground. "I feel tired," he says. The boy closes his eyes and starts to shiver.
1. Does the boy have blunt or penetrating trauma?
Penetrating trauma.

2. What care steps will you take to control bleeding? Why? Apply pressure to the femoral artery with the heel of my gloved hand. Raise the leg if it’s not broken. Add dressings to the handkerchief the mother has on the wound. I would add to the dressings and not remove the blood-soaked ones so not to disturb any clotting that may happen. Leave cleaning the wound to ER.

3. Do you feel that the boy should be transported to the hospital? Why or why not?

Yes, His altered mental status. Shock.

4. How will you handle the parent's request to take the child to the family doctor?
I would tell them this is more serious than a family doctor visit because of the child’s altered mental status and it would waste valuable time taking him to the doctor who would order the child to the ER. The child is probably in decompensated shock; a trip to the family doctor would be a bad decision.

Thats all good but somewhere in there I would want ALS back-up.....I guess it all how your protocols reads!

 

[MrBrown]

This sounds like a job for the helicopter emergency medical service

*struggles into orange jumpsuit with "DOCTOR" written on it

"What is it Oz?"
"Hmm I don't know Brown, sounds like a stabbing or something, lot of blood loss"
"Right, best we be off then"

Ambulance Control it's Westpac Rescue, lifting Mechancis bay, delta hotel alpha, be overhead in about five minutes ...

 

[Scottpre]

I guess it depends on where your area is, but in my neck of the woods, air lift is very situational-dependent.

A ground rig can get to our local trauma center (Harborview Medical Center) from any scene between Hwy 18 and I-90 to downtown Seattle faster than Airlift NW can be dispatched, load up and return with the PT. It has to do with all of the SOP's surrounding using air lift (rotors must be stopped before loading PT, etc).

 

[NomadicMedic]

I guess it depends on where your area is, but in my neck of the woods, air lift is very situational-dependent.

A ground rig can get to our local trauma center (Harborview Medical Center) from any scene between Hwy 18 and I-90 to downtown Seattle faster than Airlift NW can be dispatched, load up and return with the PT. It has to do with all of the SOP's surrounding using air lift (rotors must be stopped before loading PT, etc).

True... but I've seen more than a few instances where the medics will screw around on scene and wait for ALNW rather than just beating feet for HMC. Makes no sense to me.

 

[Scottpre]

That's messed up. No need to withhold diesel therapy to HMC.