What would you do in this scenerio?

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Judeau

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If someone is bleeding severely from his femur, found prone, and is unconscious.

I would like to give my answer first.


I would proceed to the scene making sure everything is safe and secure. Then i would check if the patient is conscious(by verbally communicating and try to stimulate their pain sensors). If he doesn't respond at all to any of these i would quickly try to stabilize his condition. First i would check his vitals and then i would carry out with stabilizing and securing his wound(first), spine and neck(because i would assume hes been hit by a profound impact), followed by inserting a Tracheal intubation, trying to prevent hypoperfusion. I would place him on a spine board then onto a wheeled stretcher keeping him supine, On our way to the hospital i would check his vitals and give medicine if needed?

Sorry, i'm new to EMT-B and new to this forum. I started class at least 3 weeks ago. I'm don't think EMT-B would be on this type of call, but i'm just wondering if i got any of this right? Please explain what would you do in this situation.
 
3 ways to approach this depending on your situation

Airway Breathing Circulation is the gold standard medically trained approach until changed to

Circulation Airway Breathing which would be the AHA guidelines

Bleeding Airway Circulation Breathing would be used in the military and tactical worlds in austere environments
 
Judeau said:
First i would check his vitals
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I'd be correcting that "severely bleeding femur" before checking vitals.

followed by inserting a Tracheal intubation, trying to prevent hypoperfusion.
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I don't know if you have trouble with English or if you really think intubating will really do anything to prevent hypoperfusion???


On top of that, you're an EMT, with several rare exceptions in just a couple of different locations, you wont have access to ETI, and just from the info you gave, there is no way to tell if ETI is indicated quite yet.
 
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Linuss said:
I'd be correcting that "severely bleeding femur" before checking vitals.
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Agreed. AHA dropped the ball not following TCCC this time around.
 
Forgot BSI (a critical fail), get in the habit of just saying "BSI, Scene Safety. Is the scene safe?" at the beginning of every scenario.

Treat life threats as you find them. Airway, breathing, circulation. What was the reasoning for intubation (which I don't believe is a basic skill in any state, except under medical director approval)? Was the patient's airway at risk? Was his breathing inadequate? Lets make sure this guy is not a candidate for CPR.

Spinal immobilization should be considered en-route, and applied at the very beginning if determined necessary.

What medicine would you give this guy?

You are correct in suspecting hypoperfusion, but think of what you can do about it.

And (because I always got this question at the end of my scenarios): How often would you check this guy's vitals?

Good luck!
 
Ok first thing you gotta do is click "spell check".

Then you start patient care....

You get on scene.

BSI/Scene Safety.

Call for ALS.

You take C-spine precautions if you think it is necessary, and if the guy is laying prone you need to roll him over. Check AVPU

Check his breathing if that is good and is airway is good that you are good. If not then start breathing for him with a BVM, check pulse if that's not there do CPR. If it is continue on.

Then you need to control the bleeding from his leg. Direct Pressure, more pressure, if that doesn't work than a tourniquet.

Do a quick head to toe assessment. Correct any other life threatening issues at that time.

Get him on a back board, and load and go. Get vitals in the truck. That's about all you can do as a basic.
 
Turn the patient over, tourniquet, RSI, turf to ortho.
 
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Anjel1030 said:
Ok first thing you gotta do is click "spell check".

Then you start patient care....

You get on scene.

BSI/Scene Safety.

Call for ALS.

You take C-spine precautions if you think it is necessary, and if the guy is laying prone you need to roll him over. Check AVPU

Check his breathing if that is good and is airway is good that you are good. If not then start breathing for him with a BVM, check pulse if that's not there do CPR. If it is continue on.

Then you need to control the bleeding from his leg. Direct Pressure, more pressure, if that doesn't work than a tourniquet.

Do a quick head to toe assessment. Correct any other life threatening issues at that time.

Get him on a back board, and load and go. Get vitals in the truck. That's about all you can do as a basic.
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Sorry, but not quite.

1. Why is he bleeding (Scene/BSI/prep).
2. Tourniquet and/or pack the wound if inguinal, high and very tight, until bleeding is controlled. Why? Because a known femoral bleed will kill very quickly. If you have a partner, this is a perfect job for him.
3. Expose and assess patient.
4. Package, treat secondary injuries, initiate transport. IVs, warming, etc can be done en route. RSI PRN, but you need to assess the patient and figure out why he's unconscious and how he responds to treatment.
 
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Airway
Breathing
Circulation
Deformity
Environment
---> Transport + secondary survey (if time/condition allows)
Know it, live it, love it.
 
Severe hemorrhage will kill before lack of an airway. You can't breathe without an airway.

Fix in that order. C-A-B.



Ironic part? I failed CPR/AED in EMT class the first time I did it because I followed that logic... the very logic that one year later, the AHA adopted as their own.
 
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If he's actively bleeding I'm gonna go out on a limb and say he still has a pulse ;)

Tourniquet the leg, strip and flip him onto a board, control the airway if indicated (if he's truly unresponsive I'd say it's indicated in some way shape or form), transport him, anything else can be done en route.
 
Linuss said:
I'd be correcting that "severely bleeding femur" before checking vitals.



I don't know if you have trouble with English or if you really think intubating will really do anything to prevent hypoperfusion???


On top of that, you're an EMT, with several rare exceptions in just a couple of different locations, you wont have access to ETI, and just from the info you gave, there is no way to tell if ETI is indicated quite yet.
Click to expand...


Sorry, i don't understand all those acronyms... I haven't gotten that far in the book yet. It was just a guess; I'm trying to see if i was right. What is up with all the criticism? What did i spell wrong?
 
Judeau said:
Sorry, i don't understand all those acronyms... I haven't gotten that far in the book yet. It was just a guess; I'm trying to see if i was right. What is up with all the criticism? What did i spell wrong?
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From the way you structured your sentence in the original post it appeared as though you were trying to say endotracheal intubation would correct hypoperfusion.

As an EMT-B, intubation isn't in your scope in most places so you shouldn't be worrying yourself about it. Focus on learning the basics before you start on the fun stuff.
 
Cup of Joe said:
Forgot BSI (a critical fail), get in the habit of just saying "BSI, Scene Safety. Is the scene safe?" at the beginning of every scenario.

Treat life threats as you find them. Airway, breathing, circulation. What was the reasoning for intubation (which I don't believe is a basic skill in any state, except under medical director approval)? Was the patient's airway at risk? Was his breathing inadequate? Lets make sure this guy is not a candidate for CPR.

Spinal immobilization should be considered en-route, and applied at the very beginning if determined necessary.

What medicine would you give this guy?

You are correct in suspecting hypoperfusion, but think of what you can do about it.

And (because I always got this question at the end of my scenarios): How often would you check this guy's vitals?

Good luck!
Click to expand...

I would assume he would need oxygen. The lack of blood could interrupt perfusion? That could potentially lead to shock? And i don't know, i'm just guessing if the medic would give medicine. I wanted you guys to correct me not criticize me. Also you would check the guys vitals every so often? I mostly read about the scope of practice, lifting, how to carry someone, what stretchers are used, and my class just started last week how to take vital signs. I haven't gotten my CPR certification yet...
 
NVRob said:
From the way you structured your sentence in the original post it appeared as though you were trying to say endotracheal intubation would correct hypoperfusion.

As an EMT-B, intubation isn't in your scope in most places so you shouldn't be worrying yourself about it. Focus on learning the basics before you start on the fun stuff.
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you're right lol. I have been trying to cram all this stuff in my head. I'm not even going to be doing this stuff yet lol. I just want to become a paramedic so baddddddd!!!
 
direct pressure BEFORE tourniquet... Not really sure why everyone has been jumping the gun on that one here..

and GCS < 9 = advanced airway. (for those others who questioned it)
 
Linuss said:
I used literally 1 more acronym than you did. :unsure:


ETI-- Endotracheal Intubation.
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So every time i enter a scene, including CPR scenerios. I have to say BSI, scene is safe? Is there anything else i have to say? Also do you have to learn all the street addresses? I want to work in a city i don't even know or go to. Wouldn't it be hard to remember all those streets? The concept of that is pretty hard.
 
TheGodfather said:
direct pressure BEFORE tourniquet... Not really sure why everyone has been jumping the gun on that one here..
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Because there are times that it's not necessarily jumping the gun. If I have a critical patient with multiple things going on, and I see massive external bleeding, I'm slapping a TQ on, then moving on to other stuff. You have several hours after application of a TQ before any real damage sets in. Plenty of time to get them to a hospital. Plus, there is also nothing wrong with putting a TQ on, doing other stuff, then coming back and re-evaluating the TQ and its necessity.



and GCS < 9 = advanced airway. (for those others who questioned it)
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GCS < 9 = sleepy patient.

I get patients with a GCS of 3 all the time that I don't do an advanced airway on... I call them diabetics and epileptics.
 
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