What would you do in this scenerio?

Judeau said:
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...
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I had assumed you were a little more advanced in the course. We aren't trying to make you feel stupid, we want you to think. If we hand you the answers, you will learn less than if you think about why you're doing something.
 
In the multiple trauma scenario, with my patient who is suffering from extensive internal/external injuries, who is unconscious (whether it be from blood loss, alcohol intoxication, neurological dysfunction, etc etc etc) -- I'd feel more comfortable breathing for my patient than having the risk of worsening airway issues arising later on during the time they are in my care -- they may physically not be able to control their own airway (and it is really not something I'd like to sit around and find out), so yes, I would intubate every patient with a GSC < 9 involved in multiple trauma.... if that is cookbook medicine, then so be it.
 
And please do the TQ right...


Had a call for a person with a lacerated AC... FD put on 3 TQs, a quicklot pack, and a crap load of abd pads and 4x4s and it was still bleeding out. We put on a single BP cuff, pumped it up, and stopped the flow...



Though FD looked at us like retards when we took out the BP cuff.. "Why would want want a blood pressure at a time like this?!"
 
Cup of Joe said:
I had assumed you were a little more advanced in the course. We aren't trying to make you feel stupid, we want you to think. If we hand you the answers, you will learn less than if you think about why you're doing something.
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Well said.
 
TheGodfather said:
In the multiple trauma scenario, with my patient who is suffering from extensive internal/external injuries, who is unconscious (whether it be from blood loss, alcohol intoxication, neurological dysfunction, etc etc etc) -- I'd feel more comfortable breathing for my patient than having the risk of worsening airway issues arising later on during the time they are in my care -- they may physically not be able to control their own airway (and it is really not something I'd like to sit around and find out), so yes, I would intubate every patient with a GSC < 9 involved in multiple trauma.... if that is cookbook medicine, then so be it.
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Depends on the trauma. Am I going to RSI a double-leg amputee after HEMCON and packaging? Yes. Am I going to RSI a non-tension penetrating chest wound with hemostasis and a patent airway? Probably not...

Extremity wounds don't always mean intubation. A lot of these patients are just fine breathing on their own.
 
Linuss said:
That wasn't what was said, though. What was said was "Any trauma patient... PERIOD"
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I'll rephrase; if I have a patient with only a single bleeding femur fracture who has a true GCS of 8, I would still intubate due to high probability of TBI.

(this is after a good history taking and scene size up of course) -- im sure there are loopholes here, and different types of patient population that may generate this from an underlying pathology
 
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Rocketmedic40 said:
Depends on the trauma. Am I going to RSI a double-leg amputee after HEMCON and packaging? Yes. Am I going to RSI a non-tension penetrating chest wound with hemostasis and a patent airway? Probably not...

Extremity wounds don't always mean intubation. A lot of these patients are just fine breathing on their own.
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I agree, given the GCS is at an acceptable level and they are able to maintain their own airway.
 
Let's all take a moment and remember that this is for a Basic class, before we go off on the tangent of what advanced providers would do.
 
I think it would be worth mentioning a C-spine precaution. Id direct my partner to hold C-spine before addressing the femur, and then i would log roll my patient. At this time i would already know his level of consciousness as i would go through AVPU before letting him know my partner is going to hold his neck. Things can go a few ways from there depending on his level of consciousness but A-B-C no mater what. As a basic I would strongly consider ALS depending on where you are due to blood loss and as you will learn and ETI is the only indefinite airway but this is also dependent on how it plays out, a pt laying prone with an arterial bleed can go a few ways. And depending on if it is just you and your partner, vitals might take the back burner to Airway, Breathing, CPR, C-spine, Controlling bleeding.
 
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abckidsmom said:
Figures that the most correct answer has the fewest words.
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The sad part is that I was being a bit of a bung hole with that reply. I originally had "page surgery" in there.
 
He is 3 weeks into a course, I'd say he's getting way ahead of himself and to concentrate on passing the course and getting certified first. The book has all he needs for now, and if his instructors are running a class that both discourages these sorts of questions during lectures and also not teaching the proper way to do things (shortcuts that work better? Super, but don't drop that on students, teach em the right way first and let them learn the tricks in the field) then he is being taught in a very poor manner. If the class is at all decent, they'll have practicals that will address such situations that will stick far better than a few forum posts will.

I'm all for outside learning, but this is exactly the kind of question that should be brought up in his class so that all can learn from the response. If he has questions about the material, so do others.
 
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* If there's an arterial bleed, it needs controlling before it stops bleeding. The TQ is entirely appropriate, and should be a priority.

* An unconscious trauma patient with major trauma should have c-spine controlled.

* The patient needs to be rolled over in order to be assessed properly. It would be good to quickly check the back now.

* Real life, multiple things happen simultaneously. Scenarioland, you have to have a standardised and methodical approach and move in a linear manner.

* Intubation depends on transport time, need or lack or need for RSI, anticipated difficulty, and anticipated clinical course.
 
Rocketmedic40 said:
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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Sorry didn't know RSI, IVs and wound packing were in a basics scope of practice. And who said it was a femoral bleed. They said the femur was bleeding badly. Not spurting.

And I covered checking out the scene with BSI/scene safety.

Thats where you check out the surroundings and see whats going on.
 
Anjel1030 said:
Sorry didn't know RSI, IVs and wound packing were in a basics scope of practice. And who said it was a femoral bleed. They said the femur was bleeding badly. Not spurting.
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This varies a little with location. In some areas IVs are BLS.
 
Linuss said:
To be fair, he DID ask about ETI.
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systemet said:
This varies a little with location. In some areas IVs are BLS.
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In some areas, one or both of these skills are within the scope of an Emergency Medical Technician - perhaps with additional training/certs, perhaps without.

JPINFV said:
The sad part is that I was being a bit of a bung hole with that reply. I originally had "page surgery" in there.
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Turf works so much better.
 
Judeau said:
Sorry for the 101 questions i have a few more bud.

My teachers in the class(I have a lot, they are all firemen/paramedic) said they don't follow everything in the book, because they have more efficient ways. Will i learn them? and when i start to work will my partner be experienced and teach me how to do things properly? My teacher said he spelled one word incorrect in 5 different rapports and he went to court. Can you spell check medical terms? I have a hard time with some of them.
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Alright, I'll bite.

Yes, you can spell-check medical terms. Charting programs often have a variety of common medical terms within their spell check database.

That said, spell check only gets you so far. You've got to use the RIGHT word, too - Best example in the above?
Rapport: http://en.wiktionary.org/wiki/rapport
Report: http://en.wiktionary.org/wiki/report

Grammar is important, too. "I" should be capitalized. And "firemen/paramedic" isn't correct because the single and plural don't agree with each other. Further, in today's politically-correct world, the word "firefighter" is considered more appropriate because it is gender neutral. So the correct way to write that would be firefighter/paramedic, or the plural firefighter/paramedics.



As for the question about court - Appropriate spelling/grammar will NOT keep you from going to court. Documenting well won't keep you from going to court, either. Only way to avoid court is to not work in this field. That said, proper spelling/grammar and good documentation skills WILL help WHEN you get called to court to testify. It is likely that the opposing side will attempt to discredit you based on your poor documentation.
 
Is hacking off the leg, replacing it with a peg, giving the guy a parrot and teaching him to say "aye" and "argh" an option?

:)
 
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