RedAirplane
Forum Asst. Chief
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(Hypothetical, inspired by a few calls on which I was an observer, want to hear your thoughts to better prepare myself for something like this if I need to respond to this sort of thing).
You are a BLS foot team dispatched for a reported assault victim. The scene appears safe, albeit pretty crowded considering the parade marching along. Event security officer is on scene, police enroute, delayed due to the traffic situation around the parade. You have minimal equipment (OPA, NPA, OTC meds, and some bandaging stuff). The transport unit is enroute, also delayed.
Initial assessment:
The patient is a middle aged female, conscious, seated on the sidewalk, screaming/crying.
Airway: some broken teeth and blood in the mouth, but pt is talking/breathing
Breathing: Patient keeps repeating "He took my money," so breathing is present.
Circulation: Blood on the face, unclear if it is from the mouth or another wound.
You ask a few questions to determine if the patient is oriented. She only gets one question right, but you're unsure if this is due to disorientation or just objession/screaming about the $50 she lost.
Witness comes up and advises that pt was kicked in the head. Would you treat the pt as a C-spine candidate?
As you move closer to the patient, the patient shuffles away, going to different locations and asking "where's my money" to herself, occasionally sitting, getting back up. She gets very agitated if you approach.
Do you let her shuffle around or forcibly keep her with you because she might injure herself further by moving? Do you bother to collect the belongings and teeth?
You finally manage to convince the patient to be calm enough for an assessment. You find some soft tissue injuries on the head and upper extremities. You find both feet swollen and painful on palpation. The patient then remembers that "the guy rolled it over my feet" with no further clarification on what "it" was. Patient does not seem to understand your questions in the SAMPLE history.
Now PD and your transport team arrive. How would you give your handoff report?
--
The thing that gets me so confused in this scenario is the number of things going on. In the event you want to protect the spine, she isn't necessarily oriented and understanding of the risks of not being treated, but you also don't want to batter her a second time in one day.
What do I do about the teeth? Remove the loose ones that are still in the mouth, or not mess with an airway that is working, at least for the moment? Assuming the parade will smash the teeth unless you collect them now, do you bother picking up teeth as you go along?
Another thing is communication. My strength is with patients who need someone to explain politely what is happening, what I'll do, and why. How do you "calm and reassure" the patient if you can't exactly communicate without scaring her away?
You are a BLS foot team dispatched for a reported assault victim. The scene appears safe, albeit pretty crowded considering the parade marching along. Event security officer is on scene, police enroute, delayed due to the traffic situation around the parade. You have minimal equipment (OPA, NPA, OTC meds, and some bandaging stuff). The transport unit is enroute, also delayed.
Initial assessment:
The patient is a middle aged female, conscious, seated on the sidewalk, screaming/crying.
Airway: some broken teeth and blood in the mouth, but pt is talking/breathing
Breathing: Patient keeps repeating "He took my money," so breathing is present.
Circulation: Blood on the face, unclear if it is from the mouth or another wound.
You ask a few questions to determine if the patient is oriented. She only gets one question right, but you're unsure if this is due to disorientation or just objession/screaming about the $50 she lost.
Witness comes up and advises that pt was kicked in the head. Would you treat the pt as a C-spine candidate?
As you move closer to the patient, the patient shuffles away, going to different locations and asking "where's my money" to herself, occasionally sitting, getting back up. She gets very agitated if you approach.
Do you let her shuffle around or forcibly keep her with you because she might injure herself further by moving? Do you bother to collect the belongings and teeth?
You finally manage to convince the patient to be calm enough for an assessment. You find some soft tissue injuries on the head and upper extremities. You find both feet swollen and painful on palpation. The patient then remembers that "the guy rolled it over my feet" with no further clarification on what "it" was. Patient does not seem to understand your questions in the SAMPLE history.
Now PD and your transport team arrive. How would you give your handoff report?
--
The thing that gets me so confused in this scenario is the number of things going on. In the event you want to protect the spine, she isn't necessarily oriented and understanding of the risks of not being treated, but you also don't want to batter her a second time in one day.
What do I do about the teeth? Remove the loose ones that are still in the mouth, or not mess with an airway that is working, at least for the moment? Assuming the parade will smash the teeth unless you collect them now, do you bother picking up teeth as you go along?
Another thing is communication. My strength is with patients who need someone to explain politely what is happening, what I'll do, and why. How do you "calm and reassure" the patient if you can't exactly communicate without scaring her away?