karantzalis
Forum Ride Along
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“You are dispatched to a shooting at an university classroom for a female patient with multiple GSW: abdomen, right shoulder, bottom of right foot, and right arm. No exit wounds. Bone is protruding from the arm.
Scene is still unsafe so you stage nearby. 10 minutes later, scene is declared safe by police. Upon arrival into the building, you are met with the professor who called 911, putting pressure on her abdomen.
Pt is about 120 lbs, 5’6”, and has lost approximately 20% of blood already. Pt is lying supine and is unconscious but wakes up when you begin to put pressure on her shoulder wound. Her skin is cold and clammy. Decreased BP, Pulse 110 full, RR 32. She complains of pain and being cold. Pt is visibly in extreme pain, is shivering, and seems anxious. Pt responds to your questions, although only after you ask multiple times. She says she is 19 years old, has no allergies, and has mild asthma. Although pt remains conscious throughout your assessment, she is becoming increasingly lethargic and distressed.
Nearest pediatric trauma center is 30 minutes by ground. Nearest adult trauma center is 40 minutes away by ground. Which hospital and do you decide to call for helicopter?
How do you distract the pt from the visible bone sticking out of their arm since that is what seems to be bothering her the most?
As a BLS unit, how do you take care of the pt in the above scenario?”
>> Here is what I would do: Immediately call for ALS ground support and begin to control bleeding with direct pressure. Check for any bullet holes we don’t already know about. I would pack the shoulder, arm, and foot wounds with hemostatic gauze while maintaining direct pressure on the abdomen. If bleeding doesn’t stop then I would use a tourniquet for her arm. Assist with BVM with high flow oxygen. If her breathing gets worse, maybe give her albuterol due to the asthma history. I’d try to keep her conscious by asking questions so I can continue assessing her status. I know the pain won’t kill her but I’d still try to use words to distract her from the pain and her injuries. Finally, try and keep pt warm using heat packs and blankets. Looks like Class II Hemorrhage so replacing fluid is key and therefore time is the biggest enemy.
Scene is still unsafe so you stage nearby. 10 minutes later, scene is declared safe by police. Upon arrival into the building, you are met with the professor who called 911, putting pressure on her abdomen.
Pt is about 120 lbs, 5’6”, and has lost approximately 20% of blood already. Pt is lying supine and is unconscious but wakes up when you begin to put pressure on her shoulder wound. Her skin is cold and clammy. Decreased BP, Pulse 110 full, RR 32. She complains of pain and being cold. Pt is visibly in extreme pain, is shivering, and seems anxious. Pt responds to your questions, although only after you ask multiple times. She says she is 19 years old, has no allergies, and has mild asthma. Although pt remains conscious throughout your assessment, she is becoming increasingly lethargic and distressed.
Nearest pediatric trauma center is 30 minutes by ground. Nearest adult trauma center is 40 minutes away by ground. Which hospital and do you decide to call for helicopter?
How do you distract the pt from the visible bone sticking out of their arm since that is what seems to be bothering her the most?
As a BLS unit, how do you take care of the pt in the above scenario?”
>> Here is what I would do: Immediately call for ALS ground support and begin to control bleeding with direct pressure. Check for any bullet holes we don’t already know about. I would pack the shoulder, arm, and foot wounds with hemostatic gauze while maintaining direct pressure on the abdomen. If bleeding doesn’t stop then I would use a tourniquet for her arm. Assist with BVM with high flow oxygen. If her breathing gets worse, maybe give her albuterol due to the asthma history. I’d try to keep her conscious by asking questions so I can continue assessing her status. I know the pain won’t kill her but I’d still try to use words to distract her from the pain and her injuries. Finally, try and keep pt warm using heat packs and blankets. Looks like Class II Hemorrhage so replacing fluid is key and therefore time is the biggest enemy.
