How would you handle the care for these Pts

[1badassEMT-I]

You have arrived at the scene of a MVC involving a car and an SUV. You recognize a side impact on the drivers side of the car with about 12 inches of intrusion into the passenger compartment and very little damage to the SUV. All other passengers have left the vichiles without injury except the driver of the car, a 20y/o male slumped over the steering wheel with obvious contact of the steering wheel to his anterior chest.

The pt. is awake, anxious, diaphoretic, and breathing rapidly (rr30). He has a weak, thready, rapid radial pulse. There is tenderness and bursing over the left upper quadrant of his ABD.


What injuries do you expect in this Pt.?

How would you manage this Pt.?

You are 30 minutes away from the nearest trauma center. How does this alter your plan of action?

PLEASE ANSWER ALL THE QUESTIONS::::: And have fun with your answers!

 

[MrBrown]

I would suspect any of the following

Cervical spine injury
Perforated bowel
Ruptured spleen
Lacerated liver
Cardiac tamponade,
Fractured ribs or sternum,
Pneumothorax,
Haemopneumothorax,
Flail chest
Pelvic or leg fractures

Plan of action

Hard collar and KED
Move to ambo
Vital signs survey
Expose and examine in partic looking for chest/abdominopelvic injuries and shock
IV access (does not mean 14ga. in the AC!)

Time factor does not change my plan at this stage, the time to hospital is probably significantly less than the time it would take for HEMS to come to me.

 

[Dominion]

I'd expect internal damage/bleeding (spleen rupture, pneumo, hemopneumo, tamponade), look out for any obvious fractures, assess for head injury, spine injury, and be suspect for any chest trauma as well.

Initial treatment would involve immobilizing and extricating, IV's for potential fluid needs to keep BP no less than 100 systolic. Supportive care currently with no further information. Note: After reading Browns reply I would like to specify the same, if the BP is stable/> 100 systolic, 18g saline lock with fluids on standby if needed.

If no signs of head injury, vitals remain stable and we can coach the breathing down we'd go ahead and transport to the local trauma center by ground.

If any of the following conditions are met; prolonged response time, prolonged extrication, unstable vitals, respiratory status worsens, or signs of significant head injury then I would go ahead and attempt air transport.

 

[thatJeffguy]

I'd expect internal damage/bleeding (spleen rupture, pneumo, hemopneumo, tamponade), look out for any obvious fractures, assess for head injury, spine injury, and be suspect for any chest trauma as well.

Initial treatment would involve immobilizing and extricating, IV's for potential fluid needs to keep BP no less than 100 systolic. Supportive care currently with no further information. Note: After reading Browns reply I would like to specify the same, if the BP is stable/> 100 systolic, 18g saline lock with fluids on standby if needed.

If no signs of head injury, vitals remain stable and we can coach the breathing down we'd go ahead and transport to the local trauma center by ground.

If any of the following conditions are met; prolonged response time, prolonged extrication, unstable vitals, respiratory status worsens, or signs of significant head injury then I would go ahead and attempt air transport.

Air? When a trauma center is 30m away?

Other than that, I agree with everything you've said. If this guy has a decent BP, (>80mmHg) he's getting a fast ride. If he's lower than that, I'd try to get a bird to meet us somewhere nice and safe.

 

[Dominion]

That is our own local protocol that if any of those conditions are met Air transport is started by dispatch not us. Also for us atleast in some extremes of the county air transport is 5-10 minutes and ground is 30-50 depending on traffic. Usually we can have air transport on scene before or right as a med unit is arriving.

Now with that said, if I beat the helicopter on scene, I'm going to transport ground, not going to wait for a helicopter to land.

 

[Simusid]

Already covered by "Doc Brown" above but I want to highlight again, just as much for myself. If I approached this scene and found a diaphoretic patient, probably my first thought would be shock management and I would get a BP ASAP.

 

[1badassEMT-I]

Already covered by "Doc Brown" above but I want to highlight again, just as much for myself. If I approached this scene and found a diaphoretic patient, probably my first thought would be shock management and I would get a BP ASAP.

I give you a A plus for the SHOCK so far!!!!

 

[1badassEMT-I]

I would suspect any of the following

Cervical spine injury
Perforated bowel
Ruptured spleen
Lacerated liver
Cardiac tamponade,
Fractured ribs or sternum,
Pneumothorax,
Haemopneumothorax,
Flail chest
Pelvic or leg fractures

Plan of action

Hard collar and KED
Move to ambo
Vital signs survey
Expose and examine in partic looking for chest/abdominopelvic injuries and shock
IV access (does not mean 14ga. in the AC!)

Time factor does not change my plan at this stage, the time to hospital is probably significantly less than the time it would take for HEMS to come to me.

Nice Brown A plus

 

[1badassEMT-I]

Answer to this scenerio!

Based on the high mechcanism of injury, you should have a high suspiscion for thoriacic and ABD injuries leading to hemorrhagic shock, as well the possiblity of nonhemorrhagic shock. Because this patient is in shock, rapid extrication is required with spinal control. High o2 concentration should be delivered to the most appropiate airway device based on the level of consciousness and the ability to main a secured airway. External sources of hemorrhage should be sought and controlled. The status of the neck viens would help differentiate hemorrhagic from nonhemorrhagic causes of the shock.

Transport should be RAPID, and establishing two or more large bore IV lines for fuild administration should be done en route. Transport should not be delayed to establish IV access. If you supect intraabdominal bleeding, and the patients status is deteriorating in the absence of penterating thoriac injury, consider PASG use in routeif available (CANT REMEMBER THE LAST TIME I USED THEM).

The major focus of management is rapid extrication and transport to the trauma canter, where definitive control of hemorrhage would prevent progression through the various stages of shock, leading to death or compilcations of hypoperfusion, such as renal failure, respiratory failure, and multiorgan dysfunction syndrome.

 

[1badassEMT-I]

I'd expect internal damage/bleeding (spleen rupture, pneumo, hemopneumo, tamponade), look out for any obvious fractures, assess for head injury, spine injury, and be suspect for any chest trauma as well.

Initial treatment would involve immobilizing and extricating, IV's for potential fluid needs to keep BP no less than 100 systolic. Supportive care currently with no further information. Note: After reading Browns reply I would like to specify the same, if the BP is stable/> 100 systolic, 18g saline lock with fluids on standby if needed.

If no signs of head injury, vitals remain stable and we can coach the breathing down we'd go ahead and transport to the local trauma center by ground.

If any of the following conditions are met; prolonged response time, prolonged extrication, unstable vitals, respiratory status worsens, or signs of significant head injury then I would go ahead and attempt air transport.

Why just a lock? Base on you information you were given that this person is in SHOCK and fuilds should be given. Just wondering why the lock? And thanks for wieghing in on this.

 

[1badassEMT-I]

Air? When a trauma center is 30m away?

Other than that, I agree with everything you've said. If this guy has a decent BP, (>80mmHg) he's getting a fast ride. If he's lower than that, I'd try to get a bird to meet us somewhere nice and safe.

What about IV and all the other good stuff?

 

[Sasha]

Why just a lock? Base on you information you were given that this person is in SHOCK and fuilds should be given. Just wondering why the lock? And thanks for wieghing in on this.

Google permissive hypotension. The administration of fluids can be more harmful than good, as long as the patient is perfusing vital organs (with blood, not koolaid) like the brain and kidneys, they probably don't need fluids

 

[Sasha]

http://emtlife.com/showthread.php?t=10970&highlight=permissive+hypotension

A thread that talks a little about it

 

[1badassEMT-I]

Google permissive hypotension. The administration of fluids can be more harmful than good, as long as the patient is perfusing vital organs (with blood, not koolaid) like the brain and kidneys, they probably don't need fluids

I gave the answer to this scenario:

Based on the high mechcanism of injury, you should have a high suspiscion for thoriacic and ABD injuries leading to hemorrhagic shock, as well the possiblity of nonhemorrhagic shock. Because this patient is in shock, rapid extrication is required with spinal control. High o2 concentration should be delivered to the most appropiate airway device based on the level of consciousness and the ability to main a secured airway. External sources of hemorrhage should be sought and controlled. The status of the neck viens would help differentiate hemorrhagic from nonhemorrhagic causes of the shock.

Transport should be RAPID, and establishing two or more large bore IV lines for fuild administration should be done en route. Transport should not be delayed to establish IV access. If you supect intraabdominal bleeding, and the patients status is deteriorating in the absence of penterating thoriac injury, consider PASG use in routeif available (CANT REMEMBER THE LAST TIME I USED THEM).

The major focus of management is rapid extrication and transport to the trauma canter, where definitive control of hemorrhage would prevent progression through the various stages of shock, leading to death or compilcations of hypoperfusion, such as renal failure, respiratory failure, and multiorgan dysfunction syndrome.

 

[1badassEMT-I]

I gave the answer to this scenario:

Based on the high mechcanism of injury, you should have a high suspiscion for thoriacic and ABD injuries leading to hemorrhagic shock, as well the possiblity of nonhemorrhagic shock. Because this patient is in shock, rapid extrication is required with spinal control. High o2 concentration should be delivered to the most appropiate airway device based on the level of consciousness and the ability to main a secured airway. External sources of hemorrhage should be sought and controlled. The status of the neck viens would help differentiate hemorrhagic from nonhemorrhagic causes of the shock.

Transport should be RAPID, and establishing two or more large bore IV lines for fuild administration should be done en route. Transport should not be delayed to establish IV access. If you supect intraabdominal bleeding, and the patients status is deteriorating in the absence of penterating thoriac injury, consider PASG use in routeif available (CANT REMEMBER THE LAST TIME I USED THEM).

The major focus of management is rapid extrication and transport to the trauma canter, where definitive control of hemorrhage would prevent progression through the various stages of shock, leading to death or compilcations of hypoperfusion, such as renal failure, respiratory failure, and multiorgan dysfunction syndrome.

I liked the article BTW!!!!!!!!!

 

[Sasha]

I gave the answer to this scenario:

Based on the high mechcanism of injury, you should have a high suspiscion for thoriacic and ABD injuries leading to hemorrhagic shock, as well the possiblity of nonhemorrhagic shock. Because this patient is in shock, rapid extrication is required with spinal control. High o2 concentration should be delivered to the most appropiate airway device based on the level of consciousness and the ability to main a secured airway. External sources of hemorrhage should be sought and controlled. The status of the neck viens would help differentiate hemorrhagic from nonhemorrhagic causes of the shock.

Transport should be RAPID, and establishing two or more large bore IV lines for fuild administration should be done en route. Transport should not be delayed to establish IV access. If you supect intraabdominal bleeding, and the patients status is deteriorating in the absence of penterating thoriac injury, consider PASG use in routeif available (CANT REMEMBER THE LAST TIME I USED THEM).

The major focus of management is rapid extrication and transport to the trauma canter, where definitive control of hemorrhage would prevent progression through the various stages of shock, leading to death or compilcations of hypoperfusion, such as renal failure, respiratory failure, and multiorgan dysfunction syndrome.

Your posts are sometimes hard to read, so I find myself skipping over most of them, my comment was directly related to your quoted statement reprimanding a poster for saying they would establish an IV lock, not just the scenario at hand. Sorry, I may have only been a medic for less than a year but I do like to read up on evidence based medicine and share my limited wealth of knowledge. Just because they're a trauma patient does not mean they require fluids.

 

[1badassEMT-I]

I gave the answer to this scenario:

Based on the high mechcanism of injury, you should have a high suspiscion for thoriacic and ABD injuries leading to hemorrhagic shock, as well the possiblity of nonhemorrhagic shock. Because this patient is in shock, rapid extrication is required with spinal control. High o2 concentration should be delivered to the most appropiate airway device based on the level of consciousness and the ability to main a secured airway. External sources of hemorrhage should be sought and controlled. The status of the neck viens would help differentiate hemorrhagic from nonhemorrhagic causes of the shock.

Transport should be RAPID, and establishing two or more large bore IV lines for fuild administration should be done en route. Transport should not be delayed to establish IV access. If you supect intraabdominal bleeding, and the patients status is deteriorating in the absence of penterating thoriac injury, consider PASG use in route if available (CANT REMEMBER THE LAST TIME I USED THEM).

The major focus of management is rapid extrication and transport to the trauma canter, where definitive control of hemorrhage would prevent progression through the various stages of shock, leading to death or compilcations of hypoperfusion, such as renal failure, respiratory failure, and multiorgan dysfunction syndrome.

I said for fluild administration didnt say DROWN THEM!

 

[1badassEMT-I]

Your posts are sometimes hard to read, so I find myself skipping over most of them, my comment was directly related to your quoted statement reprimanding a poster for saying they would establish an IV lock, not just the scenario at hand. Sorry, I may have only been a medic for less than a year but I do like to read up on evidence based medicine and share my limited wealth of knowledge. Just because they're a trauma patient does not mean they require fluids.

I didnt reprimand nobody just ask why. just a lock...see thats the problem people seem to skip over stuff. And this post wasnt hard to follow at all....and it came directly from PHTLS the sixth edition almost word for word! I suggest the next time learn what is a question is and a reprimanding is...I asked a QUESTION!

 

[Sasha]

I didnt reprimand nobody just ask why. just a lock...see thats the problem people seem to skip over stuff. And this post wasnt hard to follow at all....and it came directly from PHTLS the sixth edition almost word for word! I suggest the next time learn what is a question is and a reprimanding is...I asked a QUESTION!

It's hard to follow due to poor sentence structure and horrid spelling.

P.S: My spelling is nowhere near perfect, but not tragically bad either, and my ideas are normally understood.

 

[1badassEMT-I]

It's hard to follow due to poor sentence structure and horrid spelling.

P.S: My spelling is nowhere near perfect, but not tragically bad either, and my ideas are normally understood.

Well dont be so quick to JUDGE me. That senario was perfectly written. However you just jump on my question that I was reprimanding a poster over. THAT IS WRONG OF YOU! admit it! When in fact it was a legit question I asked the poster.