scenario

[Medivixen]

I am practising scenarios for the end of the month testing and I am interested in some feedback.

You are called the the local shopping center for a 80yr old male down.
Nobody there really knows what happened to him, passerby shoppers just said he was shopping then collapsed to the ground.
You get there
Airway-patent
Breathing- absent
Pulse- absent
Its a code....Assume there is just you and your partner there to do anything...so 2 person rescue...
My question is about c-spine ...as soon as I get there and find a unknown down I would get my partner to do c-spine but as soon as I figure it is a code that takes precedence....Would you spinal after your AED protocol is complete or just load.....
Now say instead of a fall from standing it is a 15 foot fall from a roof top or something.... does this change

 

[emt4life]

Yes, although he may have C-spine injury, your first thought should be:

What is going to kill him first, the fact that he may a C-spine injury or the fact that he is not breathing and doesn't have a pulse?

It is a good idea to put a c-collar on the pt to help keep the tube (ET or Combi) in place and you will be putting him on a backboard to ease cpr, so there is the c-spine precautions. But the potential for spinal is far less concerning than the fact that he is in cardiac arrest.

Now if by some miracle you get the patient back, absolutely be concerned with C-spine.

 

[Jon]

If it is a fall from standing and they are in arrest, as an elderly patient, I would ASSUME that they went into arrest and then keeled over. Honestly, C-Spine wouldn't really be that big a consideration for me, although he would be on a backboard to assist in CPR.

If there is a fall that meets the criteria for "mechanism" trauma consideration, then yes, C-spine is a lower priority than the "ABCs" but it is still important. If I had the manpower, I'd try to have someone holding c-spine fromt he begining, probably start the ventilations with a modified jaw-thrust, etc.

 

[CodeSurfer]

Those are all "what I would do answers". The real question is... what do those whacko test question writers want you to say? Stating the obvious here, but the answers on the test are usually only partially applicable to a real life scenario.

 

[Medivixen]

Those are all "what I would do answers". The real question is... what do those whacko test question writers want you to say?

yeah exactly

 

[oldschoolmedic]

Remember your mnemonics, ABCDE. Without the first three, nothing else matters.

A- airway. Can't breathe, won't live.
B- breathing. Not breathing, won't live.
C- circulation. If the air goes in and out, but not around, won't live.
D- disability. Here's where you control the fractures.
E- exsanguination. Blood has a limited supply so be quick.

For your question, work the code, transport in spinal precautions, and remember that part of the checklist that says "consider need for additional resources". There's nothing to stop you from requesting backup in the practicals.

 

[islandgal]

ABC's... first and foremost.

 

[Medivixen]

well i am just thinking the worst that the scenario will be just me and my partner with a code with possible spinal. I could ask for assistance but I know they will say oh they are 10 mins away you have do with what you have or something. Our mneumonics have changed a little
RSE-rescue scene evalution
LOC
D-delicate spine
A
B
C
RBS-rapid body survey
skin
O2
Decision point- stay and play or load and go
History
Vitals
Head to toe
Protocol
Treatments
transport

there is variations to that outline depending on the situation