Unconscious kid lying in a room

[EMT1A]

You and your partner walk into a room and find a kid lying unconscious on the floor with empty beer bottles laying all around. The roommate is standing there as you enter.

My answer:

BSI
Scene Safety
Have my partner hold c-spine
Check airway
Drop an opa/npa if needed
Start bagging the patient on high flow o2 at 15lpm
Check circulation
Check for any apparent life threats
If circulation is good and no apparent life threats then c collar. If there is, treat the apparent life threats first
Have my partner ask questions, ie history, what happened, patient's medical history, etc
Backboard patient
Transport

 

[DesertMedic66]

Your question is? Lol

And why would you automatically start bagging the patient? Unconscious does not mean not breathing.

 

[EMT1A]

Did I miss anything?

When I wrote check airway, I meant to see if the patient is breathing and if the patient has an open airway.

 

[Epi-do]

Why would you board this patient? Are you seeing any sort of obvious injuries that would make you think it should be considered?

Does he need bagged? What is his respiratory rate and effort? What's his airway like? Is it clear, or do you need to suction?

 

[EMT1A]

Wouldn't you automatically assume c spine precautions if you found the patient lying on the floor since there could be possibly a spinal injury? Don't you have to board the patient if you c-spine them and put a c-collar on in order to get them onto a gurney?

When you check airway you would:

1. See if it's open
2. If it isn't open, open the airway either by suction if needed, head tilt chin lift? and use an opa/npa to open the airway?
3. If the airway is open, check if the patient is breathing and their respiratory rate and effort?

Is this correct? Did I miss anything?

 

[DesertMedic66]

Wouldn't you automatically assume c spine precautions if you found the patient lying on the floor since there could be possibly a spinal injury? Don't you have to board the patient if you c-spine them and put a c-collar on in order to get them onto a gurney?

If you suspect that it is trauma related then yes. If its not trauma related then no.

(ie if drunk kid jumped off a roof then yes backboard. If said drunk kid laid down and passed out then no backboard)

 

[EMT1A]

How would you get them onto your gurney or transport the patient if they are unconscious and lying on the floor after you c-spine the patient?

 

[Epi-do]

But just because someone is on the floor, I don't assume they need to be c-spined. What does the room mate say happened? What does the scene tell you? They could have fallen from standing, but that typically isn't enough to cause a cervical injury in a teen. Maybe they got onto the floor themselves. Are they at the bottom of a staircase, and do you have reason to believe they fell down it? There are a lot of other things to also take into consideration before deciding spinal immobilization is warranted.

 

[Epi-do]

How would you get them onto your gurney or transport the patient if they are unconscious and lying on the floor after you c-spine the patient?

If they do need a collar and board, then simply pick the board up. If they don't need that, then have your partner help you pick them up off the floor and put them on the cot. You can do that by lifting under their arms and legs, using a scoop, or whatever else you can come up with.

 

[DesertMedic66]

How would you get them onto your gurney or transport the patient if they are unconscious and lying on the floor after you c-spine the patient?

C-spine = C-collar and backboard. Patient gets placed on BB and said BB gets lifted on the gurney...

 

[rwik123]

How would you get them onto your gurney or transport the patient if they are unconscious and lying on the floor after you c-spine the patient?

You COULD utilize the backboard as a transfer device from the floor to stretcher with maybe 3 straps..but ixnay c-collar, blocks, and full set of immobilizing straps because they don't need to be boarded.

 

[EMT1A]

I see.

I was taught in my EMT class that you automatically c-spine anyone you find lying down that can't tell you clearly what happened and how they got there in case there is a spinal injury.

Basically c-spine if you think it is needed no matter what since you never really can know what happened. Better safe than sorry.

For example, I had a real life incident where the patient and their family told us that the patient tripped over a step and barely fell. She got up and walked and sat down. Based on this, we didn't c-spine because we didn't think it was necessary. However, we found out while evaluating the patient that what we were told was clearly not the case and that the patient definitely had spinal injury as the patient became incontinent during evaluation and was detiorating and losing consciousness.

After that incident, my mindset is c-spine in case since you can never know what really happened. Not sure if I'm right or not.

 

[Aidey]

How does losing consciousness equal a c-spine injury?

 

[EMTjhk]

How does losing consciousness equal a c-spine injury?

I noticed that the people asking this are paramedics. At the EMT level we're pretty much taught to c-spine instead of following some algorithm. I guess better safe than sorry.

 

[EMT1A]

How does losing consciousness equal a c-spine injury?

Wouldn't incontinence be a possible indicator of a c-spine injury?

 

[EMTjhk]

Wouldn't incontinence be a possible indicator of a c-spine injury?

Yep and so would priapism

 

[rwik123]

I noticed that the people asking this are paramedics. At the EMT level we're pretty much taught to c-spine instead of following some algorithm. I guess better safe than sorry.

Im a basic and I wouldn't C-Spine this person. Use common sense and judgment on scene. Can either of you provide me with any solid reason they should be c-spined? Other then basic class told me to.

 

[rwik123]

Yep and so would priapism

C-spine injury can present in hundreds of ways. Your gunna immobilize because you identify one of them, and only based upon that?

 

[CFLA]

Book world is book world and real world is real world. If you run every call as if you're reading from your scenario sheet you're going to screw up.

Focus and use common sense.

 

[Medic Tim]

If this is for nremt testing purposes then yes board them. If this was real life I do not see a reason to board them.

Better safe than sorry does not = a board. If we were playing the evidence and numbers we wouldn't be boarding anyone.

With time and experience these types of calls will become easier and easier. It is also a good lesson that you cant believe everything you are told. You need to keep up your education. Other common lines (lies) basics are told in class are: O2 won't hurt anyone or every pt gets it no matter what, ems doesn't diagnose and certain drugs like narcan are harmless and won't cause adverse effects.