speedygodzilla

I have notice a trend that I don't exactly understand the thought process. Transporting "stable" patients emergent to the local trauma center base off of mechanism. I do take mechanism in to mind but to be honest I look more at my patient. Any LOC changes, ABCs intact, vital signs stable. I guess I use stable loosely but I don't just want to transport a patient emergent base off of mechanism. Am I thinking clearly or do I need to transport more "aggressively" based off of mechanism? I am still a new medic and want to make sure my reasoning is well reasonable. Keep in mind where I work the most transport time will be is around 20 mins but is usually less than 10 mins. So my food for thought is that transporting emergent will not save much time but will vastly increase the danger! Thus I reserve emergent transport for unstable patients no matter what the mechanism is.

Yea I have spotted the leak! Kind of hard to miss it now. Hopefully they get this capped soon.

I don't see any oil leaking from this cam. Am I missing something, or is it fixed for now?

Unforturnately I do not have an arrange of individuals who would be comfortable with me palpating "ribs." This is especially true with females. Unsure what people are so uncomfortable with. While experience and practice is always the best bet, I offer another. Know the what you should be feeling for when the opportunities arise. Ok so 1st intercostal space is very easy to find and should be where you start. Find the clavicle and place a finger just below it, than "walk" your fingers down from there counting the softer vs. harder spots. This may require some pressure and a couple tries. Another option is to feel for the "Angle of Louis" the bump located on the sternum about a quarter the way down from the top of the sternum/suprasternal notch and than proceeding laterally to the left of right as indicated. I have personally found the "Angle of Louis" easier to find on some than others. This all may be easier if your patient is laying supine or semifowler. Also remember I was taught that you can introduce the needle on top of the third rib and manuplate it to the 2nd intercostal space a little. Obviously you would have to be at the top of the third rib.

Kind of hard to give my opinion without full details.

Since the test is today there is not really much time to learn. The main thing is do what you can to have the confidence. You have passed your classed, you have read your booked, you have studied the material, etc. You are ready. Take the test and either way it doesn't end here, thus this is basically just the start. Good Luck PS If You are missing questions in the REA book, understand why, don't memorize the answer.

I am a bit confused to the exact issue here. Please be more detailed. Besides what do you hope to gain from this forum if the EMS board has already reviewed the case?

Holy crap, I had no idea it stored an images of what I makes copies of. Well anymore the question is not if your idenity will be stolen but when?

Welcome to the city! Make yourself at home.

Thanks chbare for making us think. It really make sense after your explanation and art work. Have a great EMS Week

So CEBBS but trachea diviation along with ET placement. I am drawing a blank. Fractured ribs? What does palpation of chest find? Get on the radio with MEDCON I guess and explain findings.

The left sided hematoma must not be completely blocking the left lung. Just causing a delay in the air arriving to the lung due to the blockage. Maybe try slower than usual squeeze of the BVM giving the lungs time to properly fill together. Messing with the neck in anyway sounds contraindicated to me. This patient is gonna need surgery.

Yes I would think that is possible. If the hematoma is pushing the trachea to the right thus diverting air to the right. Not a great explaination but I think it is quite possible that the hematoma and trachea deviation could be a factor. How about maintaining c-spine but accessing the hematoma and applying constant pressure to decrease its size and impact? I would weight the risk and benifits. If the patient is "stable" the rate quality and depth are adequate I am not sure I would feel comfortable messing with a large hematoma on the neck. If it is impeding on ventilations than I would move on the the constant pressure to the hematoma.

Well I am honestly not sure what is causing the asymmetrical chest wall movement other than just pure "trauma." If we have ruled out life threats we can treat, including the above I listed than it sounds like it is time to move on. Before moving on can you tell me more about ABCs. Airway establish, check. Breathing for the patient adequate rate quality and depth abnormal chest wall movement but adequate, check. Circulation? Intact? I beleive he had bilateral femur fracutures? Open? Bleeding Controlled? Skin color, temp, and condition? Or are we not ready to move on from the ABC/asymmetric chest wall movement? A guess I would throw out there is possibly a hemothorax which I don't have the training or equipment to treat.

Happy 2010 EMS Week!!! Just wondering, what are you doing for EMS Week this year? We have a Gourney Rodeo, gift card drawings, BINGO, Ice Cream Social lunch with fire (not sure how I am gonna eat around a fire ), pancake breakfast, and lunch at several ERs. We may also wear EMS Week T-Shirts rather than our usually uniform. Going to the Rodeo here in just a bit, really not a 100 percent sure what I am getting into but I figured what the heck. Not sure how much of the other stuff I will actually be involved with as I work the graveyard shift but it is nice to have to opportunity. Have fun out there and enjoy the week.

Well as long as the patient continues to appear oxygenated I would just continue care and move on to v.s, full body exam etc, while instructing the provider bagging to immediately let me know if anything changes. Abdomen distended? Lets go ahead and drop a NG tube to see if it helps.

Well with that I go to possibly three things in order of suspect: 1) Right Main Stem Intubation 2) Flail Chest (but I would suspect that would already be noted with injuries. 3) Tension Pneumothorax Lungs sounds equal? Hard to bag? Trachea midline? My first step would be to pull the tube back alittle and check to see if that fixes it. What is next? If ABCs are controlled lets move on to a detailed exam. How is skin, color, temp, condition? How are vitals? Head to toe exam etc?

No, I guess I was presuming that there could be facial trauma contradicting the use of NPA. You didn't list it cause there is none and now I understand that. So trans by air will be no faster? Thus just continue by ground. I would probably RSI. We don't have RSI here and I am a newbie medic so from what little I know about ketamine it raises BP thus presumably rasing ICP so it wouldn't be my first choice for RSI. What about nasotracheal intubation? Last I check the patient still had trismus and was breathing shallow on his own.

Well sounds like this guy is gonna get a QuickTrach or surgical cricothyroidotomy. I am presuming an NPA would be contraindicated due to head/facial trauma and besides it is not nearly as secure an airway. GCS of 3? Vitals?

Ok well it sounds like it is time to take a look at our patient. *Don't forget your reflective vest! Lets get a primary exam: -Position found? Base of mechanism take spinal precautions. -LOC found? -AVPU? -ABCs? Patent? Breathing quality, depth, and rate? Ciculation intact? Skin temp, color, condition? -Confused? -Any LOC change? Well that should get us started.

Besides the pericarditis I would suspect electrolyte imbalance, or drug abuse. Get the child alone and and ask him question pertinent to drug abuse. -->Any recent drug or alcohol use? At the age 11 it is not my first or highest index of suspicion but it did come to mind. Ask dad the same questions too. Another food for thought is has the pt been vomiting recently thus increasing my suspicion of electrolyte imbalance. To the test above add CMP, and drug screen as available. Nothing really to add to the treatment other than an emphasis on calling transporting and getting this patient to the ER. From the looks of what you have provide it appears the physical exam is normal. Does a head to toe exam provide anything besides the "usual?"

Great idea! My vote is in! Doesn't look likely to win unless we can give it a boost. It is at #183 and the way it looks only the 32 get $

Wow! Sorry to hear the bad new Anthony. I am sure you will find a better job where you are of more value than a TINY dent in the outside of the tire rim! Good luck, keep your head up, and remember at least you were honest about the situation.

I have seem few try pacing in cardiac arrest, and it has never worked. I really wonder if anyone has seen it work? I figure you can always try pacing, but chances are it is not going to circulate or get capture. Is the capture a femoral pulse or just capture on the monitor? I have to agree with Mike. Even here in the city where I work we work the cardiac arrest for 20 minutes with a few other basic criteria but do not transport if no ROSC after calling medical control. There is more criteria to it than that but that is the basic of the protocol.

Every contact is a patient. Many here have had the same argument here where I work. To help the crews with this we have multi contact forms for multiple noninjury patients without a complaint. But we still have to fill out refusals for single pt incidents or my toe hurts etc. I see both sides of the argument but would rather be safe than sorry. What if you are called to court 5 years down the road on this call. CYA Where I work the fire dept. does not fill out any sort of patient care report including refusals. Just the way it is.