Rezq304

Airway is clear. Pt is breathing 24 times per minute, good depth and volume. Skin is pink. During assessment, you note deformed R shoulder and pain on palpation in the upper two abdominal quadrants. Only medical hx is the pt had two spots of carcinoma removed over a decade ago. BP- 100/P P-96 O2 Sat- 95. Interrogation of the family reveals that the gentleman was painting the roof of his barn, when his harness rope snapped allowing him to fall approximately 10 feet onto an overhang on which he landed on R shoulder. He then rolled off of the overhang and landed on the grass 10 feet down on his R shoulder. Motor sensory is intact. Trachea mid-line. (-) JVD. Lungs clear and equal bilateral. (-) Sub Q Emphysema. (-) deformity to spinal column on palpation. Pt is c/o no other pain than the upper abdominal & R shoulder. Pt is AAOx3. Ok, you have your IV, but where do you want to put it, what size, & how do you want it to run?

Chopper is confirmed unavailable as you check on scene.

It's rather funny. We own one Wheeled Coach (2005 model), and it runs worse than our oldest running ambulance (1997 O'Sage). If I have a say in the next vehicle we buy and subsequent vehicles, they will ABSOLUTELY not be Wheeled Coaches.

I'm with Noah on this one. For 95% of my PCR's I use the CHART method. The only exception that I make to that is if I come across a run that is just WAY out of the ordinary and would be extremely difficult to fully "paint the picture" in that format.

Dispatched to scene of a rural home....male pt fallen approximately 20 feet........on scene time 10-12. Closest facility 10. Closest trauma facility 45. GO.....

own two feet

Wow folks, was I the official "thread killer" here????

In a nut shell, Marfan Syndrome is: Marfan syndrome is a connective tissue disorder characterized by unusually long limbs. The disease also affects other bodily structures — including the lungs, eyes, heart and blood vessels — in less obvious ways. It is named for Antoine Marfan, the French pediatrician who first described it in 1896. Marfan syndrome received great public attention when the musical RENT premiered in 1996. The day before the musical premiered off-Broadway, its writer, Jonathan Larson, died of an aortic dissection, which was determined to have been caused by Marfan syndrome. Cause Marfan syndrome is an autosomal dominant disorder that has been linked to the FBN1 gene on chromosome 15. FBN1 codes for a protein called fibrillin-1, which is essential for the formation of elastic fibers found in connective tissue. Marfan syndrome is also an example of a dominant negative mutation. Marfan syndrome is associated with incomplete penetrance, therefore not all persons carrying the mutation develop the disease. Without the structural support provided by fibrillin, many connective tissues are weakened, which can have severe consequences on support and stability. A related disease has been found in mice, and the study of mouse fibrillin synthesis and secretion, and connective tissue formation, has begun to further our understanding of Marfan syndrome in humans. For instance it has been found that simply reducing the level of normal fibrillin-1 causes the Marfan related disease in mice [1]. More recently, transforming growth factor β (TGFβ) has been shown to play an important role in Marfan syndrome. Fibrillin-1 binds TGFβ, inactivating it. In Marfan syndrome, reduced levels of fibrillin-1 allow TGFβ to damage the lungs and heart. New treatments for Marfan, using antagonists of TGFβ, are being investigated (Habashi et al., 2006 Science 312(5770):117-21). [edit] Diagnosis Although genetic testing is available, a diagnosis is usually made solely on clinical findings. [edit] Epidemiology Estimates indicate that perhaps 1 in 10,000 people (0.01 percent of the population) has Marfan syndrome. It affects all races and both sexes equally. Most individuals with Marfan syndrome have another affected family member, but about 30 percent of cases are due to de novo genetic mutations. Genetic counseling is available for families who may be at risk for Marfan syndrome. [edit] Symptoms The most serious conditions associated with Marfan syndrome primarily involve the cardiovascular system. Marfan syndrome may cause leakage of the mitral or aortic valves that control the flow of blood through the heart. This may produce shortness of breath, an irregular pulse, and undue tiredness. Another complication is aortic aneurysm. Marfan syndrome sufferers may grow to larger than normal height, and typically have long, slender limbs and fingers. Sometimes the fingers have a long, thin, spidery appearance known as arachnodactyly. In addition to affecting height and limb proportions, Marfan syndrome may produce other skeletal symptoms. Curvature of the spine (scoliosis) is a common problem, as is abnormal indentation (pectus excavatum) or protrusion (pectus carinatum) of the sternum. These symptoms may in turn cause unusual pressure on the heart and lungs. Other symptoms include; abnormal joint flexibility, high palates, flat feet, stooped shoulders, and dislocation of the optic lens. Nearsightedness or myopia is a common condition associated with Marfan syndrome. In addition, the weakening of connective tissue often causes detachment of the retina and/or displacement of the lens in one or both eyes.[2] [edit] Treatment There is no cure for Marfan syndrome, but effective treatment allows many people with the disorder to live normally. The heart conditions related to Marfan syndrome may not necessarily produce obvious symptoms. As a result, regular checkups by a cardiologist are needed to monitor cardiovascular health. Potential problems may be detected through echocardiography, which involves the use of ultrasound to study the heart valves and the aorta. Beta blockers have been used to control some of the complications such as aortic aneurysms. If the dilation of the aorta threatens to lead to rupture a composite aortic valve and graft may be implanted. Although aortic graft surgery is a serious undertaking it usually results in a good outcome and a satisfactory quality of life. Elective aortic valve/graft surgery is usually considered when aortic dilatation reaches 50 millimeters, but each case needs to be specifically evaluated by a qualified cardiologist. New valve-sparing surgical techniques are becoming more common. Rupture of the aorta, or aortic dissection, is the most common cause of sudden death among Marfan syndrome sufferers. The skeletal and ocular manifestations of Marfan syndrome can also be serious, although not life-threatening. These symptoms are usually treated in the typical manner for the appropriate condition. This can also affect height, arm length, and life span. The blood pressure drug losartan prevents aortic aneurysms and lung problems in a model organism mouse model of the disease. Ok folks, let's go basic yet again and talk about posturing: Decorticate & Decerebrate

This happened a couple of years ago. Responding to a report of a boy fallen off of a scooter, ankle injury. On arrival FD Chief is with kid since it was near his house. Kid is approximatley a 12 y/o male who was riding his "Razr" scooter when his foot got caught under the thing. The kid was initially covered with a blanket to keep him warm. At this time I was a BLS provider and AIC on my truck. I lift the blanket to see the kid's L foot attached by only approximately one inch of muscle. Needless to say, we picked up the pace and "hauled butt" with this kid. En route to the hospital, intercepted ALS truck. They pushed the max amount of Morphine allowed and it still barely touched his pain. I ran into the kid about six months later during a stand-by at a high school football game and he thanked me for everything that I had done to help him. He had a very large scar, but still appeared to have full use of his foot. It's things like this that keep me pressing forward.

Basically, LeForte Fx's are three different Fx's within the head/facial area. The below linked info goes further in depth. From eMedicine.com Rene Le Fort described the classic patterns of fracture in his 1901 work. Le Fort's experiments consisted of dropping cadaver skulls from several stories or striking them with a wooden club. He found 3 distinct fracture patterns, which he termed the linea minoros resistentiae. Simply stated, the Le Fort I fracture separates the palate from the maxilla, the Le Fort II separates the maxilla from the face, and the Le Fort III results in craniofacial dysjunction. The Le Fort I fracture is a low transverse fracture that crosses the floor of the nose, pyriform aperture, canine fossa, and lateral wall from the maxilla, resulting in separation of the palate from the maxilla. The Le Fort II fracture crosses the nasal bones on the ascending process of the maxilla and lacrimal bone and crosses the orbital rim. Only the Le Fort II fracture violates the orbital rim. This proximity to the infraorbital foramen causes type II fractures to have the highest incidence of infraorbital nerve hypesthesias. The Le Fort II fracture extends posteriorly to the pterygoid plates at the base of the skull. Whereas a Le Fort I fracture causes a low septal fracture, a Le Fort II fracture results in a high septal fracture. Finally, the Le Fort III fracture traverses the frontal process of the maxilla, lacrimal bone, lamina papyracea, and orbital floor. This fracture often involves the posterior plate of the ethmoid. Because of their location, Le Fort III fractures are associated with the highest rate of cerebrospinal fluid (CSF) leaks. Pathophysiology: The maxilla has 4 processes: zygomatic, frontal, palatine, and alveolar. The maxillary sinus is housed within the maxilla and varies in size depending on the degree of pneumatization. The midface can be thought of as a grid of horizontal and vertical buttresses that provide support for the face. The 3 paired vertical buttresses of the midface are the nasomaxillary, zygomaticomaxillary, and pterygomaxillary structures. The nasomaxillary buttress is formed by the lower maxilla, the frontal process of the maxilla, the lacrimal bone, and the nasal process of the frontal bone. The zygomaticomaxillary buttress is formed form the lateral portion of the maxilla, zygoma, and lateral portion of the frontal bone. The final buttress extends along the pterygoid plates to the skull base. The lone unpaired, vertical support mechanism is the nasal septum/ethmoid complex. The horizontal buttresses are comprised of the alveolus, hard palate, inferior orbital rim, and frontal bar. Horizontal buttresses have coronal and sagittal components. The sagittal buttresses are vital for facial projection. The midface is relatively deficient in sagittal buttresses. The skull base is at a 45° angle relative to the occlusal plane of the maxilla and can act as an axial buttress as well. Nahum revealed that low forces can create a fracture in the midface. This is partly due to the large air-filled sinus cavities. Therefore, the midface acts as a shock absorber. The midface is relatively resistant to vertically oriented forces (anteroposterior [AP] direction). The lateral oriented forces may fracture the obliquely directed force vectors. The fractures can be of significant functional and aesthetic importance. Functional problems can lead to disorders of occlusion, nasal obstruction, and trigeminal-nerve sensation. Aesthetic losses include decreased midface height, facial width, facial projection, and malar eminence. These losses can lead to a dish-face deformity. Clinical Details: Because of the accompanying injuries to the entire body, the standard trauma protocol of ABCs must be strictly followed prior to any intervention. Often, the midface fracture assumes a less important role because of the severity of intracranial injury and associated body injuries. Since about one half of midface fractures are associated with significant cerebral edema, a low Glasgow Coma Scale score (<5), and a poor prognosis, it is important to understand the goals of the family and the other medical teams involved in the care of the trauma patient. First of all, it is important to evaluate the airway early to rule out intraoral hemorrhage, edema, loose teeth, and posteroinferior displacement of the maxilla. Establishment of a safe airway is a priority, and a tracheostomy may be needed if intubation proves to be not possible or unsafe for the patient. Bleeding may complicate midface fractures. If the bleeding is severe enough, packing of the midface vessels and temporary reduction of the fracture may be necessary. Angiography may be necessary to locate arterial bleeding from the internal maxillary prior to embolization. Obvious clinical signs of facial skeleton compromise include malocclusion, subcutaneous emphysema, abnormally mobile skeletal structures, and palpable step-offs. Crepitus can be a result of paranasal sinus air leaking into the soft tissues of the face. Palpable step-offs are especially seen with zygomatic fractures. Associated facial fractures must be evaluated and ruled out. The patient's visual status, before and after traumatic insult, is vital in the treatment algorithm of midface fracture. There is a high incidence of visual problems associated with midface fractures, including enophthalmos, diplopia, entrapment, and epiphora. Epiphora occurs in 4% of Le Fort II or III fractures. CSF leakage is also seen, especially in Le Fort III fractures. Any persistent clear rhinorrhea should be tested appropriately for CSF fluid leak (see Skull Base, CSF Otorrhea). Patients may complain of paresthesias of the upper jaw due to damage to the superior alveolar nerve. As in all facial fractures, malocclusion is important to assess. Patients may present with trismus and mouth pain. Palatal fractures often include a lip laceration and/or lacerations of the gingival and palatal mucosa. Patients with a palatal fracture may have an anterior open-bite deformity. Facial edema may obscure the facial examination, and step-offs may not be palpable. It is important to assess fracture mobility by palpating the anterior maxilla between thumb and forefinger. Motion at the level of anterior nasal spine without simultaneous motion is a sign of a Le Fort I fracture. Le Fort I fractures may be associated with gingival crepitation. Le Fort II fractures result in motion of nasal pyramid along medial orbit rims. The patient may have midface flattening and elongation. Le Fort II fractures often are associated with infraorbital paresthesias. Le Fort III fractures have motion at the zygomaticofrontal suture (craniofacial dysjunction). The patient may have anosmia due to fracture at the cribriform plate, severe edema, or lengthening; this is known as a dish-face deformity. Midface fractures are usually not confused with other phenomena. The main concern is whether associated fractures are present. Examples include nasoethmoidal and orbitozygomatic fractures. These associated fractures are typically evident on examination or CT scanning. A history of trauma to the face and proper suspicion of imaging results should lead to the proper diagnosis. I'll be the fun killer and leave a commonly known one for my predecessor. Tell me about Tuberculosis.

the local psychologist

Negative go Kahne!!!! TPBM likes chicken soup.

It's been about 20 pages, but after the LONG, HARD fight, I'm back on top!

Only for a couple of yours Mad.....BACK ON TOP!

Back on top!

Back to claim my place ON TOP!

Back on top!

BACK ON TOP!

Not while I'm here!!!! BACK ON TOP.

Yes ma'am itku.......BACK ON TOP.

BACK ON TOP.

You folks, the KING IS BACK!!!! Back on top!!!

NOt for long!

Back to claim my spot at the TOP!!!

BACK ON TOP!!!!