DesertEMT

I have a real quick question about the trauma assessment portion of the licensing test. Would I be faulted for requesting ALS support if it turns out I don't need it? Like say, I prioritize a patient as a high priority but during my rapid trauma assessment I'm able to within my scope fix any life-threats?

The patient was searched, no weapons found and an engine is on scene

Nearest level 1 trauma hospital is 19 minutes away. In the time between you loading the patient and reaching the hospital what interventions would you/could you do?

JVD

trachea- is it mid line

what does his abdominal region look like

is it tender, rigid

is there a sucking chest wound

approx how much has he bled out onto the floor?

Does he feel nauseous? Any unusual odors such as GI odors

Go ahead and assist ventilations BVM hooked up to 02

trendleburg postion

have 2 IVS ready to go once he begins entering decompensated shock

manage any bleeding and cover any sucking chest wounds with a three sided occlusive dressing

Prepare for a L sided needle decompression if indicated

*EDIT:TKO....Until signs of decompensated shock are present and titrate to maintain a BP of 90 mmHg systolic

Go ahead and place on cardiac monitor as well. Also clear airway with suction

Trachea is beginning to show slight deviation to the right side

Abdomen is rigid & distended with diffuse tenderness

Chest wound is a sucking chest wound (sorry I forgot to mention that)

patient admits to being nauseous and urinating himself, you note hematuria

patient had lost almost 30% of his blood volume when you first arrived on scene and when you begin to load the patient onto the gurney his BP begins to drop, while his heart rate begins to increase, as does his respiration's. His mental status also begins to deteriorate, the patient shows a marked increase in anxiety and confusion

Is ABC okay? Ausculatation - results?

Undress patient - what do we say. Where are the GSW? Exit wounds?

Vitals?

GCS? Neurological examination - results?

What weapon was used? What ammu?

Airway is open but their is blood in his mouth

Breathing is rapid and shallow

pulse is rapid and thready, skin is clammy and pale

Upon auscultation you note absent lung sounds on left side

Patient shot 3 times, you note one entry and exit wound on left pectoral just above the nipple, another e/e wound in the upper left abdominal quadrant, and a third wound entry only in the lower left quadrant

Vitals are BP 110/65, R/R 28 rapid and shallow, HR 110bpm

GCS 14

Weapon was a Glock 26 with 9x19mm rounds

You and your partner are on your way to a residential neighborhood for a patient with multiple gunshot wounds, police are already on scene and have the suspected shooter in custody. As you arrive on scene you apply BSI and step out of your vehicle and are briefed by local police "the victim is a 17 year old high school senior who was attending a local house party when the gunmen approached the teen and fired 3 shots at a distance of 4ft." As you approach the patient you notice he is tracking you with his eyes but is keeping his head down, the patients is sitting slumped against a wall and is covered in blood. Go

Perfect answer...

Not to be too big of an ass, but OP if we could get back to the scenario instead of centering yet another thread around kiwi and australian speech antics I would be very appreciative.

So we have a stable patient being transported on thier Left side, with pain controlled and 2X I.V. fluid restricted.

Is that the end?

Yes this basically would be the end, the hospital is about 8 minutes out (oh the joy of living in a large city with many hospitals) and the vitals remained relatively stable.

I know this scenario was fairly simple but it really was for my benefit in trying to better understand how to work trauma scenarios. Thank you guys for taking the time to do this, I definitely learned some new things and I've got another scenario in my mind that I may post later today once I've worked it all out in my head.

CYA statement: As this wasn't answered before...Does this guy have anything on board that could be controlling his rate and pressure chemically? Because if so, then I'm going to have to step back and reconsider...

Dwayne

The vitals I gave were taken before any chemical interventions

Ok. I'm still having trouble picturing this, but from your description of serratus anterior and latissimus dorsi, it's basically punched through and is being held by the major muscles of the back, right? It pierced on the lower back and is coming out the upper back... so I'd put him on his left side... so we have questionable involvement of the chest cavity but it appears to be lower index of suspicion if I'm reading the position of the impalement right... any changes in patient presentation/condition once we get them in position of comfort and some meds on board?

Wendy

CO EMT-B

Yup, you've read it right and I think you are the first to point out that the patient should be placed on his left side

What angle did the post go in at? How did he end up on it? Trip while playing grab ass? Get thrown from a horse? Fall while standing on his truck driving it in?

In most scenarios that I'd imagine it most likely went in at a shallow angle, sounds like it pierced his Lat which is a pretty big muscle that bled for a bit but then spasm'd around the post making the external bleeding self limiting. And his vitals seem to support this assuming his rate and pressure are not chemically controlled.

The man ended up on the fence as the result of gardening accident, apparently he was on a step ladder near the fence trimming the branches of a tree in his yard when he lost his footing and fell directly on top of the dart.

As to where the dart impaled him, it appears to have entered on his right side near the serratus anterior and exited near the top of his latissimus dorsi.

I have a question for Kiwimedic and Runswithneedles, one of you said no fluids while the other said to run him with two large bore IV's at TKO, care to explain your reasoning behind your choices in how to handle fluids?

This is a great idea for a scenario. I am glad you are running it.

Is the piece of fence still in him or did the FF pull it out?

Yes the pole is still in him, but the dart at the end was removed

Spinal him and load. Start moving to closest trauma centre.

Helo available?

Vitals?

Air entry sounds?

Skin colour?

What position do you want the patient to be on the backboard? bear in mind the pole is still in him.

Hr 80, BP 150/70, GCS 15, SpO2 98%

Normal lung sounds

Skin normal p/w/d

From my understanding the difference between ILS and ALS where I was taught is; medication (cardiac and pain), endotracheal intubation, and EKG and Defibrilation (with the exception of an AED) are all out of my scope. It is easy for me to determine when ALS is needed during a medical call but trauma is a bit of a weak point with me when I can't actually see a patient.

It's an idle Sunday afternoon when you and your partner are called to a residential neighborhood, dispatch says a man has been impaled on a fence. When you arrive you find the patient suspended by the dart of a steel fence, the dart appears to have impaled the man in the right posterior-axillar line upwards about 15cm. You notice what appears to be moderate blood loss, though the bleeding seems to have stopped. The patient is conscious AOx4 and collaborating with firefighters who use a pneumatic cutter to first detach the impaled man from the fence and then remove the dart end of the pole (which had a base diameter of 2cm).

Now that the firefighters part of this is done, treat this patient

(This is my first time giving a scenario so please excuse any mistakes I may make in doing this. I'm hoping to use this as a sort of practice for myself when it comes to trauma scenarios, as they are my weak point)

I am preparing for a test with an ambulance company in the next coming weeks, this will be my second try, I only have to complete one test which is the trauma scenario and so I am trying to study up on everything I did wrong last time. One of my mistakes was not calling ALS back-up, so my question to you Emtcity is "when is it necessary to call for ALS assistance as an ILS provider?"

Hello EMTCITY, I recently joined this forum looking to find help with my trauma scenarios. I am an EMT-I and recently tested for my license, I was able to pass every test except the trauma scenario which I completely flubbed, so now I'm hoping to practice before I go for my second attempt but I don't have any friends in EMS that I could practice with and I haven't spoken with my instructor since I finished my EMT-I class which was almost 7 months ago, so I am hoping to find a partner here to practice over the internet with before my next attempt. I know many of you here are busy but if any of you have the time I will greatly appreciate it.