TZETAH

Thank you dustdevil, There you go again, you just got to keep going. Wham Bahm Smack!!!! Your are just like the little bunny that keeps going and going and never gets anywhere always stuck bang away!!!!!! Thanks scaramedic, have a great night!!!!

Excuse me, Gentlemen, But I have taken the classes necessary to perform my job as an EMT. I am not here to gloat or mislead anyone, but to learn more of what I do not already know. I have been on a lot of runs and love feed back on what I could have done different or even better in some cases because there is always room for improvement. I think that you guys just might be the type that can't let a new-by learn anything because perhaps they might just catch on quicker that you all did. I came on here to summit a scenario, if it was to confusing (obviously) than for that I apologize, but to continue to pick apart and a brake down someones self worth just because you can't grasp the text is not right. You know that I am EMT-B that's why I put the scenario here. I am in no way trying to be something I am not, I told Dustdevil long before I put this scenario up That I was an EMT-B and he basically told me exactly what he thought about EMT-B's, do you think that I wanted to tell anyone else. I just thought that this would be a place where I could learn new techniques and sharpen my skills, mentally. Sorry, Have a great day!!!!

vs-eh? Yes, you are getting it, intubating was done in the hospital not by our crew. Thank You!!! the X-ray was of the neck, looked like there had been a plate attached to the back of neck from the previous surgery, don't quote me regarding the plate--don't even want to go there for goodness sakes!! I did not see the Xrays from the chest area. Why are you so hung up on whether I am an EMT-B or P??? Would it really make you happy (relieved) if I said "B" vs "P"?? Is it because of the whole compartment thing that was discussed earlier, I forget by who!? For the record I looked that up also. And found that if it was a crush compartment Syndrome that Sodium Bi-Carb would be the First drug to administer before a pt is extricated. Take the 1987 Amtrak Derailment for example-- Middle aged women pinned for 12 hrs, conscious, alert & oriented X4 throughout stable vitals. Within 15 min of extrication, pt went into sudden V-Fib arrest & died despite rapid ACLS & transport to an area trauma center. or perhaps some could use insulin which would transport dextrose through the cell membranes and pulls potassium with it. or Albuterol lowers serum potassium case by driving it back into cells What do you think??? Off the subject, but not really since some else had brought it up in this forum and was told no don't think so. Just a thought.. :roll: Do we have a new scenario yet?

Do you know what an "SA" is. In my frustration and of trying to help you guys understand this scenario, I transposed the letters. My bad....I am new coming into this website and haven't been in the field for a full year yet. I may have transposed a few letters when I am writing with the kids running around & the TV on, But I do know what I am doing in the field and thought that I could learn & sharpen my skill here. yes, I know the difference between supine, prone, trendelenburg, etc. Thank you and have a great day. :? Next scenario Please...... :arrow:

vs-eh? and JPINFV----I will try to answer both of you. Thank you for the compliment and I will keep in mind about what was said regarding people picking apart scenarios. I suppose the confusing part might have been, because the supine position and bagging was done by what the Pt's company has a few employees which are called their blue team--What medical background any of them have is beyond me. Our crew did not bag him and did not transport supine position either. This is what was happening upon our arrival. The DCAP-BTLS was preformed while in supine position, very quickly, because we couldn't figure out why he was not on his back either. My crew was still trying to get all of the info ourselves. Obviously each of you know that I was talking about "SA" Why didn't someone just say that?! The comments I made regarding oral, nasal, combi etc. were in regards to Medic2588. He stated --"I agree, first off, board supine to better manage the airway. The fact that he can't breath supine alone is a sign that advanced airway maneuvers are necessary, in my opinion anyway. " That is when I stated that it probably would have been difficult (not that I would have known about the linement being out of whack without seeing the X-rays, it was just a comment) --I based this comment on the fact that in the ER they Tried to get a combi in before proceeding with a chest tube and they could not, had to go nasal. Once the X-RAYS were examined they showed me that he had surgery in the past and they said that his esophagus was not in line---Don't' ask me I am not an x-ray technician. I just saw what looked to me as a slight curve--trachea sounds better to me too. I don't work in a hospital and am not a nurse so I take what people tell me with face value. Regarding compartment vs crush--I thank you all very much because I left the forum with more knowledge than when I entered. Did any of this help? JPINFV-- Yes, English is my one and only language !!!!! look out!!! LOL vs-eh? Don't get mad your first instincts are usually right.

Thank you hammer, yes it does help. If these guys would pay attention, nowhere does it state that ANY EMT has done anything (thus far), but scene safety, scene assessment ( getting the facts of what has happened to pt), DCAP-BTLS, etc. I guess I expected someone to start with the true basics- maintain c-spine, get the pt spine position, etc. An EMT can't start helping a pt starting in the back of an ambulance or ER room.....What is confusing??????? Nobody has gone anywhere yet!!!!!!!! :twisted: Nowhere, and I mean nowhere does it state that any EMT has yet loaded pt and ready to go. The scenario starts at the scene and was left up to someone else to get the pt boarded, loaded and sufficient care in route. The question was designed to be what it is. And the guys need to just forget the combi >>> and go back to the facts>>>>>>>Scene..... you arrive to an unknown call and this is what you find "bystanders (company employees) doing (to/for/with ) to the pt and what you see the pt doing (At The Scene). You do a start up assessment and then ????? basically is the way the whole thing was stated on page 1....Good lord..Didn't anyone do these in class when they went to school or what??????? How in the world can this be confusing?????? Does the scenarios in this forum have to take place starting in an ambulance before some of these people can understand the question......????????? I think that I will end the whole thing here and look for another scenario, We'll see if anyone can get the next one any better, perhaps I will have to think of one that my 9yr can understand. Yes, Once we took control of the scene and followed procedure, we were able to get him to the hospital and he is going to be OK.... Ruptured disc (lumbar area), broken ribs, clasped lung as far as I know he was flown out. Thanks again, Hammer--look forward to chatting again and to a few others that were polite enough to teach me a few things (medically) and/or answer question, that is why we are all here. Have a great day!

First of all why don't you start from the beginning of page one, perhaps this will help you to understand. Second, I didn't say I was bagging anyone--Please read scenario. If you are as smart as you think you are, than why do you spend time picking out peoples faults (or what you seem to think is their faults) instead of teaching???? So far, since I have been on here, you have done nothing to help or enhance my knowledge only tried to discredit me. These forums are set up to help people learn and to communicate for improvement--not bash and make them feel worthless!!!!!! That will help nobody in the field!!!!!! Does this help you feel better about yourself??? Please read ---the entire scenario, including the other comments made by various other people--and then maybe it will help you to truly understand the conversation. Have a great day!!!!!!!

Well, I would always do an OPA or NPA before a CT, but wouldn't you want to get as much air into the pt that has been crushed and you suspect that he has a possible collapsed lung? Or would an OPA be accurate? vs-eh? wrote- plus other things in this thread would make more sense. Like what???? I presented a senario add a few tid bits and you guys took it from there. I in the mix of it all I learned a few things. No offense taken. thank you 8)

I think so, thank you!

Severe pain when muscles in affected compartment are stretched.

Excuse me---patent airway---sorry for the miss spelling and I never stated that anything way inserted. Thank you.

Ok guys, there are 3 mechanisms of crush syndrome-- 1. Immediate cell disruption. 2. Direct pressure on muscle cells. 3. Vascular Compromise. I think tha it would be a good ideal to administer soduim Bicarb, but before extrication of a crush syndrome pt. This keeps myoglobin floating in curculation postponing remal casting and heads off hyperkalemia. What do you think????? Thank goodness the pt didn't go into V-fib on me.

Now..now guys....I appreciate everyone's help......and compartment syndrome has 5 P's pain parestheias passive stretch pressure pulselessness Thank you both.

That makes more sense to me, but I am still have a lot to learn.....That's why I found this forum.

Thank you, that was my next question!!

Than how does compartment syndrome have anything to do with the chest/lungs? I am missing something?

well, I guess I am just saying/thinking-- you can't do oral with a gag reflex & if the situation went bad and pt goes unresponsive and does not react to painful stimuli then why would I do an oral instead of combi....just thinking that with 8000 plus pounds that if this pt goes down he will not respond to anything.... Thank goodness this did not happen..

What is compartment syndrome? Doesn't that pertain mostly to the legs?

a smaller combi-tube. Goes in easier, and is best used for all adults unless you have a really big guy. Chest tube is what pt received at the hospital. Thanks guys.

please see my edit on last pg for MOI. As to why prone, remember this is how we found pt upon arriving on scene not the way transported. We would not have been able to intubate the pt (using an AS) if things went bad anyway due to a previous neck surgery, sometime ago, because his esophagus is out of line. (Saw the x rays after arrival to hospital). Even though we didn't know this at the time, if he went unresponsive and we had trouble we would of gone for nasal (never my first choice).

Ok. The pt was found with in minutes of accident. pt was found lying on concrete in fetal position (knees to chest) entire body covered up to his ear lobe by this, what looks to be a crank wheel w/teeth. approx. 1 in gash (laceration), only blood, no other fluids or halo image found upon testing, no other broken bones found, do suspect possible broken spine in lumbar area due to the fact that hips and shoulder (not that the shoulder has anything to do with the lumbar) would take the brunt of claps. right??? MOI- (sorry) This piece of equipment was being removed and was attached to a huge chain that would carry it to where ever it was to be moved to, except the wrong chain was used and would only support up to 3000-4000lb and when the object came loose from the machine it was attached to it jerked and snapped the chain. This caused the piece of equipment to fall on the pt.

breath sounds are not bilateral, one side does not rise and is absent of sound. pt complaining of not being able to breath, JVD - distended and air flight is in route.

You get dispatched to call at a factory injury, unknown. You arrive on scene and is told that a 230lb male has been crushed by an 7000-8000 lb object. You Grab a C-collar, long board and trauma bag and ask where is he? You are told he is 3 flights up a metal stair case on a platform and that the companies medical team has already been assisting him and he is boarded. You reach the pt and find that this object has been removed off him, he is in a prone position on the board, no C-collar, and BVM bag being used because the pt can not breath on his back and pt is moving all his extremities in pain. You notice that there is a small gash on the right side of the neck, a few scraps on right shoulder and no other open wounds, but there is blood coming from his nose. He has a patten airway because he is answering questions when the companies med team talk to him while we are getting control of the scene. He does know his name and what happened to a point. You preform a DCAP-BTLS and find, even thought pt still on stomach, has a bulge on right side rib area--consistent with a rib fracture, and skin color in the facial area is a purplish color. What do you do next?

Why don't you tell me what you would have done in that same scenario???????? You seem to be so knowledgeable and us little people watching our pagers don't know anything........Tell me sir, how and what would you have done any differently besides show up???????? You are missing the whole point here. There are some places in this world that can not afford a full staffed ALS system, believe it or not. We work under the orders of our Medical Director of this region. We are not paramedics want-a-be's like some paramedics are doc want-a-be's. Sir, you have a good day and unless you want to help me to learn and or discuss scenarios, which this forum is set up for, then this conversation is ended. I am just me and if my town can't afford what some closed minded people think it needs, than that is just tough. I know what we are doing out here is the best that we can do and given the fact that we meet with the doctor every week/couple of weeks to go over our reports and discuss any questions that we may have and he believes in us, then it will just continue this way. good day, sir.