AnthonyM83 Posted December 6, 2007 Author Share Posted December 6, 2007 Ah, but that is what people are expecting...wanting to get to the good stuff. The reason I wanted to put this scenario up is to review the order and methods of patient assessment. Perhaps be corrected on steps we might sometimes forget to take. Yes, the patient WILL have a serious injury, but it will not be a zebra...not really. Link to comment Share on other sites More sharing options...
zzyzx Posted December 7, 2007 Share Posted December 7, 2007 Ah man, you're gonna make me do all the work?! Well alright.... Is this our only patient? Are we sure that his passenger isn't wrapped around some other telephone pole? Describe the mechanism more. How fast was he going? How much damage? Passenger-space intrusion? Belts? Airbag? Wheel damage? Windshield? Etc........... We put the patient in spinal immobilization. Any neck pain? Good motor/neuro x 4? Is the patient oriented? Pupils? Smell of alcahol? Any LOC? We ask him how the accident happened. Does he have any complaints? Pain? SOB? If he is altered or has significant injury, we put him on a mask right away. What are his breath sounds? Rate and tidal volume? Skin signs? Radial pulse rate/character? We do a rapid head to toe exam. Any obvious findings here? After he's extricated and in the ambulance, we get vital signs and do a complete physical exam. Med history? Meds? Rhythm? Blood sugar? We head to the trauma center and start 2 IV's. Now what? Link to comment Share on other sites More sharing options...
courageheartx Posted December 9, 2007 Share Posted December 9, 2007 hmmmmm... systematically,like it should be. scene assesment 1)Personal protective equipment 2)MOI?significant? 3)fire,wire,glass,wire?hazards? 4)Will i require back up?additional resources? 4)how many pt's? 5)do you have all the right equipment stocked,sterile,ready to go,ready to use 6)weather conditions? 7)rapid pt access... As you approach the pt..... general impression.. a)Pt's level of distress? b)skin?color?condition? c)are their any visible angulated fx? d)incontinence? e)can you see blood pooling?is blood visible?cerbrospinal fluid? f)emesis? g)bystanders So the MOI is obviously great,just from the description given. So I would introduce myself and my partner as EMR's from whatever EMS department and say If you could please not move while my partner stabilizes your neck....So at this point is the pt concious?What is the pt's level of conciousness?Alert?Only responds to verbal?Responds only to pain such as a sternum rub or trapezius squeeze? After assesing the need for stabilization of the neck,assessing the LOC,then I would asses the airway for patency?clear of fluids?clear of emesis?Assess breathing by listening to apices and bases. What is the pt's rate?rythm?quality?stridor?rales?wheezing?etc...next I would do a deadly bleed check to see if there are any severe bleeding as that is a part of the PRIMARY....and lastly expose anything that is bleeding or injured if you can. Load and go situation?Does the pt fit the load and go criteria? update EMS dispatch... next... DCAP-BLS-TIC.... deformities,contusions,abrasions,penetrations,burns,lacerations,swelling. you are always using the method palpation(feel) for tenderness,instability and crepitus. Visually you are also looking for racoon eyes,battle's signs,csf fluid leakage. After assesing the head,you move to the neck... DCAP-BLS-TIC.... You are feeling for any irregularities..etc..If trauma is ruled out you may release manual stabilization but in this case,this dude gets a fresh collar.Trachea midline?deviated?JVD? chest DCAP-BLS-TIC.... same as above...this is a rapid trauma assesment folks....can you feel and here subcutaneous emphysema?EXPOSE the chest. Scars?pacemakers?id necklace? DCAP-BLS-TRD...... thats right. tenderness,ridgity. soft upon palpation?tender?bruising?? pelvis.. DCAP-BLS-TIC... unstable?incontinence?priaprism? Extremities: legs DCAP BLS TIC... neurological response in the lower ext? DCAP BLS TIC.. neurological response in the upper ext? RAPID EXTRICATION.... im not going through each individual step of extrication because i am tired as hell but assess the back when you are doing the move..... I will finish this scenario when I get LOC,ABCDE,resps,pulse from you Anthony..... sorry its short. im tired Link to comment Share on other sites More sharing options...
AnthonyM83 Posted December 9, 2007 Author Share Posted December 9, 2007 Eh, if I might as well just give whole pt assessment results, diagnosis, then let people say treatment. :-/ The game (and criticism) was supposed to be in METHOD of each step. i'm over it Link to comment Share on other sites More sharing options...
courageheartx Posted December 12, 2007 Share Posted December 12, 2007 sure,now change the rules lol Link to comment Share on other sites More sharing options...
AnthonyM83 Posted December 12, 2007 Author Share Posted December 12, 2007 Read first few posts! Link to comment Share on other sites More sharing options...
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