fireflymedic Posted June 16, 2008 Share Posted June 16, 2008 You get toned out at 04:30 for a single car MVA. On arrival you find a twentyish looking male fighting with PD struggling to get out of a car. You find the car in the middle of a field having gone through some fencing and down a hill. PD states they found the guy unconscious initially, but woke up a bit later and started trying to get out of the car - lower extremities are pinned requiring extrication so he's not going anywhere. Windshield has starring, positive airbag deployment. Pt unable to tell you anything, doesn't seem to comprehend what is going on. No witnesses to the accident, guy just drove up on it and called cops. You have unlimited protocols, tell me what you want to do. Assessments and all - how would you transport? You are 45 from local hospital (community) and an hour and a half from trauma center. GO. Link to comment Share on other sites More sharing options...
flight-lp Posted June 16, 2008 Share Posted June 16, 2008 - Fire Dept. for extrication - Maintain inline stabilization if possible during extrication - Apply spinal motion restriction - Oxygen if needed - IV NS Lock, fluid to titrate BP above 80 systolic if needed - Consideration for chemical sedation and RSI if pt. becomes uncontrollable - Transport to trauma center with consideration of air resources if significant time savings is present - Grab some starbucks and get ready for the next call................. 8) Link to comment Share on other sites More sharing options...
mobey Posted June 16, 2008 Share Posted June 16, 2008 Ok now for the basic version. Maintain in line spinal control while extricating. O2 nasal at a few litres. Strap to long backboard. Use soft restraints if necissary NaCl lock. head to closest hospital for possible sedation. Of course call for ALS if available. If poor mentation persists, and there is a delay in extrication, consider a chopper. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted June 16, 2008 Share Posted June 16, 2008 Unlimited field protocols?????? Ok, bilateral lower extremity amputations and RSI. Explain that one to your Medical Director Link to comment Share on other sites More sharing options...
fireflymedic Posted June 16, 2008 Author Share Posted June 16, 2008 I'll give you RSI if you want it... PD states intitally they showed up and pt was unconscious with snoring respirations slumped on wheel, gradually became combative, but pt is now settling down some claiming he's tired. Pt has no recall of the crash, so he can't tell you what happened. Last place he remembers being is 30 miles away. Speech is slurred. Pupils are dilated, but reactive. Pt is currently taking insulin and neurontin. Anything else you would like? Link to comment Share on other sites More sharing options...
Coach Hohman Posted June 16, 2008 Share Posted June 16, 2008 Any presence of ETOH? Last Oral Intake? When did he take his insulin last? I would get a blood sugar Vital Signs? Link to comment Share on other sites More sharing options...
fireflymedic Posted June 16, 2008 Author Share Posted June 16, 2008 no etoh bg is 70 can't remember when last ate insulin 1 hour ago VS - 140 pulse, cap refill 4, bp 80/60, RR 12 shallow, total GCS 10 Link to comment Share on other sites More sharing options...
firedoc5 Posted June 16, 2008 Share Posted June 16, 2008 Fire911, are you sure you're not tapping into my mind? Have had this situation a number of times. Consider closed head injury. Supportive restraint needed usually. The confusion of events prior to the accident could be medical, but don't forget that amnesia, combativenesess, etc. can be indicative of CHI. The body's reaction to the MVA, such as an adrenaline rush can lower BG level. Is he only combative to police and not to EMS? Sedate if he keeps being combative. Monitor airway very closely. Treat medically when necesary. Does other medical problems appear while en-route? With that long of a ground transport several things could develope. Notifying air lift is a good idea. But they won't take anyone that is still combative. Link to comment Share on other sites More sharing options...
fireflymedic Posted June 21, 2008 Author Share Posted June 21, 2008 sorry to take a while to update this, I actually forgot about it lol. Anyhow, firedoc is right on with the medical - guy was hypoglycemic and had seizure behind wheel. Long time diabetic. Did send the guy by air as he came around significantly after some D 50. Did fine and rehabbed those injuries. All's well that ended well. Link to comment Share on other sites More sharing options...
jwraider Posted July 22, 2008 Share Posted July 22, 2008 Windshield was starred and a head injury was very possible. Would anyone withold the dextrose until a ctscan was performed? Link to comment Share on other sites More sharing options...
Recommended Posts