firedoc5 Posted July 3, 2008 Share Posted July 3, 2008 Responded to MVA very late at night, rainy and cold. Upon arrival car is upright but obviously had rolled. Driver was ejected an laying under the car. Luckily it was a very muddy field. 18 yr. old female, only left arm free from under the vehicle. She was submerged in mud of at least 18 inches. Volley Fire doing a good job of digging mud, but eventually needed three porta-powers to lift car. Luckily fire/ rescue had lumber for trench rescue. Myself and one other literally had to go under car to free her. Placed on back board, c-collar, full immobilized. When placed in ambulance and started assessment, complaint of chest pain, headache, felt burning pain of left thigh area but went away. Started pt. on 12 L O2 per NRM and managed c-spine control. Starting to remove clothing she seemed hesitant. Luckily had two others with me, one gal. Removed shirt and cut bra. Never mind the foam rubber that flew. (That's why she was hesitant). Bruising noted under left breast, possibly from underwire in the bra. Removed pants. Very large indented burn to left thigh, evidently from muffler laying on her. Very little bleeding from burn. Could not feel left leg or foot. Good pedal pulses bilaterally. Good lung sounds. Chest pain increases with deep inhalation. While enroute starts to complain of mid- thoracic back pain. Not sure if from spinal imobilization, but rather be safe than sorry. BP: 120/88 Pulse: 120 Monitor showed sinus tach, no ectopy. Respiration varied 20-32. Some sternal pain but described as chest wall pain. IV NS TKO, did increase enroute due to burn. Dry burn dressings to left thigh burn. Several small lacerations widespread, light bleeding. Started to shiver with possibly start of hypothermia. What else? Bueler? Bueler? Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted July 3, 2008 Share Posted July 3, 2008 lung sounds Ferris? Link to comment Share on other sites More sharing options...
Lone Star Posted July 3, 2008 Share Posted July 3, 2008 Wouldn't a wet burn dressing be better than the dry one? Link to comment Share on other sites More sharing options...
Kaisu Posted July 3, 2008 Share Posted July 3, 2008 Wouldn't a wet burn dressing be better than the dry one? Depends - partial thickness (1st degree or 2nd degree with fluid blisters) YES full thickness (2nd degree with blood blisters or 3rd degree) NO Link to comment Share on other sites More sharing options...
chbare Posted July 3, 2008 Share Posted July 3, 2008 In this case, dry would be much better. The OP stated the patient was hypothermic, so we would want to avoid anything that could decrease the temperature. Do a head to toe exam and full neurological exam to include pupil/EOM assessment and distal neuro assessment. Did she have LOC? Was a BGL obtained? Did we check her temp? What about medical/surgical history? Continue supportive care, keep her dry, and try to keep her thermoregulating adequately. Take care, chbare. Link to comment Share on other sites More sharing options...
Richard B the EMT Posted July 4, 2008 Share Posted July 4, 2008 "Ferris"? Wazzat? Link to comment Share on other sites More sharing options...
Kaisu Posted July 4, 2008 Share Posted July 4, 2008 "Ferris"? Wazzat? Link to comment Share on other sites More sharing options...
firedoc5 Posted July 4, 2008 Author Share Posted July 4, 2008 Burn to the leg was third degree. Due to the heat and weight compressing down, it was a very large "gouge", about 3/4 through the thigh. Infection control was a must. Sterile dry dressings used from the burn kit we developed. I know of at least three surgeries she had just to keep the leg, which she did. X-rays showed fx. pelvis, cracked sternum, and if I remember right fx. nose. Lung sounds were clear bilaterally. At first I just knew she had fractured ribs, but none were detected. No BGL available in rig at that time. Link to comment Share on other sites More sharing options...
chbare Posted July 4, 2008 Share Posted July 4, 2008 XII lead? We should look for cardiac contusion and consider the potential for developing tamponade. Stabilize the pelvis and ensure we have large bore vascular access. Take care, chbare. Link to comment Share on other sites More sharing options...
firedoc5 Posted July 4, 2008 Author Share Posted July 4, 2008 XII lead? We should look for cardiac contusion and consider the potential for developing tamponade. Stabilize the pelvis and ensure we have large bore vascular access. Take care, chbare. Very good. That's what I was looking for. Heart sounds good, but closely monitored for any kind of development. There was some contusion to both lungs. Twelve lead normal, repeated q. 45-60 mins. in ER and continued for first four hours in ICU. If I remember right they did insert a central line in ER, along with the 16g IV I established enroute. Link to comment Share on other sites More sharing options...
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