Just Plain Ruff Posted August 18, 2008 Share Posted August 18, 2008 Get a call for a man who is found on a cinder block. If you all know what a cinder block is - it's the 2 foot by 1 foot block of concrete with two square holes in it. It looks like a domino but made of concrete. Wife just walked out from the house to the backyard after not hearing from him for about 30 mins. He has no pulse and is not breathing. What do you want to know? Link to comment Share on other sites More sharing options...
letmesleep Posted August 18, 2008 Share Posted August 18, 2008 What was he doing prior to being slumped? Medical Hx, meds, allergies? Environmental situation? Obvious injuries? Get him supine using c-spine precautions, open his airway and ventilate, EKG, D-stick, access the situation (is he viable or not?) Link to comment Share on other sites More sharing options...
akflightmedic Posted August 18, 2008 Share Posted August 18, 2008 All I want to know is does he have a DNR or is he in asystole. Link to comment Share on other sites More sharing options...
Chief1C Posted August 18, 2008 Share Posted August 18, 2008 MI or AAA? Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted August 18, 2008 Author Share Posted August 18, 2008 What was he doing prior to being slumped? Medical Hx, meds, allergies? Environmental situation? Obvious injuries? Get him supine using c-spine precautions, open his airway and ventilate, EKG, D-stick, access the situation (is he viable or not?) He was out in the back, the wife doesn't know what he was doing out there but he did say something about trimming the trees. Wife says no allergies, only med is a cholesterol med with subsequent history of Hyperlipidemia It is 74 degrees outside Obvious injuries - well he's on top of a cinderblock You control c-spine and roll him off the block and you open his shirt and you see a cinderblock like impression on his chest and upper abomen He is not breathing, does not have a pulse, your protocols are to work trauma codes regardless of whether you feel that he is viable or not. Air goes in very nicely when ventillating him but both chest rise and abodomen is noted to rise. EKG Shows wide complexes at 34 per minute What now? Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted August 18, 2008 Author Share Posted August 18, 2008 All I want to know is does he have a DNR or is he in asystole. your service requires you to work all trauma codes regardless of whether you think they are viable or not. this is based on the new trauma center that just opened in the city limits which allows for you to have a transport time of less than 15 minutes at any time but... the caveat here is that the trauma center has to be open and not closed and today - it's open. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted August 18, 2008 Author Share Posted August 18, 2008 MI or AAA? Neither Link to comment Share on other sites More sharing options...
mshow00 Posted August 18, 2008 Share Posted August 18, 2008 Looking for other obvious injuries... any other life threats... looking for signs that he either fell from the tree to land on the cinder block or slipped off the cinder block taking it to the chest... do RTA... when I get to the chest pay close attention to TIC... any signs of a tension hemo-pneumothorax? if so pop chest (if required)... load and go...full trauma package... ET if deemed needed... transport to trauma center with 2 large bore IVs, one NS one LR, with trauma treatment, and ACLS protocols as required... Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted August 18, 2008 Author Share Posted August 18, 2008 Looking for other obvious injuries... any other life threats... looking for signs that he either fell from the tree to land on the cinder block or slipped off the cinder block taking it to the chest... do RTA... when I get to the chest pay close attention to TIC... any signs of a tension hemo-pneumothorax? if so pop chest (if required)... load and go...full trauma package... ET if deemed needed... transport to trauma center with 2 large bore IVs, one NS one LR, with trauma treatment, and ACLS protocols as required... Ok, apparantly this guy fell from a tree approximately 24 feet off the ground landing on the cinder block. With ventillations chest goes up and down as does the abdomen. You intubate him and two large bore IV's goin. You have 15 minutes to the ER. ETCO2 is good with intubation But you notice that the abdomen is getting bigger and bigger with each successive ventillation. What needs to happen. Link to comment Share on other sites More sharing options...
itku2er Posted August 18, 2008 Share Posted August 18, 2008 Ok, apparantly this guy fell from a tree approximately 24 feet off the ground landing on the cinder block. With ventillations chest goes up and down as does the abdomen. You intubate him and two large bore IV's goin. You have 15 minutes to the ER. ETCO2 is good with intubation But you notice that the abdomen is getting bigger and bigger with each successive ventillation. What needs to happen. Well the tube could be misplaced in all the movement check the CO2 monitor and see what it reads, listen to the lungs to see if air is getting in with the ventillations, if not pull back alittle on the tube after placement is checked and nonconfirmed. Or he could be swelling with some kind of internal bleed. Link to comment Share on other sites More sharing options...
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