chbare Posted May 17, 2010 Author Share Posted May 17, 2010 No helmet, abrasions all over the body, 6 cm scalp laceration over right temporal area bleeding profusely and bilateral femoral deformities are all that you see. The patient has truisms and you cannot insert an oral airway. He also looks rather smurf like. Take care, Chbare. Link to comment Share on other sites More sharing options...
DartmouthDave Posted May 17, 2010 Share Posted May 17, 2010 - Have a co-worker/FF take C-spine control - Make sure someone grabs the Longboard, c-pine eqiupment - If helemt allows access, open airway, insert OPA - Quickly check back for trauma, wounds and roll pt onto board - Remove helmet while maintaining C-spine - Assess LOC, ABC's, Vitals - support ventilations with BVM 8-10/min 15LPM - Secure on board, Move pt into ambulance - Alert Air Medivac- Dependent on duration of trip <-----Are we in California? Three different competing HEMS should be on the way! LOL - Repeat Vitals, assess LOC cut away clothing - Bilateral IV @ AC, as large bore as possible, fluid bolus to 90 systolic- as needed - BGL, Temp, Monitor, End Tidal C02 - Rapid Tranport- or air transport as warranted - Bilateral traction splints to femurs - Consider intubation - Patch level 1 trauma center I'm probably getting ahead of myself, as all the details of the pts condition have not been revealed yet. Link to comment Share on other sites More sharing options...
chbare Posted May 17, 2010 Author Share Posted May 17, 2010 You can be a responding HEMS team if you want. The team member or platform selection will not change the scenario. Take care, chbare. Link to comment Share on other sites More sharing options...
Kiwiology Posted May 17, 2010 Share Posted May 17, 2010 Aw sweet does this mean Ima finally be on COPS Damn dudes lets have a chillax and see what we are working with eh? Sounds like a plan to me! Log roll and collar, scoop, move to the ambulance. Basic vitals (BP/HR/RR/SPO2/GCS/ECG) and exam, expose, good look at pelvis and abdo. Oxygen NRB @ 10 LPM IV access Traction splint broken leg Link to comment Share on other sites More sharing options...
HellsBells Posted May 17, 2010 Share Posted May 17, 2010 (edited) 2) If the helmet allows airway access do we want to remove it or let it help with c-spine? I was taught that if you can maintain an adequate airway, leave the helmet in place en route if it's intact. I think that this applies more towards football helmets, where one can unscrew or pop off the mask. Most motorcycle helmets, with the exception of the skull cap variety, have visors or face sheilds that make it difficult to access the airway. Although I will admit, with the snug fit motorcycle helmets can be a challenge to remove while maintaining C-spine. However, it seems that he wasn't wearing a helmet, so no worries. So... In light of the new information, lets alter my Tx somewhat: - Bleeding Lac on skull- have a co-worker apply direct pressure, unless there happens to be a skull fracture, then an absorbant bandage should stop the bleeding, as its unlikely to be arterial. If worst comes to worst, some quikclot could be used I guess. - Trismus- start with an NPA, Bag through there if possible. Seeing as how the dude is a little blue we should consider an RSI- right there on scene. - Agents would preferably be Ketamine and Succ. Or Fent/Succ - Depending on the pts, Airway and LOC status, this may be one case where we go directly to SUCC and intubate Edited May 17, 2010 by HellsBells Link to comment Share on other sites More sharing options...
chbare Posted May 17, 2010 Author Share Posted May 17, 2010 Your partner voices concern over the shallow and irregular respirations along with the continued cyanosis that appears to be even more pronounced at this time. The continued bleeding is of some concern to him as well. Take care, chbare. Link to comment Share on other sites More sharing options...
speedygodzilla Posted May 17, 2010 Share Posted May 17, 2010 Well sounds like this guy is gonna get a QuickTrach or surgical cricothyroidotomy. I am presuming an NPA would be contraindicated due to head/facial trauma and besides it is not nearly as secure an airway. GCS of 3? Vitals? Link to comment Share on other sites More sharing options...
chbare Posted May 17, 2010 Author Share Posted May 17, 2010 I think that this applies more towards football helmets, where one can unscrew or pop off the mask. Most motorcycle helmets, with the exception of the skull cap variety, have visors or face sheilds that make it difficult to access the airway. Although I will admit, with the snug fit motorcycle helmets can be a challenge to remove while maintaining C-spine. However, it seems that he wasn't wearing a helmet, so no worries. So... In light of the new information, lets alter my Tx somewhat: - Bleeding Lac on skull- have a co-worker apply direct pressure, unless there happens to be a skull fracture, then an absorbant bandage should stop the bleeding, as its unlikely to be arterial. If worst comes to worst, some quikclot could be used I guess. - Trismus- start with an NPA, Bag through there if possible. Seeing as how the dude is a little blue we should consider an RSI- right there on scene. - Agents would preferably be Ketamine and Succ. Or Fent/Succ - Depending on the pts, Airway and LOC status, this may be one case where we go directly to SUCC and intubate You are able to place an NPA in each nare and bag the patient with symmetrical chest rise and fall. The cyanosis resolves and bleeding is controlled with direct pressure. The patient remains unresponsive. Vitals: P-118 weak and thready at the radial, RR- was 6-24 and irregular, you have taken over and currently have an apneic patient, BP -92/50, SPO2- 100%, temp-35 Celsius. BGL is within normal range. Take care, chbare. Well sounds like this guy is gonna get a QuickTrach or surgical cricothyroidotomy. I am presuming an NPA would be contraindicated due to head/facial trauma and besides it is not nearly as secure an airway. GCS of 3? Vitals? Would you go straight to a surgical? It will take time to prep and we currently have all the criteria for a crash airway. Would you want to consider bag mask ventilation while prepping the patient? Is NPA placement absolutely contraindicated with our current findings? Our immediate goal may not be a "definitive" airway device but rather oxygenation and ventilation. Take care, chbare. Link to comment Share on other sites More sharing options...
Kiwiology Posted May 17, 2010 Share Posted May 17, 2010 Try and ventilate with an NPA If that works get him well oxygenated and then RSI (1mcg/kg fent, 1.5mg/kg ketamine and suxamethonium) or do it anyway if the NPA doesn't work If that doesn't work perform a cricothyrotomy As far as the bleeding, apply direct pressure or if his skull is fractured and all mushy and/or floating just apply a combi dressing (4x4) 500ml NS KVO How far away is the hospital? After we get an airway I would consider (but not call) HEMS depending on how far away it and the ho'biddle is. Link to comment Share on other sites More sharing options...
chbare Posted May 17, 2010 Author Share Posted May 17, 2010 So, doing okay with the NPA's and bag mask. How are we going to roll? We can: A) Continue as a crash airway and simply give sux and tube. Do an RSI. C) Continue doing what we are currently doing. You are looking at a 30 min transport time regardless of your platform. You can call for a flight, but yup would end up being the flight crew. Either way, you will have to deal with the patient for the next half an hour. Additionally, what is the current stance on ketamine and head injuries, assuming we have head injury on our list of differentials for this guy? Take care, chbare. Link to comment Share on other sites More sharing options...
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