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Matthew99

Terrible bleeding from the mouth after a bad car accident

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Hi. Am a first aid student but we're a bit on a break and I got a question I'm quite curious about so I thought to register here and ask :)

Let's say someone got into a car accident and now his mouth is brimming with blood. You suction all the blood out, but the blood appears to refill the mouth every time. What do you do in such a case presuming you have ambo, oxygen, suction and bandages to work with, and nothing else? I think the best idea is to keep suctioning him, put oxygen in, and when the blood starts filling the mouth you suction him, then oxygen again.

And what if the person is unconscious and has no heartbeat as well? I think in that case you do the chest thrust in addition to taking care of the airway.

Does that all sound good?

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In your first scenario....as long as there is no difficulty breathing you can really use a nasal cannula and continuously suction (get an emesis basin ready for vomiting) or have the patient hold the mask by their face and move it away so you can suction. If the car accident is that bad and they are on a backboard and in a collar you will need to keep one side of the backboard tilted up otherwise there will be vomiting! I had a patient one time that I gave the suction catheter to and had him place it in his mouth and he did the suctioning himself (long story). I can't imagine a scenario where there would be that much bleeding from a mouth...maybe a severed tongue....but then you'd have facial injuries and broken teeth too...gets more complicated after that.

Second scenario...if the patient is in cardiac arrest you will need to suction to clear the airway as well as do CPR. Hopefully if you have an ALS provider there so the patient can be intubated to protect and manage the airway.

Edited by FireMedicChick164

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Let gravity do the work - turn the patient to the side to let the blood run out. Otherwise suck like hell and get a tube as soon as possible.

CPR with a lot of blood running into the mouth and no other airway management device than suctioning? Bad, even if kinda unrealistic (read: most probably won't happen). Again: Suck like hell and get a tube as soon as possible.

Never had it in this extreme, though. Always remember: all bleeding stops...eventually. :)

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CPR with a lot of blood running into the mouth and no other airway management device than suctioning? Bad, even if kinda unrealistic (read: most probably won't happen). Again: Suck like hell and get a tube as soon as possible.

Never had it in this extreme, though. Always remember: all bleeding stops...eventually

I suppose my mind can conjure up some pretty dreadful events. Is it just me or does everyone keep imagining car accidents, someone fainting, etc, in their mind while walking down the streets looking at the day to day event? That's how

I came up with this scenario, and in this scenario, I wasn't 100% sure if I'd do the right thing!

FireMedicChick your reply is great and makes a whole lot of sense to me, especially when mentioning nasal cannula. Would it be fair to say that using nasal cannula is recommended when the patient has lots of mouth secretions? What about using both nasal cannula AND oxygen mask? Is that even possible?

Second scenario...if the patient is in cardiac arrest you will need to suction to clear the airway as well as do CPR. Hopefully if you have an ALS provider there so the patient can be intubated to protect and manage the airway.

Yes, first move as always is call 911 :)

Let gravity do the work - turn the patient to the side to let the blood run out. Otherwise suck like hell and get a tube as soon as possible.

Valid point!

My worry is causing neck injury if I keep playing with his position too much, but very valid point :)

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Matthew if your worried about the C-spine due to the MOI (mechanism of injury) then collar and backboard the patient. Then as other have said let gravity do the work just tilt the backboard on its side and let the blood run out. I have been in this situation before and we did just that, backboard on the side with a few pillows holding it in that position while on the cot. Suction at the ready incase the blood blocked the airway. Thankfully we had ALS close by and got the patient tubed before long so suction wasn't an issue any longer.

In the second case, suction like hell, get a tube in all the while pumping like crazy. If the cardiac was during the accident then get him out as quickly as possible, have one provider pump like hell while a second gets the collar on and gets an airway.

Don't worry about thinking of worst case scenarios, we all do it. I actually think it makes you a better provider because if you can think of the worst and plan for it you can handle the day to day without much issue. In my case I always thought of the worst MCI I could which was a bus crash, one day I actually had it. School bus with 30 children plus 2 motor vehicles involved one with a mother with a 3 day old infant. Ran the call like I imagined and came out the other side feeling good, sometimes the worst does happen but usually its a stubbed toe at 3am :rolleyes2:

Good luck in school.

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Scenario #1: All good thoughts. If the pt is able to hold the suction catheter, let them. It will free up your hands to do something else. Keep them on their side as much as possible. You need to worry about c-spine injury but the airway comes first.

Scenario #2: Pronounce and move on. There is nothing to do for this person, you are better utiliazed caring for someone else that may have a chance.

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Matthew if your worried about the C-spine due to the MOI (mechanism of injury) then collar and backboard the patient. Then as other have said let gravity do the work just tilt the backboard on its side and let the blood run out. I have been in this situation before and we did just that, backboard on the side with a few pillows holding it in that position while on the cot. Suction at the ready incase the blood blocked the airway. Thankfully we had ALS close by and got the patient tubed before long so suction wasn't an issue any longer.

Yes but in my scenario there was no neck collar, the reason is that I'm going with the basics stuff they provide first aiders with. They usually just lug around oxygen, suction and bandages. Phili's neck collars and backboards are an ambulance thing already. But good point to those who have those stuff.

In the second case, suction like hell, get a tube in all the while pumping like crazy. If the cardiac was during the accident then get him out as quickly as possible, have one provider pump like hell while a second gets the collar on and gets an airway.

Speak of the devil, I thought that in the new CAB they've decided that those airway tubes are somewhat insignificant? We were told to give it a shot, but if one or two attempts don't go, to drop it and do without.

Don't worry about thinking of worst case scenarios, we all do it. I actually think it makes you a better provider because if you can think of the worst and plan for it you can handle the day to day without much issue. In my case I always thought of the worst MCI I could which was a bus crash, one day I actually had it. School bus with 30 children plus 2 motor vehicles involved one with a mother with a 3 day old infant. Ran the call like I imagined and came out the other side feeling good, sometimes the worst does happen but usually its a stubbed toe at 3am :rolleyes2:

Good luck in school.

Thanks, and how does someone get a stubbed toe at 3 a.m? That's what I wanna know.... ;)

Scenario #2: Pronounce and move on. There is nothing to do for this person, you are better utiliazed caring for someone else that may have a chance.

Well in my mind he was the only patient, but yes, realistically in such a hard accident the driver may be hit hard as well.

Thank you.

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Thanks, and how does someone get a stubbed toe at 3 a.m? That's what I wanna know.... ;)

It has been shown: A lot of really bad things can happen while being on the way to the bathroom... :wtf2:

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It has been shown: A lot of really bad things can happen while being on the way to the bathroom... :wtf2:

I broke my toe when working down in Miami Florida. I was at the hotel and I was walking to the bathroom and WHACK, smacked it on the dresser.

Got to the bathroom, extreme pain, looked at the little toe and it was at a 90 Degree angle. So off to the ER I went at 3:15, they took an x-ray said it was a fracture dislocation, injected a topical anesthetic to the area around the toe, then went pull/yank and put it back in place, taped the two toes back together and I was off. Took all of 2 hours (in miami I think that's a record ER time) and I was back at the hotel.

So it is pretty darn easy to get a stubbed toe at 3am

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Ok no collar around? Grab a towel make a roll and tape, instant neck collar. Also works well with obese patients and large neck patients that a collar wont fit properly. Then everything else is still the same. If no towel around have one provider hold spinal precaution while the other does the suction, again if possible keep the patient on their side to let gravity aid in keeping the airway clear.

As for the new CAB stuff yes you are correct the pumping is now more important and needs to be done first. Have the second provider try and get the OPA in. If it doesn't go in quickly forget it and hope ALS is close by so they can drop a tube. A secure airway is still important thats where ALS comes in so they can drop an endotracial tube not the little OPAs that just help keep the tongue from blocking the airway. The new CAB is for the everyday folks doing CPR where an OPA might not even be around. Just like they are pushing compression only CPR on the TV PSAs now, it gets folks to help until the rig arrives especially when they know they don't have to do mouth to mouth. Plus it helps when civilians dont have to think about number of compression to so many breaths, just pump away until help arrives.

Ruff gave a great example of a 3am stubbed toe :thumbsup: so I wont elaborate further. Most folks use it as a metaphore for the late night call that doesn't seem to warrent an ambulance yet we are there.

As far as pronouncement at the scene check your local laws and SOPs most places I know of you need to be a paramedic or higher to legally pronounce unless clear signs of death are present (decapitation, lividity, rigor, decomposition). Dont want you to do something bad young grasshopper.

Also keep the questions coming. None are stupid except the one not asked.

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