chbare Posted February 25, 2012 Share Posted February 25, 2012 Wendy, the best physicians I know are flexible and will change as contemporary methods that are evidence based appear on the scene. Also, we need to be careful about personal experience and equating "my" way to the only way. This is why all those numbers are so important. If something is effective, the results must be verified and reproduced. Unfortunately, one provider and their limited experience with something, often under limited or homogenous conditions does not count. This is why some physicians will take a concept that works for them but is novel to everybody else and publish a paper on it. After doing so, somebody may take interest and perhaps develop large studies that reproduce the original findings. Once this occurs and enough people get on board, a paradigm shift may occur. This is the power of the scientific method. Link to comment Share on other sites More sharing options...
DesertEMT Posted February 25, 2012 Author Share Posted February 25, 2012 CYA statement: As this wasn't answered before...Does this guy have anything on board that could be controlling his rate and pressure chemically? Because if so, then I'm going to have to step back and reconsider... Dwayne The vitals I gave were taken before any chemical interventions Ok. I'm still having trouble picturing this, but from your description of serratus anterior and latissimus dorsi, it's basically punched through and is being held by the major muscles of the back, right? It pierced on the lower back and is coming out the upper back... so I'd put him on his left side... so we have questionable involvement of the chest cavity but it appears to be lower index of suspicion if I'm reading the position of the impalement right... any changes in patient presentation/condition once we get them in position of comfort and some meds on board? Wendy CO EMT-B Yup, you've read it right and I think you are the first to point out that the patient should be placed on his left side Link to comment Share on other sites More sharing options...
runswithneedles Posted February 27, 2012 Share Posted February 27, 2012 (edited) I would have used two large bore IV's set for TKO since this patient is a trauma with a penetrating injury where the extent of the damage internally is unknown. Even though at this time he is presently stable it seemed logical to have the second line in place in the event he began to actively bleed again and require fluid administration. I kept it at TKO at that time because based on his initial vitals he was hemodynamically stable and to prevent a clot from forming in my line. Edited February 27, 2012 by runswithneedles Link to comment Share on other sites More sharing options...
Kiwiology Posted February 27, 2012 Share Posted February 27, 2012 I would have used two large bore IV's set for TKO since this patient is a trauma with a penetrating injury where the extent of the damage internally is unknown. Even though at this time he is presently stable it seemed logical to have the second line in place in the event he began to actively bleed again and require fluid administration. I kept it at TKO at that time because based on his initial vitals he was hemodynamically stable and to prevent a clot from forming in my line. I know you are still learning so I am enthusiastic to improve your knowledge Can you please detail what you know of haemostasis, hypovolaemic shock and the principle of fluid resuscitation in trauma? We'll take it from there Link to comment Share on other sites More sharing options...
DFIB Posted February 27, 2012 Share Posted February 27, 2012 Can you please detail what you know of haemostasis, hypovolaemic shock and the principle of fluid resuscitation in trauma? Gosh Kiwi, I would write all that out if you could give me college credit! Although I don't know what I could do with a degree in Kiwisioligy!?! 1 Link to comment Share on other sites More sharing options...
Kiwiology Posted February 27, 2012 Share Posted February 27, 2012 I wish I had a degree in Kiwiology, I just have these three other useless degrees .... bloody hell Actually if you had a degree in Kiwiology you could understand me when I speak for Kiwispeak 101 is required; pretty choice bro not even nunngered up to buggery or stink ow no ghost chips, beached or weet bix required chur Link to comment Share on other sites More sharing options...
runswithneedles Posted February 27, 2012 Share Posted February 27, 2012 I know you are still learning so I am enthusiastic to improve your knowledge Can you please detail what you know of haemostasis, hypovolaemic shock and the principle of fluid resuscitation in trauma? We'll take it from there That would take forever.... And im pretty darn sure what theyve taught isnt even the tip of the iceberg. Enlighten me kiwi as what I have missed. 1 Link to comment Share on other sites More sharing options...
DFIB Posted February 27, 2012 Share Posted February 27, 2012 That would take forever.... And im pretty darn sure what theyve taught isnt even the tip of the iceberg. Enlighten me kiwi as what I have missed. hehe Link to comment Share on other sites More sharing options...
runswithneedles Posted February 27, 2012 Share Posted February 27, 2012 And cue for the massive floodgate of kiwiology im about to be drowned in. Link to comment Share on other sites More sharing options...
mobey Posted February 27, 2012 Share Posted February 27, 2012 That would take forever.... And im pretty darn sure what theyve taught isnt even the tip of the iceberg. Enlighten me kiwi as what I have missed. Perfect answer... Not to be too big of an ass, but OP if we could get back to the scenario instead of centering yet another thread around kiwi and australian speech antics I would be very appreciative. So we have a stable patient being transported on thier Left side, with pain controlled and 2X I.V. fluid restricted. Is that the end? Link to comment Share on other sites More sharing options...
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