TZETAH Posted May 21, 2006 Share Posted May 21, 2006 You get dispatched to call at a factory injury, unknown. You arrive on scene and is told that a 230lb male has been crushed by an 7000-8000 lb object. You Grab a C-collar, long board and trauma bag and ask where is he? You are told he is 3 flights up a metal stair case on a platform and that the companies medical team has already been assisting him and he is boarded. You reach the pt and find that this object has been removed off him, he is in a prone position on the board, no C-collar, and BVM bag being used because the pt can not breath on his back and pt is moving all his extremities in pain. You notice that there is a small gash on the right side of the neck, a few scraps on right shoulder and no other open wounds, but there is blood coming from his nose. He has a patten airway because he is answering questions when the companies med team talk to him while we are getting control of the scene. He does know his name and what happened to a point. You preform a DCAP-BTLS and find, even thought pt still on stomach, has a bulge on right side rib area--consistent with a rib fracture, and skin color in the facial area is a purplish color. What do you do next? Link to comment Share on other sites More sharing options...
cumcoemt84 Posted May 21, 2006 Share Posted May 21, 2006 Start two large bore IV with LR, I would thank of flying the Pt out due to the MOI and put the PT on 15L NRB mask due to the fact he is talking and has a patten airway. I would check the breath sounds dose dose he have JVD. Repeat trauma assessment and I would fly pt out to the trauma center Link to comment Share on other sites More sharing options...
TZETAH Posted May 21, 2006 Author Share Posted May 21, 2006 breath sounds are not bilateral, one side does not rise and is absent of sound. pt complaining of not being able to breath, JVD - distended and air flight is in route. Link to comment Share on other sites More sharing options...
cumcoemt84 Posted May 21, 2006 Share Posted May 21, 2006 I would suspect a nemo and decompress that side, keep Pt warm and dry and get a ETA of AirEvac repeat V/S every 5 min maintain IV access and 15L NRB mask, After decompressing I would recheck breath sounds and contact AirEvac to give the report Link to comment Share on other sites More sharing options...
The Hook Posted May 21, 2006 Share Posted May 21, 2006 I agree with the decompression. Check and recheck often vitals and mental status. Check the pupils and talk to any witnesses. The blood coming from his nose is there only blood? Have you done a Halo test to check for CSF? Question, how long was he trapped? How much of the body was trapped and to what degree? Is compartment syndrome a concern here and what would you do in that case? And personally I would go with NS opposed to LR for the drip. If compartment syndrome is a concern LR could throw his electrolytes off even more. Apply a C-Collar, confirm strapping to the backboard is complete and adequate. Pad the voids and check for additional broken bones. If pt can only be moved on stomach then a stokes basket would come in handy here. Stabilize the flail chest with a trauma dressing. I agree with notifying a helicopter and having them en route for transport (obviously as long as location of accident is further away than you could transport in the same time by ambulance). Start one IV at kvo rate and start one INT. Check the BP to see if the pt actually needs fluids. The kvo rate will not hurt if the BP is within safe limits. Automatically flooding the pt with fluids could cause it's own problems. Let me know what you all think! The Hook, Kevin Link to comment Share on other sites More sharing options...
The Hook Posted May 21, 2006 Share Posted May 21, 2006 One addition to my comments, the gash on his neck, how deep-long is it? Another concern would be Sub_Q Emphysema and the resuliting edema in the neck. It could potentially occlude the airway if left unchecked. The Hook, Kevin Link to comment Share on other sites More sharing options...
hammerpcp Posted May 21, 2006 Share Posted May 21, 2006 Compartment syndrome?....... How about crush syndrome? Trach deviation? Is pt hypotensive? Do you do a needle decompression if he is not? I'd be thinking hemo/pneumo at this point. VS? Incident hx: what was the object? and where on his body did it fall? How long was he pinned? "He does know his name and what happened to a point." To what point? LOC? ECG? arrhythmias from cardiac contusion or cellular waste products and potassium? SpO2? abdo distention? etc, etc. Head to toe exam. Vital signs. Management: c-collar continue vents via BVM- lung compliance? Paradoxical chest movement? sensory/circulatory deficits? Pupils? Load and go. Link to comment Share on other sites More sharing options...
cumcoemt84 Posted May 21, 2006 Share Posted May 21, 2006 compartment syndrome vary good thought, only thing is to confirm it a blood test needs to be done. But if compartment syndrome is there then sodium bicarb might be used, and yes hook i do agree with your thoughts and hammers, Link to comment Share on other sites More sharing options...
akflightmedic Posted May 21, 2006 Share Posted May 21, 2006 I would suspect a nemo and decompress that side, keep Pt warm and dry and get a ETA of AirEvac repeat V/S every 5 min maintain IV access and 15L NRB mask, After decompressing I would recheck breath sounds and contact AirEvac to give the report A NEMO??? As in the friendly clown fish??? Link to comment Share on other sites More sharing options...
hammerpcp Posted May 21, 2006 Share Posted May 21, 2006 Link to comment Share on other sites More sharing options...
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