Dispatched to a call "unknown".

[JPINFV]

You didn't? Then what was this all about about? You said the patient had an "patten" airway, and went on to describe it as thus:

[EmergencyMedicalTigger]

This scenario has become a confusing mess starting on page 1. :? Has the pt made it to the hospital yet so we can end this confuzzlement? But the in depth info from the links on compartment syndrome was good. Thanks ERDoc.

[hammerpcp]

TZETAH, please continue with the scenario. Perhaps a little clarification on certain points is necessary but don't take it personally. (VS-eh? is an ugly bastard Does that help?) Anyway, communication breakdown is not an irreparable problem.

[TZETAH]

Thank you hammer, yes it does help.

If these guys would pay attention, nowhere does it state that ANY EMT has done anything (thus far), but scene safety, scene assessment ( getting the facts of what has happened to pt), DCAP-BTLS, etc. I guess I expected someone to start with the true basics- maintain c-spine, get the pt spine position, etc. An EMT can't start helping a pt starting in the back of an ambulance or ER room.....What is confusing???????

Nobody has gone anywhere yet!!!!!!!! :twisted:

Nowhere, and I mean nowhere does it state that any EMT has yet loaded pt and ready to go. The scenario starts at the scene and was left up to someone else to get the pt boarded, loaded and sufficient care in route. The question was designed to be what it is. And the guys need to just forget the combi >>> and go back to the facts>>>>>>>Scene.....

you arrive to an unknown call and this is what you find "bystanders (company employees) doing (to/for/with ) to the pt and what you see the pt doing (At The Scene). You do a start up assessment and then ????? basically is the way the whole thing was stated on page 1....Good lord..Didn't anyone do these in class when they went to school or what???????

How in the world can this be confusing??????

Does the scenarios in this forum have to take place starting in an ambulance before some of these people can understand the question......?????????

I think that I will end the whole thing here and look for another scenario, We'll see if anyone can get the next one any better, perhaps I will have to think of one that my 9yr can understand.

Yes, Once we took control of the scene and followed procedure, we were able to get him to the hospital and he is going to be OK.... Ruptured disc (lumbar area), broken ribs, clasped lung as far as I know he was flown out.

Thanks again, Hammer--look forward to chatting again and to a few others that were polite enough to teach me a few things (medically) and/or answer question, that is why we are all here. Have a great day!

[vs-eh?]

TZETAH, you seem to be a nice person, but...

You will find that certain people on this forum (myself included) will start to pick apart posts that obviously aren't jiving, have misinformation, or don't make sense. Your post unfortunately contains these elements...

It all started with this guy who has a chest wall injury from a 4 tonne object being put on a board PRONE and apparently being ventilated. This is also apparently happening while this guy is able to talk to you and the mechanism would require immobilization. I know you said that this wasn't done by your crew, but just thinking about that whole thing = me having brain explosion. I am going to assume this "medical team" was at least educated to a minimum of an EMT-B type level if they have such things as a board and BVM available to them...

You also appeared to have been discussing intubation should he have required it. Then you go on to mention this mysterious "AS" device which is similar to a combitube. What does "AS" stand for, and do you have a link/pic of this product? You then said you would not have intubated this person (was this with or without this "AS" thing?) because of previous (and then unknown) esophageal surgury. And state you would have done a "nasal". Is esophageal surgery a contraindication for this "AS" device? Why would you not have elected to orally intubate this person should he have required it? Why would you have decided to do a "nasal" (again, I assume intubation) because of this whole esophageal surgery thing? I don't quite understand that. And how would a blind technique have been better in this situation? You also questioned why you would do an "oral" instead of a combitube and mentioned something about painful stimuli and such. I honestly don't follow, a CT is a rescue device if you have oral intubation available...

You also said you didn't know what compartment syndrome was...

Are you an EMT-B or EMT-P? If you are a "B", then I would understand this post. If you are a "P", please link your scope of practice...

Why don't you just tell us what YOU did on scene from where you began the scenario...

LOL, has anybody seen that Family Guy where Peter gets his CPR ticket and is randomly doing chest compressions, the Heimlich, and AR on people? "I'LL GET TO YOU IN A MOMENT SIR!"....LOL, good times...

PS - On second thought, don't bother linking your scope of practice if you are a "P". I'll just get angry...

[JPINFV]

Well, based off of your first post, it does appear that some one is ventilating him (again, prone?). If someone is "using the BVM bag" prior to arrival, why isn't he already c-spined?

You already stated that, at the very least, a secondary survey was partly done (DCAP-BTLS. /shudders at saying the letters).

People were giving treatment options (medivac, NRB, large bore IVs x 2, chest decompression) for the first few posts. Then there was a few posts requesting information. Following that was the nemo posts (I think Dory would have tasted better. At least the taste wouldn't have been so funny...).

Then there was a confusing post where you were asking us to confirm the patients signs and symptoms ("right???").

Next there is the "I can't intubate because he had esophageal surgery." This very confusing line since you intubate the trachea, not the esophagus.

Then there was the lesson on compartment syndrome vs crush syndrome

There was people trying to run the scenario at the begining, but the scenario was very hard to follow.

Please do not be offended by this, but is English your primary or first language?

[TZETAH]

vs-eh? and JPINFV----I will try to answer both of you.

Thank you for the compliment and I will keep in mind about what was said regarding people picking apart scenarios.

I suppose the confusing part might have been, because the supine position and bagging was done by what the Pt's company has a few employees which are called their blue team--What medical background any of them have is beyond me. Our crew did not bag him and did not transport supine position either. This is what was happening upon our arrival.

The DCAP-BTLS was preformed while in supine position, very quickly, because we couldn't figure out why he was not on his back either. My crew was still trying to get all of the info ourselves. Obviously each of you know that I was talking about "SA" Why didn't someone just say that?!

The comments I made regarding oral, nasal, combi etc. were in regards to Medic2588.

He stated --"I agree, first off, board supine to better manage the airway. The fact that he can't breath supine alone is a sign that advanced airway maneuvers are necessary, in my opinion anyway. "

That is when I stated that it probably would have been difficult (not that I would have known about the linement being out of whack without seeing the X-rays, it was just a comment)

--I based this comment on the fact that in the ER they Tried to get a combi in before proceeding with a chest tube and they could not, had to go nasal. Once the X-RAYS were examined they showed me that he had surgery in the past and they said that his esophagus was not in line---Don't' ask me I am not an x-ray technician. I just saw what looked to me as a slight curve--trachea sounds better to me too. I don't work in a hospital and am not a nurse so I take what people tell me with face value.

Regarding compartment vs crush--I thank you all very much because I left the forum with more knowledge than when I entered.

Did any of this help?

JPINFV-- Yes, English is my one and only language !!!!! look out!!! LOL

vs-eh? Don't get mad your first instincts are usually right.

[vs-eh?]

vs-eh? and JPINFV----I will try to answer both of you.

Thank you for the compliment and I will keep in mind about what was said regarding people picking apart scenarios.

I suppose the confusing part might have been, because the supine position and bagging was done by what the Pt's company has a few employees which are called their blue team--What medical background any of them have is beyond me. Our crew did not bag him and did not transport supine position either. This is what was happening upon our arrival.

The DCAP-BTLS was preformed while in supine position, very quickly, because we couldn't figure out why he was not on his back either. My crew was still trying to get all of the info ourselves. Obviously each of you know that I was talking about "SA" Why didn't someone just say that?!

The comments I made regarding oral, nasal, combi etc. were in regards to Medic2588.

He stated --"I agree, first off, board supine to better manage the airway. The fact that he can't breath supine alone is a sign that advanced airway maneuvers are necessary, in my opinion anyway. "

That is when I stated that it probably would have been difficult (not that I would have known about the linement being out of whack without seeing the X-rays, it was just a comment)

--I based this comment on the fact that in the ER they Tried to get a combi in before proceeding with a chest tube and they could not, had to go nasal. Once the X-RAYS were examined they showed me that he had surgery in the past and they said that his esophagus was not in line---Don't' ask me I am not an x-ray technician. I just saw what looked to me as a slight curve--trachea sounds better to me too. I don't work in a hospital and am not a nurse so I take what people tell me with face value.

Regarding compartment vs crush--I thank you all very much because I left the forum with more knowledge than when I entered.

Did any of this help?

JPINFV-- Yes, English is my one and only language !!!!! look out!!! LOL

vs-eh? Don't get mad your first instincts are usually right.

:shock: :shock:

Did this whole thing take place in bizzaro world? Am I the only one who is not following basically anything that is being said AT ALL?

Did any of this help?

Actually no, and I think it about quadrupled the confusion in this thread...But now my brain hurts...

[MedicMal]

ok I just have to ask the original poster............

you know that supine position is someone lying on their back and that prone position is someone lying on their stomach right?

Some of the stuff that you have said would have made more sense (not much more though) had those 2 words been reversed.

MedicMal

[Dustdevil]

First of all why don't you start from the beginning of page one, perhaps this will help you to understand. Second, I didn't say I was bagging anyone--Please read scenario.

If you are as smart as you think you are, than why do you spend time picking out peoples faults (or what you seem to think is their faults) instead of teaching????

So far, since I have been on here, you have done nothing to help or enhance my knowledge only tried to discredit me.

These forums are set up to help people learn and to communicate for improvement--not bash and make them feel worthless!!!!!! That will help nobody in the field!!!!!!

Does this help you feel better about yourself???

Please read ---the entire scenario, including the other comments made by various other people--and then maybe it will help you to truly understand the conversation.

Well, as with the rest of this entire thread, I still have not the slightest idea what you are talking about. :?

I am neither criticising you, bashing you, nor attempting to discredit you. Nobody has criticised or bashed you yet. How could they? So far, none of us have figured out what it was you even did. I keep asking the same questions over and over -- as are others -- because, as VS and JP also pointed out, you are simply not making yourself clear. The story keeps changing. He's prone. He's supine. He's being bagged. He's not being bagged. He has an airway inserted. He doesn't have an airway inserted. I honestly cannot imagine that you don't understand why we are all confused here.

I'm very sorry that you feel that myself or anybody else here is being unreasonably antagonistic towards you. That is certainly not the case. We're just trying to figure out what you are saying so we can play along. I have read your original post multiple times. My reading comprehension skills are exceptional, yet it still is not clear to me. Or anybody else, for that matter. For some reason, we remain optimistic that if we just ask one more question, you'll come back with a reply that clears it all up for us. Several of us have tried. But so far, it just gets muddier everytime you try to explain.

MedicMal was thinking along the same lines as me and beat me to the point. Are you sure you know the difference between supine and prone? It does indeed sound like you are reversing the terms. If so, that would go a long ways towards starting to clear up the scenario for us, because the patient's position is one of those things that we just can't move past in order to resolve the rest of the scenario.

This whole situation seems very clear in your mind because you were there. But remember, we were not there. All we have to go on are your words. And to this point, your words make no sense.