Trauma make the diagnosis

[chbare]

You are called to the scene of a MVC. Dispatch reports that a 22 year old male lost control of his vehicle on the highway and ran into a concrete barrier at a high rate of speed. State police have secured the scene and report that the patient appears unconscious. Would you like to know anything else?

Take care,

chbare.

[PRPGfirerescuetech]

You are called to the scene of a MVC. Dispatch reports that a 22 year old male lost control of his vehicle on the highway and ran into a concrete barrier at a high rate of speed. State police have secured the scene and report that the patient appears unconscious. Would you like to know anything else?

Take care,

chbare.

Alcohol / Drugs / Seat belt / Airbag / Vehicle damage

Responsive upon arrival? Breathing? Airway intact?

[chbare]

PRPGfirerescuetech, your scene survey reveals the following; it looks like he was driving a F350 pickup truck. There is extensive damage to the front of the truck and it looks like the passenger compartment has been involved as well. The patient is trapped inside of the cab and it looks like the front of the vehicle was pushed inward causing the dash and steering wheel to trap the patient. You notice a few open beer cans within the vehicle and the state police officer reports that he smelled the scent of ETOH from the cab. No drug paraphernalia is noted. The patient is wearing a seat belt and it looks like he may have had the airbag disabled. (did not deploy) Your rapid trauma assessment reveals the following; the patient is unresponsive to any stimuli, he is breathing, but the rate is only about 8 per minute and shallow, the airway does not appear obstructed, but you do note several small abrasions and lacerations to the patients face and scalp. Fire is called and an extrication unit is 3 minutes out. Would you like to know anything else?

EDIT: the resp pattern is irregular.

Take care,

chbare.

[PRPGfirerescuetech]

PRPGfirerescuetech, your scene survey reveals the following; it looks like he was driving a F350 pickup truck. There is extensive damage to the front of the truck and it looks like the passenger compartment has been involved as well. The patient is trapped inside of the cab and it looks like the front of the vehicle was pushed inward causing the dash and steering wheel to trap the patient. You notice a few open beer cans within the vehicle and the state police officer reports that he smelled the scent of ETOH from the cab. No drug paraphernalia is noted. The patient is wearing a seat belt and it looks like he may have had the airbag disabled. (did not deploy) Your rapid trauma assessment reveals the following; the patient is unresponsive to any stimuli, he is breathing, but the rate is only about 8 per minute and shallow, the airway does not appear obstructed, but you do note several small abrasions and lacerations to the patients face and scalp. Fire is called and an extrication unit is 3 minutes out. Would you like to know anything else?

Take care,

chbare.

single passenger? no one else in the vehicle? proximity of crash to trauma center? medic alert tags?

Do I have stabilization equipment on the squad? If so, stabilize and make entry. Stabilization of C spine, trauma jaw thrust to reposition airway and hope for improved repirations. If no improvement in respirations, bag and intubate. Apply collar. Wait for rescue company.

[PRPGfirerescuetech]

EDIT: the resp pattern is irregular.

Hmmmm...

Check sugar while you have a minute. Older vehicle? Whats =his skin color like? Red maybe?

[Ace844]

In addition to the previously asked questions I would like to add the following:

A.) How far are you from what hospitals and what are their respective capabilities?

B.) How much help is present on the scene with you and what level are we operating at?

C.) What additional resources do we have available if needed and what are their response times? (i.e.: Helicopter, specialty rescue, ALS, additional units of more patients found, etc..)

D.) Extringic factors, weather, traffic, etc..things which would majoirly influence transport and treatment decisions.

E.) Is the scene safe,and or are there any hazards present?

F.) Have the SP or HP secured traffic to make the area safe for responders to 'work'...?

Thanks,

ACE844

[chbare]

I will try to answer all of the questions. You are 15 minutes from a level II trauma center. You do not have air evac assets due to the weather. (heavy wind and rain with poor visibility) You can operate at what ever level of care you would like for this scenario. The scene was secured by state police, there are no known hazards with the exception of sharp metal from the vehicle. BGL is 130 mg/dl. He actually appears very diaphoretic and pale. No medic alert tags are noted. Only one patient and you have all of the BLS and cool guy ALS supplies at your disposal. You ambulance is staffed with two people and the extrication crew will have 4 people trained at the first responder-EMT-B level. Due to a county wide mutual aid agreement one of the fire fighters can drive the ambulance or assist in the back if needed. Severe damage limits your ability to care for the patient. You cannot enter the cab and you are having extreme difficulty managing his airway through the window. Intubation will be difficult to impossible until the patient is extricated. Let me know if you need any more information.

Take care,

chbare.

[PRPGfirerescuetech]

I will try to answer all of the questions. You are 15 minutes from a level II trauma center. You do not have air evac assets due to the weather. (heavy wind and rain with poor visibility) You can operate at what ever level of care you would like for this scenario. The scene was secured by state police, there are no known hazards with the exception of sharp metal from the vehicle. BGL is 130 mg/dl. He actually appears very diaphoretic and pale. No medic alert tags are noted. Only one patient and you have all of the BLS and cool guy ALS supplies at your disposal. You ambulance is staffed with two people and the extrication crew will have 4 people trained at the first responder-EMT-B level. Due to a county wide mutual aid agreement one of the fire fighters can drive the ambulance or assist in the back if needed. Severe damage limits your ability to care for the patient. You cannot enter the cab and you are having extreme difficulty managing his airway through the window. Intubation will be difficult to impossible until the patient is extricated. Let me know if you need any more information.

Take care,

chbare.

C Spine, 02, and do your best to manage airway. Nothing more can be done safely it sounds.

How long does the extrication take?

[chbare]

Extrication takes about 8 minutes. You do your best to maintain C-spine and then perform a rapid extrication onto a board. (Note: the medics in the scenario that this situation is based on used a combi tube to initially manage the airway with success. The patient was completely unresponsive and had no gag reflex. This is not to say that other options are wrong however.)

EDIT: Oh no, I am going to have a bunch of firefighters mad at me. Disentanglement takes about 8 minutes, then rapid extrication onto a board takes place.

Take care,

chbare.

[PRPGfirerescuetech]

Extrication takes about 8 minutes. You do your best to maintain C-spine and then perform a rapid extrication onto a board. (Note: the medics in the scenario that this situation is based on used a combi tube to initially manage the airway with success. The patient was completely unresponsive and had no gag reflex. This is not to say that other options are wrong however.)

EDIT: Oh no, I am going to have a bunch of firefighters mad at me. Disentanglement takes about 8 minutes, then rapid extrication onto a board takes place.

Take care,

chbare.

My opinion has always been to start simple.

However... the combi-tube is a nice option considering the situation.

Extricate to spineboard. Pad void spaces. Extricate to truck.

Expose?

Reevaluate ABC?

General evaluation findings?

Physical exam?

Actions to follow exam.